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110th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                     110-75

======================================================================



 
              STROKE TREATMENT AND ONGOING PREVENTION ACT

                                _______
                                

 March 27, 2007.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Dingell, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 477]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 477) to amend the Public Health Service Act to 
strengthen education, prevention, and treatment programs 
relating to stroke, and for other purposes, having considered 
the same, report favorably thereon with amendments and 
recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendments.......................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     8

                               Amendments

    The amendments (stated in terms of the page and line 
numbers of the introduced bill) are as follows:
    Page 2, line 3, redesignate part R as part S.
          In such part S (as so redesignated), redesignate 
        sections 399AA through 399DD as sections 399FF through 
        399II, respectively.

                          Purpose and Summary

    The purpose of H.R. 477, the ``Stroke Treatment and Ongoing 
Prevention Act'', is to amend the Public Health Service Act to 
strengthen education, prevention, and treatment programs to 
improve health outcomes for stroke patients.

                  Background and Need for Legislation

    Stroke is the third leading cause of death in America and a 
major contributor to long-term disability. A stroke occurs when 
the blood supply to part of the brain is suddenly interrupted 
(ischemic) or when a blood vessel in the brain bursts, spilling 
blood into the spaces surrounding brain cells (hemorrhagic). 
Brain cells die when they no longer receive oxygen and 
nutrients from the blood or there is sudden bleeding into or 
around the brain.
    The symptoms of a stroke include sudden numbness or 
weakness, especially on one side of the body; sudden confusion 
or trouble speaking or understanding speech; sudden trouble 
seeing in one or both eyes; sudden trouble with walking, 
dizziness, or loss of balance or coordination; or sudden severe 
headache with no known cause.
    Although stroke is a disease of the brain, it can affect 
the entire body. A common disability that results from stroke 
is complete paralysis on one side of the body, called 
hemiplegia. A related disability that is not as debilitating as 
paralysis is one-sided weakness or hemiparesis. Stroke may 
cause problems with thinking, awareness, attention, learning, 
judgment, and memory. Recurrent stroke is frequent; about 25 
percent of people who recover from their first stroke will have 
another stroke within 5 years.
    When a stroke is diagnosed and treated within the first few 
hours, damaged cells can be saved, strengthening the chance of 
recovery. Recent studies have shown that stroke patients who 
received care in a timely manner at facilities with highly 
trained health care professionals are more likely to have 
better health outcomes. The American Heart Association reports 
that 700,000 Americans each year suffer a new or recurrent 
stroke and more than 150,000 people die annually. They estimate 
that every 3 minutes someone dies from a stroke. Additionally, 
the American Heart Association estimates that Americans will 
pay approximately $62.7 billion in 2007 for stroke-related 
medical costs and disability.
    H.R. 477 would authorize the Secretary of Health and Human 
Services to engage in activities designed to increase knowledge 
and awareness of stroke prevention and treatment. This 
legislation would require the Secretary to conduct educational 
campaigns, maintain a national stroke registry, and establish 
an information clearinghouse related to stroke. For these 
purposes, the bill would authorize an appropriation of $5 
million for each of the fiscal years 2008 through 2012.
    The legislation would authorize the Secretary to make 
grants to public and nonprofit entities for the purpose of 
planning, developing, and enhancing approved residency training 
programs and other professional training for appropriate health 
professions in emergency medicine, including diagnosis, 
treatment, and rehabilitation. For these purposes, the bill 
would authorize an appropriation of $4 million for each of the 
fiscal years 2008 through 2012.
    Finally, H.R. 477 would authorize the Secretary to make 
grants to States and other public and private entities to 
develop medical professional training programs and telehealth 
networks that seek to coordinate stroke care and improve 
patient outcomes. For these purposes, the bill would authorize 
appropriations of $10 million for fiscal year 2008; $13 million 
for fiscal year 2009; $15 million for fiscal year 2010; $8 
million for fiscal year 2011; and $4 million for fiscal year 
2012.
    H.R. 477 has 86 cosponsors and is supported by the American 
Heart Association, the American Stroke Association, the 
American Physical Therapy Association, and the STOP Stroke 
Coalition.

                                Hearings

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

                        Committee Consideration

    On Tuesday, March 13, 2007, the Subcommittee on Health met 
in open markup session and approved H.R. 477 for full Committee 
consideration by voice vote. On Thursday, March 15, 2007, the 
full Committee met in open markup session and ordered H.R. 477 
favorably reported to the House, amended, by voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list any record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken on amendments or in connection 
with ordering H.R. 477 reported. A motion by Mr. Dingell to 
order H.R. 477 favorably reported to the House, amended, was 
agreed to by voice vote.

                      Committee Oversight Findings

    Regarding clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
or legislative hearings on this legislation.

         Statement of General Performance Goals and Objectives

    H.R. 477 seeks to improve health outcomes for stroke 
patients.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 477 would result in no new or increased budget 
authority, entitlement activity, or tax expenditures or 
revenues.

                  Earmarks and Tax and Tariff Benefits

    Regarding compliance with clause 9 of rule XXI of the Rules 
of the House of Representatives, H.R. 477 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of rule XXI.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 23, 2007.
Hon. John D. Dingell,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 477, the Stroke 
Treatment and Ongoing Prevention Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Tim 
Gronniger.
            Sincerely,
                                                   Peter R. Orszag.
    Enclosure.

H.R. 477--Stroke Treatment and Ongoing Prevention Act

    Summary: H.R. 477 would amend the Public Health Service Act 
to direct the Health Resources and Services Administration and 
the Centers for Disease Control and Prevention (CDC) to 
administer several programs related to education, prevention, 
and treatment of stroke. The bill would authorize the 
appropriation for those purposes of $19 million for 2008 and 
$95 million over the 2008-2012 period. Assuming appropriation 
of the specified amounts, CBO estimates that implementing H.R. 
477 would cost $7 million in 2008 and $82 million over the 
2008-2012 period. Enacting the bill would not affect direct 
spending or revenues.
    H.R. 477 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and could benefit state, local, and tribal governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 477 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).


----------------------------------------------------------------------------------------------------------------
                                                                       By fiscal year, in millions of dollars--
                                                                    --------------------------------------------
                                                                       2008     2009     2010     2011     2012
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level................................................       19       22       24       17       13
Estimated Outlays..................................................        7       16       21       21       17
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: H.R. 477 would modify the Public Health 
Service Act to authorize the appropriation of $19 million for 
2008 and $95 million over the 2008-2012 period for several 
activities related to stroke prevention and treatment. Based on 
historical patterns of spending for similar activities, CBO 
estimates that implementing H.R. 477 would cost $7 million in 
2008 and $82 million over the 2008-2012 period, assuming 
appropriation of the specified amounts.
    The bill would authorize the appropriation of $5 million a 
year for 2008 through 2012 for the Centers for Disease Control 
and Prevention to conduct stroke education campaigns and to 
maintain an existing stroke registry. Assuming appropriation of 
the specified amounts, CBO estimates those activities would 
cost $2 million in 2008 and $22 million over the 2008-2012 
period.
    The bill would authorize the appropriation of $4 million a 
year for 2008 through 2012 to the Health Resources and Services 
Administration for grants to train physicians in treating 
stroke and traumatic injury. Assuming appropriation of the 
specified amounts, CBO estimates those activities would cost $1 
million in 2008 and $16 million over the 2008-2012 period.
    The bill also would authorize the appropriation of $10 
million for 2008 and $50 million over the 2008-2012 period for 
grants to fund pilot projects through the Office for the 
Advancement of Telehealth. Those pilot projects would attempt 
to improve stroke treatment delivered through telehealth 
communications networks. Assuming appropriation of the 
specified amounts, CBO estimates those activities would cost $4 
million in 2008 and $44 million over the 2008-2012 period.
    Intergovernmental and private-sector impact: H.R. 477 
contains no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reform Act. State, local, and 
tribal governments may qualify for grants authorized by the 
bill. Any costs those governments would incur in order to meet 
requirements of the grants would be conditions of assistance 
and would be incurred voluntarily.
    Estimate prepared by: Federal costs: Tim Gronniger. Impact 
on state, local, and tribal governments: Leo Lex. Impact on the 
private sector: Paige Shevlin.
    Estimate approved by: Peter H. Fontaine, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

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

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
the provisions of Article I, section 8, clause 1 that relate to 
expending funds to provide for the general welfare of the 
United States.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title of the bill as the 
``Stroke Treatment and Ongoing Prevention Act.''

Section 2. Amendments to Public Health Service Act regarding stroke 
        programs

    Section 2 amends the Public Health Service Act to 
strengthen education, prevention, and treatment programs to 
improve health outcomes for stroke patients.
    To increase public awareness of the signs of stroke, 
section 2 amends title III of the Public Health Service Act (42 
U.S.C. 241 et seq.) to authorize the Secretary of Health and 
Human Services to carry out an education and information 
campaign to promote stroke prevention and increase the number 
of stroke patients who seek immediate treatment. The Secretary 
is authorized to (1) make public service announcements about 
the warning signs of stroke and the importance of treating 
stroke as a medical emergency; (2) provide education regarding 
ways to prevent stroke and the effectiveness of stroke 
treatment; and (3) carry out other activities that the 
Secretary determines will promote prevention practices among 
the general public and increase the number of stroke patients 
who seek immediate care. The Secretary is required to measure 
public awareness before the start of the campaign to provide 
baseline data that can be used to establish quantitative 
benchmarks to measure the impact of the campaign over time. The 
Secretary must report on these measurements not less than once 
every two years, or at shorter intervals. The Secretary must 
avoid duplicating existing stroke education efforts by other 
Federal government agencies. The Secretary may also consult 
with organizations and individuals with expertise in stroke 
prevention, diagnosis, treatment, and rehabilitation.
    To expand research information about stroke patients, 
section 2 also reauthorizes the Paul Coverdell National Acute 
Stroke Registry and Clearinghouse of the Centers for Disease 
Control and Prevention (CDC). For purposes of this part, 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. For the public education and 
registry provisions, section 2 authorizes appropriations of $5 
million for each of fiscal years 2008 through 2012.
    To improve medical professional development in advanced 
stroke and traumatic injury treatment and prevention, section 2 
amends section 1251 of the Public Health Service Act (42 U.S.C. 
300d-51) to authorize two new grant programs. The first grant 
program created in this section authorizes the Secretary to 
make grants to public and nonprofit entities for the purposes 
of planning, developing, and enhancing approved residency 
training programs and other training for appropriate health 
professions in emergency medicine to improve stroke and 
traumatic injury prevention, diagnosis, treatment, and 
rehabilitation.
    The second grant program authorizes the Secretary, acting 
through the Administrator of the Health Resources and Services 
Administration (HRSA), to make grants to a consortium of public 
and private entities for the development and implementation of 
education programs for appropriate health care professionals in 
the use of newly developed diagnostic approaches, technologies, 
and therapies to treat stroke or traumatic injury. The 
Secretary must give preference to qualified entities that will 
train health care professionals that serve areas with a 
significant incidence of stroke or traumatic injuries. The term 
``qualified entity'' is defined as a consortium of public and 
private entities, such as universities, academic medical 
centers, hospitals, and emergency medical systems that are 
coordinating education activities among providers serving in a 
variety of medical settings. The Committee does not intend for 
the examples outlined in the statute to be an exhaustive list 
of entities. Further, the Committee expects HRSA to award these 
grants to real consortiums, groups of organizations formed to 
undertake the continuing education activities to a level that 
no one organization could accomplish by itself. The Committee 
strongly encourages HRSA to recognize the diverse training of 
health care professionals who treat stroke patients when 
awarding grants. For example, interventional radiologists who 
employ minimally invasive stroke treatments and therapies 
should be considered as well as all other health care 
professionals who directly treat stroke patients.
    The Secretary must report on these results of the 
activities of the two medical professional development grant 
programs no later than one year after the allocation of grants. 
This section authorizes appropriations of $4 million for each 
of the fiscal years 2008 through 2012 for the two medical 
professional development grant programs. The Secretary must 
equitably allocate the funds appropriated between efforts to 
address stroke and efforts to address traumatic injury.

Section 3. Pilot project on telehealth stroke treatment

    Section 3 amends part D of title II of the Public Health 
Service Act (42 U.S.C. 254b et seq.) to establish a five-year 
pilot project to improve stroke patient outcomes by 
coordinating health care delivery through telehealth networks. 
The Secretary, acting through the Director of the Office for 
the Advancement of Telehealth, is authorized to make up to 
seven grants to states or a consortium of states or political 
subdivisions for a period of up to three years during fiscal 
years 2008 through 2012.
    Grant recipients must use the funding to accomplish all of 
the following activities: (1) Identify entities with expertise 
in the delivery of high-quality stroke prevention, diagnosis, 
treatment, and rehabilitation. (2) Work with these entities to 
establish or improve telehealth networks to provide stroke 
treatment assistance and resources to health care 
professionals, hospitals, and other individuals and entities 
that serve stroke patients. (3) Inform emergency medical 
systems of the location of entities identified to facilitate 
appropriate transportation. (4) Establish networks to 
coordinate collaborative activities for stroke prevention, 
diagnosis, treatment, and rehabilitation. (5) Improve access to 
high-quality stroke care, especially for populations with a 
shortage of stroke care specialists and populations with a high 
incidence of stroke. (6) Conduct ongoing performance and 
quality evaluations to identify collaborative activities that 
improve clinical outcomes for stroke patients. The Secretary 
may not award a grant to a State unless the State agrees to 
establish a consortium of public and private entities to carry 
out the activities of the grant. Additionally, the Secretary 
may not make a grant to a State that has an existing telehealth 
network that is or may be used for the purposes of the grant 
unless the State agrees to use the existing telehealth network 
to achieve the purpose of the grant and the State will not 
establish a separate network for the same purpose. The 
Secretary must give priority to any applicant that submits a 
plan detailing specifically how the grant will improve access 
to high-quality stroke care for populations with shortages of 
stroke care specialists and populations with a high incidence 
of stroke.
    The Secretary is required to consult with officials 
responsible for other Federal programs involving stroke 
research and care and organizations and individuals with 
expertise in stroke prevention, diagnosis, treatment, and 
rehabilitation to better coordinate program activities. Grant 
recipients are required to establish baselines measures and 
benchmarks to evaluate program outcomes. Not later than March 
31, 2013, the Secretary of HHS is required to report to 
Congress on the pilot project outcomes, including 
recommendations on whether similar telehealth grant programs 
could be used to improve patient outcomes in other public 
health areas and how to promote stroke networks in ways that 
improve access to clinical care in rural and urban areas and 
reduce the incidence of stroke and the debilitating and costly 
complications resulting from stroke.
    The pilot project authorizes appropriations of $10 million 
for fiscal year 2008; $13 million for fiscal year 2009; $15 
million for fiscal year 2010; $8 million for fiscal year 2011; 
and $4 million for fiscal year 2012.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) 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 D--Primary Health Care

Subpart I--Health Centers

           *       *       *       *       *       *       *


SEC. 330M. TELEHEALTH STROKE TREATMENT GRANT PROGRAM.

    (a) Grants.--The Secretary may make grants to States, and 
to consortia of public and private entities located in any 
State that is not a grantee under this section, to conduct a 5-
year pilot project over the period of fiscal years 2008 through 
2012 to improve stroke patient outcomes by coordinating health 
care delivery through telehealth networks.
    (b) Administration.--The Secretary shall administer this 
section through the Director of the Office for the Advancement 
of Telehealth.
    (c) Consultation.--In carrying out this section, for the 
purpose of better coordinating program activities, the 
Secretary shall consult with--
            (1) officials responsible for other Federal 
        programs involving stroke research and care, including 
        such programs established by the Stroke Treatment and 
        Ongoing Prevention Act; and
            (2) organizations and individuals with expertise in 
        stroke prevention, diagnosis, treatment, and 
        rehabilitation.
    (d) Use of Funds.--
            (1) In general.--The Secretary may not make a grant 
        to a State or a consortium under this section unless 
        the State or consortium agrees to use the grant for the 
        purpose of--
                    (A) identifying entities with expertise in 
                the delivery of high-quality stroke prevention, 
                diagnosis, treatment, and rehabilitation;
                    (B) working with those entities to 
                establish or improve telehealth networks to 
                provide stroke treatment assistance and 
                resources to health care professionals, 
                hospitals, and other individuals and entities 
                that serve stroke patients;
                    (C) informing emergency medical systems of 
                the location of entities identified under 
                subparagraph (A) to facilitate the appropriate 
                transport of individuals with stroke symptoms;
                    (D) establishing networks to coordinate 
                collaborative activities for stroke prevention, 
                diagnosis, treatment, and rehabilitation;
                    (E) improving access to high-quality stroke 
                care, especially for populations with a 
                shortage of stroke care specialists and 
                populations with a high incidence of stroke; 
                and
                    (F) conducting ongoing performance and 
                quality evaluations to identify collaborative 
                activities that improve clinical outcomes for 
                stroke patients.
            (2) Establishment of consortium.--The Secretary may 
        not make a grant to a State under this section unless 
        the State agrees to establish a consortium of public 
        and private entities, including universities and 
        academic medical centers, to carry out the activities 
        described in paragraph (1).
            (3) Prohibition.--The Secretary may not make a 
        grant under this section to a State that has an 
        existing telehealth network that is or may be used for 
        improving stroke prevention, diagnosis, treatment, and 
        rehabilitation, or to a consortium located in such a 
        State, unless the State or consortium agrees that--
                    (A) the State or consortium will use an 
                existing telehealth network to achieve the 
                purpose of the grant; and
                    (B) the State or consortium will not 
                establish a separate network for such purpose.
    (e) Priority.--In selecting grant recipients under this 
section, the Secretary shall give priority to any applicant 
that submits a plan demonstrating how the applicant, and where 
applicable the members of the consortium described in 
subsection (d)(2), will use the grant to improve access to 
high-quality stroke care for populations with shortages of 
stroke-care specialists and populations with a high incidence 
of stroke.
    (f) Grant Period.--The Secretary may not award a grant to a 
State or a consortium under this section for any period that--
            (1) is greater than 3 years; or
            (2) extends beyond the end of fiscal year 2012.
    (g) Restriction on Number of Grants.--In carrying out the 
5-year pilot project under this section, the Secretary may not 
award more than 7 grants.
    (h) Application.--To seek a grant under this section, a 
State or a consortium of public and private entities shall 
submit an application to the Secretary in such form, in such 
manner, and containing such information as the Secretary may 
require. At a minimum, the Secretary shall require each such 
application to outline how the State or consortium will 
establish baseline measures and benchmarks to evaluate program 
outcomes.
    (i) Definition.--In this section, 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.
    (j) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section $10,000,000 for 
fiscal year 2008, $13,000,000 for fiscal year 2009, $15,000,000 
for fiscal year 2010, $8,000,000 for fiscal year 2011, and 
$4,000,000 for fiscal year 2012.

           *       *       *       *       *       *       *


Subpart III--Grants for Home Visiting Services for At-Risk Families

           *       *       *       *       *       *       *


  PART S--STROKE EDUCATION, INFORMATION, AND DATA COLLECTION PROGRAMS

SEC. 399FF. STROKE PREVENTION AND EDUCATION CAMPAIGN.

    (a) In General.--The Secretary shall carry out an education 
and information campaign to promote stroke prevention and 
increase the number of stroke patients who seek immediate 
treatment.
    (b) Authorized Activities.--In implementing the education 
and information campaign under subsection (a), the Secretary 
may--
            (1) make public service announcements about the 
        warning signs of stroke and the importance of treating 
        stroke as a medical emergency;
            (2) provide education regarding ways to prevent 
        stroke and the effectiveness of stroke treatment; and
            (3) carry out other activities that the Secretary 
        determines will promote prevention practices among the 
        general public and increase the number of stroke 
        patients who seek immediate care.
    (c) Measurements.--In implementing the education and 
information campaign under subsection (a), the Secretary 
shall--
            (1) measure public awareness before the start of 
        the campaign to provide baseline data that will be used 
        to evaluate the effectiveness of the public awareness 
        efforts;
            (2) establish quantitative benchmarks to measure 
        the impact of the campaign over time; and
            (3) measure the impact of the campaign not less 
        than once every 2 years or, if determined appropriate 
        by the Secretary, at shorter intervals.
    (d) No Duplication of Effort.--In carrying out this 
section, the Secretary shall avoid duplicating existing stroke 
education efforts by other Federal Government agencies.
    (e) Consultation.--In carrying out this section, the 
Secretary may consult with organizations and individuals with 
expertise in stroke prevention, diagnosis, treatment, and 
rehabilitation.

SEC. 399GG. PAUL COVERDELL NATIONAL ACUTE STROKE REGISTRY AND 
                    CLEARINGHOUSE.

    The Secretary, acting through the Centers for Disease 
Control and Prevention, shall maintain the Paul Coverdell 
National Acute Stroke Registry and Clearinghouse by--
            (1) continuing to develop and collect specific data 
        points and appropriate benchmarks for analyzing care of 
        acute stroke patients;
            (2) collecting, compiling, and disseminating 
        information on the achievements of, and problems 
        experienced by, State and local agencies and private 
        entities in developing and implementing emergency 
        medical systems and hospital-based quality of care 
        interventions; and
            (3) carrying out any other activities the Secretary 
        determines to be useful to maintain the Paul Coverdell 
        National Acute Stroke Registry and Clearinghouse to 
        reflect the latest advances in all forms of stroke 
        care.

SEC. 399HH. STROKE DEFINITION.

    For purposes of this part, 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.

SEC. 399II. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated to carry out this 
part $5,000,000 for each of fiscal years 2008 through 2012.

           *       *       *       *       *       *       *


TITLE XII--TRAUMA CARE

           *       *       *       *       *       *       *


                     Part E--Miscellaneous Programs

[SEC. 1251. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.

    [(a) In General.--The Secretary may make grants to public 
and nonprofit private entities for the purpose of planning and 
developing approved residency training programs in emergency 
medicine.
    [(b) Identification and Referral of Domestic Violence.--The 
Secretary may make a grant under subsection (a) only if the 
applicant involved agrees that training programs under 
subsection (a) will provide education and training in 
identifying and referring cases of domestic violence.
    [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there is authorized to be 
appropriated $400,000 for each of the fiscal years 1993 through 
1995.]

SEC. 1251. MEDICAL PROFESSIONAL DEVELOPMENT IN ADVANCED STROKE AND 
                    TRAUMATIC INJURY TREATMENT AND PREVENTION.

    (a) Residency and Other Professional Training.--The 
Secretary may make grants to public and nonprofit entities for 
the purpose of planning, developing, and enhancing approved 
residency training programs and other professional training for 
appropriate health professions in emergency medicine, including 
emergency medical services professionals, to improve stroke and 
traumatic injury prevention, diagnosis, treatment, and 
rehabilitation.
    (b) Continuing Education on Stroke and Traumatic Injury.--
            (1) Grants.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration, may make grants to qualified entities 
        for the development and implementation of education 
        programs for appropriate health care professionals in 
        the use of newly developed diagnostic approaches, 
        technologies, and therapies for health professionals 
        involved in the prevention, diagnosis, treatment, and 
        rehabilitation of stroke or traumatic injury.
            (2) Distribution of grants.--In awarding grants 
        under this subsection, the Secretary shall give 
        preference to qualified entities that will train health 
        care professionals that serve areas with a significant 
        incidence of stroke or traumatic injuries.
            (3) Application.--A qualified entity desiring a 
        grant under this subsection shall submit to the 
        Secretary an application at such time, in such manner, 
        and containing such information as the Secretary may 
        require, including a plan for the rigorous evaluation 
        of activities carried out with amounts received under 
        the grant.
            (4) Definitions.--For purposes of this subsection:
                    (A) The term ``qualified entity'' means a 
                consortium of public and private entities, such 
                as universities, academic medical centers, 
                hospitals, and emergency medical systems that 
                are coordinating education activities among 
                providers serving in a variety of medical 
                settings.
                    (B) 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) Report.--Not later than 1 year after the allocation of 
grants under this section, the Secretary shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives a report on the results of activities carried 
out with amounts received under this section.
    (d) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section $4,000,000 for 
each of fiscal years 2008 through 2012. The Secretary shall 
equitably allocate the funds authorized to be appropriated 
under this section between efforts to address stroke and 
efforts to address traumatic injury.

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