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113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     113-458

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



 
                   IMPROVING TRAUMA CARE ACT OF 2014

                                _______
                                

  May 20, 2014.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 3548]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3548) to amend title XII of the Public Health 
Service Act to expand the definition of trauma to include 
thermal, electrical, chemical, radioactive, and other extrinsic 
agents, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     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
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     4
Duplication of Federal Programs..................................     4
Disclosure of Directed Rule Makings..............................     5
Advisory Committee Statement.....................................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill, as Reported............     5

                               Amendment

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Improving Trauma Care Act of 2014''.

SEC. 2. TRAUMA DEFINITION.

  (a) Revised Definition Under Trauma Systems Grants Programs.--
Paragraph (4) of section 1231 of the Public Health Service Act (42 
U.S.C. 300d-31) is amended to read as follows:
          ``(4) Trauma.--The term `trauma' means an injury resulting 
        from exposure to--
                  ``(A) a mechanical force; or
                  ``(B) another extrinsic agent, including an extrinsic 
                agent that is thermal, electrical, chemical, or 
                radioactive.''.
  (b) Revised Definition Under Interagency Program for Trauma 
Research.--Paragraph (3) of section 1261(h) of the Public Health 
Service Act (42 U.S.C. 300d-61(h)) is amended to read as follows:
          ``(3) The term `trauma' means an injury resulting from 
        exposure to--
                  ``(A) a mechanical force; or
                  ``(B) another extrinsic agent, including an extrinsic 
                agent that is thermal, electrical, chemical, or 
                radioactive.''.

                          Purpose and Summary

    H.R. 3548, Improving Trauma Care Act, would amend the 
Public Health Service Act to improve the definition of trauma 
in Title 42, United States Code, section 300d-31(4) and section 
300d-61(h)(3) by including injuries caused by thermal, 
electrical, chemical, or radioactive force. These injuries 
commonly are treated by burn centers. Clarifying the definition 
of ``trauma'' to make it clear that ``trauma'' includes burn 
injuries would allow burn centers to compete for trauma care 
center grants under applicable Federal programs.

                  Background and Need for Legislation

    Traumatic injuries are understood to include a variety of 
circumstances including, crash, gunshot, and burn injuries. The 
current system contains inconsistencies in the definition of 
what constitutes ``trauma'' and fails to describe the full 
range of ``traumatic'' injuries, which can result in gaps in 
coverage and provision in care.
    Although burn injuries should fall under the definition of 
trauma, this is not currently the case. Title 42, United States 
Code, section 300d-31(4), defines ``trauma'' as an ``injury 
resulting from exposure to a mechanical force.'' A burn does 
not fall into this definition. The issue is further complicated 
by a second definition of ``trauma'' in 42 United States Code, 
section 300d-61(h)(3), which states that the term ``trauma'' 
means ``any serious injury that could result in loss of life or 
in significant disability and that would meet pre-hospital 
triage criteria for transport to a designated trauma center.'' 
Some burns fall under this definition, but the more specific 
definition in section 300d-31(4) makes it unclear whether they 
all do.\1\
---------------------------------------------------------------------------
    \1\http://www.ameriburn.org/.
---------------------------------------------------------------------------
    The definition must be modernized to accurately reflect the 
medical reality of trauma

                                Hearings

    The Subcommittee on Health held no hearings on H.R. 3548.

                        Committee Consideration

    On February 27, 2014, the Subcommittee on Health met in 
open markup session and favorably forwarded H.R. 3548 to the 
full Committee, as amended, by a voice vote.
    On April 3, 2014, the Committee on Energy and Commerce met 
in open markup session and approved H.R. 3548, as amended, by a 
voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 3548 reported. A motion by Mr. Upton to order H.R. 3548 
reported to the House, was agreed to by a voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
hearing on this legislation.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the goal of this legislation is to 
amend the Public Health Service Act to improve the definition 
of trauma in Title 42, United States Code, section 300d-31(4) 
and section 300d-61(h)(3) by including injuries caused by 
thermal, electrical, chemical, or radioactive force.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
3548 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the Rules of the House of Representatives, the Committee 
finds that H.R. 3548 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                        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, April 15, 2014.
Hon. Fred Upton,
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. 3548, the 
Improving Trauma Care Act of 2013.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                          Peter H. Fontaine
                              (For Douglas W. Elmendorf, Director).
    Enclosure.

H.R. 3548--Improving Trauma Care Act of 2013

    H.R. 3548 would amend the Public Health Service Act to 
revise the definition of trauma as it applies to grants and 
activities authorized to provide support for trauma and 
emergency care. Under current law, the definition of trauma 
means an injury resulting from exposure to a mechanical force. 
The bill would expand the definition of trauma to also include 
an injury resulting from exposure to an extrinsic agent that is 
thermal, electrical, chemical, or radioactive.
    CBO estimates that implementing the legislation would have 
no significant effect on the federal budget. Enacting H.R. 3548 
would not affect direct spending or revenues; therefore, pay-
as-you-go procedures do not apply.
    The bill would not impose intergovernmental or private-
sector mandates as defined in the Unfunded Mandates Reform Act 
and would impose no costs on state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Lisa Ramirez-
Branum. The estimate was approved by Holly Harvey, 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.

                    Duplication of Federal Programs

    No provision of H.R. 3548 establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                  Disclosure of Directed Rule Makings

    The Committee estimates that enacting H.R. 3548 would not 
specifically direct to be completed a rulemaking within the 
meaning of 5 U.S.C. 551.

                      Advisory Committee Statement

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

                  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 of the legislation cites the bill as the 
``Improving Trauma Care Act of 2013.''

Section 2. Trauma definition

    Section 2 would revise the definition under the Trauma 
Systems Grant Programs and under Interagency Program for Trauma 
Research to define trauma as ``an injury resulting from 
exposure to a mechanical force; or another extrinsic agent, 
including an extrinsic agent that is thermal, electrical, 
chemical, or radioactive.''

         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):

FEDERAL HOME LOAN BANK ACT

           *       *       *       *       *       *       *



             eligibility of members and nonmember borrowers

  Sec. 4. (a) Criteria for Eligibility.--
          (1) * * *

           *       *       *       *       *       *       *

          (5) Certain privately insured credit unions.--
                  (A) In general.--Subject to the requirements 
                of subparagraph (B), a credit union shall be 
                treated as an insured depository institution 
                for purposes of determining the eligibility of 
                such credit union for membership in a Federal 
                home loan bank under paragraphs (1), (2), and 
                (3).
                  (B) Certification by appropriate 
                supervisor.--
                          (i) In general.--For purposes of this 
                        paragraph and subject to clause (ii), a 
                        credit union which lacks Federal 
                        deposit insurance and which has applied 
                        for membership in a Federal home loan 
                        bank may be treated as meeting all the 
                        eligibility requirements for Federal 
                        deposit insurance only if the 
                        appropriate supervisor of the State in 
                        which the credit union is chartered has 
                        determined that the credit union meets 
                        all the eligibility requirements for 
                        Federal deposit insurance as of the 
                        date of the application for membership.
                          (ii) Certification deemed valid.--If, 
                        in the case of any credit union to 
                        which clause (i) applies, the 
                        appropriate supervisor of the State in 
                        which such credit union is chartered 
                        fails to make a determination pursuant 
                        to such clause by the end of the 6-
                        month period beginning on the date of 
                        the application, the credit union shall 
                        be deemed to have met the requirements 
                        of clause (i).
                  (C) Security interests of federal home loan 
                bank not avoidable.--Notwithstanding any 
                provision of State law authorizing a 
                conservator or liquidating agent of a credit 
                union to repudiate contracts, no such provision 
                shall apply with respect to--
                          (i) any extension of credit from any 
                        Federal home loan bank to any credit 
                        union which is a member of any such 
                        bank pursuant to this paragraph; or
                          (ii) any security interest in the 
                        assets of such credit union securing 
                        any such extension of credit.
                  (D) Conditions on advances.--Before making an 
                advance pursuant to section 10 to a credit 
                union which lacks Federal deposit insurance, a 
                Bank shall--
                          (i) determine the concentration risk 
                        exposure of the Bank to such a credit 
                        union, including all advances of the 
                        Bank to other such credit unions;
                          (ii) ensure that the advance will not 
                        result in a significant risk of 
                        insolvency to the Bank; and
                          (iii) ensure that the Bank--
                                  (I) has sufficient reserves 
                                to withstand any potential 
                                losses of making such advance;
                                  (II) has priority over the 
                                claims and rights of the State 
                                in which the credit union is 
                                chartered or a conservator or a 
                                liquidating agent of the credit 
                                union; and
                                  (III) has secure access to 
                                the collateral obtained from 
                                such credit union in the event 
                                of material financial distress 
                                or failure of such credit 
                                union.

           *       *       *       *       *       *       *

                              ----------                              


FEDERAL DEPOSIT INSURANCE ACT

           *       *       *       *       *       *       *


SEC. 43. DEPOSITORY INSTITUTIONS LACKING FEDERAL DEPOSIT INSURANCE.

  (a) Annual Independent Audit of Private Deposit Insurers.--
          (1) * * *
          (2) Providing copies of audit report.--
                  (A) Private deposit insurer.--The private 
                deposit insurer shall provide a copy of the 
                audit report--
                          (i) to each depository institution 
                        the deposits of which are insured by 
                        the private deposit insurer, not later 
                        than 14 days after the audit is 
                        completed; [and]
                          (ii) to the appropriate supervisory 
                        agency of each State in which such an 
                        institution receives deposits, not 
                        later than 7 days after the audit is 
                        completed[.];
                          (iii) in the case of depository 
                        institutions described in subsection 
                        (e)(2)(A) the deposits of which are 
                        insured by the private insurer which 
                        are members of a Federal home loan 
                        bank, to the Federal Housing Finance 
                        Agency, not later than 7 days after the 
                        audit is completed.

           *       *       *       *       *       *       *