Trauma Research and Access to Urgent Medical Attention Act of 2004 or TRAUMA Act of 2004 - Amends the Public Health Service Act, with respect to trauma care, to allow the Secretary of Health and Human Services to: (1) conduct and support research, training, evaluations, and demonstration projects; (2) foster the development of appropriate, modern systems of care through the sharing of information among agencies and individuals involved in the study and provision of trauma care; (3) provide State and local agencies technical assistance, including the development of a model plan for triage, transfer, and transportation policies and for the designation of trauma centers; and (4) sponsor workshops and conferences.
Allows the Director of the Centers for Disease Control and Prevention to: (1) establish and provide for the operation of information systems; and (2) collect, coordinate, and exchange information related to trauma system development or operation.
Requires the Secretary, acting through the Administrator of the Health Resources and Services Administration, to make matching grants to each State that submits an application and agrees to comply with specified requirements to improve access to and enhance the development of its trauma care systems. Allows additional grants to be made to States, political subdivisions, consortia of States or political subdivisions, and accredited schools of medicine for the same purposes.
Requires the Secretary, acting through the Director of the National Institutes of Health, to establish a comprehensive program of research on trauma, including the prevention, diagnosis, treatment, and rehabilitation of trauma-related injuries.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3999 Introduced in House (IH)]
108th CONGRESS
2d Session
H. R. 3999
To amend the Public Health Service Act with respect to trauma care, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 18, 2004
Mr. Greenwood (for himself, Mr. Green of Texas, Mr. Bilirakis, and Mr.
Brown of Ohio) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act with respect to 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 Research and Access to Urgent
Medical Attention Act of 2004'' or the ``TRAUMA Act of 2004''.
SEC. 2. AMENDMENT TO TITLE XII OF PUBLIC HEALTH SERVICE ACT.
Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.)
is amended--
(1) by striking part D; and
(2) by amending parts A, B, and C to read as follows:
``PART A--GENERAL AUTHORITY
``SEC. 1201. GENERAL AUTHORITY AND DUTIES OF THE SECRETARY.
``(a) In General.--The Secretary may, with respect to trauma care--
``(1) conduct and support research, training, evaluations,
and demonstration projects;
``(2) foster the development of appropriate, modern systems
of trauma 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, including the development of a model plan for the
designation of trauma centers and for triage, transfer, and
transportation policies; and
``(4) sponsor workshops and conferences.
``(b) Consultation.--In carrying out this section, the Secretary
shall consult with appropriate State and professional organizations.
``SEC. 1202. DATA COLLECTION.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, directly or through grants or contracts, may establish
and provide for the operation of information systems and provide for
the collection, coordination, and exchange of information related to
trauma system development or operation.
``(b) Consultation.--In carrying out this section, the Director of
the Centers for Disease Control and Prevention shall consult with the
Administrator of the Health Resources and Services Administration and
such other persons outside of the Centers as the Director deems
appropriate.
``SEC. 1203. GRANTS TO STATES TO IMPROVE TRAUMA CARE SYSTEMS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall make a
grant, in the amount referred to in section 1208(c), to each State that
submits an application and agrees to comply with the requirements of
this section, for the purpose of improving access to and enhancing the
development of trauma care systems.
``(b) Requirements.--The Secretary may make a grant to a State
under this section only if the State has developed a plan that--
``(1) specifies a public or private entity that will
designate trauma care regions and trauma centers in the State;
``(2) contains, for the designation of level I, level II,
and level III trauma centers, standards and requirements
developed by--
``(A) taking into account standards developed by
professional organizations and any guidelines or model
plans developed by the Secretary with the goal of
ensuring the greatest possible access to trauma care
and providing the highest quality of trauma care;
``(B) consulting with medical, surgical, and
nursing speciality groups, hospital associations,
emergency medical services State and local directors,
concerned advocates, and other interested parties; and
``(C) conducting public hearings on the proposed
standards after providing adequate notice to the public
concerning such hearings;
``(3) contains standards and requirements for the
implementation of regional trauma care systems, including
standards and guidelines (consistent with the provisions 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;
``(4) contains standards and requirements 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;
``(5) utilizes a program with procedures for the evaluation
of designated trauma centers (including trauma centers
described in paragraph (4)) and trauma care systems;
``(6) provides for the establishment and collection of data
from each designated trauma center in the State of a central
data reporting and analysis system (to be transmitted to the
Secretary in accordance with section 1202)--
``(A) to identify the number of severely injured
trauma patients and the number of deaths from trauma
within 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;
``(D) to monitor trauma patient care (including
prehospital care) in each designated trauma center
within regional trauma care systems in the State
(including relevant 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 and the outcomes of such patients;
``(7) provides for the use of procedures by paramedics and
emergency medical technicians to assess the severity of the
injuries incurred by trauma patients;
``(8) provides for appropriate transportation and transfer
policies 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 individuals 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 determined to be appropriate;
``(9) conducts public education activities concerning
injury prevention and obtaining access to trauma care;
``(10) 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; and
``(11) coordinates planning for trauma systems with State
disaster emergency planning and bioterrorism hospital
preparedness planning.
``(c) Trauma Plan.--
``(1) In general.--For each fiscal year, the Secretary may
not make payments to a State under this section unless, subject
to paragraph (2), the State submits to the Secretary the trauma
care component of the State plan for the provision of emergency
medical services, including any changes to the trauma care
component and any plans to address deficiencies in the trauma
care component.
``(2) Interim plan or description of efforts.--For each
fiscal year, if a State has not completed the trauma care
component of the State plan described in paragraph (1), the
State may provide, in lieu of such completed component, an
interim component or a description of efforts made toward the
completion of the component.
``(3) Information received by state reporting and analysis
system.--The Secretary may not make payments to a State under
this section unless the State agrees that the State will, not
less than once each year, provide to the Secretary the
information received by the State pursuant to subsection
(b)(6).
``(4) Availability of emergency medical services in rural
areas.--The Secretary may not make payments to a State under
this section unless--
``(A) the State identifies any rural area in the
State for which--
``(i) there is no system of access to
emergency medical services through the
telephone number 911;
``(ii) there is no basic life-support
system; or
``(iii) there is no advanced life-support
system; and
``(B) the State submits to the Secretary a list of
rural areas identified pursuant to subparagraph (A) or,
if there are no such areas, a statement that there are
no such areas.
``(d) Requirement of Matching Funds.--
``(1) Non-federal contributions.--
``(A) In general.--The Secretary may not make a
grant to a State under this section unless the State
agrees, with respect to the costs of carrying out the
grant, to make available non-Federal contributions (in
cash or in kind under paragraph (2)(A)) toward such
costs in an amount equal to--
``(i) for the first and second fiscal year
of payments under this section to the State
after the date of the enactment of the Trauma
Research and Access to Urgent Medical Attention
Act of 2004, not less than $1 for each $1 of
Federal funds provided in such payments for
such fiscal year; and
``(ii) for any subsequent fiscal year of
such payments to the State, not less than $2
for each $1 of Federal funds provided in such
payments for such fiscal year.
``(2) Determination of amount of non-federal
contribution.--With respect to compliance with paragraph (1)--
``(A) a State may make the non-Federal
contributions in cash or in kind, fairly evaluated,
including plant, equipment, or staff services; and
``(B) 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.
``(e) Restrictions.--
``(1) In general.--The Secretary may not make payments to a
State under this section unless the State agrees that the
payments will not be expended--
``(A) to make cash payments to intended recipients
of services provided pursuant to this section;
``(B) to purchase or improve real property (other
than minor remodeling of existing improvements to real
property); or
``(C) to satisfy any requirement for the
expenditure of non-Federal funds as a condition for the
receipt of Federal funds.
``(2) Waiver.--The Secretary may waive a restriction under
paragraph (1) only if the Secretary determines that the
activities outlined by the State plan submitted under
subsection (c)(1) by the State involved cannot otherwise be
carried out.
``(f) Application.--To seek a grant under this section, a State
shall submit to the Secretary an application in such form, in such
manner, and containing such information and assurances as the Secretary
may require.
``(g) Reports by States.--A grant may be made to a State under this
section only if the State agrees that, promptly after the end of the
fiscal year for which the grant is made, the State will submit to the
Secretary a report that describes the activities of the State under the
grant.
``SEC. 1204. GRANTS FOR THE IMPROVEMENT OF TRAUMA CARE.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, may make grants to
States, political subdivisions, consortia of States or political
subdivisions, and accredited schools of medicine for the purpose of
improving access to and enhancing the development of trauma care
systems.
``(b) Use of Funds.--The Secretary may make a grant under this
section only if--
``(1) in the case of an application by a State, political
subdivision, or consortium, the applicant agrees to use the
grant--
``(A) to integrate and broaden the reach of a
trauma care system, such as by developing innovative
protocols to increase access to prehospital care and
equipment necessary for the transportation of seriously
injured patients to the appropriate facilities;
``(B) to strengthen, develop, and improve an
existing trauma care system;
``(C) to expand and improve emergency medical
services for children who need treatment for trauma or
critical care;
``(D) to expand communications between the trauma
care system and emergency medical services through
improved equipment or a telemedicine system;
``(E) to improve data collection and retention; or
``(F) to increase education, training, and
technical assistance opportunities, such as training
and continuing education in the management of emergency
medical services accessible to emergency medical
personnel in rural areas through telehealth, home
studies, and other methods; or
``(2) in the case of an application by an accredited school
of medicine, the applicant agrees to use the grant to expand
and improve emergency medical services for children who need
treatment for trauma or critical care.
``(c) Preference.--In selecting among States, political
subdivisions, and consortia of States or political subdivisions (but
not accredited schools of medicine) for purposes of making grants under
this section, the Secretary shall give preference to applicants that--
``(A) have developed a process and adopted standards for
designating trauma centers;
``(B) recognize protocols for the delivery of seriously
injured patients to trauma centers;
``(C) implement a process for evaluating the performance of
the trauma system; and
``(D) agree to participate in information systems described
in section 1202 by collecting, providing, and sharing
information.
``(d) Priority.--In making grants under this section, the Secretary
shall give priority to applicants that will use the grants to focus on
improving access to trauma care systems.
``(e) Definitions.--For purposes of this section, the terms
`accredited' and `school of medicine' have the meanings given to those
terms in section 799B.
``SEC. 1205. REPORTS.
``(a) Report by Secretary.--Not later than the end of fiscal year
2006, the Secretary shall submit a report to the appropriate committees
of the Congress on the activities of the States carried out with
assistance under this part. Such report--
``(1) shall include an assessment of the extent to which
Federal and State efforts to develop systems of trauma care and
to designate trauma centers have reduced the incidence of
mortality, and the incidence of permanent disability, resulting
from trauma;
``(2) shall include an assessment of the grants awarded
under section 1204; and
``(3) may include any recommendations of the Secretary to
improve trauma care.
``(b) Evaluations by Comptroller General.--The Comptroller General
of the United States--
``(1) shall evaluate the expenditures by grantees of
payments under section 1203 and section 1204 to assure that
such expenditures are consistent with the provisions of such
sections; and
``(2) not later than December 1, 2006, shall submit to the
Committee on Energy and Commerce of the House of
Representatives and the Committee on Health, Education, Labor,
and Pensions of the Senate a report concerning such evaluation.
``SEC. 1206. RULE OF CONSTRUCTION.
``Nothing in this title authorizes the Secretary to establish
Federal standards for the treatment of patients or the licensure of
health care professionals.
``SEC. 1207. DEFINITIONS.
``For purposes of this part:
``(1) Designated trauma center.--The term `designated
trauma center' means a trauma center designated in accordance
with the provisions of the State plan described in section
1203(b).
``(2) State plan regarding emergency medical services.--The
term `State plan', with respect to the provision of emergency
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 emergency 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.
``(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
seriously injured patients.
``SEC. 1208. AUTHORIZATION OF APPROPRIATIONS.
``(a) Authorization of Appropriations.--For the purpose of carrying
out sections 1201, 1202, 1203, and 1204, there is authorized to be
appropriated $31,000,000 for each of fiscal years 2005 through 2009.
``(b) Allocation of Funds.--Of the amount appropriated for each of
fiscal years 2005 through 2009 under subsection (a)--
``(1) if such amount is $12,000,000 or less, the Secretary
shall make available 100 percent of such amount for the purpose
of carrying out sections 1201, 1202, and 1204; or
``(2) if such amount is greater than $12,000,000, the
Secretary shall make available 50 percent of such amount for
the purpose of carrying out sections 1201, 1202, and 1204 and
50 percent of such amount for the purpose of carrying out
section 1203.
``(c) Determination of Amount of Allotment.--
``(1) In general.--For purposes of section 1203(a), the
amount referred to in this subsection for a State for a fiscal
year is the sum of--
``(A) an amount determined under paragraph (2);
``(B) an amount determined under paragraph (3); and
``(C) any amount allotted to the State under
paragraph (4).
``(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 this section to carry out section
1203 for the fiscal year; 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 of--
``(A) an amount equal to 20 percent of the amounts
appropriated under this section to carry out section
1203 for the fiscal year; and
``(B) a percentage equal to the quotient of--
``(i) an amount equal to the lesser of
266,807 or the amount of the square mileage of
the State; divided by
``(ii) an amount equal to the sum of the
respective amounts determined for the States
under clause (i).
``(4) Disposition of certain funds appropriated for
allotments.--
``(A) In general.--Amounts described in
subparagraph (B) shall, in accordance with subparagraph
(C), be allotted by the Secretary to States receiving
payments under section 1203 for the fiscal year (other
than any State referred to in subparagraph (B)(iii)).
``(B) Type of amounts.--The amounts referred to in
subparagraph (A) are any amounts that are made
available pursuant to this section to carry out section
1203, but are not paid to a State as a result of--
``(i) the failure of the State to submit an
application under section 1203;
``(ii) 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
``(iii) the State informing the Secretary
that the State does not intend to expend the
full amount of the allotment made for the
State.
``(C) Amount.--The amount of an allotment under
subparagraph (A) for a State for a fiscal year shall be
an amount equal to the product of--
``(i) an amount equal to the amounts
described in subparagraph (B) for the fiscal
year involved; and
``(ii) the percentage equal to the quotient
of an amount equal to the population of the
State, divided by an amount equal to the
population of all States (other than any State
referred to in subparagraph (B)(iii)).
``(d) Failure to Comply with Agreements.--
``(1) Repayment of payments.--
``(A) Requirement.--The Secretary may, in
accordance with paragraph (2), require a State to repay
any payments received by the State under section 1203
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.
``(B) Offset of amounts.--If a State fails to make
a repayment required in subparagraph (A), the Secretary
may offset the amount of the repayment against any
amount due to be paid to the State under section 1203.
``(2) Opportunity for a hearing.--Before requiring
repayment of payments under paragraph (1)(A), the Secretary
shall provide to the State an opportunity for a hearing.''.
SEC. 3. INTERAGENCY PROGRAM FOR TRAUMA RESEARCH.
Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.)
is amended by inserting after section 494A the following:
``interagency program for trauma research
``Sec. 494B. (a) In General.--The Secretary, acting through the
Director of NIH, shall establish a comprehensive program of basic and
clinical research on trauma (in this section referred to as the
`Program'), including the prevention, diagnosis, treatment, and
rehabilitation of trauma-related injuries.
``(b) Plan for Program.--The Director of NIH shall establish and
implement a plan for carrying out the activities of the Program, taking
into consideration the recommendations contained in the report of the
NIH Trauma Research Taskforce. The plan shall be periodically reviewed,
and revised as appropriate.
``(c) Participating Agencies; Coordination and Collaboration.--The
Director of NIH--
``(1) shall provide for the conduct of activities under the
Program by the directors of the agencies of the National
Institutes of Health involved in research with respect to
trauma;
``(2) shall ensure that the activities of the Program are
coordinated among such agencies; and
``(3) shall, as appropriate, provide for collaboration
among such agencies in carrying out such activities.
``(d) Certain Activities of Program.--The Program shall include--
``(1) studies with respect to all phases of trauma care,
including prehospital, resuscitation, surgical intervention,
critical care, infection control, wound healing, nutritional
care and support, and medical rehabilitation care;
``(2) basic and clinical research regarding the response of
the body to trauma and the acute treatment and medical
rehabilitation of individuals who are the victims of trauma;
``(3) basic and clinical research regarding trauma care for
pediatric and geriatric patients; and
``(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 brain 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 traumatic brain 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;
``(D) the development of programs that increase the
participation of academic centers of excellence in
traumatic brain injury treatment and rehabilitation
research and training; and
``(E) carrying out subparagraphs (A) through (D)
with respect to cognitive disorders and neurobehavioral
consequences arising from traumatic brain injury,
including the development, modification, and evaluation
of therapies and programs of rehabilitation toward
reaching or restoring normal capabilities in areas such
as reading, comprehension, speech, reasoning, and
deduction.
``(e) Mechanisms of Support.--In carrying out the Program, the
Director of NIH, acting through the directors of the agencies referred
to in subsection (c)(1), may make grants to public and nonprofit
entities, including designated trauma centers.
``(f) Resources.--The Director of NIH shall assure the availability
of appropriate resources to carry out the Program, including the plan
established under subsection (b) and the activities described in
subsection (d).
``(g) Definitions.--For purposes of this section:
``(1) The term `designated trauma center' has the meaning
given such term in section 1207.
``(2) The term `trauma' means any serious injury that could
result in loss of life or in significant disability and that
would meet prehospital triage criteria for transport to a
designated trauma center.
``(3) The term `traumatic 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 trauma. The Secretary may revise the definition of such
term as the Secretary determines necessary, after consultation
with States and other appropriate public or nonprofit private
entities.
``(h) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2005 through 2009.''.
SEC. 4. CONFORMING AMENDMENTS.
(a) Title XII of Public Health Service Act.--Title XII of the
Public Health Service Act (42 U.S.C. 300d et seq.) is amended--
(1) in part E, by resdesignating sections 1251 through 1253
as sections 1221 through 1223, respectively;
(2) by redesignating part E as part B;
(3) by striking part F;
(4) in part G, by redesignating sections 1271 through 1274
as sections 1231 through 1234, respectively; and
(5) by redesignating part G as part C.
(b) Title XIX of Public Health Service Act.--Title XIX of the
Public Health Service Act (42 U.S.C. 300w et seq.) is amended--
(1) in subparagraph (C) of section 1904(a)(1), by striking
``section 1213(a)'' and inserting ``section 1203''; and
(2) by striking section 1910.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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