H.R.2990 - Traumatic Brain Injury Act of 1993103rd Congress (1993-1994)
|Sponsor:||Rep. Pallone, Frank, Jr. [D-NJ-6] (Introduced 08/06/1993)|
|Committees:||House - Energy and Commerce|
|Latest Action:||House - 09/03/1993 Referred to the Subcommittee on Health and the Environment. (All Actions)|
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Text: H.R.2990 — 103rd Congress (1993-1994)All Information (Except Text)
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Introduced in House (08/06/1993)
[Congressional Bills 103th Congress] [From the U.S. Government Printing Office] [H.R. 2990 Introduced in House (IH)] 103d CONGRESS 1st Session H. R. 2990 To amend the Public Health Service Act to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury, and for other purposes. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES August 6, 1993 Mr. Pallone (for himself, Mr. Quillen, and Mr. Greenwood) introduced the following bill; which was referred to the Committee on Energy and Commerce _______________________________________________________________________ A BILL To amend the Public Health Service Act to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury, and for other purposes. 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 ``Traumatic Brain Injury Act of 1993''. SEC. 2. FINDINGS AND PURPOSE. (a) Findings.--Congress finds that-- (1) the incidence of head injury in the United States is increasing, with over 2,000,000 head injuries per year resulting from automobile crashes, sports, recreational activities, assaults, violence and other falls and incidents; (2) a majority of all head injuries are caused by motor vehicle accidents; (3) individuals between the ages of 15 and 24 are at greatest risk for sustaining head injuries; (4) of the individuals who sustain head injuries each year, approximately 500,000 require hospitalization, and 75,000 to 100,000 of such individuals die within hours of the injury; (5) of the individuals who survive head injuries each year, approximately 70,000 to 90,000 will suffer irreversible debilitating loss of function, 5,000 will develop epilepsy as a result of the injury, and 2,000 will exist in a coma; (6) a significant number of individuals with traumatic brain injury are not easily restored to society and require years of rehabilitation, medical follow-up and integrated community services, which are costly and frequently not readily available; (7) individuals sustaining traumatic brain injury require coordinated and specialized services, including post-injury supervised programs facilitating reentry into the community; (8) many health and social service agencies, both public and private, overlook, exclude or inadequately serve individuals surviving traumatic brain injury; (9) society bears an economic cost of approximately $25,000,000,000 per year for the direct and indirect costs of traumatic brain injury, which include medical treatment, rehabilitative and support services and lost income; (10) a program to develop national standards for helmets used by bicyclists and others is needed; and (11) a national plan to provide services for individuals surviving traumatic brain injuries and their families is needed. (b) Purpose.--It is the purpose of this Act to-- (1) facilitate the conduct of research and the collection and compiling of accurate statistical data on traumatic brain injury; (2) raise public awareness concerning the risks and consequences of such injuries and the distinct needs of individuals (and their families) following survival from traumatic brain injury; (3) to provide the public with all necessary and relevant information about the prevention of traumatic brain injury, in order for individuals to make informed and educated safety decisions; (4) promote the creation of innovative programs and policies to prevent traumatic brain injury and to rehabilitate those individuals who have survived such injuries; (5) designate a Federal agency to oversee and promote projects relating to the prevention of, and rehabilitation from, traumatic brain injury; (6) create State advisory boards to coordinate citizen participation in community programs dealing with traumatic brain injury; (7) create a registry to advance epidemiologic research on such trauma; (8) establish standards for the marketing of brain injury services; (9) require the Secretary to publish various reports concerning the activities of the Department of Health and Human Services in this area, including an annual review of relevant activities; and (10) provide for the initiation of a program to establish national standards for helmets used by bicyclists and others. SEC. 3. AMENDMENT TO PUBLIC HEALTH SERVICE ACT. Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.) is amended-- (1) by redesignating parts C through F as parts D through G, respectively; and (2) by inserting after part B the following new part: ``Part C--Traumatic Brain Injury ``SEC. 1225. DEFINITIONS. ``As used in this part: ``(1) Administrator.--The term `Administrator' means the Administrator of the Agency for Health Care Policy and Research. ``(2) Director.--The term `Director' means the Director of the Centers for Disease Control and Prevention. ``(3) Traumatic brain injury.--The term `traumatic brain injury' means an acquired injury to the brain caused by an external physical force. Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor does such term include birth trauma. Such term is synonymous with the term `head injury'. ``SEC. 1225A. AGENCY FOR HEALTH CARE POLICY AND RESEARCH STUDY OF EFFECTIVENESS OF TRAUMATIC BRAIN INJURY INTERVENTIONS. ``(a) In General.--The Secretary, acting through the Administrator, shall conduct a study concerning traumatic brain injury. ``(b) Major Findings.--The study conducted under subsection (a) shall seek to-- ``(1) identify common therapeutic interventions which are used for the rehabilitation of individuals with traumatic brain injuries, and shall include an analysis of-- ``(A) the effectiveness of each such intervention in improving the functioning of individuals with brain injuries; and ``(B) the comparative effectiveness of interventions employed in the course of rehabilitation of individuals with brain injuries to achieve the same or similar clinical outcome; and ``(2) develop practice guidelines for the rehabilitation of traumatic brain injury. ``(c) Reporting Requirements.--Not later than 4 years after the date of enactment of this part, the Secretary shall prepare and submit to the appropriate committees of Congress, a report containing the results of the studies conducted under this section. ``(d) Authorization of Appropriation.--There are authorized to be appropriated to carry out this section, $2,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 through 1996. ``SEC. 1225B. CENTERS FOR DISEASE CONTROL AND PREVENTION STUDY OF TRAUMATIC BRAIN INJURY OCCURRENCE. ``(a) In General.--The Secretary, acting through the Director, and in cooperation with other Public Health Service agencies as may be necessary, shall conduct studies concerning traumatic brain injury, and shall establish a reporting system under subsection (b). ``(b) Reporting System.--To assist in data and information gathering, the Director shall establish a uniform reporting system under which hospitals, State and local health-related agencies will report to the Director on matters including-- ``(1) the occurrence of traumatic brain injuries; and ``(2) the health insurance status of individuals with traumatic brain injury. The reporting system should be established to permit the Director to make an accurate assessment of resource needs and long term outcomes. ``(c) Survey and Cooperative Agreements.-- ``(1) Survey.--The Director shall determine which Federal, State, local or other entities collect data on traumatic brain injury and the means by which such entities collect such data. ``(2) Cooperative agreements.--The Director may enter into cooperative agreements with other agencies, and provide assistance to other entities with responsibility for data collection, to establish traumatic brain injury as a specific reportable condition in existing and future reporting systems. Any data systems established in conjunction with such agencies should be compatible with other such data systems. ``(d) Major Findings of Studies.--The studies conducted under subsection (a) shall seek to-- ``(1) determine the major causes of traumatic brain injury; ``(2) determine the preventive efforts that are being used by States and non-profit agencies to reduce the occurrence of such injuries; ``(3) determine the number of individuals surviving traumatic brain injuries, and the cost of treatment and other related costs; ``(4) develop a uniform reporting system to facilitate the reporting to the Centers for Disease Control and Prevention concerning the occurrence of traumatic brain injury; ``(5) identify States and localities that have approved mandated helmet use laws for bicyclist; ``(6) identify States and localities that have implemented unique approaches to encouraging bicycle helmet use; ``(7) determine the health insurance status of individuals with traumatic brain injury; and ``(8) initiate a program of prevention research to develop effective prevention of traumatic brain injury. ``(e) Reporting Requirements.--Not later than 4 years after the date of enactment of this part, the Secretary shall prepare and submit to the appropriate committees of Congress, a report containing the results of the studies conducted under this section. ``(f) Biennial Report.--The Secretary shall biennially prepare a report containing recommendations for the prevention of traumatic brain injuries. The report shall also identify States that have mandated helmet laws for bicyclists, as well as States that have unique bicycle helmet-use promotion programs in place. Such reports shall be disseminated to State health officers. ``(g) Authorization of Appropriation.--There are authorized to be appropriated to carry out this section, $2,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 through 1996. ``SEC. 1225C. SPECIAL PREVENTION PROJECTS. ``(a) In General.--The Secretary shall cooperate with, and may provide assistance to, public and private nonprofit entities to reduce the incidence of traumatic brain injury through the establishment and effectuation of prevention projects. In carrying out this section, the Secretary may award grants to State and local entities, and to public or non-profit private entities, to support-- ``(1) special prevention and public awareness initiative projects; ``(2) model traumatic brain injury prevention, research and support programs; ``(3) projects that study the service needs of individuals with traumatic brain injury; and ``(4) projects involving grants for services coordination. ``(b) Requirements.--To be eligible to receive assistance under subsection (a), an entity shall-- ``(1) prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require; and ``(2) provide assurances to the Secretary that any preventive measures implemented under a prevention project funded under this section may include-- ``(A) behavioral and environmental techniques, as well as educational and responsible-use programs; ``(B) the use of innovative and proven model prevention approaches; ``(C) the promotion of activities that will minimize brain injury risk in athletes (such as the use of head protection gear); and ``(D) the improvement of community-level access to data-base systems to assist in designing, developing, and implementing traumatic brain injury prevention programs. ``(c) Restriction on Use of Funds.--A grant under subsection (a) may not be expended to engage in advocacy regarding Federal, State, or local laws. ``(d) Rule of Construction.--The Secretary may not require that, as a condition of the receipt of a grant under subsection (a), a State have in effect a law regarding the use of helmets while operating motorcycles. ``(e) Authorization of Appropriations.--There are authorized to be appropriated to carry out this section, $4,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 and 1996. ``SEC. 1225D. BASIC AND APPLIED RESEARCH. ``(a) In General.--The Secretary, acting through the Director of the National Institutes of Health, may provide assistance to public and private nonprofit entities to support the conduct of basic and applied research concerning traumatic brain injury, especially with respect to the biomechanics of brain injury, the molecular and cellular characteristics of primary and secondary injury to the brain and the development of improved experimental brain injury models. ``(b) Specific Research.--Research to be conducted with assistance provided under subsection (a) shall be determined by the Secretary, prior to the provision of such assistance, to contribute to the strategies that will limit primary and secondary mechanical, biochemical and metabolic insults to the brain and minimize the extent, severity and progression of resulting dysfunctions. In implementing this section the Secretary shall emphasize-- ``(1) the development of new methods and modalities for the more effective diagnosis, measurement of degree of injury, post-injury monitoring and prognostic assessment of head injury for acute, subacute and later phases of care; ``(2) the development, modification and evaluation of therapies that retard, prevent or reverse brain damage after acute head injury, that arrest further deterioration following injury and that provide the restitution of function for individuals with long-term injuries; ``(3) the integration of basic research into clinical care settings; ``(4) the development of 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; ``(5) the development of programs that increase the participation of academic centers of excellence in head injury treatment and rehabilitation research and training; and ``(6) the conduct of national consensus conferences on managing head injury and related rehabilitation concerns, the findings of which shall be published. ``(c) Authorization of Appropriations.--There are authorized to be appropriated to carry out this section, $5,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 and 1996. ``SEC. 1225E. STATEWIDE PROGRAM FOR TRAUMATIC BRAIN INJURY. ``(a) Grants.--The Secretary shall award grants to States for the establishment of programs related to traumatic brain injury. Such programs shall include State advisory boards, patient advocacy and service coordination systems, and State registries concerning individuals affected by traumatic brain injuries. Services may also be provided under this section, within the limits of service availability, to individuals whose deficits are not due to traumatic brain injury. To be eligible for such services, such individuals should be comparable to traumatic brain injury patients in regard to the range of services needed, the severity and duration of deficits, and the etiology of their deficits being due to a nonprogressive and nonrecurring disorder. ``(b) General Eligibility Requirements.--To be eligible to receive a grant under subsection (a), a State shall-- ``(1) prepare and submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require; ``(2) provide assurances that it will prepare and submit to the Secretary reports describing the activities undertaken under the State system established under the grant; and ``(3) provide for the establishment of a Statewide program that includes a State registry for traumatic brain injury information, a program of patient advocacy and service coordination, and a State advisory board with respect to activities under this section. ``(c) Specific Program Requirements.-- ``(1) State registry.--To be eligible to receive a grant under subsection (a), a State shall-- ``(A)(i) establish and maintain, through the utilization of procedures to ensure privacy and maintain the confidentiality of information, which are acceptable to the Secretary, a central registry of persons who sustain traumatic brain injury in order to-- ``(I) collect information to facilitate the development of injury prevention, treatment, and rehabilitation programs; and ``(II) report data to the Director on an annual basis for State reporting requirements; and ``(ii) a violation of such privacy and confidentiality procedures or the unauthorized use of such information may result in a loss of support under this section; and ``(B) provide summary registry data or data that is not personally identifiable to public and private entities to conduct studies using data collected by the traumatic brain injury registry established under subparagraph (A), for which the coordinator may charge a fee for all expenses associated with the provision of data or data analysis. ``(2) Advocacy and service coordination.--To be eligible to receive a grant under subsection (a), a State shall-- ``(A) designate a State coordinator for traumatic brain injuries who-- ``(i) shall establish policies and standards for coordinating services within the State for individuals with traumatic brain injury; ``(ii) may contract with qualified agencies or employ staff to provide services under this section on a statewide basis to eligible individuals; ``(iii) shall be responsible for a program of activities related to preventing and reducing the rate of traumatic brain injuries in the State; and ``(iv) shall, after consultation with the State advisory board established under paragraph (3), establish standards regarding the marketing of services (by hospitals and other providers) to traumatic brain injury patients or family members, disseminate the standards to case management programs, and furnish information on such standards to individuals who sustain traumatic brain injuries (and the family members of such individuals) at the earliest appropriate opportunity after the individual has sustained the injury (such standards to include (at a minimum) a rule prohibiting payments under a case management program under this section for referring patients); ``(B) provide assurances that a protection and advocacy system established under this section will-- ``(i) provide legal, administrative and other appropriate remedies or approaches to ensure the protection of, and advocacy for, the rights of individuals with traumatic brain injury within the State who are or may be eligible for treatment, services, or rehabilitation; ``(ii) provide information and referral to programs and services addressing the needs of individuals with traumatic brain injuries; and ``(iii) provide for the investigation of incidents of abuse and neglect of individuals with traumatic brain injuries when incidents are reported for the provision of excessive or unnecessary services or other complaints relating to the care of such individuals, and payment for the referral of patients; ``(C) ensure the provision to persons with traumatic brain injury of information regarding appropriate public or private agencies that provide rehabilitative services so that injured persons or individuals responsible for such persons may obtain needed service to alleviate injuries and avoid secondary problems; and ``(D) for purposes of identifying the services required to prevent the institutionalization or to minimize the need for residential rehabilitation in the case of traumatic brain injuries, establish a services coordination program that shall-- ``(i) provide for the initial assessment of the individual's need for traumatic brain injury services; ``(ii) provide for the reassessment of each patient at regular intervals to determine the extent of each patient's progress, to ascertain whether a patient is being kept too long in a given setting or provided services inappropriately, or to determine whether the patient would be better served by other services or in another setting; ``(iii) prepare a treatment plan for each individual requiring services coordination, within an appropriate period after the individual sustains the injury, based on a consultation with the individual (other than an individual who is comatose in which case consultation shall be with a person with legal responsibility over such individual) and any person named by the individual (preparation of the plan may be delayed based on a certification, including a brief explanation of the reason for the delay, by a physician attesting that such a delay is in the individual's best interests with a copy of the treatment plan and any modifications to the plan being presented to the individual or the individual's legal representative); ``(iv) ensure that each individual's treatment plan is regularly updated (based on consultation with the individual and the person responsible for the injured individual) with data and information about treatments and services provided, as well as specific measures of the individual's current performance or activity relative to goals previously established; ``(v) assist the individual in obtaining services necessary to allow the individual to remain in the community; ``(vi) coordinate home care services with other services; ``(vii) ensure appropriate, accessible, and cost-effective services; ``(viii) assist the individual with problems related to the provision of home care services; ``(ix) ensure the quality of home care services; ``(x) assess the individual's need for and level of home care services at appropriate intervals during the course of the individual's treatment under the program; and ``(xi) explore efforts to include services coordination provisions under the State's medicaid program under section 1931 of the Social Security Act. ``(3) State advisory board.-- ``(A) In general.--To be eligible to receive a grant under subsection (a), a State shall establish an advisory board within the appropriate health department of the State or within another department as designated by the chief executive officer of the State. ``(B) Functions.--An advisory board established under subparagraph (A) shall be cognizant of findings and concerns of Federal, State and local agencies, citizens groups, and private industry (such as insurance, health care, automobile, and other industry entities). Such advisory boards shall encourage citizen participation through the establishment of public hearings and other types of community outreach programs. ``(C) Composition.--An advisory board established under subparagraph (A) shall be composed of-- ``(i) representatives of-- ``(I) the corresponding State agencies involved; ``(II) public and nonprofit private health related organizations; ``(III) other disability advisory or planning groups within the State; ``(IV) members of an organization or foundation representing traumatic brain injury survivors in that State; and ``(V) injury control programs at the State or local level if such programs exist; and ``(ii) a substantial number of individuals who are survivors of traumatic brain injury, or the family members of such individuals; and ``(d) Report.--Not later than 2 years after the date of enactment of this part, the Secretary shall prepare and submit to the appropriate committees of Congress a report concerning the findings and results of the programs established under this section, including measures of outcomes and consumer and surrogate satisfaction. ``(e) Authorization of Appropriations.--There are authorized to be appropriated to carry out this section, $27,000,000 for fiscal year 1994, and such sums as may be necessary for each of the fiscal years 1995 and 1996.''. SEC. 4. NATIONAL HEAD INJURY AWARENESS MONTH. The month of October, 1993, is hereby designated as ``National Head Injury Month'' and the President is requested to issue a proclamation calling on the people of the United States to observe such month with appropriate ceremonies and activities. SEC. 5. EFFECTIVE DATE. This Act shall become effective on October 1, 1993. <all> HR 2990 IS----2