H. R. 6528
IN THE HOUSE OF REPRESENTATIVES
December 16, 2010
Mr. Walz (for himself and Mrs. Myrick) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
To provide for improvement of field emergency medical services, and for other purposes.
Short title; table of contents
This Act may be cited
Field EMS Quality, Innovation,
and Cost Effectiveness Improvements Act of 2010.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Recognition of NHTSA as primary Federal agency for field EMS.
Sec. 5. Field EMS Excellence, Quality, Universal Access, Innovation and Preparedness.
Sec. 6. Field EMS System Performance, Integration and Accountability.
Sec. 7. Field EMS quality.
Sec. 8. Field EMS education grants.
Sec. 9. Evaluating innovative models for access and delivery of field EMS for patients.
Sec. 10. Enhancing research in field EMS.
Sec. 11. National Emergency Medical Services Advisory Council.
Sec. 12. Emergency care coordination.
Sec. 13. Emergency Medical Services Trust Fund.
Sec. 14. Authorization of appropriations.
The Congress finds the following:
All persons throughout the country should have access to and receive high-quality emergency medical care as part of a coordinated emergency medical services system.
Properly functioning emergency medical services (EMS) systems, 24 hours per day, 7 days per week, are essential to ensure access to emergency medical care and transport for all patients with emergency medical conditions. Such coordinated EMS systems are also necessary for response to catastrophic incidents.
Ensuring high-quality and cost-effective EMS systems requires readiness, preparedness, medical direction, oversight, and innovation throughout the continuum of emergency medical care through Federal, State, and local multijurisdictional collaboration and sufficient resources for EMS agencies and providers.
At the Federal level, EMS responsibilities and resources of several Federal agencies consistent with their expertise and authority must emphasize the critical importance of Federal agency collaboration and coordination for all emergency medical services.
At the State and local level, EMS systems and agencies require the coordination and improved capabilities of multiple and diverse stakeholders.
Emergency medical services encompass the provision of care provided to patients with emergency medical conditions throughout the continuum, including care provided in the field, hospital, and rehabilitation settings.
Field EMS comprises essential emergency medical services, including medical care or medical transport provided to patients prior to or outside medical facilities and other clinical settings. The primary purpose of field emergency medical services is to ensure that emergency medical patients receive the right care at the right place in the right amount of time.
Coordinated and high-quality field EMS is essential to the Nation’s security. Field EMS is an essential public service provided by governmental and nongovernmental agencies and practitioners 24 hours a day, 7 days a week, and during catastrophic incidents. To ensure disaster and all-hazards preparedness for EMS operations as part of the Nation’s comprehensive disaster preparedness, Federal funding for preparedness activities, including catastrophic training and drills, must be provided to governmental and nongovernmental EMS agencies so as to ensure a greater capability within each of these areas.
recommendations from several significant national reports and documents have
demonstrated the need in multiple areas for substantial improvement for
emergency medical services provided in the field, including recommendations in
the EMS Agenda for the Future, the Institute of Medicine report
Future of Emergency Care in the United Health System, and the National
EMS Education Agenda for the Future: A Systems Approach and recommendations by
the National EMS Workforce Injury and Illness Surveillance Program, the
Department of Transportation’s National EMS Advisory Council (NEMSAC), and the
Federal Interagency Committee on Emergency Medical Services (FICEMS).
To substantially improve field EMS advancements must be made in several essential areas including in readiness, innovation, preparedness, education and workforce development, safety, financing, quality, standards, and research.
The recognition of a primary Federal agency specifically for field EMS is necessary to provide a more streamlined, cost-efficient, and comprehensive approach for field EMS as well as provide a focal point for practitioners and agencies to interface with the Federal Government.
The long-standing role and capability of the National Highway Traffic Safety Administration (NHTSA) to promote the development of field EMS should be enhanced to serve in a federally recognized leadership role for field EMS, and enable NHTSA to serve as a full and equal partner with other Federal agencies that oversee other aspects of the EMS system and national preparedness and response.
The Emergency Care Coordinating Center (ECCC) should be statutorily created to ensure its continued and essential leadership role in supporting the Federal Government’s coordination of in-hospital emergency medical care activities, including by promoting the regionalization of emergency medical care and promoting other programs and resources that improve the seamless delivery of the Nation’s daily emergency medical care and emergency behavioral care.
The essential role of field EMS in disaster preparedness and response must be incorporated into the national preparedness and response strategy and implementation as provided and overseen by the Department of Homeland Security and the Department of Health and Human Services pursuant to their respective jurisdictions.
The discretionary National EMS Advisory Council (NEMSAC) created by the Department of Transportation under the Federal Advisory Committee Act should be a statutorily established council that ensures non-Federal input and recommendations to NHTSA, FICEMS, and all Federal agencies involved with EMS.
FICEMS must continue in its essential role in coordinating the Federal activities related to the full spectrum of EMS.
In this Act:
The term EMS means emergency medical services.
The term FICEMS means the Federal Interagency Committee on Emergency Medical Services.
The term field EMS means emergency medical services provided to patients (pursuant to transport by ground, air, or otherwise) prior to or outside a medical facility or other clinical setting.
The term field EMS agency means an organization providing field EMS, regardless of—
whether such organization is governmental, nongovernmental, or volunteer; and
whether such organization provides field EMS by ground, air, or otherwise.
The term emergency medical services or EMS means emergency medical care and related services provided to patients at any point in the continuum of health care services, including emergency medical dispatch and medical care and related services provided in the field, during transport, or in a medical facility or other clinical setting.
The term field EMS patient care reports means the information that a field EMS agency typically creates regarding a patient’s medical condition and treatment in the course of providing emergency medical services to that patient.
The term NEMSAC means the National Emergency Medical Services Advisory Council established by section 12.
The term NEMSIS means the National EMS Information System.
The term NHTSA means the National Highway Traffic Safety Administration.
The term State EMS Office means an office designated by the State with primary responsibility for oversight of the State’s EMS system, such as responsibility for oversight of EMS coordination, licensing or certifying EMS practitioners, and EMS system improvement.
The term STEMI means ST–Segment Elevation Myocardial Infarction.
Recognition of NHTSA as primary Federal agency for field EMS
Primary Federal agency for field EMS
NHTSA shall serve as the primary Federal agency for field EMS to provide enhanced Federal support for the development of patient-centered, medically directed, evidence-based, cost-effective, and safe field emergency medical services that are accessible to patients throughout the United States and which ensure 24 hours a day, 7 days a week readiness, catastrophic preparedness, and continual innovation in quality and capability for the betterment of patients. In this capacity, the Administrator of NHTSA shall—
provide enhanced leadership for emergency medical services provided in the field;
work in partnership with the other Federal agencies involved with EMS in their respective leadership roles in overseeing other aspects of the full spectrum of emergency medical services and preparedness and response; and
work in collaboration with FICEMS, which coordinates all Federal EMS efforts, to ensure a seamless Federal approach to a coordinated emergency medical services system across the continuum of emergency medical care.
Cohesive national field EMS strategy
The Administrator of NHTSA shall, pursuant to this Act, develop and implement a cohesive national strategy to strengthen the development of field emergency medical services (EMS) at the Federal, State, and local levels. In establishing such a strategy, the Administrator shall—
solicit and consider the recommendations of the NEMSAC as well as relevant stakeholders;
consult and collaborate with FICEMS to ensure consistency of such a field EMS strategy within the larger Federal strategy regarding all of emergency medical services and national preparedness and response;
address issues related to EMS patient and practitioner safety, standardization of EMS practitioner licensing and credentialing, field EMS operational improvements and integration of field EMS practitioners into the broader health care system including—
promotion of the
adoption by States of the education standards identified in the
Emergency Medical Services Education Agenda for the Future: A Systems
Approach and any revisions thereto, including the standardization of
licensing and credentialing of field EMS practitioners and standards of care,
based on best practices and evidence-based medicine, including by—
the identification of differences in the levels of care, scope of practice, and licensure and credentialing requirements among the States; and
the adoption by the States of national standards for such levels of care, scope of practice and licensure and credentialing requirements;
promotion of a culture of safety, including—
the adoption of an anonymous error reporting system designed to identify systemic problems in field EMS patient and practitioner safety and ensure a single means of collecting and reporting relevant error data by field EMS agencies and States;
the establishment of field EMS patient and practitioner safety goals and the specific means to improve field EMS practitioner and patient safety to achieve such goals; and
the adoption of more uniform national ambulance vehicle safety and manufacturing standards;
the integration and utilization of field EMS practitioners as part of the larger health care system including—
the potential utilization of field EMS practitioners for the provision of care to patients with non-emergent medical conditions; and
such other strategies to implement the recommendations provided by the National Health Care Workforce Commission, pursuant to section 5101(d)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 294q(d)(2)); and
such other issues that the Administrator considers appropriate;
complete the development of such strategy not later than 18 months after the date of enactment of this Act;
communicate such strategy to the relevant congressional committees of jurisdiction;
implement such strategy to the extent practical not later than 3 years after the date of enactment of this Act; and
update such strategy not less than every 3 years.
Nothing in this Act shall be construed to preempt any statutory authority otherwise provided for any other Federal agency.
Field EMS Excellence, Quality, Universal Access, Innovation and Preparedness
The Administrator shall establish the EQUIP grant program—
to promote excellence in all aspects of the provision of field EMS by field EMS agencies;
to enhance the quality of emergency medical care provided to patients by field EMS practitioners through evidence-based, medically directed field emergency care;
to promote universal access to and availability of high-quality field EMS in all geographic locations of the Nation;
to spur innovation in the delivery of field EMS; and
to improve EMS agency preparedness for everyday and catastrophic emergency medical response.
To be eligible to receive a grant under this section, an eligible entity shall submit an application to the Administrator in such form and manner, that contains such agreements, assurances, and information as the Administrator determines to be reasonably necessary to carry out this section.
The Administrator shall ensure that grant application requirements are not unduly burdensome to smaller and volunteer field EMS agencies or other agencies with limited resources.
Use of funds
Grants may be used by eligible entities to—
sustain field EMS practitioners to ensure 24 hours a day, 7 days a week readiness and preparedness at the local level;
develop and implement initiatives related to delivery of medical services, including—
innovative clinical practices to improve the cost-effectiveness and quality of care delivered to emergency patients in the field that results in improved patient outcomes and cost savings to the health system, including for high prevalence emergency medical conditions such as sudden cardiac arrest, STEMI, stroke, and trauma; and
delivery systems to improve patient outcomes, which may include implementing evidence-based protocols, interventions, systems, and technologies to reduce clinically meaningful response times;
purchase and implement—
medical equipment and training for using such equipment;
communication systems to ensure seamless and interoperable communications with other first responders; and
information systems to comply with NEMSIS data collection and integrate field emergency care with electronic medical records;
participate in federally sponsored field EMS research;
establish or enhance comprehensive medical oversight and quality assurance programs that include the active participation by medical directors in field EMS medical direction and educational programs; and
such other uses as the Administrator may establish.
Administration of grants
In establishing and administering the EQUIP grant program, the Administrator—
shall establish a grant making process that includes—
prioritization for the awarding of grants to eligible entities and consideration of the factors in reviewing grant applications by eligible entities including—
demonstrated financial need for funding;
utilization of public and private partnerships;
enhanced access to high-quality field EMS in under served geographic areas;
unique needs of volunteer and rural field EMS agencies;
distribution among a variety of geographic areas, including urban, suburban, and rural;
distribution of funds among types of EMS agencies, including governmental, non-governmental and volunteer;
implementation of evidence-based interventions that improve quality of care, patient outcomes, efficiency, or cost effectiveness; and
such other factors as the Administrator considers necessary;
a peer reviewed process to recommend grant allocations in accordance with the prioritization established by the Administrator except that final award determinations shall be made by the Administrator; and
the provision of grant awards to eligible entities on an annual basis, except that the Administrator may reserve not more than 25 percent of the available appropriations for multi-year grants and no grant award may exceed a 2-year period;
shall consult with and take into consideration the recommendations of FICEMS, NEMSAC and relevant stakeholders;
shall ensure that funds used for catastrophic preparedness activities are consistent and aligned with Federal preparedness priorities; and
may contract with an independent, third-party, nonprofit organization to administer the grant program if the Administrator establishes conflict-of-interest requirements as part of any such contractual relationship.
Eligible grant recipients are field EMS agencies that—
are licensed by or otherwise authorized in the State in which they operate; and
have medical oversight and quality improvement programs as defined by the Administrator.
The Administrator shall submit an annual report on the EQUIP grant program under this section to the Congress.
Field EMS System Performance, Integration and Accountability
The Administrator shall establish the SPIA grant program—
to improve field EMS system performance, integration and accountability;
to ensure preparedness for field EMS at the State and local levels;
to enhance physician medical oversight of field EMS systems;
to improve coordination between regional field EMS systems and integration of such regional field EMS systems into the larger health care system;
to enhance data collection and analysis to improve, on a continuing basis, the field EMS system; and
to enhance standardization of national EMS certification of emergency medical technicians and paramedics.
Use of funds
Grants may be used by eligible entities—
to enhance pandemic influenza and all hazards EMS preparedness and coordination of medical first response;
to improve cross-border collaboration and planning among States;
to collect data with regard to—
field EMS education;
field EMS workforce;
cardiac events, including STEMI and sudden cardiac arrest;
disasters, including injuries and illnesses;
ambulance diversion and patient parking;
trauma (in a manner that is complementary and not duplicative of other trauma data collection such as the National Trauma Data Bank);
data determined necessary by the State Office of EMS for oversight and coordination of the State field EMS system; and
any other such data that the Administrator specifies;
to implement and evaluate system-wide quality improvement initiatives, including medical direction at the State, local, and regional levels;
to integrate field EMS with other health care services as part of a coordinated system of care provided to patients with emergency medical conditions to help ensure the right patient receives the right care by the right crew in the right vehicle and at the right medical facility in the right amount of time, including by enhancing regional emergency medical dispatch;
to incorporate national EMS certification for all levels of emergency medical technicians and paramedics;
to improve the State’s planning for ensuring a consistent, available EMS workforce;
to fund EMS regional and local oversight and planning organizations or develop regional systems of emergency medical care within the State to further enhance coordination and systemic development throughout the State; and
for such other uses as the Administrator may establish.
Administration of grants
In establishing and administering the SPIA grant program, the Administrator shall—
establish State EMS system performance standards to serve as guidance to States in improving their EMS systems and in applying for grants under this subsection. In establishing such standards, the Administrator shall—
take into the consideration the recommendations of FICEMS, NEMSAC, and relevant stakeholders;
include national evidence-based guidelines; and
take into account the needs and resource limitations of volunteer, smaller agencies, and agencies in rural areas;
provide technical assistance to State EMS Offices in conducting comprehensive EMS planning with regard to evidence-based workforce and development competencies for field EMS management;
allocate, within the available funds, SPIA grants to a maximum of one grant per applicant according to a formula based on population and geographic area, as determined by the Administrator, for a period not to exceed 2 years; and
require that States allocate a portion of their grant funds to regional and local oversight and planning EMS organizations within the State for the purpose of field EMS system development, maintenance and improvement of coordination among regional organizations.
To be eligible to receive a grant under this section, an eligible entity shall submit an application to the Administrators in such form and manner, that contains such agreements, assurances and information as the Administrator determines to be reasonably necessary to carry out this section.
The eligible entities for a grant under this section are the State EMS Office in each of the several States, tribes, and territories.
The Administrator shall submit an annual report on the SPIA grant program under this section to the Congress.
Field EMS quality
To improve medical oversight of field EMS and ensure continuity and accountability for such medical oversight, the Administrator of NHTSA shall—
establish national guidelines for training, credentialing, and direction in connection with medical oversight; and
promote high-quality medical direction and maximization of participation and training by physicians in medical direction.
In establishing guidelines under paragraph (1)(A), the Administrator of NHTSA shall take into consideration—
nationally recognized guidelines;
relevant stakeholder input; and
the unique needs associated with the provision of field EMS in rural areas or by volunteers.
The guidelines established under paragraph (1)(A) shall ensure high-quality training, credentialing, and direction in connection with medical oversight of field EMS at the State, regional, and local levels while providing sufficient flexibility to account for historical and legitimate differences in field EMS among States, regions, and localities.
Required use of guidelines
As a condition on receipt of a grant under section 5 or 6, the Administrator of NHTSA shall require the grant recipient to adopt and implement (to the extent applicable) the guidelines established under paragraph (1)(A).
GAO study and report
The Comptroller General of the United States shall complete a study on—
medical and administrative liability issues that may impede—
medical direction provided by physicians directly regarding specific patients or medial oversight provided by physicians in establishing medical protocols, procedures, and other activities related to the provision of emergency medical care in field EMS; or
the highest quality emergency medical care in field EMS provided by personnel other than physicians such as emergency medical technicians and paramedics;
reimbursement for any component of medical oversight; and
such other issues as the Comptroller General deems appropriate relating to improving the quality and medical oversight of emergency medical care in field EMS.
Report to Congress
Not later than 18 months after the date of the enactment of this Act, the Comptroller General shall complete the study under paragraph (1) and submit a report to the Congress on the results of such study, including any recommendations.
Data collection and exchange
National EMS Information System
The Administrator of NHTSA may maintain, improve, and expand the National EMS Information System, including the National EMS Database.
In carrying out subparagraph (A), the Administrator of NHTSA shall promote the collection and reporting of data on field EMS in a standardized manner.
Availability of data
The Administrator of NHTSA shall ensure that information in the National EMS Database (other than individually identifiable information) is available to Federal and State policymakers, EMS stakeholders, and researchers.
In carrying out subparagraph (A), the Administrator of NHTSA may provide technical assistance to State and local agencies, field EMS agencies, and other entities deemed appropriate by the Administrator to assist in the collection, analysis, and reporting of data.
Report on data gaps
Not later than 12 months after the date of the enactment of this Act, the Administrator of NHTSA, in consultation with the Secretary of Health and Human Services, shall submit to the Congress a report that—
identifies gaps in the collection of data related to the provision of field EMS; and
includes recommendations for improving the collection, reporting, and analysis of such data.
The recommendations required by subparagraph (A)(ii) shall—
take into consideration the recommendations of FICEMS and NEMSAC and relevant stakeholders;
recommend methods for improving data collection and reporting and analysis without unduly burdening reporting entities and without duplicating existing data sources (such as data collected by the National Trauma Data Bank);
address the quality and availability of data related to the provision of field EMS and utilization of field EMS with respect to a variety of illnesses and injuries (in both the everyday provision of field EMS and catastrophic or disaster response) including—
cardiac events such as chest pain, sudden cardiac arrest, and STEMI;
disaster and catastrophic incidents, such as incidents related to terrorism or natural or manmade disasters; and
ambulance diversion and patient parking; and
include an analysis of the variety of services provided by field EMS agencies.
Report on data integration to promote quality of care
Not later than 18 months after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the head of the Office of the National Coordinator for Health Information Technology, in collaboration with FICEMS and the Administrator of NHTSA as appropriate, and taking into consideration input from relevant stakeholders, shall submit a report (including recommendations) on issues, impediments, and potential solutions pertaining to the following objectives:
Incorporation of field EMS patient care reports into patient electronic health records, taking into consideration—
the extent to which field EMS patient care reports are presently created in electronic format and the potential for elements of such reports to be incorporated into patient electronic health records;
the data elements of field EMS patient care reports that would promote quality and efficiency of care if incorporated into patient electronic health records;
potential modifications to the Medicare and Medicaid programs under titles XVIII and XIX, respectively, of the Social Security Act or other Federal health programs (including potential modifications to the HITECH Act (title XIII of division A of Public Law 111–5) including modifications to the entities included as eligible for incentive payments under section 1848(o), 1853(l) (to the extent that such section 1848(o) is applied), or 1903(t) of the Social Security Act, criteria for certified EHR technology for purposes of such sections, and objectives and measures for determining meaningful use of such technology for purposes of such sections) to provide appropriate reimbursement and financial incentives for EMS agencies—
to maintain field EMS patient care reports in a structured electronic format; and
to otherwise adopt and use electronic health records; and
potential modifications to the HITECH Act to provide incentives to eligible hospitals under section 1886(n), 1853(m) (to the extent that such section 1886(n) is applied), or section 1814(l)(3) of the Social Security Act to incorporate appropriate data elements of field EMS patient care reports into patient electronic health records.
Incorporation of patient health information created subsequent to the receipt of field EMS emergency care into NEMSIS, taking into consideration—
what types of medical information created subsequent to the receipt of field EMS emergency care (such as outcomes information or information regarding subsequent care and treatment) would, if included in NEMSIS, be potentially useful in evaluating and improving the quality of EMS care;
how best to integrate such information into NEMSIS;
potential modifications to the HITECH Act to require eligible hospitals, as defined in section 1886(n)(6)(B) of the Social Security Act, for purposes of incentive payments under 1886(b)(3)(B)(ix) and 1886(n) of such Act, to develop or report relevant data to NEMSIS or other appropriate State or private registries; and
potential modifications to the Medicare and Medicaid programs under titles XVIII and XIX, respectively, of the Social Security Act or other Federal health programs to provide appropriate reimbursement and financial incentives for field EMS agencies to develop or report relevant data to NEMSIS or other appropriate State or private registries.
Clarification of HIPAA
Exchange of information related to the treatment of patients
Nothing in HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act (42 U.S.C. 300jj–19(a)(2))) shall be construed as prohibiting the exchange of information between field EMS practitioners treating an individual and personnel of a hospital to which the individual is transported for the purposes of relating information on the medical history, treatment, care, and outcome of such individual (including any health care personnel safety issues such as infectious disease).
The Secretary of Health and Human Services shall establish guidelines for exchanges of information between field EMS practitioners treating an individual and personnel of a hospital to which the individual is transported to protect the privacy of the individual while ensuring the ability of such EMS practitioners and hospital personnel to communicate effectively to further the continuity and quality of emergency medical care provided to such individual.
Nothing in HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act (42 U.S.C. 300jj–19(a)(2))) shall be construed as prohibiting—
a field EMS agency from submitting EMS data to the State EMS Office for the purpose of quality improvement and data collection by the State for submission to NEMSIS; or
the State EMS Office from submitting aggregated non-individually identifiable EMS data to the National EMS Database maintained by NHTSA.
Field EMS education grants
For the purpose of promoting field EMS as a health profession and ensuring the availability, quality, and capability of field EMS educators, practitioners, and medical directors, the Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, may make grants to eligible entities for the development, availability, and dissemination of field EMS education programs and courses that improve the quality and capability of field EMS personnel. In carrying out this section, the Secretary shall take into consideration input from the Administrator of NHTSA, FICEMS, NEMSAC, the National Health Care Workforce Commission established under section 5101 of the Patient Protection and Affordable Care Act (42 U.S.C. 294q), and relevant stakeholders.
In this section, the term eligible entity means an educational organization, an educational institution, a professional association, and any other entity involved with the education of field EMS practitioners.
Use of funds
The Secretary of Health and Human Services may award a grant to an eligible entity under paragraph (1) only if the entity agrees to use the grant to—
develop and implement education programs that—
train field EMS trainers and promote the
adoption and implementation of the education standards identified in the
Emergency Medical Services Education Agenda for the Future: A Systems
Approach including any revisions thereto;
bridge the gap in knowledge and skills in field EMS and among field EMS and other allied health professions to develop a larger cadre of educational instructors and build a stronger and more flexible field EMS practitioner corps; or
provide training and retraining programs to provide displaced workers the opportunity to enter a field EMS profession;
develop and implement educational courses pertaining to—
provision of medical direction of field EMS;
field EMS practitioners, including physicians, emergency medical technicians, paramedics, nurses, and other relevant clinicians providing emergency medical care in the field;
field EMS educational and clinical research;
bridge programs among field EMS, nursing, and other allied health professions;
field EMS management;
national evidence-based guidelines; and
translation of the lessons learned in military medicine to field EMS;
evaluate education and training courses and methodologies to identify optimal educational modalities for field EMS practitioners;
improve the field EMS education infrastructure by increasing the number of field EMS instructors and the quality of their preparation by improving, enhancing, and modernizing the dissemination of EMS education, including distance learning, and by establishing quality improvement for EMS education programs;
enhance the opportunity for medical direction training and for promoting appropriate medical oversight of field emergency medical care;
improve systems to design, implement, and evaluate education for prospective and current field EMS providers; or
carrying out such other activities as the Secretary may identify.
The Secretary of Health and Human Services, in consultation with NHTSA and relevant stakeholders, and taking into consideration the recommendations of FICEMS and NEMSAC, shall establish a system of prioritization in awarding grants under this section to eligible entities.
Duration of grants
Grants under this section shall be for a period of 1 to 3 years.
The Secretary of Health and Human Services may not award a grant to an eligible entity under this section unless the entity submits an application to the Secretary in such form, in such manner, and containing such agreements, assurances, and information as the Secretary may require. The Secretary shall ensure that the requirements for submitting an application under this section are not unduly burdensome.
Evaluating innovative models for access and delivery of field EMS for patients
Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, in consultation with the Administrator of NHTSA, and taking into consideration the recommendations of NEMSAC and FICEMS, shall complete an evaluation of—
alternative delivery models for medical care through field EMS; and
the integration of field EMS patients with other medical providers and facilities as medically appropriate.
The evaluation under paragraph (1) shall consider each of the following:
Alternative dispositions of low-acuity patients (as defined by the Secretary of Health and Human Services) such as transporting patients by ambulance to destinations other than a hospital such as the office of the patient’s physician, an urgent care center, or the facilities of another health care provider as medically necessary and appropriate.
Medical liability issues associated with transport to destinations other than a hospital emergency department.
Necessary protections to ensure that patients receive the appropriate care in the appropriate setting without delay.
Whether there are any barriers to providing alternate dispositions to low-acuity patients who are not in need of care in hospital emergency departments.
Other issues determined by the Secretary of Health and Human Services, including, when possible, issues recommended by FICEMS or NEMSAC for evaluation under this subsection.
Beginning not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall conduct or support up to 5 demonstration projects to—
evaluate the implementation of alternative dispositions of low-acuity field EMS patients (such as transporting patients by ambulance to alternate destinations when medically appropriate and in the patients’ best interests); and
determine whether such dispositions—
improve the safety, effectiveness, timeliness, and efficiency of EMS; and
reduce overall utilization and expenditures under the Medicare program under title XVIII of the Social Security Act.
The Secretary of Health and Human Services shall ensure that at least one demonstration project under paragraph (1) evaluates evidence-based protocols that give guidance on selection of the destination to which patients are transported.
The period of a demonstration project under paragraph (1) shall not exceed 36 months.
If the Secretary of Health and Human Services determines that further research is necessary prior to or in conjunction with the demonstration projects under this subsection in order to evaluation the implementation of alternative dispositions of low-acuity field EMS patients, the Secretary shall conduct or support such research.
Authorization of appropriations
Of the amount made available to carry out section 1115A of the Social Security Act (42 U.S.C. 1315a) for a fiscal year, there are authorized to be appropriated such sums as may be necessary to carry out this subsection.
Report to Congress
Not later than 1 year after the completion of all demonstration projects under subsection (b), the Secretary of Health and Human Services shall submit to the Congress a report on the results of activities under this section, including recommendations on the efficacy of alternative dispositions of low-acuity field EMS patients.
Enhancing research in field EMS
Models To be tested by Center for Medicare and Medicaid Innovation
Section 1115A(b)(2)(B) of title XI of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the following:
Enhancing health outcomes for patients receiving field emergency medical services and improving timely and efficient delivery of high-quality field emergency medical services, such as through regionalization of emergency care or medical transport to alternate destinations.
Emergency medical research
Section 498D of the Public Health Service Act (42 U.S.C. 289g–4) is amended—
by redesignating subsections (c) and (d) as subsections (d) and (e), respectively; and
by inserting after subsection (b) the following:
Field EMS emergency medical research
The Secretary shall conduct research and evaluation relating to field EMS through the Agency for Healthcare Research and Quality and the Center for Medicare and Medicaid Innovation.
Field EMS practice center
Subpart II of part D of title IX of the Public Health Service Act (42 U.S.C. 299b–33 et seq.) is amended by adding at the end the following:
Field EMS practice center
For the purpose described in subsection (b), the Director shall establish within the Agency a Field EMS Evidence-Based Practice Center.
The purpose of the Center is to conduct or support research to promote the highest quality of emergency medical care in field EMS and the most effective delivery system for the provision of such care. Research conducted or supported pursuant to the preceding sentence shall include—
comparative effectiveness research;
other appropriate clinical or systems research; and
critical care transport;
tactical emergency medical services; and
the application of lessons learned in military field medicine in the delivery of emergency medical care in field EMS.
In this section:
The term Center means the Field EMS Evidence-Based Practice Center established under subsection (a).
The term field EMS has the meaning given to such term in section 3 of the Field EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2010.
Limitations on certain uses of research
Section 1182 of the Social Security Act
(42 U.S.C. 1320e–1) is amended by striking
section 1181 each
place it appears and inserting
section 1181 of this Act or section
498D(c) or 938 of the Public Health Service Act.
For the purposes of research conducted pursuant to this section or any other research funded by the Department of Health and Human Services related to emergency medical services in the field in which informed consent is required but may not be attainable, the Secretary of Health and Human Services shall—
evaluate and consider the patient and research issues involved; and
address regulatory barriers to such research related to the need for informed consent in a manner that ensures adequate patient safety and notification, and submit recommendations to Congress for any changes to Federal statutes necessary to address such barriers.
National Emergency Medical Services Advisory Council
The Administrator of NHTSA shall establish and administer a National Emergency Medical Services Advisory Council.
Duties and authorities
shall provide advice and recommendations regarding Federal field EMS programs and activities to NHTSA, FICEMS, and other Federal agencies that deliver field EMS or support State or local field EMS;
may, upon request by any Federal agency, provide that agency with recommendations on field EMS matters; and
shall provide a national forum for individuals and entities outside of the Federal Government to deliberate on field EMS issues.
In carrying out paragraph (1), NEMSAC may gather data and provide advice and recommendations on—
the national strategy under section 4(b);
any grant program established under this Act;
any data collection improvement activity under this Act;
compliance with any requirement imposed under this Act;
any Federal field EMS program or activity;
strengthening field EMS systems through enhanced workforce development, education, training, exercises, equipment, medical oversight, or otherwise;
improved Federal coordination and support of EMS systems; and
other field EMS issues for which recommendations are solicited by the Administrator of NHTSA, FICEMS, or other Federal agencies.
Appointment, terms, and members
NEMSAC shall be composed of not more than 26 members, each appointed by the Administrator of NHTSA.
Except as provided in subparagraph (B), the Administrator of NHTSA shall appoint the members of NEMSAC to serve for a term of 3 years.
Of the initial members of NEMSAC—
not more than 8 shall be appointed for a term of 1 year;
not more than 8 shall be appointed for a term of 2 years; and
not more than 10 shall be appointed for a term of 3 years.
No official or employee of the Federal Government may serve as a member of NEMSAC.
In appointing the members of NEMSAC, the Administrator of NHTSA shall—
select members based on their individual expertise, not as representatives of specific organizations;
ensure that the membership of NEMSAC—
includes balanced representation across the field EMS community; and
has sufficient EMS expertise and geographic and demographic diversity to accurately reflect the EMS community as a whole;
to the extent practical, ensure that the membership of NEMSAC includes representation of—
air medical EMS;
local EMS service director/administrators;
EMS medical directors;
pediatric emergency physicians;
State EMS directors;
State highway safety directors;
public safety call-takers and dispatchers;
EMS data managers;
State homeland security directors;
State or local legislative bodies; and
consumers not directly affiliated with an emergency medical system or health care organization; and
appoint at least 2 members without regard to the categories listed in subparagraph (C).
A vacancy in the membership of NEMSAC shall—
not affect the powers of NEMSAC; and
be filled in the manner in which the original appointment was made.
No pay; travel expenses
Each member of NEMSAC shall serve without pay, but shall be reimbursed for travel and per diem in lieu of subsistence expenses during the performance of duties of NEMSAC while away from home or his or her regular place of business, in accordance with applicable provisions under subchapter I of chapter 57 of title 5, United States Code.
The Administrator of NHTSA shall select the Chairperson of NEMSAC from its members.
Beginning with the first calendar year following the enactment of this Act, NEMSAC shall meet at least twice per calendar year.
Personnel; reimbursement for services
Detail of NHTSA personnel
The Administrator of NHTSA shall detail to NEMSAC, without reimbursement, such personnel of NHTSA as the Administrator determines necessary to carry out this section.
Reimbursement for certain services
If NEMSAC performs services at the request of a Federal agency, such agency shall reimburse NHTSA for the actual cost of such services. The Administrator of NHTSA shall establish the method for calculating and providing reimbursement under the preceding sentence.
Federal Advisory Committee Act
Except as inconsistent with this section, NEMSAC shall operate in accordance with the Federal Advisory Committee Act (5 U.S.C. App.).
Notwithstanding section 14 of the Federal Advisory Committee Act (5 U.S.C. App.), NEMSAC shall be of permanent duration.
Functions, Personnel, Assets, Liabilities, and Administrative Actions
All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the National Emergency Medical Services Advisory Council of the Department of Transportation, as in existence on the day before the date of the enactment of this Act, shall be transferred to the National Emergency Medical Services Advisory Council established under this section.
Each year, NEMSAC shall submit to NHTSA and FICEMS a report describing NEMSAC’s activities, positions, and recommendations. The Administrator of NHTSA shall promptly provide each such report to the appropriate congressional committees of jurisdiction.
Emergency care coordination
Subtitle B of title XXVIII of the Public Health Service Act (42 U.S.C. 300hh–10 et seq.) is amended by adding at the end the following:
Emergency care coordination
Emergency Care Coordination Center
Secretary shall establish, within the Office of the Assistant Secretary for
Preparedness and Response, an Emergency Care Coordination Center (in this
section referred to as the
Center), to be headed by a
The Secretary, acting through the Director of the Center, in coordination with the Federal Interagency Committee on Emergency Medical Services, shall—
promote and fund research in emergency medicine and trauma health care;
promote regional partnerships and more effective emergency medical systems in order to enhance appropriate triage, distribution, and care of routine community patients; and
promote local, regional, and State emergency medical systems’ preparedness for and response to public health events.
Council of Emergency Care
The Secretary, acting through the Director of the Center, shall establish a Council of Emergency Care to provide advice and recommendations to the Director on carrying out this section.
The Council shall be comprised of employees of the departments and agencies of the Federal Government who are experts in emergency care and management.
Not later than 12 months after the date of the enactment of this section, the Secretary shall submit to the Congress an annual report on the activities carried out under this section.
In preparing a report under paragraph (1), the Secretary shall consider factors including—
emergency department crowding and boarding; and
delays in care following presentation.
Functions, Personnel, Assets, Liabilities, and Administrative Actions
All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Emergency Care Coordination Center, as in existence on the day before the date of the enactment of this Act, shall be transferred to the Emergency Care Coordination Center established under section 2816(a) of the Public Health Service Act, as added by subsection (a).
Emergency Medical Services Trust Fund
Designation of income tax overpayments and additional contributions for emergency medical services
Subchapter A of chapter 61 of the Internal Revenue Code of 1986 (relating to returns and records) is amended by adding at the end the following new part:
Designation of income tax overpayments and additional contributions for emergency medical services
Designation by individuals
Every individual (other than a nonresident alien)—
may designate that a specified portion of any overpayment of tax for a taxable year, and
may designate that an amount in addition to any payment of tax for such taxable year and any designation under paragraph (1),
Adjusted income tax liability
For purposes of this section, the term adjusted income tax liability means income tax liability (as defined in section 6096(b)) reduced by any amount designated under section 6096 (relating to designation of income tax payments to Presidential Election Campaign Fund).
Overpayments Treated as Refunded
For purposes of this title, any portion of an overpayment of tax designated under subsection (a) shall be treated as—
being refunded to the taxpayer as of the last date prescribed for filing the return of tax imposed by chapter 1 (determined without regard to extensions) or, if later, the date the return is filed, and
a contribution made by such taxpayer on such date to the United States.
Manner and time of designation
A designation under subsection (a) may be made with respect to any taxable year—
at the time of filing the return of the tax imposed by chapter 1 for such taxable year, or
at any other time (after the time of filing the return of the tax imposed by chapter 1 for such taxable year) specified in regulations prescribed by the Secretary.
Emergency Medical Services Trust Fund
Subchapter A of chapter 98 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
Emergency Medical Services Trust Fund
Creation of trust fund
There is established in the Treasury of the United
States a trust fund to be known as the
Emergency Medical Services Trust
Fund, consisting of such amounts as may be credited or paid to such
trust fund as provided in section 6097.
Transfers to trust fund
There are hereby appropriated to the Emergency Medical Services Trust Fund amounts equivalent to the amounts of the overpayments of tax to which designations under section 6097 apply.
Expenditures from trust fund
Amounts in the Emergency Medical Services Trust Fund shall be available, as provided in appropriation Acts, only for purposes of making expenditures to carry out section 14(a)(2) of the Field EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2010. If, for any fiscal year, amounts remain in the Emergency Medical Services Trust Fund after making such expenditures, such amounts shall be available, as provided in appropriation Acts, to carry out sections 498D, 1203, and 1204 of the Public Health Service Act; part D of title XII of such Act; and part H of title XII of such Act.
The table of parts for subchapter A of chapter 61 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:
Part. IX. Designation of income tax
overpayments and additional contributions for emergency medical
The table of sections for subchapter A of chapter 98 of such Code is amended by adding at the end the following new item:
Sec. 9512. Emergency Medical Services Trust Fund.
The amendments made by this section shall apply to taxable years beginning after December 31, 2010.
Authorization of appropriations
Out of monies in the Emergency Medical Services Trust Fund, there are authorized to be appropriated—
$11,000,000 shall be for carrying out sections 4, 7, 9(a), 9(c), and 11 of this Act, and section 2816 of the Public Health Service Act (as added by section 12 of this Act) for each of fiscal years 2013 through 2015;
$200,000,000 shall be for carrying out section 5 of this Act for each of fiscal years 2012 through 2015;
$50,000,000 shall be for carrying out section 6 of this Act for each of fiscal years 2012 through 2015;
$15,000,000 shall be for carrying out section 8 of this Act for each of fiscal years 2012 through 2015; and
$45,000,000 shall be for carrying out sections 498D(c) and 938 of the Public Health Service Act, as added by subsections (b) and (c) of section 10 of this Act, for each of fiscal years 2012 through 2015.
There are authorized to be appropriated $11,000,000 for each of fiscal years 2011 and 2012 to carry out the provisions specified in subsection (a)(1).
There are authorized to be appropriated $50,000,000 for fiscal year 2012 to carry out the provisions specified in paragraphs (2), (3), (4), and (5) of subsection (a), to be allocated in proportion to the authorizations of appropriations specified in such paragraphs. The amount of funds authorized to be appropriated under subsection (a) for fiscal year 2012 (out of any monies in the Emergency Medical Services Trust Fund) shall be reduced by the amount of any funds made available under this paragraph.
Of the amount made available under subsection (a) or (b) to carry out each of the provisions specified in subsection (a), not more than 5 percent of each such amount may be used for Federal administrative expenses.