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108th CONGRESS
2d Session
H. R. 3999
To amend the Public Health Service Act with respect to trauma care, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 18, 2004
Mr. Greenwood (for himself, Mr. Green of Texas, Mr. Bilirakis, and Mr.
Brown of Ohio) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act with respect to 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 Research and Access to Urgent
Medical Attention Act of 2004'' or the ``TRAUMA Act of 2004''.
SEC. 2. AMENDMENT TO TITLE XII OF PUBLIC HEALTH SERVICE ACT.
Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.)
is amended--
(1) by striking part D; and
(2) by amending parts A, B, and C to read as follows:
``PART A--GENERAL AUTHORITY
``SEC. 1201. GENERAL AUTHORITY AND DUTIES OF THE SECRETARY.
``(a) In General.--The Secretary may, with respect to trauma care--
``(1) conduct and support research, training, evaluations,
and demonstration projects;
``(2) foster the development of appropriate, modern systems
of trauma care through the sharing of information among
agencies and individuals involved in the study and provision of
such care;
``(3) provide to State and local agencies technical
assistance, including the development of a model plan for the
designation of trauma centers and for triage, transfer, and
transportation policies; and
``(4) sponsor workshops and conferences.
``(b) Consultation.--In carrying out this section, the Secretary
shall consult with appropriate State and professional organizations.
``SEC. 1202. DATA COLLECTION.
``(a) In General.--The Director of the Centers for Disease Control
and Prevention, directly or through grants or contracts, may establish
and provide for the operation of information systems and provide for
the collection, coordination, and exchange of information related to
trauma system development or operation.
``(b) Consultation.--In carrying out this section, the Director of
the Centers for Disease Control and Prevention shall consult with the
Administrator of the Health Resources and Services Administration and
such other persons outside of the Centers as the Director deems
appropriate.
``SEC. 1203. GRANTS TO STATES TO IMPROVE TRAUMA CARE SYSTEMS.
``(a) In General.--The Secretary, acting through the Administrator
of the Health Resources and Services Administration, shall make a
grant, in the amount referred to in section 1208(c), to each State that
submits an application and agrees to comply with the requirements of
this section, for the purpose of improving access to and enhancing the
development of trauma care systems.
``(b) Requirements.--The Secretary may make a grant to a State
under this section only if the State has developed a plan that--
``(1) specifies a public or private entity that will
designate trauma care regions and trauma centers in the State;
``(2) contains, for the designation of level I, level II,
and level III trauma centers, standards and requirements
developed by--
``(A) taking into account standards developed by
professional organizations and any guidelines or model
plans developed by the Secretary with the goal of
ensuring the greatest possible access to trauma care
and providing the highest quality of trauma care;
``(B) consulting with medical, surgical, and
nursing speciality groups, hospital associations,
emergency medical services State and local directors,
concerned advocates, and other interested parties; and
``(C) conducting public hearings on the proposed
standards after providing adequate notice to the public
concerning such hearings;
``(3) 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;
``(4) contains standards and requirements 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;
``(5) utilizes a program with procedures for the evaluation
of designated trauma centers (including trauma centers
described in paragraph (4)) and trauma care systems;
``(6) provides for the establishment and collection of data
from each designated trauma center in the State of a central
data reporting and analysis system (to be transmitted to the
Secretary in accordance with section 1202)--
``(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;
``(7) provides for the use of procedures by paramedics and
emergency medical technicians to assess the severity of the
injuries incurred by trauma patients;
``(8) 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;
``(9) conducts public education activities concerning
injury prevention and obtaining access to trauma care;
``(10) 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; and
``(11) coordinates planning for trauma systems with State
disaster emergency planning and bioterrorism hospital
preparedness planning.
``(c) Trauma Plan.--
``(1) In general.--For each fiscal year, the Secretary may
not make payments to a State under this section unless, subject
to paragraph (2), 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.
``(2) 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 paragraph (1), 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.
``(3) Information received by state reporting and analysis
system.--The Secretary may not make payments to a State under
this section 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 subsection
(b)(6).
``(4) Availability of emergency medical services in rural
areas.--The Secretary may not make payments to a State under
this section unless--
``(A) the State identifies any rural area in the
State for which--
``(i) there is no system of access to
emergency medical services through the
telephone number 911;
``(ii) there is no basic life-support
system; or
``(iii) there is no advanced life-support
system; and
``(B) 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.
``(d) Requirement of Matching Funds.--
``(1) Non-federal contributions.--
``(A) In general.--The Secretary may not make a
grant to a State under this section unless the State
agrees, with respect to the costs of carrying out the
grant, to make available non-Federal contributions (in
cash or in kind under paragraph (2)(A)) toward such
costs in an amount equal to--
``(i) for the first and second fiscal year
of payments under this section to the State
after the date of the enactment of the Trauma
Research and Access to Urgent Medical Attention
Act of 2004, not less than $1 for each $1 of
Federal funds provided in such payments for
such fiscal year; and
``(ii) for any subsequent fiscal year of
such payments to the State, not less than $2
for each $1 of Federal funds provided in such
payments for such fiscal year.
``(2) Determination of amount of non-federal
contribution.--With respect to compliance with paragraph (1)--
``(A) a State may make the non-Federal
contributions in cash or in kind, fairly evaluated,
including plant, equipment, or staff services; and
``(B) 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.
``(e) Restrictions.--
``(1) In general.--The Secretary may not make payments to a
State under this section unless the State agrees that the
payments will not be expended--
``(A) to make cash payments to intended recipients
of services provided pursuant to this section;
``(B) to purchase or improve real property (other
than minor remodeling of existing improvements to real
property); or
``(C) to satisfy any requirement for the
expenditure of non-Federal funds as a condition for the
receipt of Federal funds.
``(2) Waiver.--The Secretary may waive a restriction under
paragraph (1) only if the Secretary determines that the
activities outlined by the State plan submitted under
subsection (c)(1) by the State involved cannot otherwise be
carried out.
``(f) Application.--To seek a grant under this section, a State
shall submit to the Secretary an application in such form, in such
manner, and containing such information and assurances as the Secretary
may require.
``(g) Reports by States.--A grant may be made to a State under this
section only if the State agrees that, promptly after the end of the
fiscal year for which the grant is made, the State will submit to the
Secretary a report that describes the activities of the State under the
grant.
``SEC. 1204. 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, consortia of States or political
subdivisions, and accredited schools of medicine 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--
``(1) in the case of an application by a State, political
subdivision, or consortium, the applicant agrees to use the
grant--
``(A) to integrate and broaden the reach of a
trauma care system, such as by developing innovative
protocols to increase access to prehospital care and
equipment necessary for the transportation of seriously
injured patients to the appropriate facilities;
``(B) to strengthen, develop, and improve an
existing trauma care system;
``(C) to expand and improve emergency medical
services for children who need treatment for trauma or
critical care;
``(D) to expand communications between the trauma
care system and emergency medical services through
improved equipment or a telemedicine system;
``(E) to improve data collection and retention; or
``(F) 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; or
``(2) in the case of an application by an accredited school
of medicine, the applicant agrees to use the grant to expand
and improve emergency medical services for children who need
treatment for trauma or critical care.
``(c) Preference.--In selecting among States, political
subdivisions, and consortia of States or political subdivisions (but
not accredited schools of medicine) for purposes of making grants under
this section, the Secretary shall give preference to applicants that--
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