79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–565 

TO AUTHORIZE THE SECRETARY OF THE INTERIOR TO ESTABLISH FEES 

FOR MEDICAL SERVICES PROVIDED IN UNITS OF THE NATIONAL PARK 

SYSTEM, AND FOR OTHER PURPOSES 

FEBRUARY 15, 2018.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. BISHOP of Utah, from the Committee on Natural Resources, 

submitted the following 

R E P O R T 

[To accompany H.R. 3607] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Natural Resources, to whom was referred the 

bill (H.R. 3607) to authorize the Secretary of the Interior to establish fees for medical services provided in units of the National Park 

System, and for other purposes, having considered the same, report 

favorably thereon with an amendment and recommend that the bill 

as amended do pass. 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. FEES FOR MEDICAL SERVICES. 

(a) FEES AUTHORIZED.—The Secretary may establish and collect fees for medical 

services provided to persons in units of the National Park System or for medical 

services provided by National Park Service personnel outside units of the National 

Park System. 

(b) NATIONAL PARK MEDICAL SERVICES FUND.—There is hereby established in the 

Treasury a fund to be known as the ‘‘National Park Medical Services Fund’’. The 

Fund shall consist of— 

(1) donations to the Fund; and 

(2) fees collected under subsection (a). 

(c) AVAILABILITY OF AMOUNTS.—All amounts deposited into the Fund shall be 

available to the Secretary, to the extent provided in advance by Acts of appropriation, for the following in units of the National Park System: 

(1) Services listed in subsection (a). 

(2) Preparing needs assessments or other programmatic analyses for medical 

facilities, equipment, vehicles, and other needs and costs of providing services 

listed in subsection (a). 

(3) Developing management plans for medical facilities, equipment, vehicles, 

and other needs and costs of services listed in subsection (a). 

(4) Training related to providing services listed in subsection (a). 

(5) Obtaining or improving medical facilities, equipment, vehicles, and other 

needs and costs of providing services listed in subsection (a). 

(d) DEFINITIONS.—For the purposes of this section: 


dlhill on DSK3GLQ082PROD with HEARING
2 

(1) FUND.—The term ‘‘Fund’’ means the National Park Medical Services Fund 

established by subsection (b). 

(2) SECRETARY.—The term ‘‘Secretary’’ means the Secretary of the Interior. 

PURPOSE OF THE BILL

The purpose of H.R. 3607 is to authorize the Secretary of the Interior to establish fees for medical services provided in units of the 

National Park System. 

BACKGROUND AND NEED FOR LEGISLATION

The National Park Service (NPS) currently manages eleven units 

that provide medical services, including ambulance transport, EMT 

services, and clinical services. These units are remote and visitors 

and staff have few or no other options for receiving timely medical 

care, especially in emergency situations. 

Under current law, NPS has the authority and responsibility to 

provide medical services, but does not have authority to retain revenues from insurance payments or other payments, which go to the 

general Treasury. NPS does not collect fees directly but instead 

works with third-party agencies to bill insurance companies or individuals. The ability to retain revenues to offset the costs of medical services would help NPS to provide higher quality patient care 

with industry-standard equipment and technology. H.R. 3607 allows the Secretary of the Interior to establish and collect fees for 

medical services provided at national parks. 

The following tables provided by NPS show the amounts that 

were collected for medical services and the amounts allocated to 

run medical services at each of the eleven units in Fiscal Year (FY) 

2016: 


dlhill on DSK3GLQ082PROD with HEARING
3 


dlhill on DSK3GLQ082PROD with HEARINGInsert offset folio 4 here HR565.001
4 

COMMITTEE ACTION

H.R. 3607 was introduced on July 28, 2017, by Congressman 

Tom McClintock (R–CA). The bill was referred to the Committee on 

Natural Resources, and within the Committee to the Subcommittee 

on Federal Lands. On October 11, 2017, the Subcommittee held a 

hearing on the legislation. On November 29, 2017, the Natural Resources Committee met to consider the bill. The Subcommittee was 

discharged by unanimous consent. Congressman Tom McClintock 

offered an amendment designated #1; it was adopted by unanimous 

consent. No further amendments were offered, and the bill, as 

amended, was ordered favorably reported to the House of Representatives by unanimous consent on November 30, 2017. 

COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS

Regarding clause 2(b)(1) of rule X and clause 3(c)(1) of rule XIII 

of the Rules of the House of Representatives, the Committee on 

Natural Resources’ oversight findings and recommendations are reflected in the body of this report. 

COMPLIANCE WITH HOUSE RULE XIII AND CONGRESSIONAL BUDGET

ACT

1. Cost of Legislation and the Congressional Budget Act. With respect to the requirements of clause 3(c)(2) and (3) of rule XIII of 

the Rules of the House of Representatives and sections 308(a) and 

402 of the Congressional Budget Act of 1974, the Committee has 

received the following estimate for the bill from the Director of the 

Congressional Budget Office: 

U.S. CONGRESS, 

CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, February 7, 2018. 

Hon. ROB BISHOP, 

Chairman, Committee on Natural Resources, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 3607, a bill to authorize 

the Secretary of the Interior to establish fees for medical services 

provided in units of the National Park System, and for other purposes. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Janani Shankaran. 

Sincerely, 

KEITH HALL

Director. 

Enclosure. 

H.R. 3607—A bill to authorize the Secretary of the Interior to establish fees for medical services provided in units of the National 

Park System, and for other purposes 

H.R. 3607 would authorize (but not require) the National Park 

Service (NPS) to collect fees for medical services provided within 

the National Park System in addition to any payments it already 

receives for such services. The bill would establish a separate fund 

in the Treasury in which to deposit those new collections. Under 


dlhill on DSK3GLQ082PROD with HEARING
5 

the bill, the deposited amounts would be available to the NPS to 

the extent provided in advance by appropriation acts for medical 

services within the National Park System and to upgrade medical 

facilities and equipment. 

According to the NPS, the agency typically contracts out the operation of its medical clinics, but operates medical clinics in 11 system units where third parties choose not to compete for contracts 

to do that work. The NPS pays for medical costs at those facilities, 

which total about $4 million a year, using a mix of appropriated 

funds and direct spending of collections from park entrance fees 

and concession franchise fees. CBO expects that under the bill, the 

NPS would continue to operate clinics using funds from the same 

sources, in addition to any amounts that would be collected under 

this bill and thereafter appropriated. 

Under current law, the NPS does not have the authority to retain and spend payments it receives for medical services from people or insurance providers. Those offsetting receipts (about $2 million a year) are treated as reductions in direct spending and deposited into the general fund of the Treasury. 

Enacting H.R. 3607 could increase offsetting receipts. How or 

whether the proposed fees would be collected is unclear, however 

CBO estimates that those increases would not be significant. Because enacting the bill could affect direct spending, pay-as-you-go 

procedures apply. Enacting the bill would not affect revenues. 

CBO expects that the NPS would incur administrative costs associated with collecting those fees. Based on the costs for similar activities, CBO estimates that those costs would be less than 

$500,000 annually; such spending would be subject to the availability of appropriated funds. Any appropriation of the newly collected funds also would increase spending by less than $500,000, 

CBO estimates. 

CBO estimates that enacting H.R. 3607 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2028. 

H.R. 3607 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. 

The CBO staff contact for this estimate is Janani Shankaran. 

The estimate was approved by H. Samuel Papenfuss, Deputy Assistant Director for Budget Analysis. 

2. General Performance Goals and Objectives. As required by 

clause 3(c)(4) of rule XIII, the general performance goal or objective 

of this bill is to authorize the Secretary of the Interior to establish 

fees for medical services provided in units of the National Park 

System. 

EARMARK STATEMENT

This bill does not contain any Congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined under clause 9(e), 

9(f), and 9(g) of rule XXI of the Rules of the House of Representatives. 

COMPLIANCE WITH PUBLIC LAW 104–4

This bill contains no unfunded mandates. 


dlhill on DSK3GLQ082PROD with HEARING
6 

COMPLIANCE WITH H. RES. 5

Directed Rule Making. This bill does not contain any directed 

rule makings. 

Duplication of Existing Programs. This bill does not establish or 

reauthorize a program of the federal government known to be duplicative of another program. Such program was not included in 

any report from the Government Accountability Office to Congress 

pursuant to section 21 of Public Law 111–139 or identified in the 

most recent Catalog of Federal Domestic Assistance published pursuant to the Federal Program Information Act (Public Law 95–220, 

as amended by Public Law 98–169) as relating to other programs. 

PREEMPTION OF STATE, LOCAL OR TRIBAL LAW

This bill is not intended to preempt any State, local or tribal law. 

CHANGES IN EXISTING LAW

If enacted, this bill would make no changes to existing law. 

Æ 


dlhill on DSK3GLQ082PROD with HEARING