To amend the Public Health Service Act to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury, and for other purposes.
PL 104-166 (H.R.248), enacted 07/29/1996

PUBLIC LAW 104-166-^JULY 29, 1996 
110 STAT. 1445 
Public Law 104-166 
104th Congress 
An Act 
To amend the Public Health Service Act to provide for the conduct of expanded 
, , __ -_»„ 
studies and the establishment of innovative programs with respect to traumatic 
^—'• 
brain injtiry, and for other purposes. 
[H.R. 248] 
Be it enacted by the Senate and House of Representatives 
of 
the United States of America in Congress assembled, 
SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND 
PREVENTION. 
Part J of title III of the Public Health Service Act (42 U.S.C. 
280b et seq.) is amended by inserting after section 393 the following 
section: 
"PREVENTION OF TRAUMATIC BRAIN INJURY 
"SEC. 393A. (a) IN GENERAL.—^The Secretary, acting through 
42 USC 280b-lb. 
the Director of the Centers for Disease Control and Prevention, 
may carry out projects to reduce the incidence of traumatic brain 
injury. Such projects may be carried out by the Secretary directly 
or through awards of grants or contracts to public or nonprofit 
private entities. The Secretary may directly or through such awards 
provide technical assistance with respect to the planning, develop-
ment, and operation of such projects. 
"(b) CERTAIN ACTIVITIES.—Activities under subsection (a) may 
include— 
"(1) the conduct of research into identifying effective strate-
gies for the prevention of traumatic brain injury; and 
"(2) the implementation of public information and education 
programs for the prevention of such injury and for broadening 
the awareness of the public concerning the public health con-
sequences of such injury. 
"(c) COORDINATION OF ACTIVITIES.—The Secretary shall ensure 
that activities under this section are coordinated as appropriate 
with other agencies of the Public Health Service that carry out 
activities regarding traumatic brain injury. 
"(d) DEFINITION.—For purposes of this section, the term 'trau-
matic brain injury* means an acquired injury to the brain. Such 
term does not include brain dysfunction caused by congenital or 
degenerative disorders, nor birth trauma, but may include brain 
injuries caused by anoxia due to near drowning. The Secretary 
may revise the definition of such term as the Secretary determines 
necessary.". 
SEC. 2. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH. 
Section 1261 of the PubHc Health Service Act (42 U.S.C. 300d-
61) is amended— 
110 STAT. 1446 
PUBLIC LAW 104-166-^JULY 29, 1996 
(1) in subsection (d)— 
(A) in paragraph (2), by striking "and" Eifter the semi-
colon at the end; 
(B) in paragraph (3), by striking the period and insert-
ing "; and"; and 
(C) by adding at the end the following paragraph: 
"(4) the authority to make awards of grants or contracts 
to public or nonprofit private entities for the conduct of basic 
and applied research regarding traumatic brain injury, which 
research may include— 
"(A) the development of new methods and modalities 
for the more effective diagnosis, measurement of degree 
of injury, post-injury monitoring and prognostic assessment 
of head injury for acute, subacute and later phases of 
care; 
"(B) the development, modification and evaluation of 
therapies that retard, prevent or reverse brain damage 
after acute head injury, that arrest further deterioration 
following injury and that provide the restitution of function 
for individuals with long-term injuries; 
"(C) the development of research on a continuum of 
care from acute care through rehabilitation, designed, to 
the extent practicable, to integrate rehabilitation and long-
term outcome evaluation with acute care research; and 
"(D) the development of programs that increase the 
participation of academic centers of excellence in head 
injury treatment and rehabilitation research and training."; 
and 
(2) in subsection (h), by adding at the end the following 
paragraph: 
"(4) The term 'traumatic brain injury' means an acquired 
injury to the brain. Such term does not include brain dysfunc-
tion caused by congenital or degenerative disorders, nor birth 
trauma, but may include brain injuries caused by anoxia due 
to near drowning. The Secretary may revise the definition 
of such term as the Secretary determines necessary.". 
SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES ADMINIS-
TRATION. 
Part E of title XII of the Public Health Service Act (42 U.S.C. 
300d-51 et seq.) is amended by adding at the end the following 
section: 
42 use 300d-52. 
"SEC. 1252. STATE GRANTS FOR DEMONSTRATION PROJECTS REGARD-
ING TRAUMATIC BRAIN INJURY. 
• 
"(a) IN GENERAL.—^The Secretary, acting through the Adminis-
trator of the Health Resources and Services Administration, may 
make grants to States for the purpose of carrying out demonstration 
projects to improve access to health and other services regarding 
traumatic brain injury. 
"(b) STATE ADVISORY BOARD.— 
"(1) IN GENERAL.—^The Secretary may make a grant under 
subsection (a) only if the State involved agrees to establish 
an advisory board within the appropriate health department 
of the State or within another department as designated by 
the chief executive officer of the State. 
"(2) FUNCTIONS.—^An advisory board established under 
paragraph (1) shall advise and make recommendations to the 
PUBLIC LAW 104-166-^JULY 29, 1996 
110 STAT. 1447 
State on ways to improve services coordination regarding trau-
matic brain injury. Such advisory boards shall encourage citizen 
participation through the establishment of public hearings and 
other types of community outreach programs. In developing 
recommendations under this paragraph, such boards shall con-
sult with Federal, State, and local governmental agencies and 
with citizens groups and other private entities. 
"(3) COMPOSITION.—^An advisory board established under 
paragraph (1) shall be composed of— 
"(A) representatives of— 
"(i) the corresponding State agencies involved; 
"(ii) public and nonprofit private health related 
organizations; 
"(iii) other disability advisory or planning groups 
within the State; 
"(iv) members of an organization or foundation 
representing traumatic brain injury survivors in that 
State; and 
"(v) injury control programs at the State or local 
level if such programs exist; and 
"(B) a substantial number of individuals who are survi-
vors of traumatic brain injury, or the family members 
of such individuals. 
"(c) MATCHING FUNDS.— 
"(1) IN GENERAL.—^With respect to the costs to be incurred 
by a State in carrying out the purpose described in subsection 
(a), the Secretary may make a grant under such subsection 
only if the State agrees to make available, in cash, non-Federal 
contributions toward such costs in an amount that is not less 
than $1 for each $2 of Federal funds provided under the grant. 
"(2) DETERMINATION OF AMOUNT CONTRIBUTED.—In deter-
mining the amount of non-Federal contributions in cash that 
a State has provided pursuant to paragraph (1), the Secretary 
may not include any amounts provided to the State by the 
Federal Government. 
"(d) APPLICATION FOR GRANT.—^The Secretary may make a grant 
under subsection (a) only if 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 Secretary determines to be necessary to carry 
out this section. 
"(e) COORDINATION OF ACTIVITIES.—^The Secretary shall ensure 
that activities under this section are coordinated as appropriate 
with other agencies of the Public Health Service that carry out 
activities regarding traumatic brain injury. 
"(f) REPORT.—Not later than 2 years after the date of the 
enactment of this section, the Secretary shall submit to the Commit-
tee on Commerce of the House of Representatives, and to the 
Committee on Labor and Human Resources of the Senate, a report 
describing the findings and results of the programs established 
under this section, including measures of outcomes and consumer 
and surrogate satisfaction. 
"(g) DEFINITION.—For purposes of this section, the term 'trau-
matic brain injury' means an acquired injury to the brain. Such 
term does not include brain dysfunction caused by congenital or 
degenerative disorders, nor birth trauma, but may include brain 
injuries caused by anoxia due to near drowning. The Secretary 
110 STAT. 1448 
PUBLIC LAW 104-166-^JULY 29, 1996 
may revise the definition of such term as the Secretary determines 
necessary. 
"(h) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this section, there is authorized to be appropriated 
$5,000,000 for each of the fiscal years 1997 through 1999.". 
42 use 300d-61 
SEC. 4. STUDY; CONSENSUS CONFERENCE. 
°°*"- 
(a)STUDY.-
(1) IN GENERAL.—The Secretary of Health and Human 
Services (in this section referred to as the "Secretary"), acting 
through the appropriate agencies of the Public Health Service, 
shall conduct a study for the purpose of carrying out the follow-
ing with respect to traumatic brain injury: 
(A) In collaboration with appropriate State and local 
health-related agencies— 
(i) determine the incidence and prevalence of trau-
matic brain injury; and 
(ii) develop a uniform reporting, system under 
which States report incidents of traumatic brain injury, 
if the Secretary determines that such a system is 
appropriate. 
(B) Identify common therapeutic interventions which 
are used for the rehabilitation of individuals with such 
injuries, and shall, subject to the availability of information, 
include an analysis of— 
(i) the effectiveness of each such intervention in 
improving the functioning of individuals with brain 
injuries; 
(ii) the comparative effectiveness of interventions 
employed in the course of rehabilitation of individuals 
with brain injuries to achieve the same or similar 
clinical outcome; and 
(iii) the adequacy of existing measures of outcomes 
and knowledge of factors influencing differential out-
comes. 
(C) Develop practice guidelines for the rehabilitation 
of traumatic brain injury at such time as appropriate sci-
entific research becomes available. 
(2) DATES CERTAIN FOR REPORTS.— 
(A) Not later than 18 months Eifter the date of the 
enactment of this Act, the Secretary shall submit to the 
Committee on Commerce of the House of Representatives, 
and to the Committee on Labor and Human Resources 
of the Senate, a report describing the findings made as 
a result of carrying out paragraph (1)(A). 
(B) Not later than 3 years after the date of the enact-
ment of this Act, the Secretary shall submit to the Commit-
tees specified in subparagraph (A) a report describing the 
findings made as a result of carrying out subparagraphs 
(B) and (C) of paragraph (1). 
PUBLIC LAW 104-166-^JULY 29, 1996 
110 STAT. 1449 
(b) CONSENSUS CONFERENCE.—The Secretary, acting through 
the Director of the National Center for Medical Rehabilitation 
Research within the National Institute for Child Health and Human 
Development, shall conduct a national consensus conference on 
managing traumatic brain injury and related rehabilitation con-
cerns. 
(c) DEFINITION.—For purposes of this section, the term "trau-
matic brain injury" means an acquired injury to the brain. Such 
term does not include brain dysfunction caused by congenital or 
degenerative disorders, nor birth trauma, but may include brain 
injuries caused by anoxia due to near drowning. The Secretary 
may revise the definition of such term as the Secretary determines 
necessary. 
(d) AUTHORIZATIONS OF APPROPRIATIONS.—For the purpose of 
carrying out subsection (a)(1)(A), there is authorized to be appro-
priated $3,000,000 for each of the fiscal years 1997 through 1999. 
For the purpose of carrying out the other provisions of this section, 
there is authorized to be appropriated an aggregate $500,000 for 
the fiscal years 1997 through 1999. Amounts appropriated for such 
other provisions remain available until expended. 
SEC. 5. TECHNICAL AMENDMENTS. 
Title XXVI of the Public Health Service Aot (42 U.S.C. 300ff-
11 et seq.), as amended by Public Law 104-146 (the Ryan White 
CARE Act Amendments of 1996), is amended— 
(1) in section 2626— 
Arete, p. 1369. 
(A) in subsection (d), in the first sentence, by striking 
"(1) through (5)" and inserting "(1) through (4)"; and 
(B) in subsection (f), in the matter preceding paragraph 
(1), by striking "(1) through (5)" and inserting "(1) through 
(4)"; and 
(2) in section 2692— 
Ante, p. 1363. 
(A) in subsection (a)(1)(A)— 
(i) by striking "title XXVI programs" and inserting 
"programs under this title"; and 
(ii) by striking "infection and"; and 
(B) by striking subsection (c) and all that follows and 
inserting the following: 
110 STAT. 1450 
PUBLIC LAW 104-166-^JULY 29, 1996 
"(c) AUTHORIZATION OF APPROPRIATIONS.— 
"(1) SCHOOLS; CENTERS.—^For the purpose of grants under 
subsection (a), there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal years 1996 
through 2000. 
"(2) DENTAL SCHOOLS.—For the purpose of grants under 
subsection (b), there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal years 1996 
through 2000.". 
Approved July 29, 1996. 
LEGISLATIVE HISTORY—H.R. 248: 
HOUSE REPORTS: No. 104-652 (Comm. on Commerce). 
CONGRESSIONAL RECORD, Vol. 142 (1996): 
July 9, considered and passed House. 
July 12, considered and passed Senate.