[House Report 113-459]
[From the U.S. Government Publishing Office]
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.
* * * * * * *