Stroke Treatment and Ongoing Prevention Act of 2005 - Amends the Public Health Service Act to direct the Secretary of Health and Human Services to: (1) establish a grant program to enable states to develop statewide stroke care systems; (2) foster the development of stroke care systems through information sharing among involved agencies and individuals; (3) develop a model curriculum for training emergency medical services personnel in the identification, assessment, stabilization, and prehospital treatment of stroke patients; (4) issue recommendations and guidelines on best practices for establishing and operating such systems; and (5) provide public information on recognition of stroke signs and symptoms and appropriate actions. Authorizes the Secretary to make grants or enter into cooperative agreements for such purposes.
Directs the Secretary to: (1) maintain the Paul Coverdell National Acute Stroke Registry; and (2) award grants to states to develop stroke care systems that provide high-quality prevention, diagnosis, treatment, and rehabilitation. Authorizes the Secretary to make related state planning grants.
Requires the Secretary to give special consideration in awarding grants to states in a geographic area with an elevated incidence of stroke or stoke-caused disabilities or demonstrating a significant need for assistance in establishing such a system.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1064 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 1064
To amend the Public Health Service Act to improve stroke prevention,
diagnosis, treatment, and rehabilitation.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 18, 2005
Mr. Cochran (for himself, Mr. Kennedy, Mr. Warner, Ms. Cantwell, Ms.
Collins, and Mr. Dayton) introduced the following bill; which was read
twice and referred to the Committee on Health, Education, Labor, and
Pensions
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to improve stroke prevention,
diagnosis, treatment, and rehabilitation.
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 ``Stroke Treatment and Ongoing
Prevention Act of 2005''.
SEC. 2. FINDINGS AND GOAL.
(a) Findings.--The Congress finds as follows:
(1) Stroke is the third leading cause of death in the
United States. Each year approximately 700,000 Americans suffer
a new or recurrent stroke and over 160,000 Americans die from
stroke.
(2) Stroke costs the United States $35,000,000,000 in
direct costs and $56,800,000,000 in indirect costs each year.
(3) Stroke is one of the leading causes of adult disability
in the United States. Between 15 percent and 30 percent of
stroke survivors are permanently disabled. Presently, there are
4,700,000 stroke survivors living in the United States.
(4) Members of the general public have difficulty
recognizing the symptoms of stroke and are unaware that stroke
is a medical emergency. Frequently, stroke patients wait as
many as 22 hours or more before presenting at the emergency
room. Forty-two percent of individuals over the age of 50 do
not recognize numbness or paralysis in the face, arm, or leg as
a sign of stroke and 17 percent of them cannot name a single
stroke symptom.
(5) Recent advances in stroke treatment can significantly
improve the outcome for stroke patients, but these therapies
must be administered properly and promptly. Only 3 percent of
stroke patients who are candidates for acute stroke intravenous
thrombolytic drug therapy receive the appropriate medication.
(6) New technologies, therapies, and diagnostic approaches
are currently being developed that will extend the therapeutic
timeframe and result in greater treatment efficacy for stroke
patients.
(7) Few States and communities have developed and
implemented stroke awareness programs, prevention programs, or
comprehensive stroke care systems.
(8) The degree of disability resulting from stroke can be
reduced substantially by educating the general public about
stroke and by improving the systems for the provision of stroke
care in the United States.
(b) Goal.--It is the goal of this Act to improve the provision of
stroke care in every State and territory and in the District of
Columbia, and to increase public awareness about the prevention,
detection, and treatment of stroke.
SEC. 3. AMENDMENT REGARDING STROKE PREVENTION, TREATMENT, AND
REHABILITATION.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.)
is amended by adding at the end the following:
``PART R--STROKE PREVENTION, TREATMENT, AND REHABILITATION PROGRAMS
``Subpart I--Authorities and Duties of the Secretary
``SEC. 399AA. RESPONSIBILITIES OF THE SECRETARY.
``(a) In General.--The Secretary shall, with respect to stroke
care--
``(1) establish and evaluate a grant program under section
399DD to enable States to develop statewide stroke care
systems;
``(2) foster the development of appropriate, modern systems
of stroke 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;
``(4) develop a model curriculum for training emergency
medical services personnel, including dispatchers, first
responders, emergency medical technicians, and paramedics, in
the identification, assessment, stabilization, and prehospital
treatment of stroke patients;
``(5) issue recommendations or guidelines on best practices
for the establishment and operation of statewide stroke
systems, including recommendations or guidelines on best
practices for the establishment and operation of stroke care
centers; and
``(6) provide, to the extent practicable, information to
the public on the recognition of the signs and symptoms of
stroke and the appropriate actions to take to assist an
individual in obtaining appropriate and timely care following a
stroke.
``(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).
``(c) Rules of Construction.--
``(1) Existing guidelines.--Nothing in subsection (a)(5)
shall be construed to require the Secretary to issue new
recommendations or guidelines where existing recommendations or
guidelines issued or adopted by the Secretary are applicable to
the establishment of statewide stroke systems. Where an
existing recommendation or guideline is applicable to the
establishment of statewide stroke systems, the Secretary may
deem such recommendation or guideline to have been issued under
subsection (a)(5).
``(2) Advisory nature of guidelines.--Recommendations or
guidelines issued under subsection (a)(5) shall be considered
advisory in nature and shall not be construed to constitute a
standard of care for the treatment of stroke.
``SEC. 399BB. PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY.
``The Secretary shall maintain the Paul Coverdell National Acute
Stroke Registry by--
``(1) continuing to develop and collect specific data
points as well as appropriate benchmarks for analyzing care of
acute stroke patients;
``(2) continuing to develop a national registry model that
measures the delivery of care to patients with acute stroke in
order to provide real-time data and analysis to reduce death
and disability from stroke and improve the quality of life for
acute stroke survivors;
``(3) fostering the development of effective, modern stroke
care systems (including the development of policies related to
emergency services systems) through the sharing of information
among agencies and individuals involved in planning,
furnishing, and studying such systems;
``(4) collecting, compiling, and disseminating information
on the achievements of, and problems experienced by, State and
local agencies and private entities in developing and
implementing stroke care systems and, in carrying out this
paragraph, giving special consideration to the unique needs of
rural facilities and those facilities with inadequate resources
for providing high-quality prevention, acute treatment, post-
acute treatment, and rehabilitation services for stroke
patients; and
``(5) carrying out any other activities the Secretary
determines to be useful to fulfill the purposes of the Paul
Coverdell National Acute Stroke Registry.
``Subpart II--State Stroke Care Systems
``SEC. 399DD. GRANTS TO STATES FOR STROKE CARE SYSTEMS.
``(a) Grants.--The Secretary shall award grants to States for the
development and implementation of stroke care systems that provide
high-quality prevention, diagnosis, treatment, and rehabilitation.
``(b) Required Uses.--
``(1) In general.--In carrying out activities described in
subsection (a), each State that is awarded a grant under this
section shall--
``(A) establish, enhance, or expand a statewide
stroke care system for the purpose of ensuring access
to high-quality stroke prevention, diagnosis,
treatment, and rehabilitation, except that activities
conducted under this subparagraph shall be consistent
with guidelines or recommendations issued by the
Secretary under section 399AA(a)(5) to the extent that
such guidelines or recommendations have been issued;
``(B) establish, enhance, or expand, as
appropriate, stroke care centers, except that
activities conducted under this subparagraph shall be
consistent with guidelines or recommendations issued by
the Secretary under section 399AA(a)(5), to the extent
that such guidelines or recommendations have been
issued;
``(C) conduct evaluation activities to monitor
clinical outcomes and procedures and to verify
resources, infrastructure, and operations devoted to
stroke care;
``(D) enhance, develop, and implement model
curricula for training emergency medical services
personnel in the identification, assessment,
stabilization, and prehospital treatment of stroke
patients which may, at the discretion of the State,
consist of or be based on the model curriculum
developed by the Secretary under section 399AA(a)(4);
``(E) enhance coordination of emergency medical
services with respect to stroke care;
``(F) establish, enhance, or improve a central data
reporting and analysis system described in subsection
(c);
``(G) establish, enhance, or improve a support
network described in subsection (d) to provide
assistance to facilities with smaller populations of
stroke patients or less advanced on-site stroke
treatment resources;
``(H) consult with organizations and individuals
with expertise in stroke prevention, diagnosis,
treatment, and rehabilitation; and
``(I) with respect to carrying out subparagraph (C)
through (H), use the best available evidence and
consensus recommendations of professional associations.
``(2) Permissible uses.--In developing and implementing a
stroke care system described in paragraph (1), each State that
is awarded a grant under this section may--
``(A) improve existing State stroke prevention
programs;
``(B) conduct a stroke education and information
campaign, including by--
``(i) making public service announcements
about the warning signs of stroke and the
importance of treating stroke as a medical
emergency; and
``(ii) providing education regarding ways
to prevent stroke and the effectiveness of
stroke treatment; and
``(C) make grants to public and non-profit private
entities for medical professional development in
accordance with subsection (e).
``(c) Central Data Reporting and Analysis System.--A central data
reporting and analysis system described in this subsection is a system
that collects data from facilities that provide direct care to stroke
patients and uses the data--
``(1) to identify the number of stroke patients treated in
the State;
``(2) to monitor patient care in the State for stroke
patients at all phases of stroke for the purpose of evaluating
the diagnosis, treatment, and treatment outcome of such stroke
patients;
``(3) to identify the total amount of uncompensated and
under-compensated stroke care expenditures for each fiscal year
by each stroke care facility in the State;
``(4) to identify the number of acute stroke patients who
receive advanced drug therapy;
``(5) to identify patients transferred within the statewide
stroke care system, including reasons for such transfer; and
``(6) to communicate to the greatest extent practicable
with the Paul Coverdell National Acute Stroke Registry.
``(d) Support Network.--A support network described in this
subsection may include the following:
``(1) The use of telehealth technology to connect
facilities described in subsection (b)(1)(G) to more advanced
stroke care facilities.
``(2) The provision of neuroimaging, laboratory, and any
other equipment necessary to facilitate the establishment of a
telehealth network.
``(3) The use of phone consultation, where useful.
``(4) The use of referral links when a patient needs more
advanced care than is available at the facility providing
initial care.
``(5) Any other assistance determined appropriate by the
State.
``(e) Medical Professional Development in Advanced Stroke Treatment
and Prevention.--
``(1) In general.--A State may use funds received under a
grant under this section to make subgrants to public and non-
profit private entities for the development and implementation
of education programs for appropriate medical personnel and
health professionals in the use of newly developed diagnostic
approaches, technologies, and therapies for the prevention and
treatment of stroke.
``(2) Use of funds.--A public or non-profit private entity
shall use amounts received under a subgrant under this
subsection for the continuing education of appropriate medical
personnel in the use of newly developed diagnostic approaches,
technologies, and therapies for the prevention and treatment of
stroke.
``(3) Distribution of subgrants.--In awarding subgrants
under this subsection, the Secretary shall ensure that such
subgrants are equitably distributed among the geographical
regions of the State and between urban and rural populations.
``(4) Application.--A public or non-profit private entity
desiring a subgrant under this subsection shall prepare and
submit to the State involved an application at such time, in
such manner, and containing such information as the State may
require, including a plan for the rigorous evaluation of
activities carried out with amounts received under such a
subgrant.
``(f) Restrictions on Use of Payments.--The Secretary may not,
except as provided in paragraph (2), make payments to a State under
this section for a fiscal year unless the State agrees that the
payments will not be expended--
``(1) to make cash payments to intended recipients of
services provided pursuant to this section;
``(2) to satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of Federal
funds;
``(3) to provide financial assistance to any entity other
than a public or nonprofit private entity; or
``(4) for construction, alteration, or improvement of any
building or facility.
``(g) 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 this section
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.
``(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 this section.
``(2) Opportunity for a hearing.--Before requiring
repayment of payments under paragraph (1), the Secretary shall
provide to the State an opportunity for a hearing.
``(h) Application Requirements.--The Secretary may not award a
grant to a State under this section unless--
``(1) the State submits an application containing
agreements in accordance with this section;
``(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; 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 section.
``(i) Technical Assistance.--The Secretary shall, without charge to
a State receiving payments under this section, provide to the State (or
to any public or nonprofit entity designated by the State) technical
assistance with respect to the planning, development, and operation of
any program carried out pursuant to this section. The Secretary may
provide such technical assistance directly, through contract, or
through grants.
``(j) Supplies and Services in Lieu of Grant Funds.--
``(1) In general.--Upon the request of a State receiving
payments under this section, the Secretary may, subject to
paragraph (2), provide supplies, equipment, and services to the
State and may detail to the State any officer or employee of
the Department of Health and Human Services, for the purpose of
assisting the State to achieve the purpose of the payments.
``(2) Reduction in payments.--With respect to a request
described in paragraph (1), the Secretary shall reduce the
amount of payments to the State under this section 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.
``(k) Report.--Not later than 3 years after the date of the
enactment of the Stroke Treatment and Ongoing Prevention Act of 2005,
the Secretary shall report to the appropriate committees of the
Congress on the activities of the States carried out pursuant to this
section and section 399EE. Such report shall include an assessment of
the extent to which Federal and State efforts to identify stroke
centers, develop support networks, and enhance emergency medical
services coordination and the training of emergency medical personnel,
have increased the number of stroke patients who have received acute
stroke consultation or therapy within the appropriate timeframe and
reduced the level of disability due to stroke.
``(l) Limitation on Administrative Expenses.--The Secretary may not
award a grant to a State under this section unless the State agrees to
use not more than 10 percent of amounts received under the grant for
administrative expenses.
``SEC. 399EE. PLANNING GRANTS.
``(a) Grants.--The Secretary may award a grant to a State to assist
such State in formulating a plan to develop a stroke care system in
accordance with section 399DD or in otherwise meeting the requirements
of such section.
``(b) Submission to Secretary.--The chief executive officer of a
State that receives a grant under this section shall submit to the
Secretary a copy of the plan developed using the amounts provided under
such grant. Such plan shall be submitted to the Secretary as soon as
practicable after the plan has been developed.
``(c) Single Grant Limitation.--A State is not eligible to receive
a grant under this section if the State previously received a grant
under this section.
``SEC. 399FF. SPECIAL CONSIDERATION.
``In awarding grants under this subpart, the Secretary shall give
special consideration to any State that has submitted an application
for carrying out programs under such a grant--
``(1) in geographic areas in which there is--
``(A) an elevated incidence or prevalence of
disability resulting from stroke; or
``(B) an elevated incidence or prevalence of
stroke; or
``(2) that demonstrates a significant need for assistance
in establishing a comprehensive stroke care system.
``Subpart III--General Provisions
``SEC. 399GG. GENERAL PROVISIONS.
``(a) Consultations.--In carrying out this part, the Secretary
shall consult with organizations and individuals with expertise in
stroke prevention, diagnosis, treatment, and rehabilitation.
``(b) Definitions.--In this part:
``(1) State.--The term `State' means each of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Indian tribes, the Virgin Islands, Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands.
``(2) Stroke care system.--The term `stroke care system'
means a statewide system to provide for the diagnosis,
prehospital care, hospital definitive care, and rehabilitation
of stroke patients.
``(3) Stroke.--The term `stroke' means a `brain attack' in
which blood flow to the brain is interrupted or in which a
blood vessel or aneurysm in the brain breaks or ruptures.
``(c) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this part such sums as may be necessary for
fiscal years 2006 through 2010.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
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