Traumatic Brain Injury Act of 2006

Mr. President, I rise today to introduce the Medicare Independent Living Act of 2006 with Senators Santorum, Murray, Collins, Akaka, Jeffords, Kerry, Harkin, Kennedy, and Lieberman. This legislation would eliminate Medicare's ``in the home'' restriction for the coverage of mobility devices, including wheelchairs and scooters, for those with disabilities and expected long-term needs. This includes people with multiple sclerosis, paraglegia, osteoarthritis, and cerebrovascular disease that includes acute stroke and conditions like aneurysms.

As currently interpreted by the Centers for Medicare and Medicaid Services, CMS, the ``in the home'' restriction prevents beneficiaries from obtaining wheelchairs that are necessary for use outside the home. This precludes beneficiaries who need a wheelchair to access work, the community at-large, his or her place of worship, school, physician's offices, or pharmacies.

On July 13, 2005, 34 senators wrote Secretary Leavitt asking the Department of Health and Human Services, or HHS, to modify the ``in the home'' requirement so as to ``improve community access for Medicare beneficiaries with mobility impairments.''

Unfortunately, CMS continues to impose the ``in the home'' restriction on Medicare beneficiaries in need of mobility devices. The result is that people who may not need a wheelchair to get around their house but do need one to get around their communities, such as to a job, church, or the grocery store, can't get Medicare to pay for one. As the Medicare Rights Center in a report entitled ``Forced Isolation: Medicare's `In The home' Coverage Standards for Wheelchairs'' in March 2004 notes, ``This effectively disqualifies you from leaving your home without the assistance of others.''

Furthermore, in a Kansas City Star article dated July 3, 2005, Mike Oxford with the National Council on Independent Living noted, ``You look at mobility assistance as a way to liberate yourself.'' He added that the restriction ``is just backward.''

In fact, policies such as these are not only backward but directly contradict numerous initiatives aimed at increasing community integration of people with disabilities, including the Americans with Disabilities Act, the Ticket-to-Work Program, the New Freedom Initiative, and the Olmstead Supreme Court decision.

According to the Medicare Rights Center update dated March 23, 2006, ``This results in arbitrary denials. People with apartments too small for a power wheelchair are denied a device that could also get them down the street. Those in more spacious quarters get coverage, allowing them to scoot from room to room and to the grocery store. People who summon all their willpower and strength to hobble around a small apartment get no help for talks that are beyond them and their front door.''

In New Mexico, I have heard this complaint about the law repeatedly from our State's most vulnerable disabled and senior citizens. People argue the provision is being misinterpreted by the administration and results in Medicare beneficiaries being trapped in their home.

The ITEM Coalition adds in a letter to CMS on this issue in November 25, 2005, ``There continues to be no clinical basis for the `in the home' restriction and by asking treating practioners to document medical need only within the home setting, CMS is severely restricting patients from receiving the most appropriate devices to meet their mobility needs.''

Therefore, our bipartisan legislation would clarify that this restriction does not apply to mobility devices, including wheelchairs, for people with disabilities in the Medicare Program. The language change is fairly simple and simply clarifies that the ``in the home'' restriction for durable medical equipment does not apply in the case of mobility devices needed by Medicare beneficiaries with expected long- term needs for use ``in customary settings such as normal domestic, vocational, and community activities.''

This legislation is certainly not intended to discourage CMS from dedicating its resources to reducing waste, fraud, and abuse in the Medicare system, as those efforts are critical to ensuring that Medicare remains financially viable and strong in the future. However, it should be noted that neither Medicaid nor the Department of Veterans Affairs impose such ``in the home'' restrictions on mobility devices. As Senator Brownback said to the Kansas City Star, it is important to lift the restriction ``to reflect our goal of ensuring that Americans with disabilities are able to live independent, healthy, and productive lives.''

I thank Senators Santorum, Murray, Collins, Akaka, Jeffords, Kerry, Harkin, Kennedy, and Lieberman for cosponsoring this important legislation, and attached is a fact sheet that I request to be printed in the Record. I would also ask unanimous consent to have printed in the Record copies of the letter to the administration and the response that was received by Capitol Hill.

Mr. President, as we face the close of the 109th Congress in the coming months, I feel it is important that we reauthorize the Traumatic Brain Injury Act. It is my pleasure to introduce this reauthorization bill along with the ranking minority member of the Senate Health, Education, Labor, and Pension Committee, Senator Ted Kennedy, with whom I worked on the original legislation over 10 years ago. Our colleagues on the House side, Representatives Bill Pascrell, Jr., and Todd Russell Platts, have just recently introduced a companion bill with the same goal of reauthorizing the TBI Act this year.

Sustaining a traumatic brain injury--or TBI--can be both catastrophic and devastating. The financial and emotional costs to the individual, family, and community are enormous. Traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability annually.

Of the 1.4 million who sustain a TBI each year in the United States: 50,000 die; 235,000 are hospitalized; and 1.1 million are treated and released from an emergency department. Brain injuries are the most frequent reasons for visits to physicians and emergency rooms.

These statistics are more revealing when one considers that every 16 seconds someone in the U.S. sustains a head injury; every 12 minutes, one of these people will die and another will become permanently disabled. Of those who survive, each year, an estimated 80,000 to 90,000 people experience the onset of long-term disability associated with a TBI. An additional 2,000 will exist in a persistent vegetative state.

Even more startling is the fact that brain injury kills more Americans under the age of 34 than all other causes combined and has claimed more lives since the Turn of the Century than all United States wars combined. Sixty-eight percent of war veterans are returning home with sustained brain injuries.

The distress of TBI is not limited to diagnosis. A survivor of a severe brain injury typically faces 5 to 10 years of intensive services and estimated lifetime costs can exceed $4 million. Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $60 billion in the United States in 2000.

The Traumatic Brain Injury Act is the only Federal legislation specifically addressing issues faced by 5.3 million American children and adults who live with a long-term disability as a result of traumatic brain injury. Reauthorization of the Traumatic Brain Injury Act will provide for the continuation of research, not only for the treatment of TBI but also for prevention and awareness programs which will help decrease the occurrence of traumatic brain injury and improve the long-term outcome.

In 2006, Congress has an opportunity to strengthen the TBI Act by authorizing the Centers for Disease Control and Prevention, CDC, to determine the incidence and prevalence of traumatic brain injury in the general population of the United States, including all age groups and persons in institutional settings such as nursing homes, correctional facilities, psychiatric hospitals, child care facilities, and residential institutes for people with developmental disabilities.

This legislation authorizes the Health Resources and Services Administration, HRSA, to make grants for projects of national significance that improve individual and family access to service systems; assist states in developing service capacity; improve monitoring and evaluation of rehabilitation services and supports; and address emerging needs of servicemen and women, veterans, and individuals and families who have experienced brain injury through service delivery demonstration projects.

This bill also authorizes HRSA to include the American Indian Consortium as an eligible recipient of competitive grants awarded to States, Territories, and the District of Columbia to develop comprehensive system of services and supports nationwide.

Furthermore, this bill instructs HRSA and the Administration on Developmental Disabilities to coordinate data collection regarding protection and advocacy services.

The TBI Act offers balanced and coordinated public policy in brain injury prevention, research, education, and community-based services and supports for individuals living with traumatic brain injury and their families.

Mr. President, reauthorization of the Traumatic Brain Injury Act will further provide mechanisms for the prevention, treatment and the improvement of the quality of life for those Americans and their families who may sustain such a devastating disability. I ask my colleagues' support in promptly reauthorizing the Traumatic Brain Injury Act.

Mr. President, as we face the close of the 109th Congress in the coming months, I feel it is important that we reauthorize the Traumatic Brain Injury Act. It is my pleasure to introduce this reauthorization bill along with the ranking minority member of the Senate Health, Education, Labor, and Pension Committee, Senator Ted Kennedy, with whom I worked on the original legislation over 10 years ago. Our colleagues on the House side, Representatives Bill Pascrell, Jr., and Todd Russell Platts, have just recently introduced a companion bill with the same goal of reauthorizing the TBI Act this year.

Sustaining a traumatic brain injury--or TBI--can be both catastrophic and devastating. The financial and emotional costs to the individual, family, and community are enormous. Traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability annually.

Of the 1.4 million who sustain a TBI each year in the United States: 50,000 die; 235,000 are hospitalized; and 1.1 million are treated and released from an emergency department. Brain injuries are the most frequent reasons for visits to physicians and emergency rooms.

These statistics are more revealing when one considers that every 16 seconds someone in the U.S. sustains a head injury; every 12 minutes, one of these people will die and another will become permanently disabled. Of those who survive, each year, an estimated 80,000 to 90,000 people experience the onset of long-term disability associated with a TBI. An additional 2,000 will exist in a persistent vegetative state.

Even more startling is the fact that brain injury kills more Americans under the age of 34 than all other causes combined and has claimed more lives since the Turn of the Century than all United States wars combined. Sixty-eight percent of war veterans are returning home with sustained brain injuries.

The distress of TBI is not limited to diagnosis. A survivor of a severe brain injury typically faces 5 to 10 years of intensive services and estimated lifetime costs can exceed $4 million. Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $60 billion in the United States in 2000.

The Traumatic Brain Injury Act is the only Federal legislation specifically addressing issues faced by 5.3 million American children and adults who live with a long-term disability as a result of traumatic brain injury. Reauthorization of the Traumatic Brain Injury Act will provide for the continuation of research, not only for the treatment of TBI but also for prevention and awareness programs which will help decrease the occurrence of traumatic brain injury and improve the long-term outcome.

In 2006, Congress has an opportunity to strengthen the TBI Act by authorizing the Centers for Disease Control and Prevention, CDC, to determine the incidence and prevalence of traumatic brain injury in the general population of the United States, including all age groups and persons in institutional settings such as nursing homes, correctional facilities, psychiatric hospitals, child care facilities, and residential institutes for people with developmental disabilities.

This legislation authorizes the Health Resources and Services Administration, HRSA, to make grants for projects of national significance that improve individual and family access to service systems; assist states in developing service capacity; improve monitoring and evaluation of rehabilitation services and supports; and address emerging needs of servicemen and women, veterans, and individuals and families who have experienced brain injury through service delivery demonstration projects.

This bill also authorizes HRSA to include the American Indian Consortium as an eligible recipient of competitive grants awarded to States, Territories, and the District of Columbia to develop comprehensive system of services and supports nationwide.

Furthermore, this bill instructs HRSA and the Administration on Developmental Disabilities to coordinate data collection regarding protection and advocacy services.

The TBI Act offers balanced and coordinated public policy in brain injury prevention, research, education, and community-based services and supports for individuals living with traumatic brain injury and their families.

Mr. President, reauthorization of the Traumatic Brain Injury Act will further provide mechanisms for the prevention, treatment and the improvement of the quality of life for those Americans and their families who may sustain such a devastating disability. I ask my colleagues' support in promptly reauthorizing the Traumatic Brain Injury Act.

Mr. President, today I am proud to join with Senator Hatch in sponsoring the reauthorization of the Traumatic Brain Injury Act. This

bill will provide valuable assistance to the millions of children and adults in our nation who are facing an array of problems because of their injuries.

First, it is critical for us to acknowledge the important role which the programs authorized under this bill can play for the large number of soldiers wounded in the war. As of June 2006--almost 19,000 service members have been wounded in Iraq and data continue to demonstrate that brain injuries are approximately two-thirds of the injuries suffered in the war.

On top of that, there is an extremely high incidence of traumatic brain injuries among children between birth and age 14--approximately 475,000 a year--and some of the highest numbers of injuries are among children under the age of five.

Soldiers and children--I cannot think of groups more deserving of our attention.

Reauthorization of the TBI Act is crucial to continued federal funding for a range of traumatic brain injury programs. The bill will reauthorize grants that have provided vital assistance to States, Territories, the District of Columbia, and American Indian Consortia in building or enhancing coordinated systems of community-based services and supports for children and adults with traumatic brain injuries.

In addition, when Congress first authorized the Traumatic Brain Injury Act as part of the Children's Health Act of 2000, it had the foresight to include funding for the Protection and Advocacy for Individuals with Traumatic Brain Injury Program. This program has played a crucial role because individuals with traumatic brain injury have help in returning to work, finding a place to live, accessing needed supports and services such as attendant care and assistive technology, and obtaining appropriate mental health, substance abuse, and rehabilitation services. Often those with brain injuries--including our returning veterans--are forced to remain in extremely expensive institutional settings far longer than necessary because the community- based supports and services they need are not available. Effective protection and advocacy services for people with traumatic brain injury can lead both to reduced Government expenditures and increased productivity, independence and community integration for patients. However, those who advocate for the injured must possess specialized skills and the work is often time-intensive.

This legislation also provides funding for critical CDC programs that provide extremely important surveillance and injury prevention information.

In a time when both the administration and Congress are searching for programs that provide the right kind of ``bang for the Federal buck,'' the recent findings in an Institute of Medicine March 2006 report show that the TBI programs work. Last year the various programs in the TBI bill were funded for a total of only $12 million--yet look at the good they do. Not only should these programs be reauthorized, the funding also should be increased.

The IOM calls the TBI programs an ``overall success,'' stating that ``there is considerable value in providing funding,'' and ``it is worrisome that the modestly budgeted HRSA TBI Program continues to be vulnerable to budget cuts.'' As the IOM study suggests, this program must be continued and allowed to grow in order to ensure that each state has the resources necessary to maintain critical services and advocacy for the estimated 5.3 million people currently living with disabilities resulting from brain injury.

Again, soldiers and children, I cannot think of two more deserving groups of people in our Nation. We owe them the services and advocacy that these critical programs offer. And I urge our colleagues to support the passage of this important piece of bipartisan disability legislation this year.

Mr. President, today I am proud to join with Senator Hatch in sponsoring the reauthorization of the Traumatic Brain Injury Act. This

bill will provide valuable assistance to the millions of children and adults in our nation who are facing an array of problems because of their injuries.

First, it is critical for us to acknowledge the important role which the programs authorized under this bill can play for the large number of soldiers wounded in the war. As of June 2006--almost 19,000 service members have been wounded in Iraq and data continue to demonstrate that brain injuries are approximately two-thirds of the injuries suffered in the war.

On top of that, there is an extremely high incidence of traumatic brain injuries among children between birth and age 14--approximately 475,000 a year--and some of the highest numbers of injuries are among children under the age of five.

Soldiers and children--I cannot think of groups more deserving of our attention.

Reauthorization of the TBI Act is crucial to continued federal funding for a range of traumatic brain injury programs. The bill will reauthorize grants that have provided vital assistance to States, Territories, the District of Columbia, and American Indian Consortia in building or enhancing coordinated systems of community-based services and supports for children and adults with traumatic brain injuries.

In addition, when Congress first authorized the Traumatic Brain Injury Act as part of the Children's Health Act of 2000, it had the foresight to include funding for the Protection and Advocacy for Individuals with Traumatic Brain Injury Program. This program has played a crucial role because individuals with traumatic brain injury have help in returning to work, finding a place to live, accessing needed supports and services such as attendant care and assistive technology, and obtaining appropriate mental health, substance abuse, and rehabilitation services. Often those with brain injuries--including our returning veterans--are forced to remain in extremely expensive institutional settings far longer than necessary because the community- based supports and services they need are not available. Effective protection and advocacy services for people with traumatic brain injury can lead both to reduced Government expenditures and increased productivity, independence and community integration for patients. However, those who advocate for the injured must possess specialized skills and the work is often time-intensive.

This legislation also provides funding for critical CDC programs that provide extremely important surveillance and injury prevention information.

In a time when both the administration and Congress are searching for programs that provide the right kind of ``bang for the Federal buck,'' the recent findings in an Institute of Medicine March 2006 report show that the TBI programs work. Last year the various programs in the TBI bill were funded for a total of only $12 million--yet look at the good they do. Not only should these programs be reauthorized, the funding also should be increased.

The IOM calls the TBI programs an ``overall success,'' stating that ``there is considerable value in providing funding,'' and ``it is worrisome that the modestly budgeted HRSA TBI Program continues to be vulnerable to budget cuts.'' As the IOM study suggests, this program must be continued and allowed to grow in order to ensure that each state has the resources necessary to maintain critical services and advocacy for the estimated 5.3 million people currently living with disabilities resulting from brain injury.

Again, soldiers and children, I cannot think of two more deserving groups of people in our Nation. We owe them the services and advocacy that these critical programs offer. And I urge our colleagues to support the passage of this important piece of bipartisan disability legislation this year.