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104th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 2d Session                                                     104-652
_______________________________________________________________________


 
                   TRAUMATIC BRAIN INJURY ACT OF 1996

                                _______
                                

 June 27, 1996.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Bliley, from the Committee on Commerce, submitted the following

                              R E P O R T

                        [To accompany H.R. 248]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Commerce, to whom was referred the bill 
(H.R. 248) 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, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
The Amendment....................................................     2
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     5
Hearings.........................................................     6
Committee Consideration..........................................     6
Roll Call Votes..................................................     6
Committee Oversight Findings.....................................     6
Committee on Government Reform and Oversight.....................     6
New Budget Authority and Tax Expenditures........................     6
Committee Cost Estimate..........................................     7
Congressional Budget Office Estimate.............................     7
Inflationary Impact Statement....................................    10
Advisory Committee Statement.....................................    10
Section-by-Section Analysis of the Legislation...................    10
Changes in Existing Law Made by the Bill, as Reported............    12

    The amendment is as follows:
    Strike out all after the enacting clause and insert in lieu 
thereof the following:

SECTION 1. PROGRAMS OF CENTERS FOR DISEASE CONTROL AND PREVENTION.

  Part J of title III of the Public Health Service Act (42 U.S.C. 280b 
et seq.) is amended by inserting after section 393 the following 
section:
                 ``prevention of traumatic brain injury
  ``Sec. 393A. (a) In General.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, may carry 
out projects to reduce the incidence of traumatic brain injury. Such 
projects may be carried out by the Secretary directly or through awards 
of grants or contracts to public or nonprofit private entities. The 
Secretary may directly or through such awards provide technical 
assistance with respect to the planning, development, and operation of 
such projects.
  ``(b) Certain Activities.--Activities under subsection (a) may 
include--
          ``(1) the conduct of research into identifying effective 
        strategies for the prevention of traumatic brain injury; and
          ``(2) the implementation of public information and education 
        programs for the prevention of such injury and for broadening 
        the awareness of the public concerning the public health 
        consequences of such injury.
  ``(c) Coordination of Activities.--The Secretary shall ensure that 
activities under this section are coordinated as appropriate with other 
agencies of the Public Health Service that carry out activities 
regarding traumatic brain injury.
  ``(d) Definition.--For purposes of this section, the term `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 near drowning. The Secretary may revise the definition of 
such term as the Secretary determines necessary.''.

SEC. 2. PROGRAMS OF NATIONAL INSTITUTES OF HEALTH.

  Section 1261 of the Public Health Service Act (42 U.S.C. 300d-61) is 
amended--
          (1) in subsection (d)--
                  (A) in paragraph (2), by striking ``and'' after the 
                semicolon at the end;
                  (B) in paragraph (3), by striking the period and 
                inserting ``; and''; and
                  (C) by adding at the end the following paragraph:
          ``(4) the authority to make awards of grants or contracts to 
        public or nonprofit private entities for the conduct of basic 
        and applied research regarding traumatic brain injury, which 
        research may include--
                  ``(A) the development of new methods and modalities 
                for the more effective diagnosis, measurement of degree 
                of injury, post-injury monitoring and prognostic 
                assessment of head injury for acute, subacute and later 
                phases of care;
                  ``(B) the development, modification and evaluation of 
                therapies that retard, prevent or reverse brain damage 
                after acute head injury, that arrest further 
                deterioration following injury and that provide the 
                restitution of function for individuals with long-term 
                injuries;
                  ``(C) the development of research on a continuum of 
                care from acute care through rehabilitation, designed, 
                to the extent practicable, to integrate rehabilitation 
                and long-term outcome evaluation with acute care 
                research; and
                  ``(D) the development of programs that increase the 
                participation of academic centers of excellence in head 
                injury treatment and rehabilitation research and 
                training.''; and
          (2) in subsection (h), by adding at the end the following 
        paragraph:
          ``(4) The term `traumatic brain injury' means an acquired 
        injury to the brain. Such term does not include brain 
        dysfunction caused by congenital or degenerative disorders, nor 
        birth trauma, but may include brain injuries caused by anoxia 
        due to near drowning. The Secretary may revise the definition 
        of such term as the Secretary determines necessary.''.

SEC. 3. PROGRAMS OF HEALTH RESOURCES AND SERVICES ADMINISTRATION.

  Part E of title XII of the Public Health Service Act (42 U.S.C. 300d-
51 et seq.) is amended by adding at the end the following section:

``SEC. 1252. STATE GRANTS FOR DEMONSTRATION PROJECTS REGARDING 
                    TRAUMATIC BRAIN INJURY.

  ``(a) In General.--The Secretary, acting through the Administrator of 
the Health Resources and Services Administration, may make grants to 
States for the purpose of carrying out demonstration projects to 
improve access to health and other services regarding traumatic brain 
injury.
  ``(b) State Advisory Board.--
          ``(1) In general.--The Secretary may make a grant under 
        subsection (a) only if the State involved agrees to establish 
        an advisory board within the appropriate health department of 
        the State or within another department as designated by the 
        chief executive officer of the State.
          ``(2) Functions.--An advisory board established under 
        paragraph (1) shall advise and make recommendations to the 
        State on ways to improve services coordination regarding 
        traumatic brain injury. Such advisory boards shall encourage 
        citizen participation through the establishment of public 
        hearings and other types of community outreach programs. In 
        developing recommendations under this paragraph, such boards 
        shall consult with Federal, State, and local governmental 
        agencies and with citizens groups and other private entities.
          ``(3) Composition.--An advisory board established under 
        paragraph (1) shall be composed of--
                  ``(A) representatives of--
                          ``(i) the corresponding State agencies 
                        involved;
                          ``(ii) public and nonprofit private health 
                        related organizations;
                          ``(iii) other disability advisory or planning 
                        groups within the State;
                          ``(iv) members of an organization or 
                        foundation representing traumatic brain injury 
                        survivors in that State; and
                          ``(v) injury control programs at the State or 
                        local level if such programs exist; and
                  ``(B) a substantial number of individuals who are 
                survivors of traumatic brain injury, or the family 
                members of such individuals.
  ``(c) Matching Funds.--
          ``(1) In general.--With respect to the costs to be incurred 
        by a State in carrying out the purpose described in subsection 
        (a), the Secretary may make a grant under such subsection only 
        if the State agrees to make available, in cash, non-Federal 
        contributions toward such costs in an amount that is not less 
        than $1 for each $2 of Federal funds provided under the grant.
          ``(2) Determination of amount contributed.--In determining 
        the amount of non-Federal contributions in cash that a State 
        has provided pursuant to paragraph (1), the Secretary may not 
        include any amounts provided to the State by the Federal 
        Government.
  ``(d) Application for Grant.--The Secretary may make a grant under 
subsection (a) only if an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this section.
  ``(e) Coordination of Activities.--The Secretary shall ensure that 
activities under this section are coordinated as appropriate with other 
agencies of the Public Health Service that carry out activities 
regarding traumatic brain injury.
  ``(f) Report.--Not later than 2 years after the date of the enactment 
of this section, the Secretary shall submit to the Committee on 
Commerce of the House of Representatives, and to the Committee on Labor 
and Human Resources of the Senate, a report describing the findings and 
results of the programs established under this section, including 
measures of outcomes and consumer and surrogate satisfaction.
  ``(g) Definition.--For purposes of this section, the term `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 near drowning. The Secretary may revise the definition of 
such term as the Secretary determines necessary.
  ``(h) Authorization of Appropriations.--For the purpose of carrying 
out this section, there is authorized to be appropriated $5,000,000 for 
each of the fiscal years 1997 through 1999.''.

SEC. 4. STUDY; CONSENSUS CONFERENCE.

  (a) Study.--
          (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary''), acting 
        through the appropriate agencies of the Public Health Service, 
        shall conduct a study for the purpose of carrying out the 
        following with respect to traumatic brain injury:
                  (A) In collaboration with appropriate State and local 
                health-related agencies--
                          (i) determine the incidence and prevalence of 
                        traumatic brain injury; and
                          (ii) develop a uniform reporting system under 
                        which States report incidents of traumatic 
                        brain injury, if the Secretary determines that 
                        such a system is appropriate.
                  (B) Identify common therapeutic interventions which 
                are used for the rehabilitation of individuals with 
                such injuries, and shall, subject to the availability 
                of information, include an analysis of--
                          (i) the effectiveness of each such 
                        intervention in improving the functioning of 
                        individuals with brain injuries;
                          (ii) the comparative effectiveness of 
                        interventions employed in the course of 
                        rehabilitation of individuals with brain 
                        injuries to achieve the same or similar 
                        clinical outcome; and
                          (iii) the adequacy of existing measures of 
                        outcomes and knowledge of factors influencing 
                        differential outcomes.
                  (C) Develop practice guidelines for the 
                rehabilitation of traumatic brain injury at such time 
                as appropriate scientific research becomes available.
          (2) Dates certain for reports.--
                  (A) Not later than 18 months after the date of the 
                enactment of this Act, the Secretary shall submit to 
                the Committee on Commerce of the House of 
                Representatives, and to the Committee on Labor and 
                Human Resources of the Senate, a report describing the 
                findings made as a result of carrying out paragraph 
                (1)(A).
                  (B) Not later than 3 years after the date of the 
                enactment of this Act, the Secretary shall submit to 
                the Committees specified in subparagraph (A) a report 
                describing the findings made as a result of carrying 
                out subparagraphs (B) and (C) of paragraph (1).
  (b) Consensus Conference.--The Secretary, acting through the Director 
of the National Center for Medical Rehabilitation Research within the 
National Institute for Child Health and Human Development, shall 
conduct a national consensus conference on managing traumatic brain 
injury and related rehabilitation concerns.
  (c) Definition.--For purposes of this section, 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 near drowning. The Secretary may revise the definition of 
such term as the Secretary determines necessary.
  (d) Authorizations of Appropriations.--For the purpose of carrying 
out subsection (a)(1)(A), there is authorized to be appropriated 
$3,000,000 for each of the fiscal years 1997 through 1999. For the 
purpose of carrying out the other provisions of this section, there is 
authorized to be appropriated an aggregate $500,000 for the fiscal 
years 1997 through 1999. Amounts appropriated for such other provisions 
remain available until expended.

SEC. 5. TECHNICAL AMENDMENTS.

  Title XXVI of the Public Health Service Act (42 U.S.C. 300ff-11 et 
seq.), as amended by Public Law 104-146 (the Ryan White CARE Act 
Amendments of 1996), is amended--
          (1) in section 2626--
                  (A) in subsection (d), in the first sentence, by 
                striking ``(1) through (5)'' and inserting ``(1) 
                through (4)''; and
                  (B) in subsection (f), in the matter preceding 
                paragraph (1), by striking ``(1) through (5)'' and 
                inserting ``(1) through (4)''; and
          (2) in section 2692--
                  (A) in subsection (a)(1)(A)--
                          (i) by striking ``title XXVI programs'' and 
                        inserting ``programs under this title''; and
                          (ii) by striking ``infection and''; and
                  (B) by striking subsection (c) and all that follows 
                and inserting the following:
  ``(c) Authorization of Appropriations.--
          ``(1) Schools; centers.--For the purpose of grants under 
        subsection (a), there are authorized to be appropriated such 
        sums as may be necessary for each of the fiscal years 1996 
        through 2000.
          ``(2) Dental schools.--For the purpose of grants under 
        subsection (b), there are authorized to be appropriated such 
        sums as may be necessary for each of the fiscal years 1996 
        through 2000.''.

                          Purpose and Summary

    The purpose of this legislation is to expand the efforts to 
identify methods of preventing traumatic brain injury; expand 
biomedical research efforts to prevent or minimize the severity 
of dysfunction as a result of such an injury; and to improve 
the delivery and quality of services through State 
demonstration projects.
    To achieve these goals, H.R. 248 authorizes:
          1. The Centers for Disease Control and Prevention to 
        establish projects to prevent and reduce the incidence 
        of traumatic brain injury;
          2. The National Institutes of Health to award grants 
        to conduct basic and applied research on developing new 
        methods for more effective diagnosis, therapies, and 
        continuum of care; and
          3. The Health Resources and Services Administration 
        to make grants to States to carry out demonstration 
        programs to improve access to services regarding 
        traumatic brain injury.

                  Background and Need for Legislation

    Traumatic brain injury (TBI) is defined as brain damage 
from some externally inflicted trauma to the head that results 
in significant impairment to an individual's physical, 
psychosocial, and/or cognitive functional abilities. TBI has 
become the number one killer and cause of disability of young 
people in the United States. Motor vehicle accidents, sports 
accidents, falls, and increasing violence are the major causes 
of traumatic brain injury. Long known as the silent epidemic, 
TBI can strike anyone--infant, youth, or elderly person--
without warning and with devastating results. TBI affects the 
whole family and often results in huge medical and 
rehabilitation expenses over a lifetime.
    An estimated 1.9 million Americans experience traumatic 
brain injuries each year. About half of these cases result in 
at least short-term disability, and 52,000 people die as a 
result of their injuries. The direct medical costs for 
treatment of TBI have been estimated at more than $4 billion 
annually.
    Every year, over 90,000 people sustain severe brain 
injuries leading to irreversible debilitating loss of function. 
Because of the serious consequences of TBI and the failure of 
human services systems and educational programs to meet their 
needs properly, people with TBI want to be identified as people 
with brain injuries, not to be labeled as having some other 
disability. This is extremely important if appropriate services 
are to be developed and targeted and prevention efforts are to 
be conducted.
    The Committee believes there needs to be more research to 
find ways to repair damaged brain cells, improve memory loss, 
and improve cognitive functions. TBI is different from other 
disabilities due to the severity of cognitive loss. Most 
rehabilitation programs are designed for people with physical 
disabilities, not cognitive disabilities which require special 
accommodations. In most States, there is no central point of 
referral and no central authority to coordinate and target 
appropriate services. The bill provides authority for the 
conduct of basic and applied research with respect to TBI.
    The Committee believes that as TBI is identified as a 
unique form of brain injury, public awareness will increase and 
more effective prevention policies inside and outside of 
government can be adopted. The Committee recognizes the need 
for coordination of TBI services at the Federal and State 
levels and has authorized establishment of programs to promote 
such activities.

                                Hearings

    The Committee on Commerce has not held hearings on the 
legislation.

                        Committee Consideration

    On June 6, 1996, the Subcommittee on Health and Environment 
met in open markup session and approved H.R. 248 for Full 
Committee consideration, as amended, by a voice vote.
    On June 13, 1996, the Committee on Commerce met in open 
markup session and ordered H.R. 248 reported to the House, as 
amended, by a voice vote, a quorum being present.

                             Rollcall Votes

    Clause 2(l)(2)(B) of rule XI of the Rules of the House 
requires the Committee to list the recorded votes on the motion 
to report legislation and amendments thereto. There were no 
recorded votes taken in connection with ordering H.R. 248 
reported or in adopting the amendment. The voice votes taken in 
Committee are as follows:
    Bill: H.R. 248, 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.
    Amendment: Amendment offered by Mr. Greenwood re: provide 
specified dollar amounts for the authorization of 
appropriations.
    Disposition: Agreed to, by a voice vote.
    Motion: Motion by Mr. Bliley to order H.R. 248, as amended, 
reported to the House.
    Disposition: Agreed to, by a voice vote.

                      Committee Oversight Findings

    Pursuant to clause 2(l)(3)(A) of Rule XI of the Rules of 
the House of Representatives, the Committee has not held 
oversight or legislative hearings on this legislation.

              Committee on Government Reform and Oversight

    Pursuant to clause 2(l)(3)(D) of rule XI of the Rules of 
the House of Representatives, no oversight findings have been 
submitted to the Committee by the Committee on Government 
Reform and Oversight.

               New Budget Authority and Tax Expenditures

    In compliance with clause 2(l)(3)(B) of rule XI of the 
Rules of the House of Representatives, the Committee states 
that H.R. 248 would result in no new or increased budget 
authority or tax expenditures or revenues.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 403 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 2(l)(3)(C) of rule XI of the Rules of 
the House of Representatives, the following is the cost 
estimate provided by the Congressional Budget Office pursuant 
to section 403 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 25, 1996.
Hon. Thomas J. Bliley, Jr.,
Chairman, Committee on Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 248, as ordered 
reported by the House Committee on Commerce on June 13, 1996. 
Because enactment of H.R. 248 would not affect direct spending 
or receipts, pay-as-you-go procedures would not apply to the 
bill.
    If you wish further details on this estimate, we will be 
pleased to provide them.
            Sincerely,
                                         June E. O'Neill, Director.
    Enclosure.

               congressional budget office cost estimate

    1. Bill number: H.R. 248.
    2. Bill title: None.
    3. Bill status: As ordered reported by House Committee on 
Commerce on June 13, 1996.
    4. Bill purpose: H.R. 248 would amend several parts of 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. It would also make 
technical corrections to the Ryan White Care Act.
    5. Estimated cost to the Federal Government: The following 
table shows discretionary spending under H.R. 248. 
Authorizations of appropriations would total $24.5 million for 
fiscal years 1997 through 1999. No additional appropriations 
would be authorized for fiscal years after 1999.

----------------------------------------------------------------------------------------------------------------
                                                              1997     1998     1999     2000     2001     2002 
----------------------------------------------------------------------------------------------------------------
Section 3--Grants to States (Health Resources and Services                                                      
 Administration):                                                                                               
    Budget authority......................................      5.0      5.0      5.0  .......  .......  .......
    Outlays...............................................      1.8      3.5      5.0      3.3      1.5  .......
Section 4, Part (a)(1)(A)--Study (Centers for Disease                                                           
 Control and Prevention):                                                                                       
    Budget authority......................................      3.0      3.0      3.0  .......  .......  .......
    Outlays...............................................      1.1      2.2      2.8      1.9      1.0  .......
Section 4, Parts (a)(1)(B) and (a)(1)(C)--Study (National                                                       
 Institutes of Health) and Part (b)--Consensus Conference                                                       
 (National Institutes of Health):                                                                               
    Budget authority......................................      0.5  .......  .......  .......  .......  .......
    Outlays...............................................      0.2      0.3  .......  .......  .......  .......
                                                           -----------------------------------------------------
      Total:                                                                                                    
          Budget authority................................      8.5      8.0      8.0  .......  .......  .......
          Outlays.........................................      3.0      6.0      7.8      5.2      2.5  .......
----------------------------------------------------------------------------------------------------------------

    The costs of this bill would fall within budget function 
550.
    Estimated budget authority under Section 4, parts 
(a)(1)(B), (a)(1)(C), and (b), is based on language in H.R. 
248; however, CBO expects the $500,000 specified in this bill 
would be insufficient to carry out the study and consensus 
conference required under these parts. CBO estimates the cost 
of conducting the conference under part (b) would be $250,000. 
If only $500,000 budget authority were provided for all of the 
parts and sub-parts specified above, only $250,000--slightly 
more than the amount of one average NIH grant--would be 
available for completing all of the research required under 
sub-parts (a)(1)(B) and (a)(1)(c), including research to (1) 
identify and analyze common therapeutic interventions, and (2) 
develop practice guidelines for the rehabilitation of 
individuals with TBI.
    6. Basis of the estimate: H.R. 248 would authorize new 
spending by the Health Resources and Services Administration 
(HRSA), the Centers for Disease Control and Prevention (CDC), 
and the National Institutes of Health (NIH). Estimated spending 
under this bill would be subject to the availability of 
appropriated funds.
    Section 1 of this bill would authorize projects to reduce 
the incidence of traumatic brain injury (TBI), where such 
projects could be carried out directly by the CDC, or through 
grants and contracts made by that agency to public and 
nonprofit private entities. CBO estimates that this section 
would entail no significant costs because (1) current law is 
sufficiently broad to authorize projects for reducing the 
incidence to TBI, (2) the CDC already allocates appropriated 
funds to pay for staff salaries, projects, and grants related 
to TBI prevention; and (3) the bill would not require spending 
on such projects.
    Section 2 would provide authority to the NIH to make awards 
to public or nonprofit private entities for the conduct of 
basic and applied research regarding traumatic brain injury. As 
with Section 1, CBO estimates that this section would entail no 
significant costs because current law is already sufficiently 
broad to authorize research regarding TBI and because H.R. 248 
would not require such research.
    Section 3 would authorize HRSA to make grants to states for 
the purpose of carrying out demonstration projects to improve 
access to health and other services for the assessment and 
treatment of traumatic brain injury. Such grants could be made 
only where states establish an advisory board regarding TBI and 
contribute at least $1 in cash for each $2 in federal funds 
provided under the grant. This section would also require a 
report describing the findings and results of programs 
completed under such grants to states.
    CBO assumes that the amounts authorized in Section 3 would 
be appropriated as specified ($5 million for each of fiscal 
years 1997 through 1999). The report required under this 
section would be due two years following the date of enactment 
of this legislation, before authorized demonstration projects 
would be completed. Estimated outlays under this section are 
based on historical spending patterns for HRSA.
    Section 4 of H.R. 248 would require the completion of a 
study and the conduct of a national consensus conference 
regarding traumatic brain injury. CBO assumes that the CDC 
would perform, together with state and local health-related 
agencies, parts of the study related to TBI incidence and 
prevalence and to the development of a uniform reporting 
system. The NIH would conduct the consensus conference and 
complete parts of the study related to therapeutic 
interventions and practice guidelines.
    For this section, CBO assumes (1) that amounts authorized 
for parts of the study performed by the CDC would be 
appropriated as specified ($3 million for each of the fiscal 
years 1997 through 1999), and (2) that the $500,000 authorized 
for the rest of the study and consensus conference would be 
appropriated in full in fiscal year 1997. Estimated outlays are 
based on historical spending patterns for both CDC and NIH.
    Section 5 would make technical corrections to the Ryan 
White Care Act. CBO estimates that this section would have no 
budgetary impact.
    7. Pay-as-you-go considerations: None.
    8. Estimated cost to State, local and tribal governments: 
H.R. 248 contains no intergovernmental mandates as defined in 
P.L. 104-4. However, the bill would authorize funding for 
various state-related projects. For fiscal years 1997 through 
1999, the bill would authorize the annual appropriation of:
          $5 million for grants to states, with a $2.5 million 
        state match, for the purpose of carrying out 
        demonstration projects that would improve access to 
        health and other services regarding traumatic brain 
        injury; and
          $3 million for the Secretary of Health and Human 
        Services to conduct a study in collaboration with state 
        and local health-related agencies to determine the 
        incidence and prevalence of traumatic brain injury and 
        to develop a uniform reporting system.
    If the federal government decides to carry out the projects 
to prevent traumatic brain injury or research on these injuries 
as permitted under this bill, state and local institutions may 
receive the grant or contract to carry out these activities.
    9. Estimated impact on the private sector: None.
    10. Previous estimate: None.
    11. Estimate prepared by: Federal Cost Estimate: Jennifer 
Jenson. State and Local Cost Estimate: John Patterson.
    12. Estimate approved by: Paul N. Van de Water, Assistant 
Director for Budget Analysis.

                     Inflationary Impact Statement

    Pursuant to clause 2(l)(4) of rule XI of the Rules of the 
House of Representatives, the Committee finds that the bill 
would have no inflationary impact.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act are created by this 
legislation.

             Section-by-Section Analysis of the Legislation

Section 1. Programs of Centers for Disease Control and Prevention

    Section 1 amends the Public Health Service Act by adding to 
the Program on the Prevention and Control of Injuries a 
provision regarding the prevention of traumatic brain injury 
(TBI). This provision authorizes the Centers for Disease 
Control and Prevention to carry out projects to reduce the 
incidence of TBI. Such projects may include research to 
identify strategies for, and public information and education 
programs on, the prevention of such injury. The Secretary shall 
ensure that these activities are carried out in coordination 
with other Public Health Service agencies that carry out 
activities regarding TBI.
    This section also defines the term ``traumatic brain 
injury'' as an acquired injury to the brain. Such term does not 
include brain dysfunction caused by congenital or degenerative 
disorders, nor birth trauma, but may include brain injuries 
caused by anoxia due to near drowning. The Committee hopes that 
the inclusion of this definition in statute will begin to give 
people with TBI and their families increased recognition and 
support. A definition is also necessary because the term has 
been used in Federal and State statutes without a clear 
definition of its meaning. The terms congenital brain damage, 
head injury, organic brain damage, minimal brain dysfunction, 
acquired brain injury, and a host of other terms, have been 
used to define the injured brain without consistency of 
definition.

Section 2. Programs of National Institutes of Health

    Section 2 authorizes the National Institutes of Health to 
make awards to conduct basic and applied research regarding 
traumatic brain injury. Such research may include:
          1. the development of new methods for more effective 
        diagnosis, measurement of degree of injury, post-injury 
        monitoring, and prognostic assessment of head injury;
          2. the development, modification, and evaluation of 
        therapies that retard, prevent, or reverse brain damage 
        after head injury, that arrest further deterioration 
        following injury, and that provide restoration of 
        function;
          3. the development of research on a continuum of care 
        from acute care through rehabilitation; and
          4. the development of programs that increase the 
        participation of academic centers of excellence in head 
        injury treatment and rehabilitation research and 
        training.

Section 3. Programs of Health Resources and Services Administration

    Section 3 authorizes the Health Resources and Services 
Administration to make grants to carry out demonstration 
projects to improve access to health and other services 
regarding TBI. This program is authorized at $5 million for 
each of Fiscal Years 1997 through 1999. To be eligible for such 
a grant, a State must establish an advisory board to advise and 
make recommendations on ways to improve services coordination 
regarding TBI.
    In addition, a grant may be awarded only if the State 
agrees to make available, in cash, an amount that is not less 
than a $1 for each $2 of Federal funds provided. No funds 
provided to the State by the Federal government may be included 
in determining the State's contribution.
    The Secretary of Health and Human Services (the Secretary) 
is required to submit a report on this grant program to the 
appropriate Committees of Congress not later than 2 years after 
enactment. The report shall include the findings and results of 
the program, including measures of outcome and consumer 
satisfaction.

Section 4. Study; consensus conference

    Section 4 authorizes the Secretary to determine the 
incidence and prevalence of TBI and to develop a uniform 
reporting system. The bill authorizes $3 million for each of 
Fiscal Years 1997 through 1999 to carry out these activities. 
The Secretary is also required to report on the findings of 
these activities to the appropriate Committees of Congress, not 
later than 18 months after enactment.
    This section also authorizes the Secretary to conduct a 
study to identify common therapeutic interventions which are 
used for the rehabilitation of individuals with such injuries, 
an analysis of the effectiveness of such interventions, and the 
adequacy of existing measures of outcomes. The Secretary is 
also authorized to issue practice guidelines, if appropriate 
scientific research becomes available. The Secretary is 
required to report on the findings of this study not later than 
three years after enactment.
    In addition, this section directs the Secretary, acting 
through the National Center for Medical Rehabilitation Research 
within the National Institute of Child Health and Human 
Development, to conduct a national consensus conference on 
managing TBI and related rehabilitation concerns. The bill 
authorizes an aggregate of $500,000 for the Fiscal Years 1997 
through 1999 to conduct the study and carry out the consensus 
conference.

Section 5. Technical amendments

    Section 5 makes technical amendments to the Ryan White CARE 
Act Amendments of 1996.
      

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3 of rule XIII of the Rules of the 
House of Representatives, changes in existing law made by the 
bill, as reported, are shown as follows (existing law proposed 
to be omitted is enclosed in black brackets, new matter is 
printed in italic, existing law in which no change is proposed 
is shown in roman):

                       PUBLIC HEALTH SERVICE ACT

          * * * * * * *

     TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

          * * * * * * *

               Part J--Prevention and Control of Injuries

          * * * * * * *


                  prevention of traumatic brain injury


  Sec. 393A. (a) In General.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, may 
carry out projects to reduce the incidence of traumatic brain 
injury. Such projects may be carried out by the Secretary 
directly or through awards of grants or contracts to public or 
nonprofit private entities. The Secretary may directly or 
through such awards provide technical assistance with respect 
to the planning, development, and operation of such projects.
  (b) Certain Activities.--Activities under subsection (a) may 
include--
          (1) the conduct of research into identifying 
        effective strategies for the prevention of traumatic 
        brain injury; and
          (2) the implementation of public information and 
        education programs for the prevention of such injury 
        and for broadening the awareness of the public 
        concerning the public health consequences of such 
        injury.
  (c) Coordination of Activities.--The Secretary shall ensure 
that activities under this section are coordinated as 
appropriate with other agencies of the Public Health Service 
that carry out activities regarding traumatic brain injury.
  (d) Definition.--For purposes of this section, the term 
``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 near drowning. 
The Secretary may revise the definition of such term as the 
Secretary determines necessary.
          * * * * * * *

                         TITLE XII--TRAUMA CARE

          * * * * * * *

                     Part E--Miscellaneous Programs

          * * * * * * *

SEC. 1252. STATE GRANTS FOR DEMONSTRATION PROJECTS REGARDING TRAUMATIC 
                    BRAIN INJURY.

  (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, may make grants to States for the purpose of 
carrying out demonstration projects to improve access to health 
and other services regarding traumatic brain injury.
  (b) State Advisory Board.--
          (1) In general.--The Secretary may make a grant under 
        subsection (a) only if the State involved agrees to 
        establish an advisory board within the appropriate 
        health department of the State or within another 
        department as designated by the chief executive officer 
        of the State.
          (2) Functions.--An advisory board established under 
        paragraph (1) shall advise and make recommendations to 
        the State on ways to improve services coordination 
        regarding traumatic brain injury. Such advisory boards 
        shall encourage citizen participation through the 
        establishment of public hearings and other types of 
        community outreach programs. In developing 
        recommendations under this paragraph, such boards shall 
        consult with Federal, State, and local governmental 
        agencies and with citizens groups and other private 
        entities.
          (3) Composition.--An advisory board established under 
        paragraph (1) shall be composed of--
                  (A) representatives of--
                          (i) the corresponding State agencies 
                        involved;
                          (ii) public and nonprofit private 
                        health related organizations;
                          (iii) other disability advisory or 
                        planning groups within the State;
                          (iv) members of an organization or 
                        foundation representing traumatic brain 
                        injury survivors in that State; and
                          (v) injury control programs at the 
                        State or local level if such programs 
                        exist; and
                  (B) a substantial number of individuals who 
                are survivors of traumatic brain injury, or the 
                family members of such individuals.
  (c) Matching Funds.--
          (1) In general.--With respect to the costs to be 
        incurred by a State in carrying out the purpose 
        described in subsection (a), the Secretary may make a 
        grant under such subsection only if the State agrees to 
        make available, in cash, non-Federal contributions 
        toward such costs in an amount that is not less than $1 
        for each $2 of Federal funds provided under the grant.
          (2) Determination of amount contributed.--In 
        determining the amount of non-Federal contributions in 
        cash that a State has provided pursuant to paragraph 
        (1), the Secretary may not include any amounts provided 
        to the State by the Federal Government.
  (d) Application for Grant.--The Secretary may make a grant 
under subsection (a) only if an application for the grant is 
submitted to the Secretary and the application is in such form, 
is made in such manner, and contains such agreements, 
assurances, and information as the Secretary determines to be 
necessary to carry out this section.
  (e) Coordination of Activities.--The Secretary shall ensure 
that activities under this section are coordinated as 
appropriate with other agencies of the Public Health Service 
that carry out activities regarding traumatic brain injury.
  (f) Report.--Not later than 2 years after the date of the 
enactment of this section, the Secretary shall submit to the 
Committee on Commerce of the House of Representatives, and to 
the Committee on Labor and Human Resources of the Senate, a 
report describing the findings and results of the programs 
established under this section, including measures of outcomes 
and consumer and surrogate satisfaction.
  (g) Definition.--For purposes of this section, the term 
``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 near drowning. 
The Secretary may revise the definition of such term as the 
Secretary determines necessary.
  (h) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $5,000,000 for each of the fiscal years 1997 
through 1999.
          * * * * * * *

            Part F--Interagency Program for Trauma Research

SEC. 1261. ESTABLISHMENT OF PROGRAM.

  (a) * * *
          * * * * * * *
  (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; [and]
          (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 injury, post-injury 
                monitoring and prognostic assessment of head 
                injury for acute, subacute and later phases of 
                care;
                  (B) the development, modification and 
                evaluation of therapies that retard, prevent or 
                reverse brain damage after acute head injury, 
                that arrest further deterioration following 
                injury and that provide the restitution of 
                function for individuals with long-term 
                injuries;
                  (C) the development of research on a 
                continuum of care from acute care through 
                rehabilitation, designed, to the extent 
                practicable, to integrate rehabilitation and 
                long-term outcome evaluation with acute care 
                research; and
                  (D) the development of programs that increase 
                the participation of academic centers of 
                excellence in head injury treatment and 
                rehabilitation research and training.
          * * * * * * *
  (h) Definitions.--For purposes of this section:
          (1) * * *
          * * * * * * *
          (4) 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 near 
        drowning. The Secretary may revise the definition of 
        such term as the Secretary determines necessary.
          * * * * * * *

              TITLE XXVI--HIV HEALTH CARE SERVICES PROGRAM

          * * * * * * *

                       Part B--Care Grant Program

          * * * * * * *

Subpart II--Provisions Concerning Pregnancy and Perinatal Transmission 
                                 of HIV

          * * * * * * *

SEC. 2626.  PERINATAL TRANSMISSION OF HIV DISEASE; CONTINGENT 
                    REQUIREMENT REGARDING STATE GRANTS UNDER THIS PART.

  (a) * * *
          * * * * * * *
  (d) Determination by Secretary.--Not later than 180 days 
after the expiration of the 18-month period beginning on the 
date on which the system is implemented under subsection (c), 
the Secretary shall publish in the Federal Register a 
determination of whether it has become a routine practice in 
the provision of health care in the United States to carry out 
each of the activities described in paragraphs [(1) through 
(5)] (1) through (4) of section 2627. In making the 
determination, the Secretary shall consult with the States and 
with other public or private entities that have knowledge or 
expertise relevant to the determination.
          * * * * * * *
  (f) Limitation Regarding Availability of Funds.--With respect 
to an activity described in any of paragraphs [(1) through (5)] 
(1) through (4) of section 2627, the requirements established 
by a State under this section apply for purposes of this 
section only to the extent that the following sources of funds 
are available for carrying out the activity:
          (1) Federal funds provided to the State in grants 
        under part B or under section 2625, or through other 
        Federal sources under which payments for routine HIV 
        testing, counseling or treatment are an eligible use.
          (2) Funds that the State or private entities have 
        elected to provide, including through entering into 
        contracts under which health benefits are provided. 
        This section does not require any entity to expend non-
        Federal funds.
          * * * * * * *

                   PART F--DEMONSTRATION AND TRAINING

          * * * * * * *

            Subpart II--AIDS Education and Training Centers

SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.

  (a) Schools; Centers.--
          (1) In general.--The Secretary may make grants and 
        enter into contracts to assist public and nonprofit 
        private entities and schools and academic health 
        science centers in meeting the costs of projects--
                  (A) training health personnel, including 
                practitioners in [title XXVI programs] programs 
                under this title and other community providers, 
                in the diagnosis, treatment, and prevention of 
                HIV [infection and] disease, including the 
                prevention of the perinatal transmission of the 
                disease and including measures for the 
                prevention and treatment of opportunistic 
                infections;
          * * * * * * *
  [(c) Definition.--For purposes of this section:
          [(1) The term ``HIV disease'' means infection with 
        the human immunodeficiency virus, and includes any 
        condition arising from such infection.
          [(2) The term ``human immunodeficiency virus'' means 
        the etiologic agent for acquired immune deficiency 
        syndrome.
  [(d) Authorization of Appropriations.--
          [(1) Schools; centers.--For the purpose of grants 
        under subsection (a), there is authorized to be 
        appropriated $23,000,000 for each of the fiscal years 
        1993 through 1995.
          [(2) Dental schools.--For the purpose of grants under 
        subsection (b), there is authorized to be appropriated 
        $7,000,000 for each of the fiscal years 1993 through 
        1995.
  [(d) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section, such sums as may 
be necessary for each of the fiscal years 1996 through 2000.]
  (c) Authorization of Appropriations.--
          (1) Schools; centers.--For the purpose of grants 
        under subsection (a), there are authorized to be 
        appropriated such sums as may be necessary for each of 
        the fiscal years 1996 through 2000.
          (2) Dental schools.--For the purpose of grants under 
        subsection (b), there are authorized to be appropriated 
        such sums as may be necessary for each of the fiscal 
        years 1996 through 2000.