H6142 CONGRESSIONAL RECORD — HOUSE September 19, 2012 

labs that improperly refer proficiency tests— 

even for an unintentional referral. 

Equally importantly, there have been a number of changes in the organization and delivery of health care since these penalties provisions were enacted. In particular—the growth 

of health systems that have many providers 

joining together to operate under the same 

umbrella. In the case of laboratories, one hospital system may own and operate a number 

of labs. If one lab is found to have a proficiency testing violation, all of the labs under 

the hospital’s system would be barred from 

Medicare—even if those labs had no quality or 

proficiency testing issues. 

This is not a sensible result. This legislation 

would address that problem. 

First, H.R. 6118 ensures the statute is clear 

on the point that no proficiency testing sample 

may be referred to another laboratory even if 

such referral would be part of the testing lab’s 

standard procedure for patient specimens (a 

point of existing law on which some providers 

have been confused). 

Second, it grants the Secretary discretion in 

determining whether to revoke a lab’s CLIA 

certificate for improper referrals of PT testing 

samples—to account for the case of unintentional error. 

Finally, the bill would grant the Secretary 

discretion to apply alternate sanctions in lieu 

of the 2-year owner/operator ban if a CLIA 

certificate has been revoked due to an improper proficiency testing referral, correcting 

the problem of having to ban all labs in a 

health system, even if the others had no 

known problems. 

The Taking Essential Steps for Testing Act 

would address that issue, striking a balance to 

ensure quality protections remain, yet giving 

the Secretary the flexibility to more appropriately tailor penalties for violations of the 

law. I’m pleased to support this bill today. 

Mr. UPTON. Mr. Speaker, H.R. 6118, 

the Taking Essential Steps for Testing 

(TEST) Act of 2012, is an important 

measure that grants CMS the necessary flexibility to enforce its rules 

without unnecessarily punishing employers for unintentional acts. 

Under current law, laboratories must 

adhere to CMS procedures for processing testing samples in order to do 

business under the Clinical Laboratory 

Improvement Amendments (CLIA) law. 

In addition, they are prohibited from 

intentionally referring testing samples 

to other labs. 

Unfortunately, CMS is not allowed to 

look at the circumstances under which 

labs refer samples, and must levy the 

same penalties for those operating in 

good faith as those knowingly and willfully breaking the law. These penalties 

include the loss of a lab’s certification 

for a year and a prohibition against the 

owner operating any lab for a period of 

two years. 

In instances where a hospital or independent laboratory has accidentally referred a sample due to mistakes by employees or through automated systems, 

these penalties can be needlessly harsh 

and threaten the livelihood of American workers. H.R. 6118 would address 

these issues by allowing the Secretary 

discretion when determining penalties. 

The legislation has received bipartisan support among this body as well 

as numerous organizations. I would 

like to commend Congressmen GRIMM

and ROSKAM for their work and urge 

Members to support its passage. 

Mr. ROSKAM. Mr. Speaker, I rise 

today to express my support for H.R. 

6118, the ‘‘Taking Essential Steps for 

Testing Act of 2012’’ or TEST Act. This 

legislation will give the Centers for 

Medicare and Medicaid (CMS) greater 

leeway when dealing with hospitals and 

laboratories across the nation. 

Last year I was contacted by a hospital in my Congressional District who 

informed me that they had unintentionally referred a proficiency test to 

an outside lab because the lab technician was following patient procedure. 

They informed me that because of this 

error they would be forced to potentially close the lab and essentially fire 

the lab director. Upon further investigation, I was troubled to learn that 

the same problem was occurring across 

the country because CMS lacked the 

authority to handle these cases in any 

other fashion. 

This is why I was happy to work with 

my good friend from New York, Mr. 

GRIMM, and Mr. ROSS from Arkansas, 

as well as Senators BOOZMAN, KLOBUCHAR, and SHAHEEN, to come up with 

a simple, commonsense solution to the 

problem. While working with CMS and 

our friends across the aisle, we were 

able to demonstrate that this institution is still capable of recognizing 

problems and pursuing solutions for 

the people we represent back home. 

It is my hope that the Senate will 

quickly take up this legislation and 

send it to the President for signature 

so we can help provide regulatory relief 

to our nation’s hospitals and labs. 

The SPEAKER pro tempore. The 

question is on the motion offered by 

the gentleman from Pennsylvania (Mr. 

PITTS) that the House suspend the 

rules and pass the bill, H.R. 6118. 

The question was taken; and (twothirds being in the affirmative) the 

rules were suspended and the bill was 

passed. 

A motion to reconsider was laid on 

the table. 

f 

VETERAN EMERGENCY MEDICAL 

TECHNICIAN SUPPORT ACT OF 2012 

Mr. PITTS. Mr. Speaker, I move to 

suspend the rules and pass the bill 

(H.R. 4124) 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, as amended. 

The Clerk read the title of the bill. 

The text of the bill is as follows: 

H.R. 4124 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Veteran 

Emergency Medical Technician Support Act 

of 2012’’. 

SEC. 2. ASSISTING VETERANS WITH MILITARY 

EMERGENCY MEDICAL TRAINING TO 

MEET REQUIREMENTS FOR BECOMING CIVILIAN EMERGENCY MEDICAL 

TECHNICIANS. 

(a) IN GENERAL.—Part B of title III of the 

Public Health Service Act (42 U.S.C. 243 et 

seq.) is amended by inserting after section 

314 the following: 

‘‘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 2013, 

there is authorized to be appropriated to 

carry out this section $1,000,000 for the period 

of fiscal years 2013 through 2017.’’. 

(b) CONFORMING AMENDMENT.—Section 

751(j)(1) of the Public Health Service Act (42 

U.S.C. 294a(j)(1)) is amended by striking 

‘‘There is authorized to be appropriated’’ and 

inserting ‘‘Subject to section 315(e), there is 

authorized to be appropriated’’. 

The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 

Pennsylvania (Mr. PITTS) and the gentlewoman from California (Mrs. CAPPS) 

each will control 20 minutes. 

The Chair recognizes the gentleman 

from Pennsylvania. 

GENERAL LEAVE

Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may 

have 5 legislative days in which to revise and extend their remarks and insert extraneous materials in the 

RECORD on H.R. 4124. 

The SPEAKER pro tempore. Is there 

objection to the request of the gentleman from Pennsylvania? 

There was no objection. 

Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume. 

Mr. Speaker, I rise this evening in 

support of H.R. 4124, the Veteran Emergency Medical Technician Support Act 

of 2012. This act would take us forward 


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September 19, 2012 CONGRESSIONAL RECORD — HOUSE H6143 

in two important ways: it would reduce 

the shortages of emergency medical 

technicians in the United States and at 

the same time help our veterans find 

employment. 

Emergency response is a crucial component of our health care system and 

preparedness strategy. EMTs are often 

the first point of contact in a crisis situation, and their care can make the 

difference between life and death. 

Emergency response is even more crucial on the battlefield, where military 

medics respond to emergencies and 

provide care for the soldiers until a 

physician or other health professional 

can take over. These soldiers, trained 

as combat medics, become very experienced dealing with massive trauma injuries and other complex health problems. 

b 2120 

It seems that utilizing those with 

military medic training in our EMT 

workforce here at home would be good 

for the returning soldiers, good for the 

health care system, and good for patients. 

Areas throughout the United States 

are experiencing a shortage of EMTs, 

and military medics could potentially 

fill those workforce gaps. However, 

there are a number of issues keeping 

military medics from EMT employment. Most importantly are State licensing requirements, which can require duplicative training and education that is likely to be unnecessary 

for someone with significant experience. 

It is our hope that this bill would 

allow States to study this issue and 

streamline their EMT requirements for 

those returning from the military that 

have the experience so desperately 

needed in many communities. 

I would like to thank Mr. KINZINGER, 

a veteran who has served with many of 

these military medics, and Mrs. CAPPS

for their work on this bill. I urge my 

colleagues to vote in support of this 

legislation. 

I reserve the balance of my time. 

Mrs. CAPPS. Mr. Speaker, I yield 

myself 5 minutes. 

Mr. Speaker, our military men and 

women are trained to perform at the 

highest levels in a host of jobs. The individuals who serve our Nation in uniform do so with distinction. 

However, there is much more to be 

done to help our service men and 

women and their families when they 

return home to translate those skills 

and experiences into civilian service. 

That disconnect is what we are trying 

to address here today. 

Our military men and women receive 

some of the best technical training in 

emergency medicine, and every day, on 

the battlefield, they prove their skills 

under the very toughest of conditions. 

However, when they return home, experienced military medics are often required to start over. They must begin 

at entry-level curricula to receive certification for civilian jobs. 

Similarly, military medics with civilian credentials often must let their 

civilian certifications lapse while 

they’re defending our country. Either 

way, this keeps our veterans out of the 

civilian workforce and withholds valuable medical personnel from our communities. 

As a nurse, I know the importance of 

having qualified and capable first responders in each of our communities, 

and that is why we must do all we can 

to break down the artificial barriers 

that obstruct our military medics from 

civilian opportunities. 

So I am pleased to have joined Congressman KINZINGER to introduce H.R. 

4124, which is the Veteran Emergency 

Medical Technician Support Act. This 

bill is a straightforward, bipartisan approach to help States streamline their 

certification processes to take military 

medic training into account for civilian licensure. 

It’s a small but very important step 

towards breaking down the barriers 

that our servicemembers face when 

transitioning home. 

While the bill directs States to undertake these demonstration projects, I 

believe public and private organizations within the States, like area 

health education centers, or AHECs, 

will be important partners in the successful implementation of this initiative. This will help engage and leverage 

expertise already in our States and 

communities so that we can do our 

best by our veterans. 

I also want to take a moment to 

thank the leadership of the Energy and 

Commerce Committee, Chairman 

UPTON, Ranking Member WAXMAN, 

Chairman PITTS, and Ranking Member 

PALLONE for their dedication to this 

bill and to the staff for working in a bipartisan manner to bring this to the 

floor. 

Finally, I want to take a second to 

recognize a former congresswoman, 

Jane Harman, who spearheaded this 

issue in the last Congress. 

I urge my colleagues’ support for this 

legislation, and I look forward to swift 

consideration of it in the Senate. 

At this point, Mr. Speaker, I reserve 

the balance of my time. 

Mr. PITTS. Mr. Speaker, I would like 

to yield at this time 5 minutes to the 

gentleman from Illinois (Mr. 

KINZINGER). 

Mr. KINZINGER of Illinois. Mr. 

Speaker, I want to first off thank the 

chairman for bringing this bill forward. 

I want to thank Chairman UPTON, the 

ranking member of both the full and 

subcommittee, and I especially want to 

thank Congresswoman CAPPS for helping me on this. This is an outstanding 

bill, and I thank you for your leadership. 

Unemployment rates continue to be 

far too high among our men and 

women who are returning from Iraq 

and Afghanistan. Returning veterans 

deserve a smooth transition from the 

military into the civilian workforce. 

As a Nation, we must recognize the experience and education that our military-trained EMTs receive. It’s inefficient to force these well-trained veterans to start over with basic training 

in the civilian workforce after aiding 

wounded military men and women who 

are severely injured in combat. 

We must recognize military-trained 

EMT skills and education and streamline the process so these honorable men 

and women can return quickly to work 

here at home. 

We also need to recognize that training and education of these EMTs and 

the education that they receive in the 

military is important, and we must 

streamline the civilian certification 

process so these honorable men and 

women can return to work even faster. 

I’m a pilot in the military, and I still 

continue as an Air National Guard 

pilot. One of the things that really 

stood out to me was how I went 

through training with the military and 

came out and very quickly was able to 

receive all of the civilian equivalent 

certifications from what I got in the 

military. 

Now, that really stands out to me as 

how we, both in the Federal Government and in the State, ought to consider doing business and recognize the 

skill that these military folks are 

trained with. 

This bill is a commonsense way to 

help our veterans as they transition 

back to civilian life. By supporting 

States to make the process more efficient, veterans with military EMT 

training will more quickly become certified civilian EMTs. In doing so, they 

will not have to start over at square 

one in their training, and they can be 

ready to go. 

I urge my colleagues to support this 

commonsense bill. 

Mrs. CAPPS. In closing, Mr. Speaker, 

I also wish to thank my colleague, Mr. 

KINZINGER, for his leadership and his 

experience in the military, which led 

him to be very interested in this topic 

as well. 

The Veteran Emergency Medical 

Technician Support Act is a small but 

very important step toward helping our 

military medics transition to civilian 

EMT service, and it is a bipartisan 

measure. It fills a need both in the veterans’ community and also in our 

health care communities. 

I urge full support for this bill, and I 

yield back the balance of my time. 

Mr. PITTS. Mr. Speaker, as a veteran 

I appreciate the efforts of Mr. 

KINZINGER and Mrs. CAPPS and others 

in this commonsense and very bipartisan bill to support our veterans and 

provide for this need in the emergency 

medical technician area. 

I urge support for the bill, and I yield 

back the balance of my time. 

Mr. WAXMAN. Mr. Speaker, each of us is 

deeply indebted to the members of our military 

for their patriotism and for all they do to protect our country and its national interests. 

We know that our returning vets have 

unique skills and experiences that make them 

highly-qualified for jobs in the health care and 


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H6144 CONGRESSIONAL RECORD — HOUSE September 19, 2012 

other sectors. However, the unfortunate reality 

is that our veterans experience unemployment 

rates well above the national average. 

Congresswoman CAPPS and Congressman 

KINZINGER have introduced common-sense 

legislation—H.R. 4124—to advance our 

shared goals of getting our veterans back to 

work and addressing areas of shortage in 

health professions. Congresswoman CAPPS

has also authored legislation—H.R. 3884, the 

Emergency Medic Transition Act of 2012—that 

similarly seeks to help armed services personnel transition from military to civilian jobs in 

a timely fashion. 

H.R. 4124 authorizes a demonstration grant 

program to states to support planning efforts 

to streamline their certification and licensure 

requirements for emergency medical technicians. As Congresswoman CAPPS has noted, I 

think there is a role for partnerships between 

public and private organizations within the 

States—such as area health education centers—in the implementation of this program. 

I urge my colleagues to support H.R. 4124, 

and I commend Congresswoman CAPPS and 

Congressman KINZINGER for their work on this 

legislation. 

Mr. UPTON. Mr. Speaker, H.R. 4124, the 

Veteran Emergency Medical Technician Support Act of 2012, provides two important benefits. It addresses the shortages of emergency 

medical technicians (EMT) and it helps get our 

veterans back to work. 

Military medics receive some of the best 

medical and emergency training available 

while they serve our country. 

Yet, not all military medical training satisfies 

civilian EMT licensing and certification requirements. As a result, our returning veterans are 

unnecessarily prevented from working as an 

EMT when they re-enter civilian life. 

This bill will examine ways that states with 

a shortage of EMTs can streamline requirements so that military medics do not have to 

duplicate the education and training they received on the battlefield. Our vets will be put 

back to work, and critical workforce shortages 

in emergency care can be filled to meet public 

health needs. 

I proudly support this bill and urge my colleagues to support it. I yield the balance of my 

time. 

The SPEAKER pro tempore. The 

question is on the motion offered by 

the gentleman from Pennsylvania (Mr. 

PITTS) that the House suspend the 

rules and pass the bill, H.R. 4124, as 

amended. 

The question was taken; and (twothirds being in the affirmative) the 

rules were suspended and the bill, as 

amended, was passed. 

A motion to reconsider was laid on 

the table. 

f 

RECALCITRANT CANCER 

RESEARCH ACT OF 2012 

Mr. PITTS. Mr. Speaker, I move to 

suspend the rules and pass the bill 

(H.R. 733) to amend the Public Health 

Service Act to provide for a Pancreatic 

Cancer Initiative, and for other purposes, as amended. 

The Clerk read the title of the bill. 

The text of the bill is as follows: 

H.R. 733 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Recalcitrant 

Cancer Research Act of 2012’’. 

SEC. 2. SCIENTIFIC FRAMEWORK FOR RECALCITRANT CANCERS. 

Subpart 1 of part C of title IV of the Public 

Health Service Act (42 U.S.C. 285 et seq.) is 

amended by adding at the end the following: 

‘‘SEC. 417G. SCIENTIFIC FRAMEWORK FOR RECALCITRANT CANCERS. 

‘‘(a) DEVELOPMENT OF SCIENTIFIC FRAMEWORK.— 

‘‘(1) IN GENERAL.—For each recalcitrant 

cancer identified under subsection (b), the 

Director of the Institute shall develop (in accordance with subsection (c)) a scientific 

framework for the conduct or support of research on such cancer. 

‘‘(2) CONTENTS.—The scientific framework 

with respect to a recalcitrant cancer shall 

include the following: 

‘‘(A) CURRENT STATUS.— 

‘‘(i) REVIEW OF LITERATURE.—A summary of 

findings from the current literature in the 

areas of— 

‘‘(I) the prevention, diagnosis, and treatment of such cancer; 

‘‘(II) the fundamental biologic processes 

that regulate such cancer (including similarities and differences of such processes from 

the biological processes that regulate other 

cancers); and 

‘‘(III) the epidemiology of such cancer. 

‘‘(ii) SCIENTIFIC ADVANCES.—The identification of relevant emerging scientific areas 

and promising scientific advances in basic, 

translational, and clinical science relating 

to the areas described in subclauses (I) and 

(II) of clause (i). 

‘‘(iii) RESEARCHERS.—A description of the 

availability of qualified individuals to conduct scientific research in the areas described in clause (i). 

‘‘(iv) COORDINATED RESEARCH INITIATIVES.— 

The identification of the types of initiatives 

and partnerships for the coordination of intramural and extramural research of the Institute in the areas described in clause (i) 

with research of the relevant national research institutes, Federal agencies, and nonFederal public and private entities in such 

areas. 

‘‘(v) RESEARCH RESOURCES.—The identification of public and private resources, such as 

patient registries and tissue banks, that are 

available to facilitate research relating to 

each of the areas described in clause (i). 

‘‘(B) IDENTIFICATION OF RESEARCH QUESTIONS.—The identification of research questions relating to basic, translational, and 

clinical science in the areas described in subclauses (I) and (II) of subparagraph (A)(i) 

that have not been adequately addressed 

with respect to such recalcitrant cancer. 

‘‘(C) RECOMMENDATIONS.—Recommendations for appropriate actions that should be 

taken to advance research in the areas described in subparagraph (A)(i) and to address 

the research questions identified in subparagraph (B), as well as for appropriate benchmarks to measure progress on achieving 

such actions, including the following: 

‘‘(i) RESEARCHERS.—Ensuring adequate 

availability of qualified individuals described in subparagraph (A)(iii). 

‘‘(ii) COORDINATED RESEARCH INITIATIVES.— 

Promoting and developing initiatives and 

partnerships described in subparagraph 

(A)(iv). 

‘‘(iii) RESEARCH RESOURCES.—Developing 

additional public and private resources described in subparagraph (A)(v) and strengthening existing resources. 

‘‘(3) TIMING.— 

‘‘(A) INITIAL DEVELOPMENT AND SUBSEQUENT

UPDATE.—For each recalcitrant cancer identified under subsection (b)(1), the Director of 

the Institute shall— 

‘‘(i) develop a scientific framework under 

this subsection not later than 18 months 

after the date of the enactment of this section; and 

‘‘(ii) review and update the scientific 

framework not later than 5 years after its 

initial development. 

‘‘(B) OTHER UPDATES.—The Director of the 

Institute may review and update each scientific framework developed under this subsection as necessary. 

‘‘(4) PUBLIC NOTICE.—With respect to each 

scientific framework developed under subsection (a), not later than 30 days after the 

date of completion of the framework, the Director of the Institute shall— 

‘‘(A) submit such framework to the Committee on Energy and Commerce and Committee on Appropriations of the House of 

Representatives, and the Committee on 

Health, Education, Labor, and Pensions and 

Committee on Appropriations of the Senate; 

and 

‘‘(B) make such framework publically 

available on the Internet website of the Department of Health and Human Services. 

‘‘(b) IDENTIFICATION OF RECALCITRANT CANCER.— 

‘‘(1) IN GENERAL.—Not later than 6 months 

after the date of the enactment of this section, the Director of the Institute shall identify two or more recalcitrant cancers that 

each— 

‘‘(A) have a 5-year relative survival rate of 

less than 20 percent; and 

‘‘(B) are estimated to cause the death of at 

least 30,000 individuals in the United States 

per year. 

‘‘(2) ADDITIONAL CANCERS.—The Director of 

the Institute may, at any time, identify 

other recalcitrant cancers for purposes of 

this section. In identifying a recalcitrant 

cancer pursuant to the previous sentence, 

the Director may consider additional 

metrics of progress (such as incidence and 

mortality rates) against such type of cancer. 

‘‘(c) WORKING GROUPS.—For each recalcitrant cancer identified under subsection 

(b), the Director of the Institute shall convene a working group comprised of representatives of appropriate Federal agencies 

and other non-Federal entities to provide expertise on, and assist in developing, a scientific framework under subsection (a). The 

Director of the Institute (or the Director’s 

designee) shall participate in the meetings of 

each such working group. 

‘‘(d) REPORTING.— 

‘‘(1) BIENNIAL REPORTS.—The Director of 

NIH shall ensure that each biennial report 

under section 403 includes information on actions undertaken to carry out each scientific 

framework developed under subsection (a) 

with respect to a recalcitrant cancer, including the following: 

‘‘(A) Information on research grants 

awarded by the National Institutes of Health 

for research relating to such cancer. 

‘‘(B) An assessment of the progress made in 

improving outcomes (including relative survival rates) for individuals diagnosed with 

such cancer. 

‘‘(C) An update on activities pertaining to 

such cancer under the authority of section 

413(b)(7). 

‘‘(2) ADDITIONAL ONE-TIME REPORT FOR CERTAIN FRAMEWORKS.—For each recalcitrant 

cancer identified under subsection (b)(1), the 

Director of the Institute shall, not later than 

6 years after the initial development of a scientific framework under subsection (a), submit a report to the Congress on the effectiveness of the framework (including the update 

required by subsection (a)(3)(A)(ii)) in improving the prevention, detection, diagnosis, 

and treatment of such cancer. 

‘‘(e) RECOMMENDATIONS FOR EXCEPTION

FUNDING.—The Director of the Institute shall 


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