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113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     113-459

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



 
 TRAUMA SYSTEMS AND REGIONALIZATION OF EMERGENCY CARE REAUTHORIZATION 
                                  ACT

                                _______
                                

  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. 4080]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4080) to amend title XII of the Public Health 
Service Act to reauthorize certain trauma care programs, 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
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............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Duplication of Federal Programs..................................     6
Disclosure of Directed Rule Makings..............................     6
Advisory Committee 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............     6

                               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 ``Trauma Systems and Regionalization of 
Emergency Care Reauthorization Act''.

SEC. 2. REAUTHORIZATION OF CERTAIN TRAUMA CARE PROGRAMS.

  Section 1232(a) of the Public Health Service Act (42 U.S.C. 300d-
32(a)) is amended by striking ``2014'' and inserting ``2019''.

SEC. 3. IMPROVEMENTS AND CLARIFICATIONS TO CERTAIN TRAUMA CARE 
                    PROGRAMS.

  (a) Allocation of Funds for Competitive Grants for Regionalized 
Systems for Emergency Care Response.--Section 1232(c) of the Public 
Health Service Act (42 U.S.C. 300d-31(c)) is amended----
          (1) in paragraph (1), by striking ``and'' at the end;
          (2) in paragraph (2), by striking the period at the end and 
        inserting ``; and''; and
          (3) by adding at the end the following new paragraph:
          ``(3) for a fiscal year after fiscal year 2014, not more than 
        50 percent of such amounts remaining for such fiscal year after 
        application of paragraphs (1) and (2) shall be allocated for 
        the purpose of carrying out section 1204.''.
  (b) Clarifications Under Trauma Systems Formula Grants Requirements 
Relating to the American Burn Association.--Section 1213 of the Public 
Health Service Act (42 U.S.C. 300d-13) is amended----
          (1) in subsection (a)(3), by inserting ``and (for a fiscal 
        year after fiscal year 2014) contains national standards and 
        requirements of the American Burn Association for the 
        designation of verified burn centers,'' after ``such entity,'';
          (2) in subsection (b)(3)(A), by striking ``and the American 
        Academy of Pediatrics,'' and inserting ``the American Academy 
        of Pediatrics, and (for a fiscal year after fiscal year 2014) 
        the American Burn Association,''; and
          (3) in subsection (c)(1)----
                  (A) in the matter preceding subparagraph (A), by 
                inserting ``and not later than 1 year after the date of 
                the enactment of the Trauma Systems and Regionalization 
                of Emergency Care Reauthorization Act'' after ``Act of 
                2007''; and
                  (B) in subparagraph (A), by striking ``and the 
                American Academy of Pediatrics'' and inserting ``the 
                American Academy of Pediatrics, and (with respect to 
                the update pursuant to the Trauma Systems and 
                Regionalization of Emergency Care Reauthorization Act) 
                the American Burn Association''.
  (c) Conforming Amendments.--Part B of title XII of the Public Health 
Service Act is amended----
          (1) in section 1218(c)(2) (42 U.S.C. 300d-18(c)(2)), in the 
        matter preceding subparagraph (A), by striking ``1232(b)(3)'' 
        and inserting ``section 1232(b)''; and
          (2) in section 1222 (42 U.S.C. 300d-22), by striking 
        ``October 1, 2008'' and inserting ``October 1, 2016''.

                          Purpose and Summary

    H.R. 4080, ``Trauma Systems and Regionalization of 
Emergency Care Reauthorization Act'' was introduced on February 
25, 2014, by Rep. Michael Burgess (R-TX) and Rep. Gene Green 
(D-TX) and referred to the Committee on Energy and Commerce. 
The legislation would amend the Public Health Service Act 
(PHSA) to reauthorize certain trauma care programs and for 
other purposes.

                  Background and Need for Legislation

    Traumatic injury is the leading cause of death for those 
under the age of 45.\1\ The care received in the first hour or 
the ``golden hour'' after a traumatic injury presents the 
highest likelihood that the patient will survive.\2\ From 1990 
to 2005, 30 percent of trauma centers closed, leaving 45 
million Americans, including vulnerable populations, without 
access to rapid intervention after a traumatic injury. Without 
that immediate care, their survival rates decrease by 25 
percent.\3\
---------------------------------------------------------------------------
    \1\http://www.cdc.gov/traumacare/pdfs/
traumacentersfactsheet20090921-a.pdf.
    \2\https://www.oumedicine.com/oumedicalcenter/medical-services-and-
departments/trauma-one-center/what-is-the-golden-hour-.
    \3\http://www.cdc.gov/traumacare/pdfs/
traumacentersfactsheet20090921-a.pdf.
---------------------------------------------------------------------------
    A trauma system is an organized, coordinated effort in a 
defined geographic area that delivers the full range of care to 
injured patients. It provides resources, supporting equipment 
and personnel, along a continuum of care, including pre-
hospital, hospital, and rehabilitation services.\4\ While 
trauma centers are known for saving lives from shootings, car 
accidents, or mass casualty events, most injuries are caused by 
falls and occur among the elderly and children. Trauma centers 
are designed to treat different levels of injury and classified 
by levels ranging from level 1, which provides care to the most 
seriously injured, to level 5, for those with less serious 
injuries.\5\
---------------------------------------------------------------------------
    \4\http://www.nhtsa.gov/People/injury/ems/emstraumasystem03/
traumasystem.htm.
    \5\http://www.amtrauma.org/resources/trauma-categorization/
index.aspx.
---------------------------------------------------------------------------
    The bill would reauthorize Trauma Care Systems Planning 
Grants, which support State development of trauma systems. It 
also would reauthorize pilot projects to implement and assess 
the regionalized emergency care model, including grants for 
improving trauma care and access to high-quality trauma care.

                                Hearings

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

                        Committee Consideration

    On February 27, 2014, the Subcommittee on Health met in 
open markup session and favorably forwarded H.R. 4080 to the 
full Committee, as amended, by a voice vote. On April 3, 2014, 
the Energy and Commerce Committee met in open markup session 
and approved H.R. 4080, as amended, by unanimous consent.

                            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. 4080 reported. A motion by Mr. Upton to order H.R. 4080 
reported to the House, as amended, was agreed to by unanimous 
consent.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing and made 
findings that are reflected in this report.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(1) of rule XIII of the House of 
Representatives, the goal of the legislation is to reauthorize 
trauma and emergency care systems grants established in the 
(PHSA).

   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. 
4080 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, 
the Committee finds that H.R. 4080 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 16, 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. 4080, the Trauma 
Systems and Regionalization of Emergency Care Reauthorization 
Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                         Robert A. Sunshine
                              (For Douglas W. Elmendorf, Director).
    Enclosure.

H.R. 4080--Trauma Systems and Regionalization of Emergency Care 
        Reauthorization Act

    Summary: H.R. 4080 would amend the Public Health Service 
Act to authorize funding for public and private entities that 
provide trauma and emergency care services and for the 
administration of the Federal Interagency Committee on 
Emergency Medical Services (FICEMS).
    The bill would authorize the appropriation of $24 million a 
year for each of fiscal years 2015 through 2019. CBO estimates 
that implementing the bill would cost $101 million over the 
2015-2019 period, assuming appropriation of the authorized 
amounts. Pay-as-you-go procedures do not apply to this 
legislation because it would not affect direct spending or 
revenues.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 4080 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                By fiscal year, in millions of dollars----
                                                         -------------------------------------------------------
                                                            2015     2016     2017     2018     2019   2015-2019
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level.....................................       24       24       24       24       24       120
Estimated Outlays.......................................       10       21       23       23       24       101
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that H.R. 
4080 will be enacted before the end of fiscal year 2014, that 
the Congress will appropriate the authorized amounts, and that 
spending will follow historical patterns for similar programs. 
In fiscal year 2014, no funds were appropriated for the 
programs that would be authorized by this bill.
    H.R. 4080 would authorize the appropriation of $24 million 
a year for 2015 through 2019 for public and private entities 
that provide trauma and emergency care services and for the 
administration of FICEMS. The bill also would require states 
that receive grant aid to comply with national standards and 
requirements for designating verified burn centers. Finally, 
the bill would require the Secretary of Health and Human 
Services to submit a report to the Congress on federal and 
state activities associated with trauma and emergency care 
services.
    Based on historical patterns of spending for similar 
activities, CBO estimates that implementing the bill would cost 
$101 million over the 2015-2019 period, assuming appropriation 
of the specified amounts.
    Pay-As-You-Go considerations: None.
    Intergovernmental and private-sector impact: H.R. 4080 
contains no intergovernmental or private-sector mandates as 
defined in UMRA.
    Estimate prepared by: Federal Costs: Lisa Ramirez-Branum; 
Impact on state, local, and tribal governments: J'nell L. 
Blanco; Impact on the private sector: Alexia Diorio.
    Estimate 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. 4080 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. 4080 would not 
specifically direct 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 provides the short title of ``Trauma Systems and 
Regionalization of Emergency Care Reauthorization Act.''

Section 2. Reauthorization of certain trauma care programs

    Section 2 would amend Section 1232(a) of the PHSA by 
striking ``2014'' and inserting ``2019''.

Section 3. Improvements and clarifications to certain trauma care 
        programs

    Section 3 would amend Section 1232(c) of the PHSA to 
clarify the division of remaining funds and for States to 
consider the national standards of the American Burn 
Association for the designation of verified burn centers in 
their plan for the provision of emergency medical services.

         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 XII--TRAUMA CARE

           *       *       *       *       *       *       *



Part B--Formula Grants With Respect to Modifications of State Plans

           *       *       *       *       *       *       *



SEC. 1213. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF 
                    ALLOTMENTS.

  (a) Trauma Care Modifications to State Plan for Emergency 
Medical Services.--With respect to the trauma care component of 
a State plan for the provision of emergency medical services, 
the modifications referred to in section 1211(b) are such 
modifications to the State plan as may be necessary for the 
State involved to ensure that the plan provides for access to 
the highest possible quality of trauma care, and that the 
plan--
          (1) * * *

           *       *       *       *       *       *       *

          (3) subject to subsection (b), contains national 
        standards and requirements of the American College of 
        Surgeons or another appropriate entity for the 
        designation of level I and level II trauma centers, and 
        in the case of rural areas level III trauma centers 
        (including trauma centers with specified capabilities 
        and expertise in the care of pediatric trauma 
        patients), by such entity, and (for a fiscal year after 
        fiscal year 2014) contains national standards and 
        requirements of the American Burn Association for the 
        designation of verified burn centers, including 
        standards and requirements for--
                  (A) * * *

           *       *       *       *       *       *       *

  (b) Certain Standards With Respect to Trauma Care Centers and 
Systems.--
          (1) * * *

           *       *       *       *       *       *       *

          (3) Approval by the secretary.-- The Secretary may 
        not make payments under section 1211(a) to a State if 
        the Secretary determines that--
                  (A) in the case of payments for fiscal year 
                2008 and subsequent fiscal years, the State has 
                not taken into account national standards, 
                including those of the American College of 
                Surgeons, the American College of Emergency 
                Physicians, [and the American Academy of 
                Pediatrics,] the American Academy of 
                Pediatrics, and (for a fiscal year after fiscal 
                year 2014) the American Burn Association, in 
                adopting standards under this subsection; or

           *       *       *       *       *       *       *

  (c) Model Trauma Care Plan.--
          (1) In general.-- Not later than 1 year after the 
        date of the enactment of the Trauma Care Systems 
        Planning and Development Act of 2007 and not later than 
        1 year after the date of the enactment of the Trauma 
        Systems and Regionalization of Emergency Care 
        Reauthorization Act, the Secretary shall update the 
        model plan for the designation of trauma centers and 
        for triage, transfer, and transportation policies that 
        may be adopted for guidance by the State. Such plan 
        shall--
                  (A) take into account national standards, 
                including those of the American College of 
                Surgeons, American College of Emergency 
                Physicians, [and the American Academy of 
                Pediatrics] the American Academy of Pediatrics, 
                and (with respect to the update pursuant to the 
                Trauma Systems and Regionalization of Emergency 
                Care Reauthorization Act) the American Burn 
                Association;

           *       *       *       *       *       *       *


SEC. 1218. DETERMINATION OF AMOUNT OF ALLOTMENT.

  (a) * * *

           *       *       *       *       *       *       *

  (c) Disposition of Certain Funds Appropriated for 
Allotments.--
          (1) * * *
          (2) Type of amounts.--The amounts referred to in 
        paragraph (1) are any amounts made available pursuant 
        to [1232(b)(3)] section 1232(b) that are not paid under 
        section 1211(a) to a State as a result of--
                  (A) * * *

           *       *       *       *       *       *       *


SEC. 1222. REPORT BY SECRETARY.

  Not later than [October 1, 2008] October 1, 2016, the 
Secretary shall report to the appropriate committees of 
Congress on the activities of the States carried out pursuant 
to section 1211. Such report shall include an assessment of the 
extent to which Federal and State efforts to develop systems of 
trauma care and to designate trauma centers have reduced the 
incidence of mortality, and the incidence of permanent 
disability, resulting from trauma. Such report may include any 
recommendations of the Secretary for appropriate administrative 
and legislative initiatives with respect to trauma care.

Part C--General Provisions Regarding Parts A and B

           *       *       *       *       *       *       *



SEC. 1232. FUNDING.

  (a) Authorization of Appropriations.--For the purpose of 
carrying out parts A and B, subject to subsections (b) and (c), 
there are authorized to be appropriated $24,000,000 for each of 
fiscal years 2010 through [2014] 2019.

           *       *       *       *       *       *       *

  (c) Allocation of Part A Funds.--Of the amounts appropriated 
under subsection (a) for a fiscal year to carry out part A--
          (1) 10 percent of such amounts for such year shall be 
        allocated for administrative purposes; [and]
          (2) 10 percent of such amounts for such year shall be 
        allocated for the purpose of carrying out section 
        1202[.]; and
          (3) for a fiscal year after fiscal year 2014, not 
        more than 50 percent of such amounts remaining for such 
        fiscal year after application of paragraphs (1) and (2) 
        shall be allocated for the purpose of carrying out 
        section 1204.

           *       *       *       *       *       *       *