I

103D CONGRESS

1ST SESSION H. R. 443

To amend the Public Health Service Act to establish an Office of Emergency

Medical Services, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JANUARY 5, 1993

Mr. GUNDERSON introduced the following bill; which was referred to the

Committee on Energy and Commerce

A BILL

To amend the Public Health Service Act to establish an

Office of Emergency Medical Services, and for other

purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Emergency Medical

5 Services Amendments Act of 1993’’.

6 SEC. 2. ESTABLISHMENT OF OFFICE OF EMERGENCY MEDI7 CAL SERVICES.

8 Title XII of the Public Health Service Act (42 U.S.C.

9 300d et seq.) is amended—
2

•HR 443 IH

1 (1) in the heading for the title, by striking

2 ‘‘TRAUMA CARE’’ and inserting ‘‘EMERGENCY

3 MEDICAL SERVICES’’;

4 (2) in the heading for part A, by striking

5 ‘‘GENERAL’’ and all that follows and inserting

6 ‘‘GENERAL AUTHORITIES AND DUTIES’’; and

7 (3) by amending section 1201 to read as fol8 lows:

9 ‘‘SEC. 1201. ESTABLISHMENT OF OFFICE OF EMERGENCY

10 MEDICAL SERVICES.

11 ‘‘(a) IN GENERAL.—The Secretary shall establish an

12 office to be known as the Office of Emergency Medical

13 Services, which shall be headed by a director appointed

14 by the Secretary. The Secretary shall carry out this title

15 acting through the Director of such Office.

16 ‘‘(b) GENERAL AUTHORITIES AND DUTIES.—With

17 respect to emergency medical services (including trauma

18 care), the Secretary shall—

19 ‘‘(1) conduct and support research, training,

20 evaluations, and demonstration projects;

21 ‘‘(2) foster the development of appropriate,

22 modern systems of such services through the sharing

23 of information among agencies and individuals in24 volved in the study and provision of such services;

25 ‘‘(3) sponsor workshops and conferences;
3

•HR 443 IH

1 ‘‘(4) as appropriate, disseminate to public and

2 private entities information obtained in carrying out

3 paragraphs (1) through (4);

4 ‘‘(5) provide technical assistance to State and

5 local agencies;

6 ‘‘(6) coordinate activities of the Department of

7 Health and Human Services; and

8 ‘‘(7) as appropriate, coordinate activities of

9 such Department with activities of other Federal

10 agencies.

11 ‘‘(c) CERTAIN REQUIREMENTS.—With respect to

12 emergency medical services (including trauma care), the

13 Secretary shall ensure that activities under subsection (b)

14 are carried out regarding—

15 ‘‘(1) maintaining an adequate number of health

16 professionals with expertise in the provision of the

17 services, including hospital-based professionals and

18 prehospital-based professionals;

19 ‘‘(2) developing, periodically reviewing, and re20 vising as appropriate, in collaboration with appro21 priate public and private entities, guidelines for the

22 provision of such services (including, for various typ23 ical circumstances, guidelines on the number and va24 riety of professionals, on equipment, and on train25 ing);
4

•HR 443 IH

1 ‘‘(3) the appropriate use of available tech2 nologies, including communications technologies; and

3 ‘‘(4) the unique needs of underserved inner-city

4 areas and underserved rural areas.

5 ‘‘(d) GRANTS, COOPERATIVE AGREEMENTS, AND

6 CONTRACTS.—In carrying out subsections (b) and (c), the

7 Secretary may make grants and enter into cooperative

8 agreements and contracts.

9 ‘‘(e) DEFINITIONS.—For purposes of this part:

10 ‘‘(1) The term ‘hospital-based professional’

11 means a health professional (including an allied

12 health professional) who has expertise in providing

13 one or more emergency medical services and who

14 normally provides the services at a medical facility.

15 ‘‘(2) The term ‘prehospital-based professional’

16 means a health professional (including an allied

17 health professional) who has expertise in providing

18 one or more emergency medical services and who

19 normally provides the services at the site of the med20 ical emergency or during transport to a medical fa21 cility.’’.

22 SEC. 3. STATE OFFICES OF EMERGENCY MEDICAL SERV23 ICES.

24 (a) TECHNICAL AMENDMENTS TO FACILITATE ES25 TABLISHMENT OF PROGRAM.—
5

•HR 443 IH

1 (1) IN GENERAL.—Title XII of the Public

2 Health Service Act (42 U.S.C. 300d et seq.) is

3 amended—

4 (A) by redesignating section 1232 as sec5 tion 1235;

6 (B) by redesignating sections 1231 and

7 1233 as sections 1241 and 1242, respectively;

8 and

9 (C) by redesignating sections 1211 through

10 1222 as sections 1221 through 1232, respec11 tively.

12 (2) MODIFICATIONS IN FORMAT OF TITLE

13 XII.—Title XII of the Public Health Service Act, as

14 amended by paragraph (1) of this subsection, is

15 amended—

16 (A) by striking ‘‘PART B’’ and all that fol17 low through ‘‘STATE PLANS’’ and inserting the

18 following:

19 ‘‘Subpart II—Formula Grants With Respect to

20 Modifications of State Plans’’;

21 (B) by striking ‘‘PART C—GENERAL PRO22 VISIONS’’ and inserting the following:
6

•HR 443 IH

1 ‘‘Subpart III—General Provisions’’;

2 (C) by redesignating sections 1202 and

3 1203 as sections 1211 and 1212, respectively;

4 and

5 (D) by inserting before section 1211 (as so

6 redesignated) the following:

7 ‘‘PART B—TRAUMA CARE

8 ‘‘Subpart I—Advisory Council; Clearinghouse’’.

9 (b) STATE OFFICES.—Title XII of the Public Health

10 Service Act, as amended by subsection (a) of this section,

11 is amended by inserting after section 1201 the following

12 new section:

13 ‘‘SEC. 1202. STATE OFFICES OF EMERGENCY MEDICAL

14 SERVICES.

15 ‘‘(a) PROGRAM OF GRANTS.—The Secretary may

16 make grants to States for the purpose of improving the

17 availability and quality of emergency medical services

18 through the operation of State offices of emergency medi19 cal services.

20 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.—

21 ‘‘(1) IN GENERAL.—The Secretary may not

22 make a grant under subsection (a) unless the State

23 involved agrees, with respect to the costs to be in24 curred by the State in carrying out the purpose de-
7

•HR 443 IH

1 scribed in such subsection, to provide non-Federal

2 contributions toward such costs in an amount that—

3 ‘‘(A) for the first fiscal year of payments

4 under the grant, is not less than $1 for each $3

5 of Federal funds provided in the grant;

6 ‘‘(B) for any second fiscal year of such

7 payments, is not less than $1 for each $1 of

8 Federal funds provided in the grant; and

9 ‘‘(C) for any third fiscal year of such pay10 ments, is not less than $3 for each $1 of Fed11 eral funds provided in the grant.

12 ‘‘(2) DETERMINATION OF AMOUNT OF NON13 FEDERAL CONTRIBUTION.—

14 ‘‘(A) Subject to subparagraph (B), non15 Federal contributions required in paragraph (1)

16 may be in cash or in kind, fairly evaluated, in17 cluding plant, equipment, or services. Amounts

18 provided by the Federal Government, or serv19 ices assisted or subsidized to any significant ex20 tent by the Federal Government, may not be in21 cluded in determining the amount of such non22 Federal contributions.

23 ‘‘(B) The Secretary may not make a grant

24 under subsection (a) unless the State involved

25 agrees that—
8

•HR 443 IH

1 ‘‘(i) for the first fiscal year of pay2 ments under the grant, 100 percent or less

3 of the non-Federal contributions required

4 in paragraph (1) will be provided in the

5 form of in-kind contributions;

6 ‘‘(ii) for any second fiscal year of such

7 payments, not more than 50 percent of

8 such non-Federal contributions will be pro9 vided in the form of in-kind contributions;

10 and

11 ‘‘(iii) for any third fiscal year of such

12 payments, such non-Federal contributions

13 will be provided solely in the form of cash.

14 ‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec15 retary may not make a grant under subsection (a) unless

16 the State involved agrees that activities carried out by an

17 office operated pursuant to such subsection will include—

18 ‘‘(1) coordinating the activities carried out in

19 the State that relate to emergency medical services;

20 ‘‘(2) activities regarding the matters described

21 in paragraphs (1) through (4) section 1201(b);

22 ‘‘(3) identifying Federal and State programs re23 garding emergency medical services and providing

24 technical assistance to public and nonprofit private

25 entities regarding participation in such programs.
9

•HR 443 IH

1 ‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET

2 FOR OFFICE.—The Secretary may not make a grant

3 under subsection (a) unless the State involved agrees that,

4 for any fiscal year for which the State receives such a

5 grant, the office operated pursuant to subsection (a) will

6 be provided with an annual budget of not less than

7 $50,000.

8 ‘‘(e) CERTAIN USES OF FUNDS.—

9 ‘‘(1) RESTRICTIONS.—The Secretary may not

10 make a grant under subsection (a) unless the State

11 involved agrees that—

12 ‘‘(A) if research with respect to emergency

13 medical services is conducted pursuant to the

14 grant, not more than 10 percent of the grant

15 will be expended for such research; and

16 ‘‘(B) the grant will not be expended to pro17 vide emergency medical services (including pro18 viding cash payments regarding such services).

19 ‘‘(2) ESTABLISHMENT OF OFFICE.—Activities

20 for which a State may expend a grant under sub21 section (a) include paying the costs of establishing

22 an office of emergency medical services for purposes

23 of such subsection.

24 ‘‘(f) REPORTS.—The Secretary may not make a

25 grant under subsection (a) unless the State involved
10

•HR 443 IH

1 agrees to submit to the Secretary reports containing such

2 information as the Secretary may require regarding activi3 ties carried out under this section by the State.

4 ‘‘(g) REQUIREMENT OF APPLICATION.—The Sec5 retary may not make a grant under subsection (a) unless

6 an application for the grant is submitted to the Secretary

7 and the application is in such form, is made in such man8 ner, and contains such agreements, assurances, and infor9 mation as the Secretary determines to be necessary to

10 carry out this section.’’.

11 SEC. 4. PROGRAMS FOR RURAL AREAS.

12 (a) IN GENERAL.—Title XII of the Public Health

13 Service Act, as amended by section 3 of this Act, is

14 amended—

15 (1) by transferring section 1204 to part A;

16 (2) by redesignating such section as section

17 1203;

18 (3) by inserting such section after section 1202;

19 and

20 (4) in section 1203 (as so redesignated)—

21 (A) by redesignating subsection (c) as sub22 section (d); and

23 (B) by inserting after subsection (b) the

24 following new subsection:
11

•HR 443 IH

1 ‘‘(c) DEMONSTRATION PROGRAM REGARDING TELE2 COMMUNICATIONS.—

3 ‘‘(1) LINKAGES FOR RURAL FACILITIES.—

4 Projects under subsection (a)(1) shall include dem5 onstration projects to establish telecommunications

6 between rural medical facilities and medical facilities

7 that have expertise or equipment that can be utilized

8 by the rural facilities through the telecommuni9 cations.

10 ‘‘(2) MODES OF COMMUNICATION.—The Sec11 retary shall ensure that the telecommunications

12 technologies demonstrated under paragraph (1) in13 clude (interactive) video telecommunications, (static

14 video imaging transmitted through the telephone

15 system), and facsimiles transmitted through such

16 system.’’.

17 (b) CONFORMING AMENDMENT.—Section 1203 of the

18 Public Health Service Act, as redesignated by subsection

19 (a)(2) of this section, is amended in the heading for the

20 section by striking ‘‘ESTABLISHMENT’’ and all that

21 follows and inserting ‘‘PROGRAMS FOR RURAL

22 AREAS.’’.

23 SEC. 5. FUNDING.

24 Title XII of the Public Health Service Act, as amend25 ed by the preceding provisions of this Act, is amended—
12

•HR 443 IH

1 (1) by inserting after subpart III of part B the

2 following:

3 ‘‘PART C—FUNDING’’;

4 (2) by transferring section 1235 to part C (as

5 so added); and

6 (3) in such section, by striking subsections (a)

7 and (b) and inserting the following:

8 ‘‘(a) EMERGENCY MEDICAL SERVICES GEN9 ERALLY.—

10 ‘‘(1) IN GENERAL.—For the purpose of carry11 ing out section 1201 other than with respect to trau12 ma care, there are authorized to be appropriated

13 $2,000,000 for fiscal year 1993, and such sums as

14 may be necessary for each of the fiscal years 1994

15 and 1995.

16 ‘‘(2) STATE OFFICES.—For the purpose of car17 rying out section 1202, there are authorized to be

18 appropriated $3,000,000 for fiscal year 1993, and

19 such sums as may be necessary for each of the fiscal

20 years 1994 and 1995.

21 ‘‘(3) CERTAIN TELECOMMUNICATIONS DEM22 ONSTRATIONS.—For the purpose of carrying out sec23 tion 1203(c), there are authorized to be appro24 priated $10,000,000 for fiscal year 1993 and such
13

•HR 443 IH

1 sums as may be necessary for each of the fiscal

2 years 1994 and 1995.

3 ‘‘(b) TRAUMA CARE AND CERTAIN OTHER ACTIVI4 TIES.—

5 ‘‘(1) IN GENERAL.—For the purpose of carry6 ing out part B, section 1201 with respect to trauma

7 care, and section 1203 (other than subsection (c) of

8 such section), there are authorized to be appro9 priated $60,000,000 for fiscal year 1993, and such

10 sums as may be necessary for each of the fiscal

11 years 1994 and 1995.

12 ‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—

13 ‘‘(A) For the purpose of carrying out sub14 part I of part B, section 1201 with respect to

15 trauma care, and section 1203 (other than sub16 section (c) of such section), the Secretary shall

17 make available 10 percent of the amounts ap18 propriated for a fiscal year under paragraph

19 (1).

20 ‘‘(B) For the purpose of carrying out sec21 tion 1203 (other than subsection (c) of such

22 section), the Secretary shall make available 10

23 percent of the amounts appropriated for a fiscal

24 year under paragraph (1).
14

•HR 443 IH

1 ‘‘(C)(i) For the purpose of making allot2 ments under section 1221(a), the Secretary

3 shall, subject to subsection (c), make available

4 80 percent of the amounts appropriated for a

5 fiscal year under paragraph (1).

6 ‘‘(ii) Amounts paid to a State under sec7 tion 1221(a) for a fiscal year shall, for the pur8 poses for which the amounts were paid, remain

9 available for obligation until the end of the fis10 cal year immediately following the fiscal year

11 for which the amounts were paid.’’.

12 SEC. 6. CONFORMING AMENDMENTS.

13 Title XII of the Public Health Service Act, as amend14 ed by the preceding provisions of this Act, is amended—

15 (1) in section 1203(b), by striking ‘‘1214(c)(1)’’

16 and inserting ‘‘1224(c)(1)’’;

17 (2) in section 1211(b)(3), by striking ‘‘1213(c)’’

18 and inserting ‘‘1223(c)’’;

19 (3) in section 1221—

20 (A) in subsection (a)—

21 (i) by striking ‘‘1218’’ and inserting

22 ‘‘1228’’; and

23 (ii) by striking ‘‘1217’’ and inserting

24 ‘‘1227’’; and

25 (B) in subsection (b)—
15

•HR 443 IH

1 (i) by striking ‘‘1233’’ and inserting

2 ‘‘1242’’; and

3 (ii) by striking ‘‘1213’’ and inserting

4 ‘‘1223’’;

5 (4) in section 1222—

6 (A) in subsection (a)—

7 (i) in paragraph (1), by striking

8 ‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and

9 (ii) in paragraph (2)(A), by striking

10 ‘‘1211(c)’’ and inserting ‘‘1221(c)’’; and

11 (B) in subsection (b), by striking

12 ‘‘1211(a)’’ and inserting ‘‘1221(a)’’;

13 (5) in section 1223—

14 (A) in subsection (a), by striking

15 ‘‘1211(b)’’ and inserting ‘‘1221(b)’’;

16 (B) in subsection (b)—

17 (i) in paragraph (1), by striking

18 ‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and

19 (ii) in paragraph (3), by striking

20 ‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and

21 (C) in subsection (d), by striking

22 ‘‘1211(a)’’ and inserting ‘‘1221(a)’’;

23 (6) in section 1224—
16

•HR 443 IH

1 (A) in each of subsections (a) through (c),

2 by striking ‘‘1211(a)’’ and inserting ‘‘1221(a)’’;

3 and

4 (B) in subsection (b), by striking

5 ‘‘1213(a)(7)’’ and inserting ‘‘1223(a)(7)’’;

6 (7) in section 1225—

7 (A) in subsection (a)—

8 (i) by striking ‘‘1211(a)’’ and insert9 ing ‘‘1221(a)’’; and

10 (ii) by striking ‘‘1233’’ and inserting

11 ‘‘1242’’; and

12 (B) in subsection (b), by striking

13 ‘‘1211(b)’’ and inserting ‘‘1221(b)’’;

14 (8) in section 1226, in each of subsections (a)

15 through (c), by striking ‘‘1211(a)’’ and inserting

16 ‘‘1221(a)’’;

17 (9) in section 1227—

18 (A) by striking ‘‘1211(a)’’ and inserting

19 ‘‘1221(a)’’; and

20 (B) by striking ‘‘1214’’ and inserting

21 ‘‘1224’’;

22 (10) in section 1228—

23 (A) in each of subsections (a) through (c),

24 by striking ‘‘1211(a)’’ each place such term ap25 pears and inserting ‘‘1221(a)’’;
17

•HR 443 IH

1 (B) in subsection (b), in each of para2 graphs (2)(A) and (3)(A), by striking

3 ‘‘1232(a)’’ and inserting ‘‘1251(a)’’; and

4 (C) in subsection (c)(2)—

5 (i) by striking ‘‘1232(b)(3)’’ and in6 serting ‘‘1251(b)(3)’’; and

7 (ii) by striking ‘‘1217’’ and inserting

8 ‘‘1227’’;

9 (11) in section 1229(a), by striking ‘‘1211(a)’’

10 each place such term appears and inserting

11 ‘‘1221(a)’’;

12 (12) in section 1230(a), by striking ‘‘1211(a)’’

13 each place such term appears and inserting

14 ‘‘1221(a)’’;

15 (13) in section 1231—

16 (A) in each of subsections (a) and (b), by

17 striking ‘‘1211(a)’’ each place such term ap18 pears and inserting ‘‘1221(a)’’; and

19 (B) in each of subsections (a) and (b), by

20 striking ‘‘1211(b)’’ and inserting ‘‘1221(b)’’;

21 (14) in section 1232, by striking ‘‘1211’’ and

22 inserting ‘‘1221’’;

23 (15) in section 1241—
18

•HR 443 IH

1 (A) in the matter preceding paragraph (1),

2 by striking ‘‘this title’’ and inserting ‘‘this

3 part’’; and

4 (B) in paragraph (1), by striking ‘‘1213’’

5 and inserting ‘‘1223’’;

6 (16) in section 1242—

7 (A) in each of subsections (a) and (b), by

8 striking ‘‘1211’’ each place such term appears

9 and inserting ‘‘1221’’;

10 (B) in subsection (b)—

11 (i) by striking ‘‘part B’’ and inserting

12 ‘‘subpart II’’; and

13 (ii) by striking ‘‘1214(c)(1)’’ and in14 serting ‘‘1224(c)(1)’’; and

15 (C) in subsection (c), by striking ‘‘1213’’

16 and inserting ‘‘1223’’; and

17 (17) in section 1251(c)(1)—

18 (A) by striking ‘‘1211(a)’’ and inserting

19 ‘‘1221(a)’’;

20 (B) by striking ‘‘1218(a)(2)’’ and inserting

21 ‘‘1228(a)(2)’’; and

22 (C) by striking ‘‘part B’’ and inserting

23 ‘‘subpart II’’.
19

•HR 443 IH

1 SEC. 7. EFFECTIVE DATE.

2 The amendments made by this Act shall take effect

3 October 1, 1992, or upon the date of the enactment of

4 this Act, whichever occurs later.

Æ

HR 443 IH——2