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II 



103d congress 
1st Session 



S. 1098 



To amend title XK of the Social Security Act to pro^^ide for optional coverage 
under State medicaid plans of ease-management services for individuals 
who sustain traumatic brain injuries, and for other purposes. 



IN THE SENATE OF THE UNITED STATES 

June 15, 1993 

Mr. Rockefeller (for himself and Mr. Durenberger) introduced the 
follo"\\ing bill; which was read twice and referred to the Committee on Finance 



A BILL 

To amend title XIX of the Social Security Act to provide 
for optional coverage under State medicaid plans of case- 
management sendees for indi^dduals who sustain trau- 
matic brain injuries, and for other purposes. 

1 Be it enacted hy tJie Senate and House of Representa- 

2 tives oftJw United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act ma}^ be cited as the ''Brain Injurj^ Rehabili- 

5 tation Qualit}^ Act of 1993". 



2 

\ SEC. 2. MEDICAID COVERAGE OF CASE-MANAGEMENT 

2 SERVICES FOR INDIVIDUALS WITH TRAU- 

3 MATIC BRAIN INJURIES. 

4 (a) In General. — Section 1905(a) of the Social Se- 

5 curity Act (42 U.S.C. 1396d(a)) is amended— 

6 (1) b}^ striking "and" at the end of paragraph 

7 (21); 

8 (2) by striking the period at the end of para- 

9 gi^aph (24) and inserting a semicolon; 

10 (3) by redesignating paragraphs (22), (23), and 

11 (24) as paragraphs (25), (22), and (23), respec- 

12 lively, and b}^ transferring and inserting paragraph 

13 (25) after paragraph (23), as so redesignated; and 

14 (4) by inserting after paragraph (23), as redes- 

15 ignated, the following new paragraph: 

16 "(24) case-management semces provided (in 

17 accordance \\Ai\\ section 1931) for individuals who 

18 sustain tramiiatic brain injuries; and". 

19 (b) Case-IManageiment SEmacES Described. — 

20 Title XIX of the Social Security Act (42 U.S.C. 1396 et 

21 seq.) is amended b}^ adding at the end the following new 

22 section: 

23 "CASE-]\LySIAGEMENT SER^^CES FOR INDmDUALS WITH 

24 TRAU]\'L\TIC BRAIN INJURIES 

25 "Sec. 1931. (a) In General. — For purposes of sec- 

26 tion 1905 (a) (24), case-management sendees for individ- 

•S 1098 IS 



3 

1 uals who sustain traumatic brain injuries are services pro- 

2 vided to an eligible indi"\ddual (as described in subsection 

3 (d)) through a State case-management program that 

4 meets the requirements of subsection (b). 



5 "(b) Requirements for State Case-]\1anage- 

6 ment Prograjms. — 

7 "(1) State coordinator. — State case-man- 

8 agement program meets the requirements of this 

9 subsection if the State has designated a State coor- 

10 dinator for traumatic brain injuries who — 

11 "(A) establishes pohcies, standards, and 

12 procedures for pro^dding sendees under this sec- 

13 tion to eligible indiAd duals, 

14 "(B) contracts with qualified agencies or 

15 emplo3'S staff to pro^dde sendees under this sec- 

16 tion to eligible indi^dduals, -u 

17 "(C) supendses and coordinates services 

18 for eligible indi^dduals, 

19 "(D) makes necessaiy reports to the Sec- 

20 retary, and 

21 "(E) performs am^ other duties described 

22 in this section. 

23 "(2) Case-i\ianagei\ient ser^^ces. — State 

24 case-management program meets the requirements 

25 of this subsection if the program pro^ddes or ar- 



•S 1098 IS 



4 

1 ranges for the pro^dsion of the folloAving; case-man- 

2 agement sendees for ehgible indhdduals: 

3 "(A) An initial assessment of — 

4 "(i) the indi^ddual's need for case- 
5, management sendees, and j 

6 "(ii) if the indi^ddual is an appro- 

7 priate candidate for recei^dng case-nianage- 

8 ment sendees, the indi^ddual's need for 

9 other sendees, ^^dth an emphasis on identi- 

10 f)dng communitA^-based services required to 

11 prevent institntionahzation or minimize the 

12 need for residential rehabilitation. 

13 "(B) Preparation of a treatment plan for 

14 each indi\ddnal requiring case-management 

15 sendees based on consultation \vith the individ- 

16 ual (other than an indi^ddual who is comatose) 

17 and an}^ person named b}^ the individual. Prepa- 

18 ration of the plan shall be completed — 

19 "(i) as soon as possible after the indi- 

20 ^ddual suffers the injury, but may be de- 

21 layed (by one or more periods of no more 

22 than 15 days each) based on a physician 

23 certification that contains a brief expla- 

24 nation of the reason for the delay and at- 



•S 1098 IS 



5 

1 tests that such a delay is in the best inter- 

2 ests of the individual, or 

3 "(ii) in the case of an individual who, 

4 at the time the individual sustains the 

5 ■ traumatic brain injuiy, is not an eligible 

6 individual, mthin 60 days after such indi- 

7 vidual becomes an eligible individual. 

8 .'i ''(C) Presentation of a copy of the initial 

9 treatment plan and any subsequent modifica- 

10 tions to the plan to the individual or the indi- 

11 vidual's legal representative. 

12 ''(D) Regular updates of each individual's 

13 treatment plan (based on consultation \vith the 

14 care provider, the individual, and an}^ person 

15 named by the individual) mth data and infor- 

16 mation about treatments and services provided, 

17 as well as specific outcome measures of the in- 

18 dividual's performance or activity relative to 

19 goals previously established. n , 

20 "(E) Assistance in obtaining services nec- 

21 essary to allow the individual to remain in the 

22 community, including coordination of home care 

23 services with other services. 



•S 1098 IS 



6 

"(P) Advocacy sendees to assist the indi- 
^ddual in obtaining appropriate, accessible, and 
cost-effective sendees. 

"(G) Assessment of the individual's need 
for and level of home care sendees at appro- 
priate inten^als during the course of the individ- 
ual's treatment under the progi^am. 

"(H) Reassessment of each individual at 
regular intemils of at least ever}^ 3 months to 
determine the extent of each individual's 
progress and to ascertain whether the 
indivddual — 

"(i) is being kept too long in a given 

setting, ■ ■ , M 

^ "(ii) is being provdded sendees inap- 

propriatel}^ or ' 

"(iii) would be better sensed by other 

sendees or in another setting. 

"(I) In accordance v\dth standards estab- 
lished bv the State coordinator, verification that 

*,' / 

an}^ residential setting or facilit}^ which provides 
sendees to indivdduals under the program meets 
the requirements applicable to nursing facilities 
under section 1919. 



7 

1 ''(J) A complaint procedure, overseen by 

2 the State coordinator, regarding any treatment 

3 or semce pro^dded to an individual which pro- 

4 vides that — 

5 ■ • . "(i) the indi^ddual or an^^ person 

6 • ; ■ : named b}^ the indi^ddual may make an oral 

7 : or MTitten complaint; ' ■ ' 

8 < ■': , "(ii) the indi^ddual or an}^ person 

9 named by the indi^ddual may receive the 

10 response to the complaint; ,ji 

11 "(iii) the confidentialit}^ of any com- 

12 plainant is maintained; 

13 "(iv) an investigation of the complaint 

14 ■ is completed ^\dthin — 

15 . "(I) 30 days for a routine com- 

16 • , : , plaint, • , . ■ ■ ; 

17 "(11) 7 da3^s for a complaint of 

18 - abuse or neglect, and 

19 "(HI) 24 hours if the individual's 

20 life or safet}^ is immediatel}^ threat- 

21 ened; and 

22 "(v) if the complaint is ^^nth respect to 

23 - a publicl}^ appointed case manager or case 

24 worker, substitution of such manager or 

25 worker is allowed. 



•S 1098 IS 



8 

1 "(3) Coordination and administration op 

2 benefits and SERAaCES. — State ease-manage- 

3 ment progTam meets the requirements of this sub- 

4 section if the program assists in ensuring that an el- 

5 igible indi^adual is referred to and apphes for other 

6 benefits (through cooperative agTcements Avith agen- 

7 cies administering benefit programs) and services for 

8 which the indi^adual is eHgible under other Federal, 

9 State, or local programs, including — 

10 "(A) emplo^mient services, including voca- 

11 tional assessment, training, and placement, 

12 sheltered emplo3mient, and supported employ- 

13 ment; 

14 "(B) education benefits, including primary, 

15 secondar}^, and higher education programs; 

16 "(C) semces available under the Older 

17 Americans Act of 1965; 

18 "(D) disabilit}^ insurance under title II; 

19 and 

20 "(E) independent li^ang sendees under title 

21 Yll of the Rehabilitation Act of 1973. 

22 "(c) Coordination of Ser^^ces. — 

23 "(1) In general. — An eligible individual who 

24 is recei^dng case-management sendees described in 

25 subsection (b)(2) may receive the folloA\dng services 

•S 1098 IS - / 



9 

1 under such indhdduars treatment plan for which the 

2 individual is othenvise eligible under a State plan: 

3 "(A) Acute rehabilitation services, focusing 

4 on intensive physical and cognitive restorative 

5 semces in the early months follo^ving injury. 

6 "(B) Subacute rehabilitation in either in- 

7 patient or outpatient settings. ' - 

8 "(C) Transitional li^dng services to train 

9 the indi^ddual for more independent living, ^vith 

10 an emphasis on compensating for the loss of 

11 skills which may not be restored. ? 

12 L "(D) Lifelong li^dng sendees for individuals 

13 discharged from rehabilitation who require on- 

14 going lifetime support. 

15 "(E) Home care, including comprehensive 

16 training for famil}^ or other informal caregivers. 

17 "(F) Day treatment and other outpatient 

18 programs in nonresidential settings. 

19 . ' ' ; "(G) Independent li\dng sendees to allow 

20 the individual to live at home with optimal per- 

21 sonal control over sendees. 

22 "(H) Beha^dor disorder treatment services 

23 to address or resolve patterns of behavior which 

24 prevent or hinder participation in active reha- 

25 bilitation. 



S 1098 IS 2 



10 

1 "(I) Respite and recreation services to aid 

2 the indi^ddual and members of the individual's 

3 family in adapting psj^chologically and environ- 

4 mentally to residual deficits resulting from 

5 brain injur}''. " 

6 "(J) Treatment for conditions related to 

7 alcoholism and drug dependenc}^ "^^ 

8 "(2) Wart^r of certain limitations on the 

9 expenditure of funds. — 

10 "(A) In general. — In accordance ^vith 

11 standards established bv the State coordinator, 

12 a State case-management progi^am may waive 

13 restrictions on the amount, duration, and scope 

14 of sendees othen^dse applicable under the State 

15 plan for medical assistance under this title to 

16 the extent necessary to csLrry out a treatment 

17 plan for an indi^ddual. 

18 "(B) Home care serwces in excess of 

19 limitations established by state coordi- 

20 nator. — In accordance A\dth standards estab- 

21 lished b}^ the State coordinator, a State case- 

22 management program ma}^ approve the use of 

23 funds pro^dded under the State plan for medical 

24 assistance under this title to pay for home care 



•S 1098 IS 



11 

1 semces when such home care sendees exceed 

2 Hmitations estabhshed b}^ the State coordinator. 

3 "(C) Out-of-state placements for 

4 residentlal rehabilitation serwces. — In 

5 accordance ^^dth standards estabhshed by the 

6 State coordinator, a State case management 

7 , progTam may approve the use of funds provided 

8 under the State plan for medical assistance 

9 ' ■ under this title to ptw for out-of-State place- 

10 ments for residential rehabilitation sendees. : ' 

11 "(3) Special rule for pro^^ders of LmNG 

12 SER^aCES. — No li\ing sendees described in para- 

13 graph (1) may be pro^dded to or on behalf of any 

14 individual under this section unless the State case- 

15 management program wliich the individual is 

16 enrolled has entered into an agreement \vith the en- 

17 tity pro^dding such sendees that specifies — ; ; 

18 "(A) the li^dng semces to be provided, 

19 ^'(B) the period of time over which such 

20 services will be provided, and 

21 : -; "(C) the charges to the patient for provid- 

22 ing such semces. 

23 "(d) Eligibility of iNDmouALS To Receive 



24 SER^acES. — 



>S 1098 IS 



12 

1 "(1) In general. — ^An indmdual is eligible to 

2 receive case-management sendees under this section 

3 if the indi^ddual resides in a State that has imple- 

4 mented a ease-management progTam that meets the 

5 requirements of this section, is eligible to receive 

6 medical assistance under a State plan under this 

7 title, has suffered a traumatic brain injuiy (as de- 

8 fined in paragraph (2)), and is moderately or se- 

9 verel}^ disabled (as defined in paragraph (3)). 

10 "(2) Traujmatic brain injury defined. — 

11 For purposes of this section, the term 'traumatic 

12 brain injurv' means a sudden insult or damage to 

13 the brain or its coverings caused by an external 

14 phj^sical force which may produce a diminished or al- 

15 tered state of consciousness, and which results in a 

16 temporar}^ or permanent impairment of cognitive or 

17 mental abilities or plwsical functioning, or disturb- 

18 ance of beha^doral or emotional functioning. Such 

19 term does not include any injuries of a degenerative 

20 or congenital nature. ' ' 

21 "(3) Definitions relating to moderately 

22 or se^rerely disabled indmduals. — ■ 

23 "(A) In general. — For purposes of this 

24 section, the term 'moderatel}^ or severely dis- 

25 abled' means in the case of an individual 6 



•S 1098 IS 



1^3 

1 years of age or older, an individual who (^vith- 

2 out regard to income or employment status) is 

3 certified under the case-management program 

4 as — 

5 - - "(i) needing substantial assistance or 

6 supenasion from another individual with at 

7 " least 2 aetiiities of daih^ li^dng (as defined 

8 "in subparagTaph (C)); 

9 ■ - "(ii) needing substantial supervision 

10 due to cogTiitive or other mental impair- 

1 1 ment and needing substantial assistance or 

12 supendsion from another individual \vith at 

13 least 1 activity of daily li^dng or in comply- 

14 ing ^^^th a daily drug regimen; or 

15 "(iii) needing substantial supemsion 

16 from another indi^ddual due to behaviors 

17 that are dangerous (to the individual or 

18 others), dismptive, or difficult to manage. 

19 ' "(B) Moderately or se^^erely dis- 

20 ABLED CHILD.— 

21 "(i) In GENERAL. — For purposes of 

22 this section, the term 'moderately or se- 

23 verel}' disabled' means, in the case of an 

24 indi^ddual under 6 3'^ears of age, an individ- 

25 ual who is certified under the State case 



•S 1098 IS 



14 

1 management program as suffering from 

2 comparable levels of disability which would 

3 entitle such indi^ddual to benefits under 

4 this title. 

5 "(ii) Comparable levels of dis- 

6 ABILITY. — For purposes of clause (i), the 

7 V -. : term 'comparable levels of disability' 

8 means physical, cognitive, or other mental 

9 impairments that limit the ability of an in- 

10 di^ddual who is under 6 3^ears of age to 

11 perform acti^dties of daily living appro- 

12 - priate for the age of the indi^ddual that are 

13 comparable to the ph^^sical, cognitive, or 

14 other mental impairments that limit the 

15 ability of an indi^ddual 6 years of age or 

16 older such that the indi\ddual is described 

17 in clause (i), (ii), or (iii) of subparagraph 

18 (A). 

19 "(C) ACTmTY OF DAILY LmNG DE- 

20 PINED. — The term 'acti^dt}^ of daify living' 

21 means an}'^ of the follo^\dng acti^dties: 

22 ■ "(i) Bathing. . 

23 "(ii) Dressing. 

24 "(iii) Transferring. 

25 . "(iv) Toileting. , 



•S 1098 IS 



I 



15 

1 "(v) Eating. 

2 "(4) CO^TERAGE OP INDmDUALS UNDER DIS- 

3 ABILITY PROTECTIONS. — Individuals receiving serv- 

4 ices through a State case-management program 

5 under this section shall be considered to be individ- 

6 uals ^^dth disabilities for purposes of the Americans 

7 ^^dth Disabihties Act of 1990. ' ' 

8 "(e) Additional Duties of State Coordina- 

9 tor. — ' ■ : ^ ^ 

10 i; ' "(1) Pre^ti:ntion of traui\iatic brain in- 

11 JURY. — The State coordinator shall establish a pro- 

12 gram of acti^dties related to preventing and reducing 

13 the rate of traumatic brain injuries in the State. 

14 "(2) Trauiniatic brain injury registry. — 

15 "(A) In general. — The State coordinator 

16 shall establish and maintain a central registry 

17 of individuals who sustain traumatic brain in- 

18 • jury using standards established by the Sec- 

19 ' retaiy under subsection (f) in order to — '■ 

20 "(i) collect information to facilitate 

21 the development of injur}^ prevention, 

22 treatment, and rehabilitation programs; 

23 and 

24 "(ii) ensure the provdsion to individ- 

25 uals with traumatic brain injuiy of infor- 



•S 1098 IS 



16 

1 mation regarding* appropriate public or pri- 

2 vate agencies tliat pro^ade rehabilitative 

3 sendees so that injured individuals may ob- 

4 tain needed semce to allevaate injuries and 

5 avoid secondary problems, such as mental 

6 illness and chemical dependency, , 

7 "(B) Dissemination op data. — The 

8 State coordinator shall provdde summary reg- 

9 istry data to public and private entities to con- 

10 duct studies using data collected b}^ the trau- 

11 matic brain injur}^ registiy established under 

12 subparagraph (A). The State coordinator may 

13 charge a fee for all expenses associated vvith the 

14 provdsion of data or data anal3^sis. ; ij^^! 

15 "(3) Notification of injuries to job 

16 training prograims. — Within a reasonable period 

17 of time after receivdng a report that an individual 

18 has sustained a traumatic brain injuiy or spinal 

19 cord injury, the State coordinator shall notify any 

20 State agency responsible for emplojmient semces 

21 and job training and shall forward the individual's 

22 name and other identifying information to such 

23 agenc}^ 

24 "(4) Standards for ]\iariceting of brain 

25 INJURY services. — The State coordinator, after 



•S 1098 IS 



J 



17 

1 consultation ^^dth the achasoiy committee established 

2 under paragraph (6), shall — 

3 "(A) monitor standards established by the 

4 Secretar\^ regarding the marketing of services 

5 (by hospitals and other pro^aders) to any indi- 

6 vidual who has sustained traumatic brain injury 

7 or famih^ members of such indi\ddual, \' 

8 "(B) disseminate such standards to State 

9 ease-management programs, and 

10 "(C) furnish information about such stand- 

11 ards to such indiAddual and such family mem- 

12 bers at the earliest appropriate opportunity 

13 after such indi^ddual has sustained the injury. 

14 Such standards shall include (at a minimum) a rale 

15 prohibiting pa^nnents under a State case-manage- 

16 ment program under this section for referring indi- 

17 vi duals to rehabilitation facilities. 

18 "(5) Studies. — The State coordinator shall 

19 collect injuiy incidence information (including the 

20 prevalence, prevention, and treatment of traumatic 

21 brain injuiy), anah'ze the information, and conduct 

22 special studies regarding traumatic brain injury. 

23 "(6) ESTABLISmiENT OF AD^aSORY COMMIT- 

24 TEE. — The State coordinator shall establish an advi- 

25 sor}^ committee (consisting of representatives of pro- 



•S 1098 IS 



18 

1 fessionals who pro^nde community-based services 

2 under this section and individuals with traumatic 

3 brain injuries and famih^ members of such individ- 

4 uals) to provdde reconnnendations regarding the 

5 needs of indivnduals with traumatic brain injuries, 

6 provide advice on activities under paragraph (1), and 

7 assist in the estabhshment of marketing standards 

8 under paragrapli (4). & 

9 "(7) Prwacy. — Any data identifying specific 

10 individuals which is collected b}^ or provided to the 

11 State coordinator may be used only for purposes of 

12 case-management and rehabilitation and studies by 

13 the State coordinator, in accordance with mles 

14 adopted by the State coordinator. 1*1 

15 "(8) Adoption of standards for report- 

16 ing data and operation of registries. — the 

17 State coordinator shall adopt such standards estab- 

18 lished under subsection (f) as are necessar}^ to cany 

19 out this subsection. At a minimum, the State coordi- 

20 nator shall adopt the standards relating to the mat- 

21 ters identified in subparagraphs (A) through (E) of 

22 subsection (f)(2). ■ ■ <t 

23 "(9) Establishment of reporting sys- 

24 TEM. — 



•S 1098 IS 



1 



19 

1 "(A) In general. — The State coordinator 

2 shall design and establish a reporting sj^stem 

3 which requires either the treating hospital, med- 

4 ical facilitj^, or plwsician to report to the State 

5 coordinator ^^^thin a reasonable period of time 

6 after the identification of an}^ individual mth 

7 ICD diagnostic codes treated for a traumatic 

8 brain injury in the State. The consent of the in- 

9 jured indiAddual is not required. 

10 , "(B) Report. — report under subpara- 

11 gTaph (A) shall include — ! 

12 "(i) the name, age, and residence of 

13 the injured indi^ddual; 

14 : : "(ii) the date and cause of the injur}^; 

15 "(iii) the initial diagnosis; and 

16 "(iv) other information required by 

17 the State coordinator. 

18 "(C) Liability protection. — The far- 

19 nishing of information pursuant to the system 

20 established under subparagraph (A) shall not 

21 subject am^ indi^ddual or facilit}^ to any action 

22 for damages or other relief, pro^dded that the 

23 individual or facility acted in good faith in fur- 

24 nishing the information. 



S 1098 IS 



20 

1 "(f) Standards for Reporting Data and Oper- 

2 ATioN OF Registries. — ' ■ 

3 "(1) In general. — Not later than January 1, 

4 1995, the Secretary of Health and Human Services, 

5 acting through the Director of the Centers for Dis- 

6 ease Control and Prevention, shall establish stand- 

7 ards for the reporting of data on traumatic brain in- 

8 juries and the operation of registries of traumatic 

9 brain injuries for use b}^ State coordinators under 

10 this section. 

11 "(2) Scope. — The standards established under 

12 paragraph (1) shall at a minimum pro^ade for — 

13 "(A) the specific International Classifica- 

14 tion of Diseases, Ninth Re\dsion, Clinical Modi- 

15 fication, diag^lostic codes (hereafter referred to 

16 in this subsection as 'ICD diagnostic codes') in- 

17 eluded in the definitions of traumatic brain in- 

18 jury; 

19 "(B) the t^q^e of data to be reported; 

20 * "(C) standards for reporting specific types 

21 of data; v - ^ 

22 "(D) the indi^dduals and facilities required 

23 to report and the time period in which reports 

24 must be submitted; and 



•S 1098 IS 



1 



21 

1 "(E) criteria relating to the use of registry 

2 data by public and private entities engaged in 

3 research.". 

4 (c) Budget Neutrality. — 

5 (1) In general. — During the first 12-month 

6 period a State pro^ddes case-management services to 

7 which the amendments made b}^ this section apply, 

8 and each 12-month period thereafter, Federal finan- 

9 eial participation for all sendees under a State plan 

10 approved under title XIX of the Social Security Act 

11 provided to indi^dduals with, traumatic brain injuries 

12 shall not exceed the base-year amount determined 

13 under paragraph (2). 

14 (2) Base-year a^iount. — 

15 (A) First year. — The base-j^ear amount 

16 for the first 12-month period to which para- 

17 graph (1) applies shall be equal to the sum of — 

18 (i) the amount of Federal financial 

19 participation attributable to all services 

20 provided to indi\dduals ^^dth traumatic 

21 brain injuries under a State plan in the 

22 12-month period prior to the inclusion of 

23 case-management sendees in the State 

24 plan, as certified b}^ the Secretar^^, plus 



•S 1098 IS 



99 

1 (ii) such amount multiplied by the es- 

2 timated percentage increase in the 

3 Consumer Price Index for All-Urban Con- 

4 sumers for the preceding 12-month period, 

5 ^^^th appropriate adjustments to reflect 

6 . pre^dous underestimations or overesti- 

7 mations under this clause. - 

8 (B) Other years. — The base-year 

9 amount for any other 12 -month period shall be 

10 equal to the sum of — vq; 0| 

11 (i) the base-3^ear amount for the pre- 

12 ceding 12-month period, pais ' ' S.f 

13 (ii) such amount multiplied by the es- 

14 timated percentage increase in the 

15 Consumer Price Index for All-Urban Con- 

16 sumers for the preceding 12-month period, 

17 ^\dth appropriate adjustments to reflect 

18 pre^dous underestimations or overesti- 

19 : mations under this clause. 

20 (d) Conforming A^mendment. — Section 1915(g)(2) 

21 of the Social Security Act (42 U.S.C. 1396n(g)(2)) is 

22 amended by striking the period at the end and inserting 

23 the follo^ving: but does not include any semces provided 

24 under section 1931.". . , 



•S 1098 IS 



1 

23 

1 (e) Authorization of Appropriations. — There 

2 are authorized to be appropriated $5,000,000 for each fis- 

3 cal 3'ear beginning with fiscal 3^ear 1995 to cany out para- 

4 graphs (1) and (2) of section 1931(e) of the Social Secu- 

5 rity Act (as added b}'' subsection (b)). 

6 (f) Effectrte Date. — The amendments made by 

7 subsections (a), (b), and (d) shall apply to calendar quar- 

8 ters beginning on or after Januar}^ 1, 1995. 

9 SEC. 3. STUDY OF EFFECTIVENESS OF TRAUMATIC BRAIN 

10 INJURY INTERVENTIONS. 

11 (a) Study. — The Administrator of the Agency for 

12 Health Care Polic}^ and Research shall conduct a study 

13 to identify common therapeutic inten^entions which are 

14 used for the rehabilitation of traumatic brain injury pa- 

15 tients, and shall include in the study an analysis of — 

16 (1) the effectiveness of each such intervention 

17 in impro^dng the functioning of traumatic brain in- 

18 jur)^ patients; and 

19 (2) the comparative effectiA^eness of interven- 

20 tions emplo3'^ed in the course of rehabilitation of 

21 traumatic brain injuiy pritients to achieve the same 

22 or similar clinical outcome. 

23 (b) Report. — Not later than 3 3^ears after the date 

24 of the enactment of this Act, the Administrator of the 

25 Agency for Health Care Polic}^ and Research shall submit 



I 



•S 1098 IS 



ens LIBRflRV 




3 flOTS □0DLaQ5^ 3 



1 a report on the study conducted under subsection (a) to 

2 the Congress. ' ' ' 

3 (c) Authorization of Appropriations. — There 

4 are authorized to be appropriated $2,000,000 for each of 

5 fiscal years 1994 through 1997 to cany out the purposes 

6 of this section. ' ■ 

O • ' / ,: 



•S 1098 IS