II

106TH CONGRESS

1ST SESSION S. 911

To amend title XVIII of the Social Security Act to ensure medicare reimbursement for certain ambulance services, and to improve the efficiency of

the emergency medical system, and for other purposes.

IN THE SENATE OF THE UNITED STATES

APRIL 29, 1999

Mr. GRAMS introduced the following bill; which was read twice and referred

to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to ensure

medicare reimbursement for certain ambulance services,

and to improve the efficiency of the emergency medical

system, 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 Efficiency Act of 1999’’.
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1 TITLE I—MEDICARE COVERAGE

2 OF CERTAIN AMBULANCE

3 SERVICES

4 SEC. 101. MEDICARE COVERAGE OF CERTAIN AMBULANCE

5 SERVICES.

6 (a) COVERAGE.—Section 1861(s)(7) of the Social Se7 curity Act (42 U.S.C. 1395x(s)(7)) is amended by striking

8 ‘‘regulations;’’ and inserting ‘‘regulations, except that

9 such regulations shall not fail to treat ambulance services

10 as medical and other health services solely because the ul11 timate diagnosis of the individual receiving the ambulance

12 services results in the conclusion that ambulance services

13 were not necessary, as long as the request for ambulance

14 services is made after the sudden onset of a medical condi15 tion that is manifested by symptoms of such sufficient se16 verity, including severe pain, that a prudent layperson,

17 who possesses an average knowledge of health and medi18 cine, could reasonably expect to result, without immediate

19 medical attention, in—

20 ‘‘(A) placing the individual’s health in serious

21 jeopardy;

22 ‘‘(B) serious impairment to the individual’s

23 bodily functions; or

24 ‘‘(C) serious dysfunction of any bodily organ or

25 part of the individual;’’.
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1 (b) EFFECTIVE DATE.—The amendment made by

2 subsection (a) shall apply to items and services provided

3 on or after the date of enactment of this Act.

4 TITLE II—STATE EMERGENCY

5 MEDICAL SERVICES AGENCY

6 PARTICIPATION IN CERTAIN

7 FEDERAL PROGRAMS

8 SEC. 201. TELEMEDICINE AND DISTANCE LEARNING SERV9 ICES IN RURAL AREAS.

10 (a) IN GENERAL.—Section 2333(c)(1) of chapter 1

11 of subtitle D of title XXIII of the Food, Agriculture, Con12 servation, and Trade Act of 1990 (7 U.S.C. 950aaa–

13 2(c)(1)) is amended by adding at the end the following

14 flush sentence:

15 ‘‘For purposes of this paragraph, the term ‘entities’

16 shall include State emergency medical services agen17 cies.’’.

18 (b) EFFECTIVE DATE.—The amendment made by

19 subsection (a) shall take effect on the date of enactment

20 of this Act.

21 SEC. 202. INFORMATICS, TELEMEDICINE, AND EDUCATION

22 DEMONSTRATION PROJECT.

23 (a) IN GENERAL.—Section 4207(c) of the Balanced

24 Budget Act of 1997 (42 U.S.C. 1395b–1(c) note.) is
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1 amended by adding at the end the following flush sen2 tence:

3 ‘‘A State emergency medical services agency may

4 participate in the consortium under this section.’’.

5 (b) EFFECTIVE DATE.—The amendment made by

6 subsection (a) shall take effect on the date of enactment

7 of this Act.

8 TITLE III—FEDERAL COMMIS9 SION FOR EMERGENCY AMBU10 LANCE SERVICES

11 SEC. 301. DEFINITION OF EMERGENCY AMBULANCE SERV12 ICES.

13 In this title, the term ‘‘emergency ambulance

14 services’’—

15 (1) means resources used by a qualified public,

16 private, or nonprofit entity to deliver medical care

17 under emergency conditions—

18 (A) that occur as a result of the condition

19 of a patient; or

20 (B) that occur as a result of a natural dis21 aster or similar situation; and

22 (2) includes services delivered by an emergency

23 ambulance employee that is licensed or certified by

24 a State as an emergency medical technician, a para-
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1 medic, a registered nurse, a physician assistant, or

2 a physician.

3 SEC. 302. ESTABLISHMENT OF COMMISSION.

4 (a) ESTABLISHMENT.—There is established a com5 mission to be known as the Federal Commission for Emer6 gency Ambulance Services (in this title referred to as the

7 ‘‘Commission’’).

8 (b) MEMBERSHIP.—

9 (1) COMPOSITION.—The Commission shall be

10 composed of 21 members, of whom—

11 (A) 1 shall be an individual who is ap12 pointed by the Majority Leader of the Senate;

13 (B) 1 shall be an individual who is ap14 pointed by the Minority Leader of the Senate;

15 (C) 1 shall be an individual who is ap16 pointed by the Speaker of the House of Rep17 resentatives;

18 (D) 1 shall be an individual who is ap19 pointed by the Minority Leader of the House of

20 Representatives;

21 (E) 1 shall be a member of the American

22 Academy of Pediatrics, appointed by the Presi23 dent from a list of nominations submitted by

24 the American Academy of Pediatrics;
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1 (F) 1 shall be a member of the American

2 Ambulance Association, appointed by the Presi3 dent from a list of nominations submitted by

4 the American Ambulance Association;

5 (G) 1 shall be a member of the American

6 College of Emergency Physicians, appointed by

7 the President from a list of nominations sub8 mitted by the American College of Emergency

9 Physicians;

10 (H) 1 shall be a member of the Committee

11 on Trauma within the American College of Sur12 geons, appointed by the President from a list of

13 nominations submitted by the American College

14 of Surgeons;

15 (I) 1 shall be a member of the American

16 Hospital Association, appointed by the Presi17 dent from a list of nominations submitted by

18 the American Hospital Association;

19 (J) 1 shall be a member of the North

20 American EMS Employee Organization Net21 work, appointed by the President from a list of

22 nominations submitted by the North American

23 EMS Employee Organization Network;

24 (K) 1 shall be a member of the Associated

25 Public Safety Communications Officials Inter-
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1 national, appointed by the President from a list

2 of nominations submitted by the Associated

3 Public Safety Communications Officials Inter4 national;

5 (L) 1 shall be a member of the Association

6 of Air Medical Services, appointed by the Presi7 dent from a list of nominations submitted by

8 the Association of Air Medical Services;

9 (M) 1 shall be a member of the Emergency

10 Nurses Association, appointed by the President

11 from a list of nominations submitted by the

12 Emergency Nurses Association;

13 (N) 1 shall be a member of the Inter14 national Association of Fire Chiefs, appointed

15 by the President from a list of nominations sub16 mitted by the International Association of Fire

17 Chiefs;

18 (O) 1 shall be a member of the Inter19 national Association of Fire Fighters, appointed

20 by the President from a list of nominations sub21 mitted by the International Association of Fire

22 Fighters;

23 (P) 1 shall each be a member of a gov24 erning body of an Indian tribe (as that term is

25 defined in section 4(e) of the Indian Self-Deter-
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1 mination and Education Assistance Act (25

2 U.S.C. 450b(e))), appointed by the President;

3 (Q) 1 shall be a member of the National

4 Association of Emergency Medical Services

5 Physicians, appointed by the President from a

6 list of nominations submitted by the National

7 Association of Emergency Medical Services

8 Physicians;

9 (R) 1 shall be a member of the National

10 Association of State Emergency Medical Serv11 ices Directors, appointed by the President from

12 a list of nominations submitted by the National

13 Association of State Emergency Medical Serv14 ices Directors;

15 (S) 1 shall be a member of the National

16 Association of Emergency Medical Technicians,

17 appointed by the President from a list of nomi18 nations submitted by the National Association

19 of Emergency Medical Technicians;

20 (T) 1 shall be a member of the National

21 Rural Health Association, appointed by the

22 President from a list of nominations submitted

23 by the National Rural Health Association; and

24 (U) 1 shall be a member of the National

25 Volunteer Fire Council, appointed by the Presi-
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1 dent from a list of nominations submitted by

2 the National Volunteer Fire Council.

3 (2) ADDITIONAL REQUIREMENTS.—

4 (A) GEOGRAPHICAL REPRESENTATION AND

5 URBAN AND RURAL REPRESENTATION.—In

6 making appointments of members under para7 graph (1), the appointing officials described in

8 such paragraph shall, through consultation and

9 collaboration with each other, select—

10 (i) members who are geographically

11 representative of the United States; and

12 (ii) members who are representative of

13 rural areas and urban areas.

14 (B) SPECIAL RULE.—The appointing offi15 cials described in paragraph (1) shall ensure

16 that, of the members appointed—

17 (i) 11 shall be representative of rural

18 areas; and

19 (ii) 11 shall be representative of

20 urban areas.

21 (3) DATE.—The appointments of the members

22 of the Commission shall be made not later than Jan23 uary 1, 2000.

24 (c) PERIOD OF APPOINTMENT; VACANCIES.—
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1 (1) PERIOD OF APPOINTMENT.—Members shall

2 be appointed for a term of 4 years.

3 (2) VACANCY.—

4 (A) IN GENERAL.—Any vacancy in the

5 Commission shall not affect the powers of the

6 Commission, but shall be filled in the same

7 manner as the original appointment.

8 (B) FILLING UNEXPIRED TERMS.—An in9 dividual chosen to fill a vacancy under this

10 paragraph shall be appointed for the unexpired

11 term of the member replaced.

12 (d) INITIAL MEETING.—Not later than 30 days after

13 the date on which all members of the Commission have

14 been appointed, the Commission shall hold its first meet15 ing.

16 (e) MEETINGS.—The Commission shall meet at the

17 call of the Chairperson.

18 (f) QUORUM.—A majority of the members of the

19 Commission shall constitute a quorum, but a lesser num20 ber of members may hold hearings.

21 (g) CHAIRPERSON AND VICE CHAIRPERSON.—The

22 Commission shall select a Chairperson and Vice Chair23 person from among the members of the Commission.
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1 SEC. 303. DUTIES OF THE COMMISSION.

2 (a) STUDY.—The Commission shall conduct a thor3 ough study of all matters relating to emergency ambulance

4 services, including any existing or proposed Federal de5 partment or agency rules that impact such services.

6 (b) RECOMMENDATIONS.—The Commission shall de7 velop recommendations regarding the improvement of all

8 matters relating to emergency ambulance services, includ9 ing any existing or proposed Federal department or agen10 cy rules that impact such services.

11 (c) REPORT.—Not later than 1 year after the date

12 of enactment of this Act and annually thereafter, the Com13 mission shall submit a report to the President and Con14 gress containing a detailed statement of the results of the

15 matters studied by the Commission pursuant to subsection

16 (a), together with the Commission’s recommendations for17 mulated pursuant to subsection (b).

18 SEC. 304. POWERS OF THE COMMISSION.

19 (a) HEARINGS.—The Commission may hold such

20 hearings, sit and act at such times and places, take such

21 testimony, and receive such evidence as the Commission

22 considers necessary to carry out the purposes of this title.

23 (b) INFORMATION FROM FEDERAL AGENCIES.—The

24 Commission may secure directly from any Federal depart25 ment or agency such information as the Commission con26 siders necessary to carry out the provisions of this title.
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1 Upon request of the Chairperson of the Commission, the

2 head of such department or agency shall furnish such in3 formation to the Commission.

4 (c) POSTAL SERVICES.—The Commission may use

5 the United States mails in the same manner and under

6 the same conditions as other departments and agencies of

7 the Federal Government.

8 (d) GIFTS.—The Commission may accept, use, and

9 dispose of gifts or donations of services or property.

10 SEC. 305. COMMISSION PERSONNEL MATTERS.

11 (a) COMPENSATION OF MEMBERS.—Members of the

12 Commission shall receive no additional pay, allowances, or

13 benefits by reason of the service of the members on the

14 Commission.

15 (b) TRAVEL EXPENSES.—The members of the Com16 mission shall be allowed travel expenses, including per

17 diem in lieu of subsistence, at rates authorized for employ18 ees of agencies under subchapter I of chapter 57 of title

19 5, United States Code, while away from the homes or reg20 ular places of business of the members in the performance

21 of services for the Commission.

22 (c) STAFF.—

23 (1) IN GENERAL.—The Chairperson of the

24 Commission may, without regard to the civil service

25 laws and regulations, appoint and terminate an exec-
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1 utive director and such other additional personnel as

2 may be necessary to enable the Commission to per3 form the duties of the Commission. The employment

4 of an executive director shall be subject to confirma5 tion by the Commission.

6 (2) COMPENSATION.—The Chairperson of the

7 Commission may fix the compensation of the execu8 tive director and other personnel without regard to

9 the provisions of chapter 51 and subchapter III of

10 chapter 53 of title 5, United States Code, relating

11 to classification of positions and General Schedule

12 pay rates, except that the rate of pay for the execu13 tive director and other personnel may not exceed the

14 rate payable for level V of the Executive Schedule

15 under section 5316 of such title.

16 (d) DETAIL OF GOVERNMENT EMPLOYEES.—Any

17 Federal Government employee may be detailed to the

18 Commission without compensation in addition to that re19 ceived for service as an employee of the United States,

20 and such detail shall be without interruption or loss of

21 civil service status or privilege.

22 (e) PROCUREMENT OF TEMPORARY AND INTERMIT23 TENT SERVICES.—The Chairperson of the Commission

24 may procure temporary and intermittent services under

25 section 3109(b) of title 5, United States Code, at rates
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1 for individuals that do not exceed the daily equivalent of

2 the annual rate of basic pay prescribed for level V of the

3 Executive Schedule under section 5316 of such title.

4 SEC. 306. FUNDING.

5 The Secretary of Labor, the Secretary of Commerce,

6 and the Secretary of Health and Human Services equally

7 shall provide to the Commission, out of funds otherwise

8 available to such Secretaries, such sums as are necessary

9 to carry out the purposes of the Commission under this

10 title.

11 SEC. 307. APPLICABILITY OF FEDERAL ADVISORY COM12 MITTEE ACT.

13 Section 14 of the Federal Advisory Committee Act

14 (5 U.S.C. App.) shall not apply to the Commission.

15 TITLE IV—STUDY AND REPORT

16 REGARDING CONSOLIDATION

17 OF FEDERAL AUTHORITY

18 OVER EMERGENCY MEDICAL

19 SERVICES

20 SEC. 401. STUDY AND REPORT REGARDING CONSOLIDA21 TION OF FEDERAL AUTHORITY OVER EMER22 GENCY MEDICAL SERVICES.

23 (a) STUDY AND RECOMMENDATIONS.—

24 (1) IN GENERAL.—The Comptroller General of

25 the United States shall conduct a thorough study
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1 and make recommendations on all matters relating

2 to the transfer of all functions (other than the func3 tions referred to in paragraph (2)) of Federal agen4 cies relating to emergency medical services to a sin5 gle Federal agency (and if appropriate, to a specific

6 office within such agency), including the transfer of

7 appropriations and personnel associated with such

8 services to such agency.

9 (2) EXCEPTIONS.—The recommendations for10 mulated pursuant to paragraph (1) shall not provide

11 for the transfer of any function—

12 (A) of the Department of Defense; or

13 (B) related to a Federal health care pro14 gram (as defined in section 1128B(f) of the So15 cial Security Act (42 U.S.C. 1320a–7b(f))).

16 (b) REPORT.—Not later than 1 year after the date

17 of enactment of this Act, the Comptroller General of the

18 United States shall submit a report to the President and

19 Congress containing a detailed statement of the results of

20 the matters studied and recommendations formulated by

21 the Comptroller General pursuant to subsection (b), to22 gether with any legislative recommendations that the

23 Comptroller General determines to be appropriate for car24 rying out the recommendations.

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