[House Report 111-632]
[From the U.S. Government Publishing Office]
111th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 111-632
======================================================================
CONCUSSION TREATMENT AND CARE TOOLS ACT OF 2010
_______
September 28, 2010.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Waxman, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 1347]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 1347) to amend title III of the Public Health
Service Act to provide for the establishment and implementation
of concussion management guidelines with respect to school-aged
children, and for other purposes, having considered the same,
report favorably thereon with amendments and recommend that the
bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings and Recommendations................. 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Statement of General Performance Goals and Objectives............ 5
Constitutional Authority Statement............................... 5
Earmarks and Tax and Tariff Benefits............................. 5
Federal Advisory Committee Statement............................. 5
Applicability of Law to the Legislative Branch................... 5
Federal Mandates Statement....................................... 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Cost Estimate........................ 6
Section-by-Section Analysis of the Legislation................... 7
Explanation of Amendments........................................ 7
Changes in Existing Law Made by the Bill, as Reported............ 8
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 ``Concussion Treatment and Care Tools
Act of 2010'' or the ``ConTACT Act of 2010''.
SEC. 2. CONCUSSION MANAGEMENT GUIDELINES WITH RESPECT TO SCHOOL-AGED
CHILDREN.
Part B of title III of the Public Health Service Act (42 U.S.C. 243
et seq.) is amended by inserting after section 317T the following:
SEC. 317U. CONCUSSION MANAGEMENT GUIDELINES WITH RESPECT TO SCHOOL-AGED
CHILDREN.
``(a) Concussion Management Guidelines.--
``(1) Establishment.--Not later than 2 years after the date
of the enactment of this section, the Secretary shall establish
concussion management guidelines that address the prevention,
identification, treatment, and management of concussions (as
defined by the Secretary) in school-aged children, including
standards for such children to return to play after
experiencing such a concussion, and shall make available such
guidelines and standards to the general public, including
health professionals.
``(2) Conference.--The Secretary shall convene a conference
of medical, athletic, and educational stakeholders for purposes
of assisting in the establishment of the guidelines.
``(b) Grants to States.--
``(1) In general.--After establishing the guidelines under
subsection (a), the Secretary may make grants to States for
purposes of--
``(A) providing for the collection by target entities
of information on the incidence and prevalence of
concussions among school-aged children attending or
participating in such entities;
``(B) adopting, disseminating, and ensuring the
implementation by target entities of the guidelines;
``(C) funding implementation by target entities of
pre-season baseline and post-injury testing, including
computerized testing, for school-aged children; and
``(D) any other activity or purpose specified by the
Secretary.
``(2) Grant applications.--
``(A) In general.--To be eligible to receive a grant
under this subsection, the Secretary shall require a
State to submit an application to the Secretary at such
time, in such manner, and containing such information
as the Secretary shall require.
``(B) Minimum contents.--The Secretary shall require
that an application of a State under subparagraph (A)
contain at a minimum--
``(i) a description of the strategies the
State will use to disseminate, and ensure the
implementation by target entities of, the
guidelines, including coordination with ongoing
State-based efforts to implement State laws
governing youth concussion management; and
``(ii) an agreement by the State to
periodically provide data to the Secretary with
respect to the incidence of concussions and
second impact syndrome among school-aged
children in the State.
``(3) Utilization of high school sports associations, youth
sports associations, athletic trainer associations, and local
chapters of national brain injury organizations.--In
disseminating and ensuring the implementation by target
entities of the guidelines pursuant to a grant under this
subsection, the Secretary shall require States receiving grants
under this subsection to utilize, to the extent practicable,
applicable expertise and services offered by high school sports
associations, youth sports associations, athletic trainer
associations, and local chapters of national brain injury
organizations in such States.
``(c) Coordination of Activities.--In carrying out activities under
this section, the Secretary shall coordinate in an appropriate manner
with the heads of other Federal departments and agencies that carry out
activities related to concussions and other traumatic brain injuries.
``(d) Reports.--
``(1) Establishment of the guidelines.--Not later than 2
years after the date of the enactment of this section, the
Secretary shall submit to the Congress a report on the
implementation of subsection (a).
``(2) Grant program and data collection.--Not later than 4
years after the date of the enactment of this section, the
Secretary shall submit to the Congress a report on the
implementation of subsection (b), including--
``(A) the number of States that have adopted the
guidelines;
``(B) the number of target entities that have
implemented pre-season baseline and post-injury
testing, including computerized testing, for school-
aged children; and
``(C) the data collected with respect to the
incidence of concussions and second impact syndrome
among school-aged children.
``(e) Definitions.--In this section:
``(1) The term `guidelines' means the concussion management
guidelines established under subsection (a).
``(2) The term `return to play' means, with respect to a
school-aged child experiencing a concussion, the return of such
child to participating in the sport or other activity related
to such concussion.
``(3) The term `school-aged children' means individuals who
are at least 5 years of age and not more than 18 years of age.
``(4) The term `second impact syndrome' means catastrophic or
fatal events that occur when an individual suffers a concussion
while symptomatic and healing from a previous concussion.
``(5) The term `Secretary' means the Secretary of Health and
Human Services, acting through the Director of the Centers for
Disease Control and Prevention.
``(6) The term `State' means each of the 50 States and the
District of Columbia.
``(7) The term `target entity' means an elementary school, a
secondary school, or a youth sports association.''.
Amend the title so as to read:
A bill to amend title III of the Public Health Service Act to
provide for the establishment and implementation of concussion
management guidelines with respect to school-aged children, and for
other purposes.
Purpose and Summary
H.R. 1347, the ``Concussion Treatment and Care Tools Act of
2009'', was introduced on March 5, 2009, by Rep. Bill Pascrell,
Jr. (D-NJ), and referred to the Committee on Energy and
Commerce.
The goal of H.R. 1347 is to address the growing concern
about concussions and other serious head injuries among school-
aged children. The bill directs the Secretary of the Department
of Health and Human Services (HHS) to establish concussion
management guidelines that focus on the prevention and
management of concussions in school-aged children, including
standards for student athletes to return to play after a
concussion. The bill also authorizes the Secretary to convene a
conference of medical, athletic, and educational stakeholders
to establish such guidelines.
Background and Need for Legislation
A concussion is defined as a type of traumatic brain injury
(TBI) that changes the way the brain normally works. According
to the Centers for Disease Control and Prevention (CDC),
concussions are one of the most commonly reported injuries
among the nearly 38 million children and adolescents that
engage in organized youth sports and recreation activities in
the United States. Concussions are caused by a bump, blow, or
jolt to the head. They can also occur from a fall or blow to
the body that causes the head and brain to move rapidly back
and forth.
The majority of sports-related concussion injuries seen in
emergency rooms occur among youth aged 5-18. The incidence and
impact of concussions vary by age group and gender. Children
aged 0 to 4 years and older adolescents aged 15 to 19 years are
most likely to sustain a concussion and take longer to recover
compared to adults. Furthermore, male children aged 0 to 4
years have the highest rates of TBI-related emergency
department visits, hospitalizations, and deaths. In every age
group, TBI rates are higher for males than for females.
According to the American Academy of Pediatrics (AAP), however,
female athletes have a higher rate of concussions than boys who
play similar sports, though reasons for this are not well
understood.
The CDC conducts research and surveillance on brain injury
and provides educational materials on concussion management
through various programs, including the CORE State Injury
Program and the Heads Up initiative. There are currently,
however, no federal programs that mandate concussion injury
guidelines for children aged 5-18 and provide funding for this
targeted group. H.R. 1347 is designed to do just that.
Committee Consideration
H.R. 1347, the ``Concussion Treatment and Care Tools Act of
2009'' or the ``ConTACT Act of 2010'', was introduced by Mr.
Pascrell of New Jersey on March 5, 2009, and referred to the
Committee on Energy and Commerce. The bill was subsequently
referred to the Subcommittee on Health on March 6, 2009. On
September 8, 2010, the Subcommittee held a legislative field
hearing on the bill. The Subcommittee met in open markup
session to consider H.R. 1347 on September 16, 2010. An
amendment in the nature of a substitute (manager's amendment)
by Mr. Pallone was adopted by a voice vote. Subsequently, H.R.
1347 was favorably forwarded to the full Committee, amended, by
a voice vote.
On September 23, 2010, the Committee on Energy and Commerce
met in open markup session to consider H.R. 1347 as approved by
the Subcommittee on Health. The Committee agreed to an
amendment by Mr. Pallone by a voice vote and subsequently
ordered H.R. 1347 favorably reported to the House, 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 each record vote
on the motion to report legislation and amendments thereto. A
motion by Mr. Pallone of New Jersey ordering H.R. 1347 reported
to the House, amended, was approved by a voice vote. There were
no record votes taken during consideration of this bill.
Committee Oversight Findings and Recommendations
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the oversight findings and recommendations of
the Committee are reflected in the descriptive portions of this
report, including the finding that there are currently no
federal programs that mandate concussion injury guidelines for
children aged 5-18 and provide funding for this targeted group.
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. 1347 would result in no new budget authority,
entitlement authority, or tax expenditures or revenues.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the performance goals and
objectives of the Committee are reflected in the descriptive
portions of this report, including the goal of providing for
concussion injury guidelines for children aged 5-18 and funding
for this targeted group.
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 H.R. 1347 is provided under
article I, section 8, clauses 3 and 18 of the Constitution of
the United States.
Earmarks and Tax and Tariff Benefits
H.R. 1347 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
Federal Advisory Committee Statement
The Committee finds that the legislation does not establish
or authorize the establishment of an advisory committee within
the definition of 5 U.S.C. App., section 5(b) of the Federal
Advisory Committee Act.
Applicability of Law to the Legislative Branch
Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch where the bill relates to terms and conditions of
employment or access to public services and accommodations.
H.R. 1347 contains no such provisions.
Federal Mandates Statement
Section 423 of the Congressional Budget and Impoundment
Control Act of 1974 (as amended by section 101(a)(2) of the
Unfunded Mandates Reform Act, Public Law 104-4) requires a
statement on whether the provisions of the report include
unfunded mandates. In compliance with this requirement the
Committee adopts as its own the analysis of federal mandates
prepared by the Director of the Congressional Budget Office
regarding H.R. 1347.
Committee Cost Estimate
Pursuant to clause 3(d)(2) of rule XIII of the Rules of the
House of Representatives, the Committee adopts as its own the
cost estimate of H.R. 1347 prepared by the Director of the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
Congressional Budget Office Cost Estimate
With respect to the requirements of clause (3)(c)(3) of
rule XIII of the Rules of the House of Representatives and
section 402 of the Congressional Budget Act of 1974, the
Committee has received the following cost estimate for H.R.
1347 from the Director of Congressional Budget Office:
September 24, 2010.
Hon. Henry A. Waxman,
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. 1347, the
Concussion Treatment and Care Tools Act of 2010.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Stephanie
Cameron.
Sincerely,
Douglas W. Elmendorf.
Enclosure.
H.R. 1347--Concussion Treatment and Care Tools Act of 2010
Summary: H.R. 1347 would require the Secretary of Health
and Human Services (HHS) to establish guidelines for the
management of concussions in school-aged children. It also
would authorize the Secretary to make grants to states to
collect data on such concussions and to implement the
guidelines.
CBO estimates that implementing H.R. 1347 would cost $29
million over the 2011-2015 period. Enacting H.R. 1347 would not
affect direct spending or revenues; therefore, pay-as-you-go
procedures do not apply.
H.R. 1347 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. 1347 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
--------------------------------------------------------
2011 2012 2013 2014 2015 2011-2015
----------------------------------------------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level.......................... 2 3 6 15 15 41
Estimated Outlays...................................... 1 2 4 9 13 29
----------------------------------------------------------------------------------------------------------------
Basis of estimate: For this estimate, CBO assumes that H.R.
1347 will be enacted near the beginning of fiscal year 2011,
that the necessary amounts will be appropriated each year, and
that outlays will follow historical patterns for similar
activities of the Centers for Disease Control and Prevention
(CDC). CBO estimates that implementing H.R. 1347 would cost $29
million over the 2011-2015 period.
H.R. 1347 would require the Secretary of HHS to convene a
conference for the purpose of assisting in the development of
guidelines to prevent, identify, treat, and manage concussions
in school-aged children. The Secretary would be required to
issue those guidelines within two years.
The bill also would authorize the Secretary to make grants
to states to implement the guidelines. States that receive
grant assistance would be required to ensure that schools and
youth sports associations comply with implementation and
reporting requirements. CBO assumes that CDC would implement
that provision beginning in fiscal year 2013.
Pay-as-you-go considerations: None.
Intergovernmental and private-sector impact: H.R. 1347
contains no intergovernmental or private-sector mandates as
defined in UMRA. Grant activities authorized in the bill would
benefit state and local governments.
Estimate prepared by: Federal Costs: Stephanie Cameron;
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on the Private Sector: Jimmy Jin.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 designates the Act may be cited as the
``Concussion Treatment and Care Tools Act of 2010'' or the
``ConTACT Act of 2010''.
Section 2. Concussion management guidelines with respect to school-aged
children
Section 2 amends title III of the Public Health Service Act
to direct the Secretary of Health and Human Services to
establish concussion management guidelines that address the
prevention and management of concussions in school-aged
children, including standards for student athletes to return to
play after a concussion. The Secretary is required to make such
guidelines available to the general public, including heath
professionals. The Secretary is also required to convene a
conference of medical, athletic, and educational stakeholders
to establish such guidelines.
In addition, section 2 authorizes the Secretary to make
grants to states for: (1) adopting, disseminating, and ensuring
the implementation by schools and youth sport associations of
the guidelines; and (2) funding implementation by schools of
pre-season baseline and post-injury testing, including
computerized testing, for student athletes. States receiving
such grants must utilize the expertise and services offered by
high school sports associations, youth sports associations,
national brain injury associations, and athletic trainer
associations for dissemination purposes.
Explanation of Amendments
During the Subcommittee on Health markup of H.R. 1347, Mr.
Pallone of New Jersey offered an amendment in the nature of a
substitute (manager's amendment), which was adopted by a voice
vote. During full Committee consideration, Mr. Pallone offered
a technical amendment to H.R. 1347, as approved by the
Subcommittee on Health. The amendment was adopted by a voice
vote. The substance of each amendment is reflected in the
section-by-section analysis contained in this report.
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 (new matter is
printed in italic and 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 B--Federal-State Cooperation
* * * * * * *
SEC. 317U. CONCUSSION MANAGEMENT GUIDELINES WITH RESPECT TO SCHOOL-AGED
CHILDREN.
(a) Concussion Management Guidelines.--
(1) Establishment.--Not later than 2 years after the
date of the enactment of this section, the Secretary
shall establish concussion management guidelines that
address the prevention, identification, treatment, and
management of concussions (as defined by the Secretary)
in school-aged children, including standards for such
children to return to play after experiencing such a
concussion, and shall make available such guidelines
and standards to the general public, including health
professionals.
(2) Conference.--The Secretary shall convene a
conference of medical, athletic, and educational
stakeholders for purposes of assisting in the
establishment of the guidelines.
(b) Grants to States.--
(1) In general.--After establishing the guidelines
under subsection (a), the Secretary may make grants to
States for purposes of--
(A) providing for the collection by target
entities of information on the incidence and
prevalence of concussions among school-aged
children attending or participating in such
entities;
(B) adopting, disseminating, and ensuring the
implementation by target entities of the
guidelines;
(C) funding implementation by target entities
of pre-season baseline and post-injury testing,
including computerized testing, for school-aged
children; and
(D) any other activity or purpose specified
by the Secretary.
(2) Grant applications.--
(A) In general.--To be eligible to receive a
grant under this subsection, the Secretary
shall require a State to submit an application
to the Secretary at such time, in such manner,
and containing such information as the
Secretary shall require.
(B) Minimum contents.--The Secretary shall
require that an application of a State under
subparagraph (A) contain at a minimum--
(i) a description of the strategies
the State will use to disseminate, and
ensure the implementation by target
entities of, the guidelines, including
coordination with ongoing State-based
efforts to implement State laws
governing youth concussion management;
and
(ii) an agreement by the State to
periodically provide data to the
Secretary with respect to the incidence
of concussions and second impact
syndrome among school-aged children in
the State.
(3) Utilization of high school sports associations,
youth sports associations, athletic trainer
associations, and local chapters of national brain
injury organizations.--In disseminating and ensuring
the implementation by target entities of the guidelines
pursuant to a grant under this subsection, the
Secretary shall require States receiving grants under
this subsection to utilize, to the extent practicable,
applicable expertise and services offered by high
school sports associations, youth sports associations,
athletic trainer associations, and local chapters of
national brain injury organizations in such States.
(c) Coordination of Activities.--In carrying out activities
under this section, the Secretary shall coordinate in an
appropriate manner with the heads of other Federal departments
and agencies that carry out activities related to concussions
and other traumatic brain injuries.
(d) Reports.--
(1) Establishment of the guidelines.--Not later than
2 years after the date of the enactment of this
section, the Secretary shall submit to the Congress a
report on the implementation of subsection (a).
(2) Grant program and data collection.--Not later
than 4 years after the date of the enactment of this
section, the Secretary shall submit to the Congress a
report on the implementation of subsection (b),
including--
(A) the number of States that have adopted
the guidelines;
(B) the number of target entities that have
implemented pre-season baseline and post-injury
testing, including computerized testing, for
school-aged children; and
(C) the data collected with respect to the
incidence of concussions and second impact
syndrome among school-aged children.
(e) Definitions.--In this section:
(1) The term ``guidelines'' means the concussion
management guidelines established under subsection (a).
(2) The term ``return to play'' means, with respect
to a school-aged child experiencing a concussion, the
return of such child to participating in the sport or
other activity related to such concussion.
(3) The term ``school-aged children'' means
individuals who are at least 5 years of age and not
more than 18 years of age.
(4) The term ``second impact syndrome'' means
catastrophic or fatal events that occur when an
individual suffers a concussion while symptomatic and
healing from a previous concussion.
(5) The term ``Secretary'' means the Secretary of
Health and Human Services, acting through the Director
of the Centers for Disease Control and Prevention.
(6) The term ``State'' means each of the 50 States
and the District of Columbia.
(7) The term ``target entity'' means an elementary
school, a secondary school, or a youth sports
association.
* * * * * * *