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[House Report 113-5]
[From the U.S. Government Publishing Office]

113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                      113-5

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        VETERAN EMERGENCY MEDICAL TECHNICIAN SUPPORT ACT OF 2013

                                _______
                                

February 4, 2013.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 235]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 235) to amend the Public Health Service Act to 
provide grants to States to streamline State requirements and 
procedures for veterans with military emergency medical 
training to become civilian emergency medical technicians, 
having considered the same, report favorably thereon without 
amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for the Legislation..........................     2
Hearings.........................................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     5
Duplication of Federal Programs..................................     5
Disclosure of Directed Rule Makings..............................     5
Advisory Committee Statement.....................................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    H.R. 235, the ``Veteran Emergency Medical Technician 
Support Act of 2013,'' was introduced on January 14, 2013, by 
Rep. Adam Kinzinger (R-IL) and referred to the Committee on 
Energy and Commerce.
    The legislation would amend the Public Health Service Act 
(PHSA) to provide demonstration grants to states with emergency 
medical technician (EMT) shortages to streamline state 
requirements for returning veterans with military EMT training 
to enter the EMT workforce without unnecessary duplication of 
their training.

                Background and Need for the Legislation

    Members of the U.S. military who trained as combat medics 
face State licensing challenges when they try to find similar 
work after discharge. Many States do not recognize their 
qualifications as applicable to the licensing requirements of 
the civilian health care system for emergency medical services, 
such as EMTs or paramedics. State licensing laws vary, and 
while some States make exceptions for former military medics to 
allow for reciprocity and a chance to sit for the licensing 
exam without repeating their training, many States do not. With 
many EMT shortage areas, and a 10% unemployment rate among post 
9/11 veterans,\1\ the legislation addresses two important 
policy goals and will help veterans transition into the 
civilian workforce as quickly as possible.
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    \1\http://vets.syr.edu/wp-content/uploads/2012/09/Employment-
Situation-July-20121.pdf
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    H.R. 235, the ``Veteran Emergency Medical Technician 
Support Act of 2013,'' would provide demonstration grants to 
States with emergency medical technician (EMT) shortages to 
help streamline State requirements for returning veterans to 
enter the EMT workforce without unnecessary duplication of 
their training. States could determine the extent to which the 
State requirements for education and training of EMTs are 
equivalent to that of the military and identify methods, such 
as waivers, for qualified military EMTs to forego duplicative 
requirements. The bill would provide for an annual report to 
Congress on the demonstration grants.
    H.R. 235 would make available a total of $1,000,000 over a 
five-year period (FY 2014-FY 2018) for the program. Funding 
would be offset by authorizing it within total amounts 
authorized for the Area Health Education Centers (Section 751 
of the PHSA). Any cost associated with enacting the provisions 
of this Act should be paid for out of existing funds.
    This bill is essentially the same as H.R. 4124, the 
``Veteran Emergency Medical Technician Support Act of 2012'' 
that was passed by the House in September 2012 and sent to the 
Senate. No further action was taken on H.R. 4124 in the 112th 
Congress.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on H.R. 235 during the 113th Congress. However, the 
Subcommittee on Health held a hearing on H.R. 4124 during the 
112th Congress.

                        Committee Consideration

    On January 22, 2012, the Committee on Energy and Commerce 
met in open markup session and approved H.R. 235, the ``Veteran 
Emergency Medical Technician Support Act of 2013,'' by 
unanimous consent.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 235 reported. A motion by Mr. Upton to order H.R. 235 
reported to the House, without amendment, was agreed to by 
unanimous consent.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held oversight 
hearings on this legislation.

         Statement of General Performance Goals and Objectives

    The goal of the legislation is to help Veteran EMTs to 
enter the civilian EMT workforce without unnecessary 
duplication of their training.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
235, the ``Veteran Emergency Medical Technician Support Act of 
2013,'' would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

       Earmark, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the Rules of the House of Representatives, the Committee 
finds that H.R. 235, the ``Veteran Emergency Medical Technician 
Support Act of 2013,'' contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, January 31, 2013.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 235, the Veteran 
Emergency Medical Technician Support Act of 2013.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 235--Veteran Emergency Medical Technician Support Act of 2013

    Summary: H.R. 235 would authorize grants to states for 
streamlining state certification and licensing requirements for 
veterans to become licensed or certified emergency medical 
technicians (EMT).
    The bill would authorize the appropriation of $1 million 
and CBO estimates that implementing the bill would cost $1 
million over the 2014-2018 period, assuming the appropriation 
of the authorized amount. Pay-as-you-go procedures do not apply 
to this legislation because it would not affect direct spending 
or revenues.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated Cost to the Federal Government: The estimated 
budgetary impact of H.R. 235 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                             By fiscal year, in millions of dollars--
                                                ----------------------------------------------------------------
                                                   2013     2014     2015     2016     2017     2018   2013-2018
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level..................        0        1        0        0        0        0         1
Estimated Outlays..............................        0        *        *        *        *        0        1
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.

    Basis of estimate: The bill would direct the Secretary of 
Health and Human Services to award demonstration grants to 
states to streamline state licensing and certification 
standards to assist veterans to meet state requirements 
applicable to becoming a certified or licensed EMT in the state 
if they have completed military EMT training while serving in 
the Armed Forces. The bill would authorize the appropriation of 
$1 million for the period of 2014 through 2018 and direct that 
the authorized amount come from funds appropriated in fiscal 
year 2014 to provide grants to area health education centers.
    For this estimate, CBO assumes that H.R. 225 will be 
enacted near the end of fiscal year 2013 and that the full 
amount authorized will be appropriated. Based on historical 
patterns of spending for the similar demonstration programs, 
CBO estimates that implementing the bill would cost less than 
$1 million in 2014 and a total of $1 million over the 2014-2018 
period, assuming appropriation of the specified amounts.
    Intergovernmental and private-sector impact: H.R. 235 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Funds authorized in the bill would benefit 
states that restructure state procedures to certify or license 
eligible veterans as emergency medical technicians.
    Estimate prepared by: Federal costs: Lisa Ramirez-Branum, 
Impact on state, local, and tribal governments: Lisa Ramirez-
Branum, Impact on the private sector: Michael Levine.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                    Duplication of Federal Programs

    No provision of H.R. 235, the ``Veteran Emergency Medical 
Technician Support Act of 2013,'' establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                  Disclosure of Directed Rule Makings

    The Committee estimates that enacting H.R. 235, the 
``Veteran Emergency Medical Technician Support Act of 2013,'' 
specifically directs to be completed no specific rule makings 
within the meaning of 5 U.S.C. 551.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation

Section 1. Short title

    Section 1 states that the legislation may be cited as the 
``Veteran Emergency Medical Technician Support Act of 2013.''

Section 2. Assisting Veterans with military emergency medical training 
        to meet requirements for becoming civilian emergency medical 
        technicians

    Section 2 amends the PHSA by adding a new Section 315. The 
new section would allow the Secretary of Health and Human 
Services (HHS) to establish a program for awarding 
demonstration grants to states to streamline state requirements 
and procedures and assist veterans who have completed military 
emergency medical training in meeting state certification and 
licensing requirements. In addition, the HHS Secretary would be 
required to submit an annual report on the demonstration 
projects to Congress. Funding would be authorized within total 
amounts authorized for the Area Health Education Centers 
program (PHSA Section 751(j)(1))

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *

TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *

Part B--Federal-State Cooperation

           *       *       *       *       *       *       *

SEC. 315. ASSISTING VETERANS WITH MILITARY EMERGENCY MEDICAL TRAINING 
                    TO MEET REQUIREMENTS FOR BECOMING CIVILIAN 
                    EMERGENCY MEDICAL TECHNICIANS.

  (a) Program.--The Secretary shall establish a program 
consisting of awarding demonstration grants to States to 
streamline State requirements and procedures in order to assist 
veterans who completed military emergency medical technician 
training while serving in the Armed Forces of the United States 
to meet certification, licensure, and other requirements 
applicable to becoming an emergency medical technician in the 
State.
  (b) Use of Funds.--Amounts received as a demonstration grant 
under this section shall be used to prepare and implement a 
plan to streamline State requirements and procedures as 
described in subsection (a), including by--
          (1) determining the extent to which the requirements 
        for the education, training, and skill level of 
        emergency medical technicians in the State are 
        equivalent to requirements for the education, training, 
        and skill level of military emergency medical 
        technicians; and
          (2) identifying methods, such as waivers, for 
        military emergency medical technicians to forego or 
        meet any such equivalent State requirements.
  (c) Eligibility.--To be eligible for a grant under this 
section, a State shall demonstrate that the State has a 
shortage of emergency medical technicians.
  (d) Report.--The Secretary shall submit to the Congress an 
annual report on the program under this section.
  (e) Funding.--Of the amount authorized by section 751(j)(1) 
to be appropriated to carry out section 751 for fiscal year 
2014, there is authorized to be appropriated to carry out this 
section $1,000,000 for the period of fiscal years 2014 through 
2018.

           *       *       *       *       *       *       *

TITLE VII--HEALTH PROFESSIONS EDUCATION

           *       *       *       *       *       *       *

PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

           *       *       *       *       *       *       *

SEC. 751. AREA HEALTH EDUCATION CENTERS.

  (a) * * *

           *       *       *       *       *       *       *

  (j) Authorization of Appropriations.--
          (1) In general.--[There is authorized to be 
        appropriated] Subject to section 315(e), there is 
        authorized to be appropriated to carry out this section 
        $125,000,000 for each of the fiscal years 2010 through 
        2014.

           *       *       *       *       *       *       *

                                  
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