[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 727 Introduced in House (IH)]
110th CONGRESS
1st Session
H. R. 727
To amend the Public Health Service Act to add requirements regarding
trauma care, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 30, 2007
Mr. Gene Green of Texas (for himself and Mr. Burgess) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to add requirements regarding
trauma care, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Trauma Care Systems Planning and
Development Act of 2007''.
SEC. 2. ESTABLISHMENT.
Section 1201 of the Public Health Service Act (42 U.S.C. 300d) is
amended to read as follows:
``SEC. 1201. ESTABLISHMENT.
``(a) In General.--The Secretary shall, with respect to trauma
care--
``(1) conduct and support research, training, evaluations,
and demonstration projects;
``(2) foster the development of appropriate, modern systems
of such care through the sharing of information among agencies
and individuals involved in the study and provision of such
care;
``(3) collect, compile, and disseminate information on the
achievements of, and problems experienced by, State and local
agencies and private entities in providing trauma care and
emergency medical services and, in so doing, give special
consideration to the unique needs of rural areas;
``(4) provide to State and local agencies technical
assistance to enhance each State's capability to develop,
implement, and sustain the trauma care component of each
State's plan for the provision of emergency medical services;
``(5) sponsor workshops and conferences; and
``(6) promote the collection and categorization of trauma
data in a consistent and standardized manner.
``(b) Grants, Cooperative Agreements, and Contracts.--The Secretary
may make grants, and enter into cooperative agreements and contracts,
for the purpose of carrying out subsection (a).''.
SEC. 3. CLEARINGHOUSE ON TRAUMA CARE AND EMERGENCY MEDICAL SERVICES.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended--
(1) by striking section 1202; and
(2) by redesignating section 1203 as section 1202.
SEC. 4. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN RURAL
AREAS.
Section 1202 of the Public Health Service Act, as redesignated by
section 3(2), is amended to read as follows:
``SEC. 1202. ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN
RURAL AREAS.
``(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of carrying out research and
demonstration projects with respect to improving the availability and
quality of emergency medical services in rural areas--
``(1) by developing innovative uses of communications
technologies and the use of new communications technology;
``(2) by developing model curricula, such as advanced
trauma life support, for training emergency medical services
personnel, including first responders, emergency medical
technicians, emergency nurses and physicians, and paramedics--
``(A) in the assessment, stabilization, treatment,
preparation for transport, and resuscitation of
seriously injured patients, with special attention to
problems that arise during long transports and to
methods of minimizing delays in transport to the
appropriate facility; and
``(B) in the management of the operation of the
emergency medical services system;
``(3) by making training for original certification, and
continuing education, in the provision and management of
emergency medical services more accessible to emergency medical
personnel in rural areas through telecommunications, home
studies, providing teachers and training at locations
accessible to such personnel, and other methods;
``(4) by developing innovative protocols and agreements to
increase access to prehospital care and equipment necessary for
the transportation of seriously injured patients to the
appropriate facilities;
``(5) by evaluating the effectiveness of protocols with
respect to emergency medical services and systems; and
``(6) by increasing communication and coordination with
State trauma systems.
``(b) Special Consideration for Certain Rural Areas.--In making
grants under subsection (a), the Secretary shall give special
consideration to any applicant for the grant that will provide services
under the grant in any rural area identified by a State under section
1214(d)(1).
``(c) Requirement of Application.--The Secretary may not make a
grant under subsection (a) unless 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.''.
SEC. 5. COMPETITIVE GRANTS.
Part A of title XII of the Public Health Service Act, as amended by
section 3, is amended by adding at the end the following:
``SEC. 1203. COMPETITIVE GRANTS FOR THE IMPROVEMENT OF TRAUMA CARE.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, may make grants to
States, political subdivisions, or consortia of States or political
subdivisions for the purpose of improving access to and enhancing the
development of trauma care systems.
``(b) Use of Funds.--The Secretary may make a grant under this
section only if the applicant agrees to use the grant--
``(1) to integrate and broaden the reach of a trauma care
system, such as by developing innovative protocols to increase
access to prehospital care;
``(2) to strengthen, develop, and improve an existing
trauma care system;
``(3) to expand communications between the trauma care
system and emergency medical services through improved
equipment or a telemedicine system;
``(4) to improve data collection and retention; or
``(5) to increase education, training, and technical
assistance opportunities, such as training and continuing
education in the management of emergency medical services
accessible to emergency medical personnel in rural areas
through telehealth, home studies, and other methods.
``(c) Preference.--In selecting among States, political
subdivisions, and consortia of States or political subdivisions for
purposes of making grants under this section, the Secretary shall give
preference to applicants that--
``(1) have developed a process, using national standards,
for designating trauma centers;
``(2) recognize protocols for the delivery of seriously
injured patients to trauma centers;
``(3) implement a process for evaluating the performance of
the trauma system; and
``(4) agree to participate in information systems described
in section 1202 by collecting, providing, and sharing
information.
``(d) Priority.--In making grants under this section, the Secretary
shall give priority to applicants that will use the grants to focus on
improving access to trauma care systems.
``(e) Special Consideration.--In awarding grants under this
section, the Secretary shall give special consideration to projects
that demonstrate strong State or local support, including availability
of non-Federal contributions.''.
SEC. 6. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT TO
FIRST FISCAL YEAR OF PAYMENTS.
Section 1212 of the Public Health Service Act (42 U.S.C. 300d-12)
is amended to read as follows:
``SEC. 1212. REQUIREMENT OF MATCHING FUNDS FOR FISCAL YEARS SUBSEQUENT
TO FIRST FISCAL YEAR OF PAYMENTS.
``(a) Non-Federal Contributions.--
``(1) In general.--The Secretary may not make payments
under section 1211(a) unless the State involved agrees, with
respect to the costs described in paragraph (2), to make
available non-Federal contributions (in cash or in kind under
subsection (b)(1)) toward such costs in an amount that--
``(A) for the second and third fiscal years of such
payments to the State, is not less than $1 for each $1
of Federal funds provided in such payments for such
fiscal years; and
``(B) for the fourth and subsequent fiscal years of
such payments to the State, is not less than $2 for
each $1 of Federal funds provided in such payments for
such fiscal years.
The Secretary may not require any non-Federal contributions for
the first fiscal year of such payments to the State.
``(2) Program costs.--The costs referred to in paragraph
(1) are--
``(A) the costs to be incurred by the State in
carrying out the purpose described in section 1211(b);
or
``(B) the costs of improving the quality and
availability of emergency medical services in rural
areas of the State.
``(3) Initial year of payments.--The Secretary may not
require a State to make non-Federal contributions as a
condition of receiving payments under section 1211(a) for the
first fiscal year of such payments to the State.
``(b) Determination of Amount of Non-Federal Contribution.--With
respect to compliance with subsection (a) as a condition of receiving
payments under section 1211(a)--
``(1) a State may make the non-Federal contributions
required in such subsection in cash or in kind, fairly
evaluated, including plant, equipment, or services; and
``(2) the Secretary may not, in making a determination of
the amount of non-Federal contributions, include amounts
provided by the Federal Government or services assisted or
subsidized to any significant extent by the Federal
Government.''.
SEC. 7. REQUIREMENTS WITH RESPECT TO CARRYING OUT PURPOSE OF
ALLOTMENTS.
Section 1213 of the Public Health Service Act (42 U.S.C. 300d-13)
is amended to read as follows:
``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) specifies that the modifications required pursuant to
paragraphs (2) through (11) will be implemented by the
principal State agency with respect to emergency medical
services or by the designee of such agency;
``(2) specifies a public or private entity that will
designate trauma care regions and trauma centers in the State;
``(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 patient), by such entity, including standards and
requirements for--
``(A) the number and types of trauma patients for
whom such centers must provide care in order to ensure
that such centers will have sufficient experience and
expertise to be able to provide quality care for
victims of injury;
``(B) the resources and equipment needed by such
centers; and
``(C) the availability of rehabilitation services
for trauma patients;
``(4) contains standards and requirements for the
implementation of regional trauma care systems, including
standards and guidelines (consistent with the provisions of
section 1867 of the Social Security Act) for medically directed
triage and transportation of trauma patients (including
patients injured in rural areas) prior to care in designated
trauma centers;
``(5) subject to subsection (b), contains national
standards and requirements, including those of the American
Academy of Pediatrics and the American College of Emergency
Physicians, for medically directed triage and transport of
severely injured children to designated trauma centers with
specified capabilities and expertise in the care of the
pediatric trauma patient;
``(6) utilizes a program with procedures for the evaluation
of designated trauma centers (including trauma centers
described in paragraph (5)) and trauma care systems;
``(7) provides for the establishment and collection of data
in accordance with data collection requirements developed in
consultation with surgical, medical, and nursing specialty
groups, State and local emergency medical services directors,
and other trained professionals in trauma care, from each
designated trauma center in the State of a central data
reporting and analysis system--
``(A) to identify the number of severely injured
trauma patients and the number of deaths from trauma
within trauma care systems in the State;
``(B) to identify the cause of the injury and any
factors contributing to the injury;
``(C) to identify the nature and severity of the
injury;
``(D) to monitor trauma patient care (including
prehospital care) in each designated trauma center
within regional trauma care systems in the State
(including relevant emergency-department discharges and
rehabilitation information) for the purpose of
evaluating the diagnosis, treatment, and treatment
outcome of such trauma patients;
``(E) to identify the total amount of uncompensated
trauma care expenditures for each fiscal year by each
designated trauma center in the State; and
``(F) to identify patients transferred within a
regional trauma system, including reasons for such
transfer and the outcomes of such patients;
``(8) provides for the use of procedures by paramedics and
emergency medical technicians to assess the severity of the
injuries incurred by trauma patients;
``(9) provides for appropriate transportation and transfer
policies to ensure the delivery of patients to designated
trauma centers and other facilities within and outside of the
jurisdiction of such system, including policies to ensure that
only individuals appropriately identified as trauma patients
are transferred to designated trauma centers, and to provide
periodic reviews of the transfers and the auditing of such
transfers that are determined to be appropriate;
``(10) conducts public education activities concerning
injury prevention and obtaining access to trauma care;
``(11) coordinates planning for trauma systems with State
disaster emergency planning and bioterrorism hospital
preparedness planning; and
``(12) with respect to the requirements established in this
subsection, provides for coordination and cooperation between
the State and any other State with which the State shares any
standard metropolitan statistical area.
``(b) Certain Standards With Respect to Trauma Care Centers and
Systems.--
``(1) In general.--The Secretary may not make payments
under section 1211(a) for a fiscal year unless the State
involved agrees that, in carrying out paragraphs (3) through
(5) of subsection (a), the State will adopt standards for the
designation of trauma centers, and for triage, transfer, and
transportation policies, and that the State will, in adopting
such standards--
``(A) take into account national standards
concerning that outline resources for optimal care of
the injured patient;
``(B) consult with medical, surgical, and nursing
speciality groups, hospital associations, emergency
medical services State and local directors, concerned
advocates and other interested parties;
``(C) conduct hearings on the proposed standards
after providing adequate notice to the public
concerning such hearing; and
``(D) beginning in fiscal year 2007, take into
account the model plan described in subsection (c).
``(2) Quality of trauma care.--The highest quality of
trauma care shall be the primary goal of State standards
adopted under this subsection.
``(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, in adopting standards under this
subsection; or
``(B) in the case of payments for fiscal year 2008
and subsequent fiscal years, the State has not, in
adopting such standards, taken into account the model
plan developed under subsection (c).
``(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, 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;
``(B) take into account existing State plans;
``(C) be developed in consultation with medical,
surgical, and nursing speciality groups, hospital
associations, emergency medical services State
directors and associations, and other interested
parties; and
``(D) include standards for the designation of
rural health facilities and hospitals best able to
receive, stabilize, and transfer trauma patients to the
nearest appropriate designated trauma center, and for
triage, transfer, and transportation policies as they
relate to rural areas.
``(2) Applicability.--Standards described in paragraph
(1)(D) shall be applicable to all rural areas in the State,
including both non-metropolitan areas and frontier areas that
have populations of less than 6,000 per square mile.
``(d) Rule of Construction With Respect to Number of Designated
Trauma Centers.--With respect to compliance with subsection (a) as a
condition of the receipt of a grant under section 1211(a), such
subsection may not be construed to specify the number of trauma care
centers designated pursuant to such subsection.''.
SEC. 8. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND
CERTAIN INFORMATION.
Section 1214 of the Public Health Service Act (42 U.S.C. 300d-14)
is amended to read as follows:
``SEC. 1214. REQUIREMENT OF SUBMISSION TO SECRETARY OF TRAUMA PLAN AND
CERTAIN INFORMATION.
``(a) In General.--For each fiscal year, the Secretary may not make
payments to a State under section 1211(a) unless, subject to subsection
(b), the State submits to the Secretary the trauma care component of
the State plan for the provision of emergency medical services,
including any changes to the trauma care component and any plans to
address deficiencies in the trauma care component.
``(b) Interim Plan or Description of Efforts.--For each fiscal
year, if a State has not completed the trauma care component of the
State plan described in subsection (a), the State may provide, in lieu
of such completed component, an interim component or a description of
efforts made toward the completion of the component.
``(c) Information Received by State Reporting and Analysis
System.--The Secretary may not make payments to a State under section
1211(a) unless the State agrees that the State will, not less than once
each year, provide to the Secretary the information received by the
State pursuant to section 1213(a)(7).
``(d) Availability of Emergency Medical Services in Rural Areas.--
The Secretary may not make payments to a State under section 1211(a)
unless--
``(1) the State identifies any rural area in the State for
which--
``(A) there is no system of access to emergency
medical services through the telephone number 911;
``(B) there is no basic life-support system; or
``(C) there is no advanced life-support system; and
``(2) the State submits to the Secretary a list of rural
areas identified pursuant to subparagraph (A) or, if there are
no such areas, a statement that there are no such areas.''.
SEC. 9. RESTRICTIONS ON USE OF PAYMENTS.
Section 1215 of the Public Health Service Act (42 U.S.C. 300d-15)
is amended to read as follows:
``SEC. 1215. RESTRICTIONS ON USE OF PAYMENTS.
``(a) In General.--The Secretary may not, except as provided in
subsection (b), make payments under section 1211(a) for a fiscal year
unless the State involved agrees that the payments will not be
expended--
``(1) for any purpose other than developing, implementing,
and monitoring the modifications required by section 1211(b) to
be made to the State plan for the provision of emergency
medical services;
``(2) to make cash payments to intended recipients of
services provided pursuant to this section;
``(3) to purchase or improve real property (other than
minor remodeling of existing improvements to real property);
``(4) to satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of Federal
funds; or
``(5) to provide financial assistance to any entity other
than a public or nonprofit private entity.
``(b) Waiver.--The Secretary may waive a restriction under
subsection (a) only if the Secretary determines that the activities
outlined by the State plan submitted under section 1214(a)(1) by the
State involved cannot otherwise be carried out.''.
SEC. 10. REQUIREMENTS OF REPORTS BY STATES.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
striking section 1216.
SEC. 11. REPORT BY SECRETARY.
Section 1222 of the Public Health Service Act (42 U.S.C. 300d-22)
is amended to read as follows:
``SEC. 1222. REPORT BY SECRETARY.
``Not later than October 1, 2008, 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.''.
SEC. 12. FUNDING.
Section 1232 of the Public Health Service Act (42 U.S.C. 300d-32)
is amended to read as follows:
``SEC. 1232. FUNDING.
``(a) Authorization of Appropriations.--For the purpose of carrying
out parts A and B, there are authorized to be appropriated $12,000,000
for fiscal year 2008, $10,000,000 for fiscal year 2009, and $8,000,000
for each of the fiscal years 2010 through 2012.
``(b) Reservation of Funds.--If the amount appropriated under
subsection (a) for a fiscal year is equal to or less than $1,000,000,
such appropriation is available only for making grants under part A. If
the amount so appropriated is greater than $1,000,000, 50 percent of
such appropriation shall be made available for grants under part A and
50 percent shall be made available for grants under part B.
``(c) Allocation of Funds by Secretary.--
``(1) General authority.--For the purpose of carrying out
part A, the Secretary shall make available 10 percent of the
amounts appropriated for a fiscal year under subsection (a).
``(2) Rural grants.--For the purpose of carrying out
section 1202, the Secretary shall make available 10 percent of
the amounts appropriated for a fiscal year under subsection
(a).''.
SEC. 13. INSTITUTE OF MEDICINE STUDY.
Part E of title XII of the Public Health Service Act (20 U.S.C.
300d-51 et seq.) is amended by adding at the end the following:
``SEC. 1254. INSTITUTE OF MEDICINE STUDY.
``(a) In General.--The Secretary shall enter into a contract with
the Institute of Medicine of the National Academy of Sciences, or
another appropriate entity, to conduct a study on the state of trauma
care and trauma research.
``(b) Content.--The study conducted under subsection (a) shall--
``(1) examine and evaluate the state of trauma care and
trauma systems research (including the role of Federal entities
in trauma research) on the date of enactment of this section,
and identify trauma research priorities;
``(2) examine and evaluate the clinical effectiveness of
trauma care and the impact of trauma care on patient outcomes,
with special attention to high-risk groups, such as children,
the elderly, and individuals in rural areas;
``(3) examine and evaluate trauma systems development and
identify obstacles that prevent or hinder the effectiveness of
trauma systems and trauma systems development;
``(4) examine and evaluate alternative strategies for the
organization, financing, and delivery of trauma care within an
overall systems approach; and
``(5) examine and evaluate the role of trauma systems and
trauma centers in preparedness for mass casualties.
``(c) Report.--Not later than 2 years after the date of enactment
of this section, the Secretary shall submit to the appropriate
committees of Congress a report containing the results of the study
conducted under this section.
``(d) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $750,000 for fiscal year
2008.''.
SEC. 14. RESIDENCY TRAINING PROGRAMS IN EMERGENCY MEDICINE.
Section 1251 of the Public Health Service Act (42 U.S.C. 300d-51)
is amended to read as follows:
``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 in the applicant
involved agrees that the 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 2008 though 2012.''.
SEC. 15. STATE GRANTS FOR CERTAIN PROJECTS.
Section 1252 of the Public Health Service Act (42 U.S.C. 300d-52)
is amended in the section heading by striking ``demonstration''.
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