Traumatic Brain Injury Act​

President Bill Clinton signed the Traumatic Brain Injury Act of 1996 (P.L. 104-166) into law on July 29, 1996. At the time, the TBI Act was the only federal legislation that specifically addressed TBI prevention, research, and service delivery through grants to states that were originally administered by the Health Resources and Services Administration (HRSA). The key federal agencies involved are:

• Centers for Disease Control and Prevention (CDC): CDC is responsible for conducting public information and education and prevention activities and for determining the incidence and prevalence of TBI in the U.S.
• National Institutes of Health (NIH): NIH is authorized to conduct basic and clinical research on TBI, including research on the prevention, diagnosis, and treatment of TBI and the general management of trauma.
• Administration for Community Living (ACL): ACL administers two grant programs. The first program, which is overseen by the Independent Living Administration, provides grants to states to improve access to service delivery. The second program, which is overseen by the Administration on Intellectual and Developmental Disabilities, provides grants to the designated Protection and Advocacy (P&A) System in each state.

Legislative History

TBI Act of 1996 (PL 104-166)

When signed into law, this legislation:

• Defined traumatic brain injury as “[A]n acquired injury to the brain. Such term does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to near drowning.”
• Required the National Center for Medical Rehabilitation Research within the Eunice Kennedy Shriver National Institute of Child Health and Human Development at NIH to conduct a national consensus conference on the rehabilitation of persons with TBI.
• Authorized $3 million for each fiscal year from 1997 through 1999 for CDC to carry out projects to reduce the incidence of TBI either directly or through awards of grants or contracts to public or nonprofit private entities.
• Authorized the National Institutes of Health (NIH) to award grants or contracts to public or nonprofit private entities for the conduct of basic and applied research.
• Authorized $5 million for each fiscal year from 1997 through 1999 for HRSA to make grants to states to carry out demonstration projects to improve access to health and other services and required:
  • States to establish an advisory board to make recommendations on ways to improve services coordination regarding TBI,
  • States to match Federal dollars in the amount that is not less than $1 for each $2 Federal funds provided under the grant, and
  • HHS to coordinate activities under this section with other Public Health service agencies.

TBI Amendments of 2000 (P.L. 106-310)

The TBI Amendments of 2000 (P.L. 106-310) reauthorized the programs at HHS as part of the Children’s Health Act of 2000. The 2000 Amendments added funding authority to HRSA to make grants to state Protection & Advocacy (P&A) Systems to expand their advocacy services to include TBI. Other key provisions of the reauthorization were:

• Extended authorization for funding from three to five years and authorized “sums as may be necessary” to carry out programs in lieu of specific appropriations.
• Changed the definition of TBI by replacing the phrase “anoxia due to near drowning” with “anoxia due to trauma,” except for the section pertaining to data collection for determining incidence and prevalence.
• Established a National Education and Awareness Campaign in conjunction with the goals set forth in Healthy People 2010, including:
  • The national dissemination of information on incidence and prevalence of TBI and information relating to secondary consequences arising from TBI upon discharge from hospitals and trauma centers; and
  • The provision of information in primary care settings, including emergency rooms and trauma centers, concerning the availability of state level services and resources.
• Expanded TBI surveillance to include individuals in institutional settings and individuals with mild brain injury and required a report of findings on mild brain injury to Congress.
• Authorized NIH to carry out applied research related to cognitive disorders and neurobehavioral consequences, including the development, modification, and evaluation of therapies and programs of rehabilitation toward reaching or restoring normal capabilities in areas such as reading, comprehension, speech, reasoning, and deduction.
• Removed the term “demonstration” with regard to state grants and expanded the type and range of projects that could be funded, including consumer education, service coordination systems, and improved data across systems.
  • Allowed states to use “in-kind” matches in lieu of a state dollar match; and
  • Added language that recognizes self-determination and consumer direction in services and supports.
• Added a new section authorizing HRSA to make grants to state P&A systems for advocacy services for individuals with TBI to include information, referrals, and advice; individual and family advocacy; legal representation; and specific assistance in self-advocacy.

Traumatic Brain Injury Act of 2008 (P.L. 111-36)

The Reauthorization of the TBI Act of 2008 reauthorized appropriations to HHS through Fiscal Year 2012. The bill made minor changes to reflect current language used by the CDC in public education and data collection, re-designated sections relating to CDC, and added the American Indian Consortium as an eligible entity for grant funds awarded by the HRSA Federal TBI State Grant Program. A key provision of note:

• Required CDC and NIH, in consultation with the Department of Defense and the Department of Veterans Affairs, to submit a report to Congress on methods for collecting and disseminating compatible epidemiological studies on the incidence and prevalence of TBI in the military and veterans’ populations that return to civilian life.

TBI Reauthorization Act of 2014 (P.L. 113-196)

The TBI Reauthorization Act of 2014 (P.L. 113-196) reauthorized funding through FY 2019 for TBI prevention, surveillance or registry programs, grants to states and Indian Consortia for improving access to TBI services, and grants to state P&A systems. The law removed HRSA from the sections relating to the state grant and the P&A grant programs and authorized the HHS Secretary to determine the proper agency(s) to administer these programs. The law also:

• Directed the Secretary of HHS to develop a plan for the improved coordination of federal activities with regard to TBI.
• Directed the CDC, in consultation with NIH, to review the scientific evidence related to brain injury management in children and identify opportunities for research.

TBI Program Reauthorization Act of 2018 (P.L. 115-377)

The current authorizing legislation was signed into law in 2018. It was reauthorized one year early as a way to honor Sen. Orrin Hatch (R-Utah), who retired in 2018 and was an original sponsor of the 1996 bill in the Senate. The law:

• Authorized the CDC to collect and analyze data regarding the national prevalence and incidence of concussions.
• Designated ACL as the agency to administer the TBI state and P&A grant programs.
• Reauthorized funding through 2024.
• Required HHS to submit to two House Committees and the Senate a report describing the findings and results of the programs established for state grant and P&A grant programs, including measures of outcomes and consumer and surrogate satisfaction.