[House Report 115-330]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-330
======================================================================
MILITARY INJURY SURGICAL SYSTEMS INTEGRATED OPERATIONALLY NATIONWIDE TO
ACHIEVE ZERO PREVENTABLE DEATHS ACT
_______
September 25, 2017.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Walden, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 880]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 880) to amend the Public Health Service Act to
facilitate assignment of military trauma care providers to
civilian trauma centers in order to maintain military trauma
readiness and to support such centers, 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
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 4
Committee Action................................................. 4
Committee Votes.................................................. 4
Oversight Findings and Recommendations........................... 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Statement of General Performance Goals and Objectives............ 6
Duplication of Federal Programs.................................. 6
Committee Cost Estimate.......................................... 6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 6
Disclosure of Directed Rule Makings.............................. 6
Advisory Committee Statement..................................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill, as Reported............ 7
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 ``Military Injury Surgical Systems
Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths
Act'' or the ``MISSION ZERO Act''.
SEC. 2. MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA READINESS GRANT
PROGRAM.
Title XII of the Public Health Service Act (42 U.S.C. 300d et seq.)
is amended by adding at the end the following new part:
``PART I--MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA READINESS GRANT
PROGRAM
``SEC. 1291. MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA READINESS
GRANT PROGRAM.
``(a) Military Trauma Team Placement Program.--
``(1) In general.--The Secretary shall award grants to not
more than 20 eligible high-acuity trauma centers to enable
military trauma teams to provide, on a full-time basis, trauma
care and related acute care at such trauma centers.
``(2) Limitations.--In the case of a grant awarded under
paragraph (1) to an eligible high-acuity trauma center, such
grant--
``(A) shall be for a period of at least 3 years and
not more than 5 years (and may be renewed at the end of
such period); and
``(B) shall be in an amount that does not exceed
$1,000,000 per year.
``(3) Availability of funds after performance period.--
Notwithstanding section 1552 of title 31, United States Code,
or any other provision of law, funds available to the Secretary
for obligation for a grant under this subsection shall remain
available for expenditure for 100 days after the last day of
the performance period of such grant.
``(b) Military Trauma Care Provider Placement Program.--
``(1) In general.--The Secretary shall award grants to
eligible trauma centers to enable military trauma care
providers to provide trauma care and related acute care at such
trauma centers.
``(2) Limitations.--In the case of a grant awarded under
paragraph (1) to an eligible trauma center, such grant--
``(A) shall be for a period of at least 1 year and
not more than 3 years (and may be renewed at the end of
such period); and
``(B) shall be in an amount that does not exceed, in
a year--
``(i) $100,000 for each military trauma care
provider that is a physician at such eligible
trauma center; and
``(ii) $50,000 for each other military trauma
care provider at such eligible trauma center.
``(c) Grant Requirements.--
``(1) Deployment.--As a condition of receipt of a grant under
this section, a grant recipient shall agree to allow military
trauma care providers providing care pursuant to such grant to
be deployed by the Secretary of Defense for military
operations, for training, or for response to a mass casualty
incident.
``(2) Use of funds.--Grants awarded under this section to an
eligible trauma center may be used to train and incorporate
military trauma care providers into such trauma center,
including expenditures for malpractice insurance, office space,
information technology, specialty education and supervision,
trauma programs, research, and State license fees for such
military trauma care providers.
``(d) Rule of Construction.--Nothing in this section shall be
construed to affect the extent to which State licensing requirements
for health care professionals are preempted by other Federal law from
applying to military trauma care providers.
``(e) Reporting Requirements.--
``(1) Report to the secretary and the secretary of defense.--
Each eligible trauma center or eligible high-acuity trauma
center awarded a grant under subsection (a) or (b) for a year
shall submit to the Secretary and the Secretary of Defense a
report for such year that includes information on--
``(A) the number and types of trauma cases managed by
military trauma teams or military trauma care providers
pursuant to such grant during such year;
``(B) the financial impact of such grant on the
trauma center;
``(C) the educational impact on resident trainees in
centers where military trauma teams are assigned;
``(D) any research conducted during such year
supported by such grant; and
``(E) any other information required by the
Secretaries for the purpose of evaluating the effect of
such grant.
``(2) Report to congress.--Not less than once every 2 years,
the Secretary, in consultation with the Secretary of Defense,
shall submit a report to Congress that includes information on
the effect of placing military trauma care providers in trauma
centers awarded grants under this section on--
``(A) maintaining readiness of military trauma care
providers for battlefield injuries;
``(B) providing health care to civilian trauma
patients in both urban and rural settings;
``(C) the capability to respond to surges in trauma
cases, including as a result of a large scale event;
and
``(D) the financial State of the trauma centers.
``(f) Definitions.--For purposes of this part:
``(1) Eligible trauma center.--The term `eligible trauma
center' means a Level I, II, or III trauma center that
satisfies each of the following:
``(A) Such trauma center has an agreement with the
Secretary of Defense to enable military trauma care
providers to provide trauma care and related acute care
at such trauma center.
``(B) Such trauma center utilizes a risk-adjusted
benchmarking system to measure performance and
outcomes, such as the Trauma Quality Improvement
Program of the American College of Surgeons.
``(C) Such trauma center demonstrates a need for
integrated military trauma care providers to maintain
or improve the trauma clinical capability of such
trauma center.
``(2) Eligible high-acuity trauma center.--The term `eligible
high-acuity trauma center' means a Level I trauma center that
satisfies each of the following:
``(A) Such trauma center has an agreement with the
Secretary of Defense to enable military trauma teams to
provide trauma care and related acute care at such
trauma center.
``(B) At least 20 percent of patients of such trauma
center in the most recent 3-month period for which data
is available are treated for a major trauma at such
trauma center.
``(C) Such trauma center utilizes a risk-adjusted
benchmarking system to measure performance and
outcomes, such as the Trauma Quality Improvement
Program of the American College of Surgeons.
``(D) Such trauma center is an academic training
center--
``(i) affiliated with a medical school;
``(ii) that maintains residency programs and
fellowships in critical trauma specialties and
subspecialties, and provides education and
supervision of military trauma team members
according to those specialties and
subspecialties; and
``(iii) that undertakes research in the
prevention and treatment of traumatic injury.
``(E) Such trauma center serves as a disaster
response leader for its community, such as by
participating in a partnership for State and regional
hospital preparedness established under section 319C-2.
``(3) Major trauma.--The term `major trauma' means an injury
that is greater than or equal to 15 on the injury severity
score.
``(4) Military trauma team.--The term `military trauma team'
means a complete military trauma team consisting of military
trauma care providers.
``(5) Military trauma care provider.--The term `military
trauma care provider' means a member of the Armed Forces who
furnishes emergency, critical care, and other trauma acute
care, including a physician, military surgeon, physician
assistant, nurse, respiratory therapist, flight paramedic,
combat medic, or enlisted medical technician.
``(g) Authorization of Appropriations.--For each of fiscal years 2018
through 2022, there are authorized to be appropriated--
``(1) $10,000,000 for carrying out subsection (a); and
``(2) $5,000,000 for carrying out subsection (b).''.
Purpose and Summary
H.R. 880 was introduced on February 6, 2017, by Rep.
Michael C. Burgess (R-TX). The bill establishes a grant program
for military-civilian partnerships in trauma care, which will
allow both sectors to benefit from the others' expertise and
experience.
Background and Need for Legislation
Traumatic injury imposes an incredible burden on the
nation's health system. The military has made significant
strides in improving trauma care based on wartime lessons
learned. Unfortunately, these lessons are often not translated
to civilian trauma care or are not sustained during peacetime.
Increasing military civilian partnerships is a critical
step toward achieving the goal of zero preventable injury
deaths, as highlighted in the 2016 National Academies of
Sciences, Engineering and Medicine (NASEM) report, ``A National
Trauma Care System: Integrating Military and Civilian Trauma
Systems to Achieve Zero Preventable Deaths After Injury.'' By
utilizing civilian trauma centers as opportunities for military
trauma providers to practice skills prior to deployment and/or
to maintain skills after returning home from service, both
military readiness is achieved and access to civilian trauma
care is improved by assigning more trauma providers to domestic
hospitals.
Committee Action
During the 114th Congress, on July 12, 2016, the
Subcommittee on Health held a hearing on a discussion draft
entitled ``Military, Civilian, and Mass Casualty Trauma
Readiness Partnership Act,'' which was substantially similar to
H.R. 880. The hearing was entitled ``Strengthening our National
Trauma System.'' The Subcommittee received testimony from:
Jorie Klein, BSN, RN; Director, Trauma
Program, Rees-Jones Trauma Center at Parkland;
David Marcozzi, MD; University of Maryland
Department of Emergency Medicine;
C. William Schwab, MD, FACS; Professor of
Surgery, Penn Presbyterian Medical Center;
Craig Manifold, DO, FACEP; Committee Chair,
American College of Emergency Physicians; and,
J. Brent Myers, MD, MPH, FACEP; President-
Elect, National Association of EMS Physicians.
On June 29, 2017, the Subcommittee on Health met in open
markup session and forwarded H.R. 880, as amended, to the full
Committee by a voice vote. On July 27, 2017, the full Committee
on Energy and Commerce met in open markup session and ordered
H.R. 880, as amended, favorably reported to the House by a
voice vote.
Committee Votes
Clause 3(b) of rule XIII 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. 880 reported.
Oversight Findings and Recommendations
Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of
rule XIII, the Committee has not held hearings on this
legislation.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to clause 3(c)(2) of rule XIII, the Committee
finds that H.R. 880 would result in no new or increased budget
authority, entitlement authority, or tax expenditures or
revenues.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII, the following is
the cost estimate provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
H.R. 880--MISSION ZERO Act
Summary: H.R. 880 would establish a grant program for
qualified military personnel to provide trauma care in civilian
trauma centers. The bill would provide a total of $15 million
annually for grants to eligible trauma centers through fiscal
year 2022.
CBO estimates that implementing H.R. 880 would cost $63
million over the 2018-2022 period, assuming appropriation of
the specified amounts.
Pay-as-you-go procedures do not apply to this legislation
because it would not affect direct spending or revenues. CBO
estimates that enacting H.R. 880 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2028.
H.R. 880 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on state, local, or tribal
governments.
Estimated cost to the Federal Government: The estimated
budgetary effect of H.R. 880 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
----------------------------------------------------------
2017 2018 2019 2020 2021 2022 2017-2022
----------------------------------------------------------------------------------------------------------------
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Authorization Level.................................. 0 15 15 15 15 15 75
Estimated Outlays.................................... 0 7 12 15 15 15 63
----------------------------------------------------------------------------------------------------------------
Note: Components may not add to totals because of rounding.
Basis of estimate: H.R. 880 would authorize the Secretary
of Health and Human Services to award grants to trauma centers
for the purpose of training and incorporating military trauma
providers into civilian trauma centers. The bill would
authorize a total of $15 million per year for fiscal years
2018-2022 for such grants. Assuming appropriation of the
authorized amounts, the Military Trauma Team Placement Program
would award $10 million annually, through up to 20 grants, to
Level I trauma centers that meet certain eligibility criteria.
The Military Trauma Care Provider Placement Program would award
$5 million in grants annually to eligible Level I, II, or III
trauma centers.
Based on historical spending patterns for similar
activities, CBO estimates that implementing H.R. 880 would cost
$63 million over the 2018-2022 period; the remaining amounts
would be spent in years after 2022. For this estimate, CBO
assumes that the legislation will be enacted near the beginning
of fiscal year 2018 and that the specified amounts will be
appropriated.
Pay-As-You-Go Considerations: None.
Increase in long-term direct spending and deficits: CBO
estimates that enacting H.R. 880 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2028.
Intergovernmental and private-sector impact: H.R. 880
contains no intergovernmental or private-sector mandates as
defined in UMRA and would impose no costs on state, local, or
tribal governments.
Estimate prepared by: Federal Costs: Emily King; Impact on
state, local, and tribal governments: Zach Byrum; Impact on the
private sector: Amy Petz.
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.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to
establish a grant program that bolsters access to high quality
domestic trauma care.
Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 880 is known to be duplicative of another Federal program,
including any program that was included in a report to Congress
pursuant to section 21 of Public Law 111-139 or the most recent
Catalog of Federal Domestic Assistance.
Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, 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.
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 880 contains no earmarks, limited tax
benefits, or limited tariff benefits.
Disclosure of Directed Rule Makings
Pursuant to section 3(i) of H. Res. 5, the Committee finds
that H.R. 880 contains no directed rule makings.
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 that the Act may be cited as the
``Military Injury Surgical Systems Integrated Operationally
Nationwide to Achieve ZERO Preventable Deaths Act'' or the
``MISSION ZERO Act.''
Section 2. Military and civilian partnership for trauma readiness grant
program
Section 2 authorizes the appropriation of $15 million for
each of fiscal years 2018 to 2022 to establish a grant program
to assist civilian trauma centers in partnering with military
trauma professionals. Grants may be used to train and integrate
military trauma practitioners into trauma center staffs in
order to maintain battlefield currency and to help translate
military trauma care lessons to the civilian trauma system. The
Secretary of Health and Human Services, in consultation with
the Secretary of Defense, is required to report on the effects
of military-civilian trauma integration, including its impacts
on military readiness, the civilian community, and the
financial impacts of trauma care.
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 italics and existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE XII--TRAUMA CARE
* * * * * * *
PART I--MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA READINESS GRANT
PROGRAM
SEC. 1291. MILITARY AND CIVILIAN PARTNERSHIP FOR TRAUMA READINESS GRANT
PROGRAM.
(a) Military Trauma Team Placement Program.--
(1) In general.--The Secretary shall award grants to
not more than 20 eligible high-acuity trauma centers to
enable military trauma teams to provide, on a full-time
basis, trauma care and related acute care at such
trauma centers.
(2) Limitations.--In the case of a grant awarded
under paragraph (1) to an eligible high-acuity trauma
center, such grant--
(A) shall be for a period of at least 3 years
and not more than 5 years (and may be renewed
at the end of such period); and
(B) shall be in an amount that does not
exceed $1,000,000 per year.
(3) Availability of funds after performance period.--
Notwithstanding section 1552 of title 31, United States
Code, or any other provision of law, funds available to
the Secretary for obligation for a grant under this
subsection shall remain available for expenditure for
100 days after the last day of the performance period
of such grant.
(b) Military Trauma Care Provider Placement Program.--
(1) In general.--The Secretary shall award grants to
eligible trauma centers to enable military trauma care
providers to provide trauma care and related acute care
at such trauma centers.
(2) Limitations.--In the case of a grant awarded
under paragraph (1) to an eligible trauma center, such
grant--
(A) shall be for a period of at least 1 year
and not more than 3 years (and may be renewed
at the end of such period); and
(B) shall be in an amount that does not
exceed, in a year--
(i) $100,000 for each military trauma
care provider that is a physician at
such eligible trauma center; and
(ii) $50,000 for each other military
trauma care provider at such eligible
trauma center.
(c) Grant Requirements.--
(1) Deployment.--As a condition of receipt of a grant
under this section, a grant recipient shall agree to
allow military trauma care providers providing care
pursuant to such grant to be deployed by the Secretary
of Defense for military operations, for training, or
for response to a mass casualty incident.
(2) Use of funds.--Grants awarded under this section
to an eligible trauma center may be used to train and
incorporate military trauma care providers into such
trauma center, including expenditures for malpractice
insurance, office space, information technology,
specialty education and supervision, trauma programs,
research, and State license fees for such military
trauma care providers.
(d) Rule of Construction.--Nothing in this section shall be
construed to affect the extent to which State licensing
requirements for health care professionals are preempted by
other Federal law from applying to military trauma care
providers.
(e) Reporting Requirements.--
(1) Report to the secretary and the secretary of
defense.--Each eligible trauma center or eligible high-
acuity trauma center awarded a grant under subsection
(a) or (b) for a year shall submit to the Secretary and
the Secretary of Defense a report for such year that
includes information on--
(A) the number and types of trauma cases
managed by military trauma teams or military
trauma care providers pursuant to such grant
during such year;
(B) the financial impact of such grant on the
trauma center;
(C) the educational impact on resident
trainees in centers where military trauma teams
are assigned;
(D) any research conducted during such year
supported by such grant; and
(E) any other information required by the
Secretaries for the purpose of evaluating the
effect of such grant.
(2) Report to congress.--Not less than once every 2
years, the Secretary, in consultation with the
Secretary of Defense, shall submit a report to Congress
that includes information on the effect of placing
military trauma care providers in trauma centers
awarded grants under this section on--
(A) maintaining readiness of military trauma
care providers for battlefield injuries;
(B) providing health care to civilian trauma
patients in both urban and rural settings;
(C) the capability to respond to surges in
trauma cases, including as a result of a large
scale event; and
(D) the financial State of the trauma
centers.
(f) Definitions.--For purposes of this part:
(1) Eligible trauma center.--The term ``eligible
trauma center'' means a Level I, II, or III trauma
center that satisfies each of the following:
(A) Such trauma center has an agreement with
the Secretary of Defense to enable military
trauma care providers to provide trauma care
and related acute care at such trauma center.
(B) Such trauma center utilizes a risk-
adjusted benchmarking system to measure
performance and outcomes, such as the Trauma
Quality Improvement Program of the American
College of Surgeons.
(C) Such trauma center demonstrates a need
for integrated military trauma care providers
to maintain or improve the trauma clinical
capability of such trauma center.
(2) Eligible high-acuity trauma center.--The term
``eligible high-acuity trauma center'' means a Level I
trauma center that satisfies each of the following:
(A) Such trauma center has an agreement with
the Secretary of Defense to enable military
trauma teams to provide trauma care and related
acute care at such trauma center.
(B) At least 20 percent of patients of such
trauma center in the most recent 3-month period
for which data is available are treated for a
major trauma at such trauma center.
(C) Such trauma center utilizes a risk-
adjusted benchmarking system to measure
performance and outcomes, such as the Trauma
Quality Improvement Program of the American
College of Surgeons.
(D) Such trauma center is an academic
training center--
(i) affiliated with a medical school;
(ii) that maintains residency
programs and fellowships in critical
trauma specialties and subspecialties,
and provides education and supervision
of military trauma team members
according to those specialties and
subspecialties; and
(iii) that undertakes research in the
prevention and treatment of traumatic
injury.
(E) Such trauma center serves as a disaster
response leader for its community, such as by
participating in a partnership for State and
regional hospital preparedness established
under section 319C-2.
(3) Major trauma.--The term ``major trauma'' means an
injury that is greater than or equal to 15 on the
injury severity score.
(4) Military trauma team.--The term ``military trauma
team'' means a complete military trauma team consisting
of military trauma care providers.
(5) Military trauma care provider.--The term
``military trauma care provider'' means a member of the
Armed Forces who furnishes emergency, critical care,
and other trauma acute care, including a physician,
military surgeon, physician assistant, nurse,
respiratory therapist, flight paramedic, combat medic,
or enlisted medical technician.
(g) Authorization of Appropriations.--For each of fiscal
years 2018 through 2022, there are authorized to be
appropriated--
(1) $10,000,000 for carrying out subsection (a); and
(2) $5,000,000 for carrying out subsection (b).
* * * * * * *
[all]