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[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.

           *       *       *       *       *       *       *