I 
111TH CONGRESS 
1ST SESSION 
H. R. 936 
To ensure the continued and future availability of lifesaving trauma health 
care in the United States and to prevent further trauma center closures 
and downgrades by assisting trauma centers with uncompensated care 
costs, core mission services, emergency needs, and information tech-
nology. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 10, 2009 
Mr. TOWNS (for himself, Mr. BURGESS, Ms. CASTOR of Florida, Mrs. 
BLACKBURN, Mr. HONDA, Mr. WU, and Mr. GRIJALVA) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
A BILL 
To ensure the continued and future availability of lifesaving 
trauma health care in the United States and to prevent 
further trauma center closures and downgrades by assist-
ing trauma centers with uncompensated care costs, core 
mission services, emergency needs, and information tech-
nology. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘National Trauma Cen-
ter Stabilization Act of 2009’’. 
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SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) Victims of traumatic injury should have ac-
cess to lifesaving care regardless of their geographic 
location or ability to pay. Major multisystem trauma 
victims receiving care within the first hour following 
their injury are substantially more likely to survive. 
(2) Maintaining a strong and effective trauma 
care system for all victims of traumatic injury re-
quires the availability of a sufficient number of trau-
ma centers at appropriate levels of trauma care ca-
pability in all geographic regions of the Nation. 
(3) Regional trauma centers annually treat 
678,000 patients, regardless of their ability to pay. 
When a trauma victim cannot afford treatment, the 
trauma center pays for care that may save the vic-
tim’s life. 
(4) The cost of delivering trauma care has 
steadily increased during the last decade. Trauma 
centers collectively have accrued $230,000,000 per 
year in losses for treating victims who are uninsured 
or whose care is reimbursed well below the cost of 
providing care, putting the Nation’s trauma care 
system at-risk. 
(5) Substantial uncompensated care costs are 
distressing trauma centers and threatening the avail-
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ability of lifesaving trauma services in numerous 
areas across the Nation. Since 2000, 19 hospitals 
have closed their trauma centers, and 10 others have 
downgraded their trauma service by 1 or 2 levels. 
(6) At a time when the threat of mass emer-
gencies is high, financial pressures are placing trau-
ma centers at serious risk. Trauma centers are re-
quired to respond to mass emergencies including 
natural disasters, large-scale accidents, and terrorist 
attacks. Trauma centers maintain a constant state 
of readiness to serve distressed victims. Trauma cen-
ters must also maintain additional capacity and 
strong health care facility connections with the local 
and regional emergency care community to serve 
their regions. 
(7) Many trauma centers lack information tech-
nology that could improve the efficiency and effec-
tiveness of trauma care delivery and decrease the 
costs of providing care by facilitating patient track-
ing and information flow, and strengthening patient 
information sharing within the trauma center and 
coordination among other health care providers. 
Connecting trauma care centers using health infor-
mation technology is a part of the efforts to make 
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health information technology available especially in 
medically underserved communities. 
SEC. 3. GRANTS FOR CERTAIN TRAUMA CENTERS. 
(a) GRANTS FOR CERTAIN TRAUMA CENTERS.—Sec-
tion 1241 of the Public Health Service Act (42 U.S.C. 
300d–41) is amended to read as follows: 
‘‘SEC. 1241. GRANTS FOR CERTAIN TRAUMA CENTERS. 
‘‘(a) IN GENERAL.—The Secretary shall establish 4 
programs to award grants to trauma centers meeting the 
qualifications described in subsection (b). Of the 4 pro-
grams— 
‘‘(1) one shall be for grants to assist in defray-
ing substantial uncompensated care costs; 
‘‘(2) one shall be for grants to further the core 
mission of the trauma center, including by defraying 
costs associated with patient stabilization and trans-
fer, trauma education and outreach, coordination 
with local and regional trauma systems, and essen-
tial personnel and other fixed costs; 
‘‘(3) one shall be for grants to provide emer-
gency relief to ensure continued and future avail-
ability of trauma service by— 
‘‘(A) trauma centers at risk of closing or 
losing capacity to deliver trauma care; 
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‘‘(B) centers operating in an area where a 
closing or loss of trauma service availability has 
occurred within their primary service area; or 
‘‘(C) centers in need of financial assistance 
after the area in which they are located is af-
fected by a natural disaster or other cata-
strophic event, such as a terrorist attack; and 
‘‘(4) one shall be for grants to support the de-
velopment and maintenance of innovative informa-
tion technology systems, including through the use 
of electronic health records and by facilitating the 
interconnection of trauma care facilities (including 
Internet-based connectivity) with other local and re-
gional health facilities, for the purpose of— 
‘‘(A) improving information sharing and 
coordination between trauma centers, ambu-
lances, helicopters, and other health care pro-
viders, such as physician practitioners, commu-
nity health centers, and rehabilitation facilities, 
to facilitate continuity of care for trauma pa-
tients throughout their recovery; and 
‘‘(B) improving patient tracking and infor-
mation flow within trauma centers and between 
health facilities (including developing, updating, 
and maintaining databases) to improve the 
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overall delivery of trauma care and community 
health care. 
‘‘(b) MINIMUM QUALIFICATIONS OF CENTERS.— 
‘‘(1) PARTICIPATION IN TRAUMA CARE SYSTEM 
OPERATING UNDER CERTAIN PROFESSIONAL GUIDE-
LINES.—Subject to paragraph (2), the Secretary 
may not make a grant under subsection (a) unless 
the trauma center involved is a participant in a sys-
tem that— 
‘‘(A) provides comprehensive medical care 
to victims of trauma in the geographic area in 
which the trauma center is located; 
‘‘(B) is established by the State or political 
subdivision in which such center is located; and 
‘‘(C) has either adopted State guidelines 
for the designation of trauma centers, and for 
triage, transfer, and transportation policies, or 
adopted guidelines equivalent to (or more pro-
tective than) the applicable trauma care des-
ignated guidelines developed by the American 
College of Surgeons or utilized in the model 
plan established under section 1213(c). 
‘‘(2) EXCEPTION.—The requirements of para-
graph (1) do not apply with respect to a trauma cen-
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ter located in a State with no existing trauma care 
system described in such paragraph. 
‘‘(3) PUBLIC
OR
NONPROFIT
STATUS.—The 
Secretary may not make a grant under paragraph 
(1), (2), or (4) of subsection (a) unless the trauma 
center involved is a public or nonprofit entity. 
‘‘(4) LEVELS
OF
CARE.—The Secretary may 
not make a grant under subsection (a)(1) (relating 
to uncompensated care costs) unless the trauma cen-
ter demonstrates to the Secretary’s satisfaction at 
least one of the following: 
‘‘(A) At least 20 percent of the visits in 
the emergency department of the hospital in 
which the trauma center is located are ones for 
which there is no insurance coverage or other 
third-party payment. 
‘‘(B) At least 40 percent of the visits in 
such emergency department are ones for which 
there either is no such coverage or payment or 
for which such coverage or payment is provided 
only under the Medicaid program under title 
XIX of the Social Security Act. 
‘‘(C) The average annual uncompensated 
care costs in such hospital that are attributable 
to visits for which there is no insurance cov-
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erage or other third-party payment is at least 
$5,000,000 during each of the 3 most recent 
fiscal years before the first fiscal year for which 
the center is applying for the grant. 
‘‘(D) The trauma center qualifies for funds 
under a low-income pool or safety net care pool 
established through a waiver approved under 
section 1115 of the Social Security Act. 
‘‘(c) SUBMISSION AND APPROVAL OF LONG-TERM 
PLAN.—The Secretary may not make a grant under sub-
section (a)(1) of this section unless the trauma center in-
volved— 
‘‘(1) submits to the Secretary a plan satisfac-
tory to the Secretary that— 
‘‘(A) is developed on the assumption that 
the center will continue to incur substantial un-
compensated care costs in providing trauma 
care; 
‘‘(B) provides for the long-term continued 
operation of the center at similar or greater lev-
els of medical care than in prior years notwith-
standing such uncompensated care costs; 
‘‘(2) agrees to implement the plan according to 
a schedule approved by the Secretary; and 
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‘‘(3) demonstrates that such center has policies 
in place— 
‘‘(A) to assist patients who cannot pay for 
all or part of the care they received, including 
a sliding fee scale; and 
‘‘(B) to ensure fair billing and collection 
practices.’’. 
(b) PREFERENCES
IN MAKING GRANTS.—Section 
1242 of the Public Health Service Act (42 U.S.C. 300d– 
42) is amended to read as follows: 
‘‘SEC. 1242. PREFERENCE IN MAKING GRANTS. 
‘‘(a) 
SUBSTANTIAL
UNCOMPENSATED
CARE 
COSTS.—In making grants under section 1241(a)(1), the 
Secretary shall— 
‘‘(1) reserve 95 percent of the amounts allo-
cated pursuant to subsections (b)(1) and (c) of sec-
tion 1246 for grants to level I and level II trauma 
centers; 
‘‘(2) reserve 5 percent of the amounts allocated 
pursuant to subsections (b)(1) and (c) of section 
1246 for grants to level III and level IV trauma cen-
ters; 
‘‘(3) if there are not sufficient qualifying cen-
ters to obligate the 95 percent reservation in para-
graph (1) or the 5 percent reservation in paragraph 
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