to the United States for an amount equal to the sum 
of— 
‘‘(A) the amount of assistance provided to 
the center under section 1241(a) for the fiscal 
year involved; and 
‘‘(B) an amount representing interest on 
the amount specified in subparagraph (A). 
‘‘(b) PERIOD OF CERTAIN GRANTS.—The period of 
a grant under section 1241(a)(3) (relating to emergency 
relief) shall be 3 fiscal years, except that the Secretary 
may waive the application of this subsection to a trauma 
center and authorize the center to receive payments under 
such section for 1 additional fiscal year. 
‘‘(c) MAINTENANCE OF FINANCIAL SUPPORT.—With 
respect to activities for which a grant under section 1241 
is authorized to be expended, the Secretary may not make 
such a grant unless the trauma center involved agrees 
that, during the grant period, the center will maintain ac-
cess to trauma services at levels not less than the prior 
year, taking into account reasonable volume fluctuation 
not caused by— 
‘‘(1) intentional trauma boundary reduction or 
downgrading of level; or 
‘‘(2) diversion of services in excess of 5 percent. 
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‘‘(d) SUPPLEMENT, NOT SUPPLANT.—The Secretary 
may not make a grant under section 1241 unless the trau-
ma center involved agrees that funds received through the 
grant will be used to supplement and not supplant funding 
otherwise available for the activities and costs described 
in such section. 
‘‘(e) TRAUMA CARE REGISTRY.—The Secretary may 
not make a grant under section 1241(a) unless the trauma 
center involved agrees that— 
‘‘(1) the center will— 
‘‘(A) operate a registry of trauma cases in 
accordance with guidelines developed by the 
American College of Surgeons or similar guide-
lines applicable to the center in the State in-
volved; and 
‘‘(B) begin operation of the registry not 
later than 6 months after the date on which the 
center submits to the Secretary the application 
for the grant; and 
‘‘(2) in carrying out paragraph (1), the center 
will maintain information on the number of trauma 
cases treated by the center and, for each such case, 
the extent to which the center incurs uncompensated 
care costs in providing trauma care.’’. 
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(d) GENERAL PROVISIONS.—Section 1244 of the 
Public Health Service Act (42 U.S.C. 300d–44) is amend-
ed to read as follows: 
‘‘SEC. 1244. GENERAL PROVISIONS. 
‘‘(a) APPLICATION.—The Secretary may not make a 
grant under section 1241(a) unless an application for the 
grant is submitted to the Secretary and the application 
is in such form, is made in such manner, and contains 
such agreements, assurances, and information as the Sec-
retary determines to be necessary to carry out this part. 
‘‘(b) LIMITATION
ON AMOUNT
OF GRANT.—The 
amount of a grant under section 1241 for a fiscal year 
may not exceed $2,000,000. 
‘‘(c) ELIGIBILITY.—Receipt of or eligibility for a 
grant under any 1 of the 4 grant programs described in 
section 1241(a) shall not preclude a trauma center from 
receipt of or eligibility for a grant under any of the other 
programs described in such section. 
‘‘(d) NOTICE OF ELIGIBILITY.—The Secretary shall 
annually determine and notify trauma centers of their eli-
gibility to receive a grant under section 1241. 
‘‘(e) REPORT.—Beginning 2 years after the date of 
enactment of the National Trauma Center Stabilization 
Act of 2009, and every 2 years thereafter, the Secretary 
shall— 
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‘‘(1) report to the Congress on the status of the 
grants made pursuant to section 1241; 
‘‘(2) evaluate and report to the Congress on the 
overall financial stability of trauma centers in the 
United States; 
‘‘(3) report on the populations using trauma 
care centers and include aggregate patient data on 
income, race, ethnicity, and geography; and 
‘‘(4) evaluate the effectiveness and efficiency of 
trauma care center activities using standard public 
health measures and evaluation methodologies.’’. 
(e) DEFINITION.—Part D of title XII of the Public 
Health Service Act (42 U.S.C. 300d–41 et seq.) is amend-
ed— 
(1) by redesignating section 1245 as section 
1246; and 
(2) by inserting after section 1244 the fol-
lowing: 
‘‘SEC. 1245. UNCOMPENSATED CARE COSTS DEFINED. 
‘‘In this part, the term ‘uncompensated care costs’ 
means, with respect to a hospital, unreimbursed costs of 
the hospital from serving patients for which there is either 
no insurance coverage or other third-party payment or for 
which such coverage or payment is provided only under 
the Medicaid program under title XIX of the Social Secu-
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rity Act, which are attributable to emergency care and 
trauma care in the hospital— 
‘‘(1) including costs related to inpatient admis-
sions to the hospital subsequent to receiving such 
care in the hospital; and 
‘‘(2) excluding payments under section 1923 of 
the Social Security Act.’’. 
(f) AUTHORIZATIONS OF APPROPRIATIONS.—Section 
1246 of the Public Health Service Act, as redesignated 
by subsection (e), is amended to read as follows: 
‘‘SEC. 1246. AUTHORIZATIONS OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—For the purpose of carrying out 
this part, there are authorized to be appropriated— 
‘‘(1) with respect to grants under paragraphs 
(1), (2), and (3) of section 1241(a), $100,000,000 
for each of fiscal years 2010 through 2015; and 
‘‘(2) with respect to grants under paragraph (4) 
of section 1241(a), $25,000,000 for each of fiscal 
years 2010 through 2015. 
Authorizations of appropriations pursuant to this section 
are in addition to any other authorizations of appropria-
tions available for carrying out this part. 
‘‘(b) FUNDING DISTRIBUTION.—Of the amount ap-
propriated pursuant to subsection (a)(1) for a fiscal year, 
the Secretary shall reserve— 
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‘‘(1) 70 percent for grants under section 
1241(a)(1) (relating to substantial uncompensated 
care costs); 
‘‘(2) 20 percent for grants under section 
1241(a)(2) (relating to the core mission of a trauma 
center); and 
‘‘(3) 10 percent for grants under section 
1241(a)(3) (relating to emergency relief). 
‘‘(c) MINIMUM AMOUNT FOR SUBSTANTIAL UNCOM-
PENSATED
CARE
COSTS.—Notwithstanding subsection 
(b), if the amount appropriated pursuant to subsection 
(a)(1) for a fiscal year is less than $25,000,000, such 
amount shall be used exclusively for grants under section 
1241(a)(1).’’. 
(g) CONFORMING AMENDMENT.—The heading of 
part D of title XII of the Public Health Service Act (42 
U.S.C. 300d–41 et seq.) is amended to read as follows: 
‘‘PART D—GRANTS FOR CERTAIN TRAUMA CENTERS’’. 
Æ 
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