Trauma Care Systems Planning and Development Act of 1990
PL 101-590 (H.R.1602), enacted 11/16/1990

PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2915 
Public Law 101-590 
101st Congress 
An Act 
To amend the Public Health Service Act to improve emergency medical services smd 
trauma care, and for other purposes. 
Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the "Trauma Care Systems Planning and 
Development Act of 1990". 
SEC. 2. FINDINGS. 
The Congress finds that— 
(1) the Federal Government and the governments of the 
States have established a history of cooperation in the develop-
ment, implementation, and monitoring of integrated, com-
prehensive systems for the provision of emergency medical 
services throughout the United States; 
(2) physical trauma is the leading cause of death of Americans 
between the ages of 1 and 44 and is the third leading cause of 
death in the general population of the United States; 
(3) physical trauma in the United States results in an aggre-
gate annual cost of $180,000,000,000 in medical expenses, insur-
ance, lost wages, and property damage; 
(4) barriers to the provision of prompt and appropriate emer-
gency medical services exist in many areas of the United States; 
(5) few States and communities have developed and imple-
mented trauma care systems; 
(6) many trauma centers have incurred substantial un-
compensated costs in providing trauma care, and such costs 
have caused many such centers to cease participation in trauma 
care systems; and 
(7) the number of incidents of physical trauma in the United 
States is a serious medical and social problem, and the number 
of deaths resulting from such incidents can be substantially 
reduced by improving the trauma-care components of the sys-
tems for the provision of emergency medical services in the 
United States. 
SEC. 3. ESTABLISHMENT OF PROGRAMS WITH RESPECT TO TRAUMA 
CARE. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended 
by inserting after title XI the following new title: 
Nov. 16, 1990 
[H.R. 1602] 
Trauma Care 
Systems 
Planning and 
Development 
Act 
of 1990. 
Inter-
governmental 
relations. 
42 u s e 201 note. 
42 u s e 300d 
note. 
104 STAT. 2916 
PUBLIC LAW 101-590—NOV. 16, 1990 
"TITLE XII—TRAUMA CARE 
"PART A—GENERAL AUTHORITY AND DUTIES OF SECRETARY 
42 use 300d. 
"SEC. 1201. ESTABLISHMENT. 
"(a) IN GENERAL.—The Secretary shall, with respect to trauma 
care— 
"(1) conduct and support research, training, evaluations, and 
demonstration projects; 
"(2) foster the development of appropriate, modern systems of 
such care through the sharing of information among agencies 
and individuals involved in the study and provision of such care; 
"(3) provide to State and local agencies technical assistance; 
and 
"(4) sponsor workshops and conferences. 
"(b) GRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS.—The 
Secretary may make grants, and enter into cooperative agreements 
and contracts, for the purpose of carrying out subsection (a). 
42 use 300d-l. 
"SEC. 1202. ADVISORY COUNCIL ON TRAUMA CARE SYSTEMS. 
"(a) ESTABUSHMENT.—The Secretary shall establish an advisory 
council to be known as the Advisory Council on Trauma Care 
Systems (hereafter in this section referred to as the 'Council'). 
"(b) DUTIES.—The Council shall— 
"(1) periodically conduct assessments of the needs in the 
United States with respect to trauma care and the extent to 
which the States are responding to such needs, including special 
consideration of the unique needs of rural areas; 
"(2) submit to the Secretary the findings made as a result of 
such assessments; and 
"(3) advise the Secretary with respect to activities carried out 
under this title, including the development of the model trauma 
plan described in section 1213(c). 
"(c) MEMBERSHIP.— 
"(1) IN GENERAL,—The Secretary shall appoint to the Council 
12 appropriately qualified representatives of the public who 
are not officers or employees of the United States. Of such 
members— 
"(A) 3 shall be individuals experienced or specially 
trained in trauma surgery (including a critical care nurse); 
"(B) 3 shall be individuals experienced or specially 
trained in emergency medicine (including a nurse who is 
specially trained in emergency medicine); 
"(C) 1 shall be an individual experienced or specially 
trained in the care of injured children; 
"(D) 1 shall be an individual experienced or specially 
trained in physical medicine and rehabilitation; and 
"(E) 4 shall be individuals experienced or specially 
trained in the development, administration, or financing of 
trauma care systems. 
"(2) Ex OFFICIO MEMBERS.—The Secretary may designate as ex 
officio members of the Council appropriately qualified rep-
resentatives of the Department of Health and Human Services, 
the Department of Transportation, the Federal Emergency 
Management Agency, and such other agencies of the Federal 
Government £is the Secretary determines to have functions 
affecting emergency medical services. 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2917 
"(3) KNOWLEDGE CONCERNING RURAL AREAS.—Of the members 
described in paragraph (1), 25 percent of the members shall be 
knowledgeable about the unique needs of rural areas with 
respect to the purpose of the Council. 
"(d) TERMS.— 
"(1) GENERAL TERM.—Except as provided in paragraph (2), 
members of the Council appointed under subsection (c)(1) shall 
serve for a term of 4 years. 
"(2) INITIAL MEMBERS.—Of the members first appointed to the 
Council under subsection (c)(1), the Secretary shall appoint 4 
members to serve for a term of 4 years, 4 members to serve for a 
term of 3 years, and 4 members to serve for a term of 2 years. 
"(e) VACANCIES.— 
"(1) SERVICE FOR REMAINDER OF TERM.—Any member of the 
Council appointed under subsection (c)(1) to fill a vacancy occur-
ring before the expiration of the term of the predecessor of the 
member shall be appointed for the remainder of the term of the 
predecessor. 
"(2) 
CONTINUED SERVICE AFTER EXPIRATION OF TERM.—A 
member of the Council appointed under subsection (cXD may 
continue to serve after the expiration of the term of the member 
until a successor is appointed. 
"(f) CHAIR.—The Secretary, or the designee of the Secretary, shall 
serve as the chair of the Council. 
"(g) MEETINGS.—The Council shall meet at the call of the Chair 
and shall meet not less than once each 3 months. 
"(h) COMPENSATION AND REIMBURSEMENT OF EXPENSES.— 
"(1) FEDERAL OFFICIALS.—Ex officio members of the Council 
under subsection (c)(2) may not receive compensation for service 
on the Council in addition to the compensation otherwise re-
ceived for duties carried out as officers or employees of the 
United States. 
"(2) APPOINTMENT MEMBERS.—Members of the Council ap-
pointed under subsection (c)(1) may not receive compensation 
for service on the Council. Such members may be reimbursed 
for travel, subsistence, and other necessary expenses incurred in 
carrying out the duties of the Council. 
"(i) STAFF.—The Secretary shall provide to the Council such staff, 
information, and other assistance £is may be necessary to carry out 
the duties of the Council. 
"0) TERMINATION.—Notwithstanding section 14(a) of the Federal 
Advisory Committee Act, the Council shall continue in existence 
until otherwise provided by law. 
"SEC. 1203. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDI- 
42 USC 300D-2. 
CAL SERVICES. 
"(a) ESTABUSHMENT.—The Secretary shall by contract provide for 
Government 
the establishment and operation of a National Clearinghouse on 
contracts. 
Trauma Care and Emergency Medical Services (hereafter in this 
section referred to as the Clearinghouse'). 
"(b) DUTIES.—The Clearinghouse shall— 
"(1) foster the development of appropriate, modern trauma 
care and emergency medical services (including the develop-
ment of policies for the notification of family members of 
individuEds involved in medical emergencies) through the shar-
ing of information among agencies and individuals involved in 
planning, furnishing, and studying such services and care; 
104 STAT. 2918 
PUBLIC LAW 101-590—NOV. 16, 1990 
Public 
information. 
42 use 300d-3. 
Grant programs. 
"(2) collect, compile, and disseminate information on the 
achievements of, and problems experienced by, State and local 
agencies and private entities in providing trauma care and 
emergency medical services and, in so doing, give special consid-
eration of the unique needs of rural areas; 
"(3) provide technical assistance relating to trauma care and 
emergency medical services to State and local agencies; and 
"(4) sponsor workshops and conferences on trauma care and 
emergency medical services. 
"(c) FEES AND ASSESSMENTS.—A contract entered into by the Sec-
retary under this section may provide that the Clearinghouse 
charge fees or assessments in order to defray, and beginning with 
fiscal year 1992, to cover, the costs of operating the Clearinghouse. 
"SEC. 1204. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA 
CARE IN RURAL AREAS. 
"(a) IN GENERAL.—The Secretary may make grants to public and 
nonprofit private entities for the purpose of carrying out research 
and demonstration projects with respect to improving the availabil-
ity and quality of emergency medical services in rural areas— 
"(1) by developing innovative uses of communications tech-
nologies arid the use of new communications technology; 
"(2) by developing model curricula for training emergency 
medical services personnel, including first responders, emer-
gency medical technicians, emergency nurses and physicians, 
£md paramedics— 
"(A) in the assessment, stabilization, treatment, prepara-
tion for transport, and resuscitation of seriously injured 
patients, with special attention to problems that arise 
during long transports and to methods of minimizing delays 
in transport to the appropriate facility; and 
"(B) in the management of the operation of the emer-
gency medical services system; 
"(3) by making training for original certification, and continu-
ing education, in the provision and management of emergency 
medical services more accessible to emergency medical person-
nel in rural areas through telecommunications, home studies, 
providing teachers and training at locations accessible to such 
personnel, and other methods; 
"(4) by developing innovative protocols and agreements to 
increase access to prehospital care and equipment necessary for 
the transportation of seriously injured patients to the appro-
priate facilities; and 
"(5) by evaluating the effectiveness of protocols with respect 
to emergency medical services and systems. 
"(b) 
SPECIAL CONSIDERATION FOR CERTAIN RURAL AREAS.—In 
making grants under subsection (a), the Secretary shall give special 
consideration to any applicant for the grant that will provide serv-
ices under the grant in any rural area identified by a State under 
section 1214(c)(1). 
"(c) REQUIREMENT OF APPLICATION.—The Secretary may not make 
a grant under subsection (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 £is the Secretary. 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2919 
"PART B—FORMULA GRANTS WITH RESPECT TO MODIFICATIONS OF 
STATE PLANS 
"SEC. 1211. ESTABLISHMENT OF PROGRAM. 
42 USC 300d-ll. 
"(a) REQUIREMENT OF ALLOTMENTS FOR STATES.—The Secretary 
shall for each fiscal year make an allotment for each State in an 
amount determined in accordance with section 1218. The Secretary 
shall make payments, £is grants, each fiscal year to each State from 
the allotment for the State if the Secretary approves for the fiscal 
year involved an application submitted by the State pursuant to 
section 1217. 
"(b) PURPOSE.—Except as provided in section 1233, the Secretary 
may not make payments under this part for a fiscal year unless the 
State involved agrees that, with respect to the trauma care compo-
nent of the State plan for the provision of emergency medical 
services, the pajnnents will be expended only for the purpose of 
developing, implementing, and monitoring the modifications to such 
component described in section 1213. 
"SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUB- 
42 USC 300d-12. 
SEQUENT TO FIRST FISCAL YEAR OF PAYMENTS. 
"(a) NON-FEDERAL CONTRIBUTIONS.— 
"(1) IN GENERAL.—The Secretary may not make payments 
under section 1211(a) unless the State involved agrees, with 
respect to the costs described in paragraph (2), to make avail-
able non-Federal contributions (in cash or in kind under subsec-
tion (bXD) toward such costs in an amount equal to— 
"(A) for the second fiscal year of such payments to the 
State, not less than $1 for each $1 of Federal funds provided 
in such pa3rments for such fiscal year; and 
"(B) for any subsequent fiscal year of such payments to 
the State, not less than $3 for each $1 of Federal funds 
provided in such payments for such fiscal year. 
"(2) PROGRAM COSTS.—The costs referred to in parsigraph (1) 
are— 
"(A) the costs to be incurred by the State in carrying out 
the purpose described in section 1211(c); or 
"(B) the costs of improving the quality and availability of 
emergency medical services in rural areas of the State. 
"(3) INITIAL YEAR OF PAYMENTS.—The Secretary may not re-
quire a State to make non-Federal contributions as a condition 
of receiving payments under section 1211(a) for the first fiscal 
year of such payments to the State. 
"(b) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.—With respect to compliance with subsection (a) as a condition 
of receiving payments under section 1211(a)— 
"(1) a State may make the non-Federal contributions required 
in such subsection in cash or in kind, fairly evaluated, including 
plant, equipment, or services; 
"(2) the Secretary may not, in making a determination of the 
amount of non-Federal contributions, include amounts provided 
by the Federal Government or services assisted or subsidized to 
any significant extent by the Federal Government; and 
"(3) the Secretary shall, in making such a determination, 
include only non-Federal contributions in excess of the amount 
of non-Federal contributions made by the State during fiscal 
year 1990 toward— 
104 STAT. 2920 
PUBLIC LAW 101-590—NOV. 16, 1990 
"(A) the costs of providing trauma care in the State; and 
"(B) the costs of improving the quality and availability of 
emergency medical services in rural areas of the State. 
42 u s e 300d-13. 
"SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE 
OF ALLOTMENTS. 
"(a) TRAUMA CARE MODIFICATIONS TO STATE PLAN FOR EMERGENCY 
MEDICAL SERVICES.—With respect to the trauma care component of 
a State plan for the provision of emergency medical services, the 
modifications referred to in section 1211(b) are such modifications to 
the State plan as may be necessary for the State involved to ensure 
that the plan provides for access to the highest possible quality of 
trauma care, and that the plan— 
"(1) specifies that the modifications required pursuant to 
paragraphs (2) through (10) will be implemented by the prin-
cipal State agency with respect to emergency medical services 
or by the designee of such agency; 
"(2) specifies any public or private entity that will designate 
trauma care regions and trauma centers in the State; 
"(3) subject to subsection (b), contains standards and require-
ments for the designation of level I and level II trauma centers, 
and in the case of rural areas level III trauma centers (including 
trauma centers with specified capabilities and expertise in the 
care of the pediatric trauma patient), by such entity, including 
standards and requirements for— 
"(A) the number and types of trauma patients for whom 
such centers must provide care in order to ensure that such 
centers will have sufficient experience and expertise to be 
able to provide quality care for victims of injury; 
"(B) the resources and equipment needed by such centers; 
and 
"(C) the availability of rehabilitation services for trauma 
patients; 
"(4) subject to subsection (b), contains standards and require-
ments for the implementation of regional trauma care systems, 
including standards and guidelines (consistent with the provi-
sions of section 1867 of the Social Security Act for medically 
directed triage and transportation of trauma patients (including 
patients injured in rural areas) prior to care in designated 
trauma centers; 
"(5) subject to subsection (b), contains standards and require-
ments for medically directed triage and transport of severely 
injured children to designated trauma centers with specified 
capabilities and expertise in the care of the pediatric trauma 
patient; 
"(6) specifies procedures for the evaluation of designated 
trauma centers (including trauma centers described in para-
graph (5)) and trauma care systems; 
"(7) provides for the establishment and collection of data from 
each designated trauma center in the State of a central data 
reporting and analysis system— 
"(A) to identify the number of severely injured trauma 
patients within regional trauma care systems in the State; 
"(B) to identify the cause of the injury and any factors 
contributing to the injury; 
"(C) to identify the nature and severity of the injury; 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2921 
"(D) to monitor 
trauma 
patient 
care 
(including 
prehospital care) in each designated trauma center within 
regional trauma care systems in the State (including rel-
evant emergency-department discharges and rehabilitation 
information) for the purpose of evaluating the diagnosis, 
treatment and treatment outcome of such trauma patients; 
"(E) to identify the total amount of uncompensated 
trauma care expenditures for each fiscal year by each 
designated trauma center in the State; and 
"(F) to identify patients transferred within a regional 
trauma system, including reasons for such transfer; 
"(8) to provide for the use of procedures by paramedics and 
emergency medical technicians to assess the severity of the 
injuries incurred by trauma patients; 
"(9) to provide appropriate transportation and transfer poli-
cies to ensure the delivery of patients to designated trauma 
centers and other facilities within and outside of the jurisdiction 
of such system, including policies to ensure that only individ-
uals appropriately identified as trauma patients are transferred 
to designated trauma centers, and to provide periodic reviews of 
the transfers and the auditing of such transfers that are deter-
mined to be appropriate; 
"(10) to conduct public education activities concerning injury 
prevention and obtaining access to trauma care; £uid 
"(11) with respect to the requirements established in this 
subsection, provides for coordination and cooperation between 
the State and any other State with which the State shares any 
standard metropolitan statistical area. 
"(b) CERTAIN STANDARDS WITH RESPECT TO TRAUMA CARE CENTERS 
AND SYSTEMS.— 
"(1) IN GENERAL.—The Secretary may not make payments 
under section 1211(a) for a fiscal year unless the State involved 
agrees that, in carrying out paragraphs (3) through (5) of subsec-
tion (a), the State will adopt standards for the designation of 
trauma centers, and for triage, transfer, and transportation 
policies, and that the State wSl, in adopting such standards— 
"(A) take into account national standards concerning 
such; 
"(B) consult with medical, surgical, and nursing speciality 
groups, hospital associations, emergency medical services 
State and local directors, concerned advocates and other 
interested parties; 
"(C) conduct hearings on the proposed standards after 
providing adequate notice to the public concerning such 
hearing; and 
"(D) beginning in fiscal year 1992, take into account the 
model plan described in subsection (c). 
"(2) QUALITY OF TRAUMA CARE.—The highest quality of 
trauma care shall be the primary goal of State standards 
adopted under this subsection. 
"(3) APPROVAL BY SECRETARY.—The Secretary may not make 
pa5rments under section 1211(a) to a State if the Secretary 
determines that— 
"(A) in the case of pajnnents for fiscal year 1991 and 
subsequent fiscal years, the State has not taken into 
account national standards, including those of the Amer-
ican College of Surgeons, the American College of Emer-
104 STAT. 2922 
PUBLIC LAW 101-590—NOV. 16, 1990 
gency Physicians and the American Academy of Pediatrics, 
in adopting standards under this subsection; or 
"(B) in the case of pa3rments for fiscal year 1992 and 
subsequent fiscal years, the State has not, in adopting such 
standards, taken into account the model plan developed 
under subsection (c). 
"(c) MODEL TRAUMA CARE PLAN.—Not later than 1 year after the 
date of the enactment of the Trauma Care Systems Planning and 
Development Act of 1990, the Secretary shall develop a model plan 
for the designation of trauma centers and for triage, transfer and 
transportation policies that may be adopted for guidance by the 
State. Such plan shall— 
"(1) take into account national standards, including those of 
the American CloUege of Surgeons, American CJoUege of Emer-
gency Physicians and the American Academy of Pediatrics; 
"(2) take into account existing State plans; 
"(3) be developed in consultation with medical, surgical, and 
nursing speciality groups, hospital associations, emergency 
medical services State directors and associations, and other 
interested parties; and 
"(4) include standards for the designation of rural health 
facilities and hospitals best able to receive, stabilize, and trans-
fer trauma patients to the nearest appropriate designated 
trauma center, and for triage, transfer, and transportation 
policies as they relate to rural areas. 
Rural areas. 
Standards described in paragraph (4) shall be applicable to all rural 
aresis in the State, including both non-metropolitan areas and fron-
tier areas that have populations of less than 6,000 per square mile. 
"(d) RULE OF CONSTRUCTION WITH RESPECT TO NUMBER OF DES-
IGNATED TRAUMA CENTERS.—With respect to compliance with 
subsection (a) as a condition of the receipt of a grant under section 
1211(a), such subsection may not be construed to specify the number 
of trauma care centers designated pursuant to such subsection. 
42 u s e 300d-14 
"SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA 
PLAN AND CERTAIN INFORMATION. 
"(a) TRAUMA PLAN.— 
"(1) IN GENERAL.—For fiscal year 1991 and subsequent fiscal 
years, the Secretary may not make pajrments under section 
1211(a) unless, subject to paragraph (2), the State involved 
submits to the Secretary the trauma care component of the 
State plan for the provision of emergency medical services. 
"(2) INTERIM PLAN OR DESCRIPTION OF EFFORTS.—For fiscal year 
1991, if a State has not completed the trauma care component of 
the State plan described in paragraph (1), the State may pro-
vide, in lieu of a completed such component, an interim compo-
nent or a description of efforts made toward the completion of 
the component. 
"Ot)) INFORMATION RECEIVED BY STATE REPORTING AND ANALYSIS 
SYSTEM.—The Secretary may not make pajonents under section 
1211(a) for a fiscal year unless the State involved agrees that the 
State will, not less than once each year, provide to the Secretary the 
information received by the State pursuant to section 1213(aX7). 
"(c) AVAILABILITY OF EMERGENCY MEDICAL SERVICES IN RURAL 
AREAS.—The Secretary may not make pa3mients under section 
1211(a) for a fiscal year unless— 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2923 
"(1) the State involved identifies any rural area in the State 
for which— 
"(A) there is no system of access to emergency medical 
services through the telephone number 911; 
"(B) there is no basic life-support system; or 
"(C) there is no advanced life-support system; and 
"(2) the State submits to the Secretary a list of rural areas 
identified pursuant to paragraph (1) or, if there are no such 
areas, a statement that there are no such areas. 
"SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS. 
42 USC 300d-15. 
"(a) IN GENERAL.—The Secretary may not, except as provided in 
subsection (b), make pa5rments under section 1211(a) for a fiscal year 
unless the State involved agrees that the payments will not be 
expended— 
"(1) subject to section 1233, for any purpose other than devel-
oping, 
implementing, and monitoring the modifications 
required by section 1211(b) to be made to the State plan for the 
provision of emergency medical services. 
"(2) to make cash payments to intended recipients of services 
provided pursuant to such section; 
"(3) to purchase or improve real property (other than minor 
remodeling of existing improvements to real property) or to 
purchase major medical or communication equipment, ambu-
lances, or aircraft; 
"(4) to satisfy any requirement for the expenditure of non-
Federal funds as a condition for the receipt of Federal funds; or 
"(5) to provide financial assistance to any entity other than a 
public or nonprofit private entity. 
"(b) EXCEPTION.—If the Secretary finds that the purpose described 
in section 1211(b) cannot otherwise be carried out, the Secretary 
may, with respect to an otherwise qualified State, waive the restric-
tion established in subsection (aX3). 
"SEC. 1216. REQUIREMENT OF REPORTS BY STATES. 
42 USC 300d-16. 
"(a) IN GENERAL.—The Secretary may not make payments under 
section 1211(a) for a fiscal year unless the State involved agrees to 
prepare and submit to the Secretary an annual report in such form 
and containing such information as the Secretary determines (after 
consultation with the States and the (Domptroller General of the 
United States) to be necessary for— 
"(1) securing a record and a description of the purposes for 
which payments received by the State pursuant to such section 
were expended and of the recipients of such payments; and 
"(2) determining whether the payments were expended in 
accordance with the purpose of the program involved. 
"(b) AVAILABILITY TO PUBLIC OF REPORTS.—The Secretary may not 
make payments under section 1211(a) unless the State involved 
agrees that the State will make copies of the report described in 
subsection (a) available for public inspection. 
"(c) EVALUATIONS BY COMPTROLLER GENERAL.—The Comptroller 
General of the United States shall evaluate the expenditures by 
States of payments under section 1211(a) in order to assure that 
expenditures are consistent with the provisions of this part, and not 
later than December 1, 1993, prepare and submit to the Committee 
on Energy and Commerce of the House of Representatives and the 
104 STAT. 2924 
PUBLIC LAW 101-590—NOV. 16, 1990 
Committee on Labor and Human Resources of the Senate a report 
concerning such evaluation. 
42 u s e 300d-17. 
"SEC. 1217. REQUIREMENT OF SUBMISSION OF APPLICATION CONTAIN-
ING CERTAIN AGREEMENTS AND ASSURANCES. 
"The Secretary may not make pajnnents under section 1211(a) to a 
State for a fiscal year unless— 
"(1) the State submits to the Secretary an application for the 
pajnnents containing agreements in accordance with this part; 
"(2) the agreements are made through certification from the 
chief executive officer of the State; 
"(3) with respect to such agreements, the application provides 
assurances of compliance satisfactory to the Secretary; 
"(4) the application contains the plan provisions and the 
information required to be submitted to the Secretary pursuant 
to section 1214; and 
"(5) the application otherwise 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 part. 
42 u s e 300d-18. 
"SEC. 1218. DETERMINATION OF AMOUNT OF ALLOTMENT. 
"(a) MINIMUM ALLOTMENT.—Subject to the extent of amounts 
made available in appropriations Acts, the amount of an allotment 
under section 1211(a) for a State for a fiscal year shall be the greater 
of— 
"(1) the amount determined under subsection (b)(1); and 
"(2) $250,000 in the case of each of the several States, the 
District of Columbia, and the Commonwealth of Puerto Rico, 
and $50,000 in the case of each of the Virgin Islands, Guam, 
American Samoa, and the Commonwealth of the Northern 
Mariana Islands. 
"(b) DETERMINATION UNDER FORMULA.— 
"(1) IN GENERAL.—The amount referred to in subsection (a)(1) 
for a State for a fiscal year is the sum of— 
"(A) an amount determined under paragraph (2); and 
"(B) an amount determined under paragraph (3). 
"(2) AMOUNT RELATING TO POPULATION.—The amount referred 
to in subparagraph (A) of paragraph (1) for a State for a fiscal 
year is the product of— 
"(A) an amount equal to 80 percent of the amounts 
appropriated under section 1232(a) for the fiscal year and 
available for allotment under section 1211(a); and 
"(B) a percentage equal to the quotient of^ 
"(i) an amount equal to the population of the State; 
divided by 
"(ii) an amount equal to the population of all States. 
"(3) AMOUNT RELATING TO SQUARE MILEAGE.—The amount 
referred to in subparagraph (B) of paragraph (1) for a State for a 
fiscal year is the product o
f
— 
"(A) an amount equal to 20 percent of the amounts 
appropriated under section 1232(a) for the fiscal year and 
available for allotment under section 1211(a); and 
"(B) a percentage equal to the quotient o
f
— 
"(i) an amount equal to the lesser of 266,807 and the 
amount of the square mileage of the State; divided by 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2925 
"(ii) an amount equal to the sum of the respective 
amounts determined for the States under clause (i). 
"(c) DISPOSITION OF CERTAIN FUNDS APPROPRIATED FOR ALLOT-
MENTS.— 
"(1) IN GENERAL.—Amounts described in paragraph (2) shall, 
in accordance with paragraph (3), be allotted by the Secretary to 
States receiving payments under section 1211(a) for the fiscal 
year (other than any State referred to in paragraph (2XC)). 
"(2) TYPE OF AMOUNTS.—The amounts referred to in para-
graph (1) are any amounts made available pursuant to 1232(bX3) 
that are not paid under section 1211(a) to a State as a result of— 
"(A) the failure of the State to submit an application 
under section 1217; 
"(B) the failure, in the determination of the Secretary, of 
the State to prepare within a reasonable period of time such 
application in compliance with such section; or 
(C) the State informing the Secretary that the State does 
not intend to expend the full amount of the allotment made 
for the State. 
"(3) AMOUNT.—The amount of an allotment under paragraph 
(1) for a State for a fiscal year shall be an amount equal to the 
product of— 
"(A) an amount equal to the amount described in para-
graph (2) for the fiscal year involved; and 
"(B) the percentage determined under subsection (bX2) for 
the State. 
"SEC. 1219. FAILURE TO COMPLY WITH AGREEMENTS. 
42 USC 300d-19. 
"(a) REPAYMENT OF PAYMENTS.— 
"(1) REQUIREMENT.—The Secretary may, in accordance with 
subsection (b), require a State to repay any payments received 
by the State pursuant to section 1211(a) that the Secretary 
determines were not expended by the State in accordance with 
the agreements required to be made by the State as a condition 
of the receipt of payments under such section. 
"(2) OFFSET OF AMOUNTS.—If a State fails to make a repay-
ment required in paragraph (1), the Secretary may offset the 
amount of the repayment against any amount due to be paid to 
the State under section 1211(a). 
"(b) OPPORTUNITY FOR A HEARING.—Before requiring repajonent of 
payments under subsection (a)(1), the Secretary shall provide to the 
State an opportunity for a hearing. 
"SEC. 1220. PROHIBITION AGAINST CERTAIN FALSE STATEMENTS. 
42 USC 300d-20. 
"(a) IN GENERAL.— 
"(1) FALSE STATEMENTS OR REPRESENTATIONS.—A person may 
not knowingly and willfully make or cause to be made any false 
statement or representation of a material fact in connection 
with the furnishing of items or services for which payments 
may be made by a State from amounts paid to the State under 
section 1211(a). 
"(2) (DONCEAUNG OR FAIUNG TO DISCLOSE INFORMATION.—A 
person with knowledge of the occurrence of any event affecting 
the right of the person to receive any payments from amounts 
paid to the State under section 1211(a) may not conceal or fail to 
disclose any such event with the intent of fraudulently securing 
such amount. 
39-194 O - 91 - 20 : QL 3 Part 4 
104 STAT. 2926 
PUBLIC LAW 101-590—NOV. 16, 1990 
"(b) CRIMINAL PENALTY FOR VIOLATION OF PROHIBITION.—Any 
person who violates a prohibition established in subsection (a) may 
for each violation be fined in accordance with title 18, United States 
Code, or imprisoned for not more than 5 years, or both. 
42 use 300d-21. 
"SEC. 1221. TECHNICAL ASSISTANCE AND PROVISION BY SECRETARY OF 
SUPPLIES AND SERVICES IN LIEU OF GRANT FUNDS. 
"(a) TECHNICAL ASSISTANCE.—The Secretary shall, without charge 
to a State receiving pajnnents under section 1211(a), provide to the 
State (or to any public or nonprofit private entity designated by the 
State) technical assistance with respect to the plainning, develop-
ment, and operation of any program carried out pursuant to section 
1211(b). The Secretary may provide such technical assistance di-
rectly, through contract, or through grants. 
"(b) PROVISION BY SECRETARY OF SUPPLIES AND SERVICES IN LIEU OF 
GRANT FUNDS.— 
"(1) IN GENERAL.—Upon the request of a State receiving 
pajonents under section 1211(a), the Secretary may, subject to 
paragraph (2), provide supplies, equipment, and services for the 
purpose of aiding the State in carrying out section 1211(b) and, 
for such purpose, may detail to the State any officer or em-
ployee of the Department of Health and Human Services. 
(2) REDUCTION IN PAYMENTS.—With respect to a request de-
scribed in paragraph (1), the Secretary shall reduce the amount 
of payments to the State under section 1211(a) by an amount 
equal to the costs of detailing personnel and the fair market 
value of any supplies, equipment, or services provided by the 
Secretary. The Secretary shall, for the payment of expenses 
incurred in complying with such request, expend the amounts 
withheld. 
42 use 300d-22. 
"SEC. 1222. REPORT BY SECRETARY. 
"Not later than October 1, 1992, the Secretary shall report to the 
appropriate committees of Congress on the activities of the States 
carried out pursuant to section 1211. Such report may include any 
recommendations of the Secretary for appropriate administrative 
and legislative initiatives with respect to trauma care, 
"PART C—GENERAL PROVISIONS 
42 use 300d-31. 
"SEC. 1231. DEFINITIONS. 
"For purposes of this title: 
"(1) DESIGNATED TRAUMA CENTER.—The term 'designated 
trauma center' means a trauma center designated in accord-
ance with the modifications to the State plan described in 
section 1213. 
"(2) STATE PLAN REGARDING EMERGENCY MEDICAL SERVICES.— 
The term 'State plan', with respect to the provision of emer-
gency medical services, means a plan for a comprehensive, 
organized system to provide for the access, response, triage, field 
stabilization, transport, hospital stabilization, definitive care, 
and rehabilitation of patients of all ages with respect to emer-
gency medical services. 
"(3) STATE.—The term 'State' means each of the several 
States, the District of Columbia, the Commonwealth of Puerto 
Rico; the Virgin Islands, Guam, American Samoa, and the 
Commonwealth of the Northern Mariana Islands. 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2927 
"(4) TRAUMA.—The term 'trauma' means an injury resulting 
from exposure to a mechanical force. 
"(5) TRAUMA CARE COMPONENT OF STATE PLAN.—The term 
'trauma care component', with respect to components of the 
State plan for the provision of emergency medical services, 
means a plan for a comprehensive health care system, within 
rural and urban areas of the State, for the prompt recognition, 
prehospital care, emergency medical care, acute surgical and 
medical care, rehabilitation, and outcome evaluation of seri-
ously injured patients. 
"SEC. 1232. FUNDING. 
42 USC 300d-32. 
"(a) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of 
carrying out this title, there are authorized to be appropriated 
$60,000,000 for fiscal year 1991 and such sums as may be necessary 
for each of the fiscal years 1992 and 1993. 
"Go) ALLOCATION OF FUNDS BY SECRETARY.— 
"(1) GENERAL AUTHORITY.—For the purpose of carr5dng out 
part A, the Secretary shall make available 10 percent of the 
amounts appropriated for a fiscal year under subsection (a). 
"(2) RURAL GRANTS.—For the purpose of carrying out section 
1204, the Secretary shall make available 10 percent of the 
amounts appropriated for a fiscal year under subsection (a). 
"(3) FORMULA GRANTS.— 
"(A) For the purpose of making allotments under section 
1211(a), the Secretary shall, subject to subsection (c), make 
available 80 percent of the amounts appropriated for a 
-
fiscal year pursuant to subsection (a). 
"(B) Amounts paid to a State under section 1211(a) for a 
fiscal year shall, for the purposes for which the amounts 
were paid, remain available for obligation until the end of 
the fiscal year immediately following the fiscal year for 
which the amounts were paid. 
"(c) EFFECT OF INSUFFICIENT APPROPRIATIONS FOR MINIMUM ALLOT-
MENTS.— 
"(1) IN GENERAL.—If the amounts made available under 
subsection Ot))(3XA) for a fiscal year are insufficient for providing 
each State with an allotment under section 1211(a) of not less 
than the applicable amount under section 1218(a)(2), the Sec-
retary shall, from such amounts as are made available under 
subsection (bX3XA), make grants to States described in para-
graph (2) for carrying out part B. 
"(2) EuGiBLE STATES.—'The States referred to in paragraph (1) 
are States that— 
"(A) have the greatest need to develop, implement, and 
maintain trauma care systems; and 
"(B) demonstrate in their applications under section 1217 
the greatest commitment to establishing and maintaining 
such systems, 
"(3) RULE OF CONSTRUCTION.—Paragraph (1) may not be con-
strued to require the Secretary to make a grant under such 
parEigraph to each State. 
"SEC. 1233. WAIVER OF REQUIREMENT REGARDING PURPOSE OF GRANTS. 
42 USC 300d-33. 
"(a) AUTHORITY FOR REIMBURSEMENTS REGARDING UNCOMPEN-
SATED COSTS OF TRAUMA CENTERS.—Upon the request of a State 
described in subsection O
t
>
)
, the Secretary may grant a waiver to the 
104 STAT. 2928 
PUBLIC LAW 101-590—NOV. 16, 1990 
State of the requirement established in subsection (b) of section 
1211. A State granted such a waiver may expend payments under 
subsection (a) of such section to provide reimbursements to 1 or 
more designated trauma centers described in subsection (c) for such 
portion of the uncompensated trauma care expenditures of such 
centers as the State considers appropriate. Such reimbursements 
may include reimbursments for expenditures for uncompensated 
professional services for trauma care. 
"(b) EuGiBLE STATES.—The State referred to in subsection (a) is 
any State that meets the requirements under part B for receiving 
payments under subsection (a) of section 1211 for the fiscal year 
involved, and that— 
"(1) with respect to the State plan for the provision of emer-
gency medical services, has fully implemented the portions of 
the plan developed pursuant to subsection Ot)) of such section; 
and 
"(2) contains no rural area described in section 1214(cXl). 
"(c) EuGiBLE TRAUMA CENTERS.—The designated trauma center 
referred to in subsection (a) is such a center that— 
"(A) meets the standards and requirements established 
under section 1213 by the State for trauma centers; 
"(B) serves an area in which the trauma care system 
meets the standards and requirements established under 
such section by the State for trauma care systems; and 
"(C) maintains its designation as a designated trauma 
center throughout the fiscal year for which reimbursement 
is provided under this section.". 
SEC. 4. COOPERATION BETWEEN STATE AGENCIES. 
Section 1905(c) of the Public Health Service Act (42 U.S.C. 300w-
4(c)) is amended— 
(1) by striking out "and" at the end of paragraph (5); 
(2) by striking out the period at the end of paragraph (6) and 
inserting in lieu thereof "; and"; and 
(3) by adding at the end thereof the following new paragraph: 
"(7) agrees to provide the officer of the State government 
responsible for the administration of the State highway safety 
program with an opportunity to— 
"(A) participate in the development of any plan by the 
State relating to emergency medical services, as such plan 
relates to highway safety; and 
"(B) review and comment on any proposal by any State 
agency to use any Federal grant or Federal pajmaent re-
ceived by the State for the provision of emergency medical 
services as such proposal relates to highway safety.". 
SEC. 5. EMERGENCY MEDICAL SERVICES FOR CHILDREN. 
Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9) is 
amended— 
(1) in the first sentence of subsection (a)— 
(A) by striking out "not more that four grants in any 
fiscal year" and inserting in lieu thereof "grants"; and 
(B) by striking out "in such States"; and 
(2) in subsection (d), by striking out "fiscal year 1991" and 
inserting in lieu thereof "each of the fiscal years 1991 and 
1992". 
PUBLIC LAW 101-590—NOV. 16, 1990 
104 STAT. 2929 
SEC. 6. GRANT REGARDING MEDICAL FACILITIES. 
(a) IN GENERAL.—The Secretary of Health and Human Services 
may make a grant to the George Washington University Hospital, a 
nonprofit private hospital located in the District of Columbia, for 
the purpose of constructing or modernizing a medical facility of such 
Hospital. 
(b) REQUIREMENT OF MATCHING FUNDS.— 
(1) IN GENERAL.—The Secretary may not make a grant under 
subsection (a) unless the applicant for the grant agrees, with 
respect to the costs of carrying out the purpose described in 
such subsection, to make available (directly or through dona-
tions from public or private entities) non-Federal contributions 
in cash toward such costs in an amount that is not less than $1 
for each $1 of Federal funds provided in the grant. 
(2) DETERMINATION OF AMOUNT OF NON-FEDERAL CONTRIBU-
TION.—In determining the amount of non-Federal contributions 
in cash that has been provided for purposes of paragraph (1), the 
Secretary may not include any amounts provided by the Federal 
Government. 
(c) OBUGATIONS REGARDING FREE CARE AND COMMUNITY SERV-
ICE.—The Secretary may not make a grant under subsection (a) 
unless the applicant for the grant agrees that clauses (i) and (ii) of 
section 1621(b)(l)(K) of the Public Health Service Act (and regula-
tions issued under such clauses), and section 1622 of such Act (and 
regulations issued under such section), will apply with respect to the 
medical facility constructed or modernized with the grant to the 
same extent and in the same manner as such sections and regula-
tions apply with respect to medical facilties constructed or modern-
ized with funds that have been paid under title XVI of such Act. 
(d) DEFINITION.—For purposes of this Act, the term "Secretary" 
means the Secretary of Health and Human Services. 
(e) FUNDING.— 
(1) AUTHORIZATION OF APPROPRIATIONS.— 
(A) Subject to subparagraph (B), there is authorized to be 
appropriated an aggregate $50,000,000 for the fiscal years 
1992 through 1995. 
(B) The authorization of appropriations established in 
subparagraph (A) is effective only with respect to appro-
priations made from allocations under section 302(b) of the 
Congressional Budget Act of 1974— 
(i) for the Subcommittee on the District of Columbia 
of the Committee on Appropriations of the House of 
Representatives, in the case of any bill, resolution, or 
amendment considered in the House; and 
(ii) for the Subcommittee on District of Columbia of 
the Committee on Appropriations of the Senate, in the 
case of any bill, resolution, or amendment considered 
in the Senate. 
104 STAT. 2930 
PUBLIC LAW 101-590—NOV. 16, 1990 
(2) AMOUNT OF GRANT.—Subject to the extent of amounts 
made available in appropriations Act, the -amount of a grant 
under subsection (a) shall be $50,000,000. 
Approved November 16, 1990. 
LEGISLATIVE HISTORY—H.R. 1602 (S. 15): 
HOUSE REPORTS: No. 101-346 (Comm. on Energy and Commerce) and No. 101-956 
(Comm. of Conference). 
SENATE REPORTS: No. 101-292 accompanying S. 15 (Comm. on Labor and Human 
Resources). 
CONGRESSIONAL RECORD: 
Vol. 135 (1989): Nov. 14, considered and passed House. 
Vol. 136 (1990): Oct. 17, S. 15 considered and passed Senate. 
Oct. 18, H.R. 1602 considered and passed Senate, amended, in 
lieu of S. 15. 
Oct. 26, House agreed to conference report. 
Oct. 27, Senate agreed to conference report.