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[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 809 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 809

To provide for improvement of field emergency medical services, and for 
                            other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           February 25, 2013

 Mr. Bucshon introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
To provide for improvement of field emergency medical services, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Field EMS Quality, 
Innovation, and Cost Effectiveness Improvements Act of 2013''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Recognition of HHS as primary Federal agency for emergency 
                            medical services and trauma care.
Sec. 5. Field EMS Excellence, Quality, Universal Access, Innovation, 
                            and Preparedness.
Sec. 6. Field EMS System Performance, Integration, and Accountability.
Sec. 7. Field EMS quality.
Sec. 8. Field EMS education grants.
Sec. 9. Evaluating innovative models for access and delivery of field 
                            EMS for patients.
Sec. 10. Enhancing research in field EMS.
Sec. 11. Emergency Medical Services Trust Fund.
Sec. 12. Authorization of appropriations.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) All persons throughout the country should have access 
        to and receive high-quality emergency medical care as part of a 
        coordinated emergency medical services system.
            (2) Properly functioning emergency medical services (EMS) 
        systems, 24 hours per day, 7 days per week, are essential to 
        ensure access to emergency medical care and transport for all 
        patients with emergency medical conditions. Such coordinated 
        EMS systems are also necessary for response to catastrophic 
        incidents.
            (3) Ensuring high-quality and cost-effective EMS systems 
        requires readiness, preparedness, medical direction, oversight, 
        and innovation throughout the continuum of emergency medical 
        care through Federal, State, and local multijurisdictional 
        collaboration and sufficient resources for EMS agencies and 
        providers.
            (4) At the Federal level, EMS responsibilities and 
        resources of several Federal agencies consistent with their 
        expertise and authority must emphasize the critical importance 
        of Federal agency collaboration and coordination for all 
        emergency medical services.
            (5) At the State and local level, EMS systems and agencies 
        require the coordination and improved capabilities of multiple 
        and diverse stakeholders.
            (6) Emergency medical services encompass the provision of 
        care provided to patients with emergency medical conditions 
        throughout the continuum, including emergency medical care and 
        trauma care provided in the field, hospital, and rehabilitation 
        settings.
            (7) Field EMS comprises essential emergency medical 
        services, including medical care or medical transport provided 
        to patients prior to or outside medical facilities and other 
        clinical settings. The primary purpose of field emergency 
        medical services is to ensure that emergency medical patients 
        receive the right care at the right place in the right amount 
        of time.
            (8) Coordinated and high-quality field EMS is essential to 
        the Nation's security. Field EMS is an essential public service 
        provided by governmental and nongovernmental agencies and 
        practitioners 24 hours a day, 7 days a week, and during 
        catastrophic incidents. To ensure disaster and all-hazards 
        preparedness for EMS operations as part of the Nation's 
        comprehensive disaster preparedness, Federal funding for 
        preparedness activities, including catastrophic training and 
        drills, must be provided to governmental and nongovernmental 
        EMS agencies so as to ensure a greater capability within each 
        of these areas.
            (9) Numerous recommendations from several significant 
        national reports and documents have demonstrated the need in 
        multiple areas for substantial improvement of emergency medical 
        services provided in the field, including recommendations in 
        the EMS Agenda for the Future, the Institute of Medicine report 
        ``The Future of Emergency Care in the United Health System'', 
        and the National EMS Education Agenda for the Future: A Systems 
        Approach and recommendations by the National EMS Workforce 
        Injury and Illness Surveillance Program, the Department of 
        Transportation's National EMS Advisory Council (NEMSAC), and 
        the Federal Interagency Committee on Emergency Medical Services 
        (FICEMS).
            (10) To substantially improve field EMS, advancements must 
        be made in several essential areas including readiness, 
        innovation, preparedness, education and workforce development, 
        safety, financing, quality, standards, and research.
            (11) The recognition of a primary programmatic Federal 
        agency for emergency medical services within the Department of 
        Health and Human Services was recommended by the Institute of 
        Medicine and is necessary to provide a more streamlined, cost-
        efficient, and comprehensive approach for field EMS and a focal 
        point for practitioners and agencies to interface with the 
        Federal Government.
            (12) The essential role of field EMS in disaster 
        preparedness and response must be incorporated into the 
        national preparedness and response strategy and implementation 
        as provided and overseen by the Department of Homeland Security 
        and the Department of Health and Human Services pursuant to 
        their respective jurisdictions.
            (13) The essential role of NHTSA in the continued 
        development of NEMSIS and in overseeing transportation issues 
        related to field EMS such as EMS and ambulance vehicle safety 
        standards should be maintained.
            (14) FICEMS must continue in its essential role in 
        coordinating the Federal activities related to the full 
        spectrum of EMS.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) The term ``ambulance diversion'' means the practice by 
        hospitals of denying access to an incoming ambulance by 
        requesting it to proceed to another facility due to a stated 
        lack of capacity at the initial facility, resulting in delayed 
        access to definitive care.
            (2) The term ``EMS'' means emergency medical services.
            (3) The term ``FICEMS'' means the Federal Interagency 
        Committee on Emergency Medical Services.
            (4) The term ``field EMS'' means emergency medical services 
        provided to patients (including transport by ground, air, or 
        otherwise) prior to or outside a medical facility or other 
        clinical setting.
            (5) The term ``field EMS agency'' means an organization 
        providing field EMS, regardless of--
                    (A) whether such organization is governmental, 
                nongovernmental, or volunteer; and
                    (B) whether such organization provides field EMS by 
                ground, air, or otherwise.
            (6) The term ``emergency medical services'' or ``EMS'' 
        means emergency medical care, trauma care, and related services 
        provided to patients at any point in the continuum of health 
        care services, including emergency medical dispatch and 
        emergency medical care, trauma care, and related services 
        provided in the field, during transport, or in a medical 
        facility or other clinical setting.
            (7) The term ``field EMS patient care reports'' means the 
        information that a field EMS agency typically creates regarding 
        a patient's medical condition and treatment in the course of 
        providing emergency medical services to that patient.
            (8) The term ``medical oversight'' means the supervision by 
        a physician of the medical aspects of an EMS system or agency 
        and its providers including prospective, concurrent, and 
        respective components of field EMS and the education of EMS 
        providers.
            (9) The term ``NEMSAC'' means the National Emergency 
        Medical Services Advisory Council.
            (10) The term ``NEMSIS'' means the National EMS Information 
        System.
            (11) The term ``NHTSA'' means the National Highway Traffic 
        Safety Administration.
            (12) The term ``patient parking'' means the practice by 
        hospitals of refusing to accept transfer of a patient's care 
        from an ambulance crew until a regular emergency department bed 
        is available, requiring the crew to continue to provide patient 
        care on the ambulance stretcher other than a patient bed in the 
        hospital until hospital staff will accept the transfer of care, 
        resulting in delayed access to definitive care.
            (13) The term ``State EMS Office'' means an office 
        designated by the State with primary responsibility for 
        oversight of the State's EMS system, such as responsibility for 
        oversight of EMS coordination, licensing or certifying EMS 
        practitioners, and EMS system improvement.
            (14) The term ``STEMI'' means ST-Segment Elevation 
        Myocardial Infarction.

SEC. 4. RECOGNITION OF HHS AS PRIMARY FEDERAL AGENCY FOR EMERGENCY 
              MEDICAL SERVICES AND TRAUMA CARE.

    (a) Primary Federal Agency.--The Department of Health and Human 
Services shall serve as the primary Federal agency with responsibility 
for programs and activities relating to emergency medical services and 
trauma care.
    (b) Office of EMS and Trauma.--
            (1) Establishment.--There is established an Office of 
        Emergency Medical Services and Trauma, to be known as the 
        Office of EMS and Trauma, within the Department of Health and 
        Human Services. The Office of EMS and Trauma shall be headed by 
        a director appointed by the Secretary of Health and Human 
        Services.
            (2) Role of office within hhs.--
                    (A) In general.--The Office of EMS and Trauma shall 
                have--
                            (i) the responsibilities delegated to the 
                        Office of EMS and Trauma pursuant to paragraph 
                        (3);
                            (ii) the responsibilities and authorities 
                        vested in the Office of EMS and Trauma by other 
                        provisions of this Act; and
                            (iii) such responsibilities and authorities 
                        as may be delegated or transferred to the 
                        Office of EMS and Trauma pursuant to 
                        subparagraph (B).
                    (B) Additional responsibilities and authorities.--
                In addition to the responsibilities and authorities 
                specified in clauses (i) and (ii) of subparagraph (A), 
                the Secretary of Health and Human Services may delegate 
                or transfer to the Office of EMS and Trauma any other 
                responsibility or authority of the Department of Health 
                and Human Services relating to emergency medical 
                services and trauma care, including such services and 
                care relating to--
                            (i) the full continuum of emergency medical 
                        services, including field EMS and trauma and 
                        hospital emergency medical care; or
                            (ii) improving the quality, innovation, or 
                        cost effectiveness of emergency medical 
                        services.
                    (C) Location of office in hhs.--The Secretary shall 
                locate the Office of EMS and Trauma within the 
                organizational structure of the Department of Health 
                and Human Services in a manner that achieves each of 
                the following:
                            (i) Recognition of the importance and 
                        unique life-saving services associated with 
                        field EMS, trauma care, and hospital emergency 
                        care as a significant Federal priority.
                            (ii) Integration of these essential 
                        services with the larger health care system and 
                        within the disaster preparedness system, 
                        including through regionalization of such 
                        services and by enhancing daily readiness 
                        capabilities to ensure adequate disaster 
                        readiness capabilities, consistent with the 
                        National Health Security Strategy.
                            (iii) Consolidation, co-location, and cost 
                        efficiencies in administering programs and 
                        activities related to field EMS, trauma care, 
                        and hospital emergency medical care.
                            (iv) Establishment of a Federal focal point 
                        for leadership and improved coordination, 
                        support, and oversight of field EMS, trauma 
                        care and hospital emergency medical care.
                            (v) Sufficient level and stature such 
                        that--
                                    (I) such Office is able to fulfill 
                                its role, responsibilities, and 
                                authorities; and
                                    (II) the Director of such Office 
                                reports directly to the Secretary or an 
                                official within the Department who 
                                reports directly to the Secretary.
                            (vi) Establishment of a visible and 
                        identifiable point of contact with which the 
                        public; EMS agencies and practitioners; State 
                        and local government agencies; EMS educational 
                        institutions; EMS, trauma, and hospital 
                        emergency care professional associations; and 
                        all other parties may interact.
            (3) Responsibilities.--The Secretary of Health and Human 
        Services shall, at a minimum, delegate responsibility to the 
        Office of EMS and Trauma to carry out--
                    (A) sections 5 and 6 (relating to the EQUIP and 
                SPIA grant programs, respectively);
                    (B) section 330J of the Public Health Service Act 
                (42 U.S.C. 254c-15; relating to rural emergency service 
                training and equipment assistance program);
                    (C) part A (42 U.S.C. 300d et seq.), part B (42 
                U.S.C. 300d-11 et seq.), part C (42 U.S.C. 300d-31 et 
                seq.), part D (42 U.S.C. 300d-41 et seq.), and part H 
                (42 U.S.C. 300d-81 et seq.) of title XII of the Public 
                Health Service Act (relating to trauma care);
                    (D) section 8 (relating to the field EMS education 
                grant program); and
                    (E) section 9 (relating to evaluating innovative 
                models for access and delivery of field EMS for 
                patients).
    (c) National EMS Strategy.--The Secretary of Health and Human 
Services, acting through the Director of the Office of EMS and Trauma, 
and in consultation with the Assistant Secretary for Preparedness and 
Response and the Administrator of the Health Resources and Services 
Administration, shall develop and implement a cohesive national EMS 
strategy to strengthen the development of the full continuum of EMS at 
the Federal, State, and local levels. In establishing such a strategy, 
the Secretary shall--
            (1) solicit and consider the recommendations of the NEMSAC 
        as well as relevant stakeholders;
            (2) consult and collaborate with FICEMS to ensure 
        consistency of such national EMS strategy within the larger 
        Federal strategy regarding all of emergency medical services 
        and national preparedness and response;
            (3) address issues related to EMS patient and practitioner 
        safety, standardization of EMS practitioner licensing and 
        credentialing, field EMS quality and medical oversight, 
        regionalization of field EMS and trauma and emergency care 
        services, availability of field EMS and trauma care and 
        emergency medical services throughout the Nation, and 
        integration of field EMS practitioners into the broader health 
        care system, including--
                    (A) promotion of the adoption by States of the 
                education standards identified in the ``Emergency 
                Medical Services Education Agenda for the Future: A 
                Systems Approach'' and any revisions thereto, including 
                the standardization of licensing and credentialing of 
                field EMS practitioners and standards of care, based on 
                best practices and evidence-based medicine, including 
                by--
                            (i) the identification of differences in 
                        the levels of care, scope of practice, and 
                        licensure and credentialing requirements among 
                        the States; and
                            (ii) the adoption by the States of national 
                        standards for such levels of care, scope of 
                        practice and licensure and credentialing 
                        requirements;
                    (B) promotion of a culture of safety, including--
                            (i) the adoption of an anonymous error 
                        reporting system designed to identify systemic 
                        problems in field EMS patient and practitioner 
                        safety and ensure a single means of collecting 
                        and reporting relevant error data by field EMS 
                        agencies and States;
                            (ii) the establishment of field EMS patient 
                        and practitioner safety goals and the specific 
                        means to improve field EMS practitioner and 
                        patient safety to achieve such goals; and
                            (iii) the adoption of more uniform national 
                        ambulance vehicle safety and manufacturing 
                        standards as developed by the National Fire 
                        Protection Administration or coordinated by 
                        NHTSA;
                    (C) the integration and utilization of field EMS 
                practitioners as part of the larger health care system 
                including--
                            (i) the potential utilization of field EMS 
                        practitioners for the provision of care to 
                        patients with nonemergent medical conditions; 
                        and
                            (ii) strategies to implement the 
                        recommendations provided by the National Health 
                        Care Workforce Commission, pursuant to section 
                        5101(d)(2) of the Patient Protection and 
                        Affordable Care Act (42 U.S.C. 294q(d)(2); and
                    (D) such other issues as the Secretary considers 
                appropriate;
            (4) incorporate into such strategy the preparedness and 
        response objectives identified by the Secretary of Homeland 
        Security and the Assistant Secretary for Preparedness and 
        Response in order--
                    (A) to ensure the capability and capacity of the 
                full spectrum of EMS to respond to terrorist attacks, 
                disasters, catastrophic events, and mass casualty 
                events; and
                    (B) to coordinate with the Secretary of Homeland 
                Security accordingly;
            (5) complete the development of such strategy not later 
        than 18 months after the date of enactment of this Act;
            (6) communicate such strategy to the relevant congressional 
        committees of jurisdiction;
            (7) implement such strategy to the extent practical not 
        later than 3 years after the date of enactment of this Act; and
            (8) update such strategy not less than every 3 years.
    (d) Statutory Construction.--Nothing in this Act shall be construed 
to supercede any statutory authority of any Federal agency that is not 
within the Department of Health and Human Services.

SEC. 5. FIELD EMS EXCELLENCE, QUALITY, UNIVERSAL ACCESS, INNOVATION, 
              AND PREPAREDNESS.

    (a) In General.--The Director of the Office of EMS and Trauma (in 
this section referred to as the ``Director''), shall establish the 
EQUIP grant program--
            (1) to promote excellence in all aspects of the provision 
        of field EMS by field EMS agencies;
            (2) to enhance the quality of emergency medical care 
        provided to patients by field EMS practitioners through 
        evidence-based, medically directed field emergency care;
            (3) to promote universal access to and availability of 
        high-quality field EMS in all geographic locations of the 
        Nation;
            (4) to spur innovation in the delivery of field EMS; and
            (5) to improve EMS agency readiness and preparedness for 
        day-to-day emergency medical response.
    (b) Application.--
            (1) In general.--To be eligible to receive a grant under 
        this section, an eligible entity shall submit an application to 
        the Director in such form and manner, that contains such 
        agreements, assurances, and information as the Director 
        determines to be reasonably necessary to carry out this 
        section.
            (2) Simple form.--The Director shall ensure that grant 
        application requirements are not unduly burdensome to smaller 
        and volunteer field EMS agencies or other agencies with limited 
        resources.
            (3) Consistency with preparation goals.--The Director shall 
        ensure that grant applications are consistent with national and 
        relevant State preparedness plans and goals.
    (c) Use of Funds.--Grants may be used by eligible entities to--
            (1) sustain field EMS practitioners to ensure 24 hours a 
        day, 7 days a week readiness and preparedness at the local 
        level;
            (2) develop and implement initiatives related to delivery 
        of medical services, including--
                    (A) innovative clinical practices to improve the 
                cost effectiveness and quality of care delivered to 
                emergency patients in the field that results in 
                improved patient outcomes and cost savings to the 
                health system, including for high prevalence emergency 
                medical conditions such as sudden cardiac arrest, 
                STEMI, stroke, and trauma; and
                    (B) delivery systems to improve patient outcomes, 
                which may include implementing evidence-based 
                protocols, interventions, systems, and technologies to 
                reduce clinically meaningful response times;
            (3) purchase and implement--
                    (A) medical equipment and training for using such 
                equipment;
                    (B) communication systems to ensure seamless and 
                interoperable communications with other first 
                responders; and
                    (C) information systems to comply with NEMSIS data 
                collection and integrate field emergency care with 
                electronic medical records;
            (4) participate in federally sponsored field EMS research;
            (5) establish or enhance comprehensive medical oversight 
        and quality assurance programs that include the active 
        participation by medical directors in field EMS medical 
        direction and educational programs; and
            (6) such other uses as the Director may establish.
    (d) Administration of Grants.--In establishing and administering 
the EQUIP grant program, the Director--
            (1) shall establish a grantmaking process that includes--
                    (A) prioritization for the awarding of grants to 
                eligible entities and consideration of the factors in 
                reviewing grant applications by eligible entities 
                including--
                            (i) demonstrated financial need for 
                        funding;
                            (ii) utilization of public and private 
                        partnerships;
                            (iii) enhanced access to high-quality field 
                        EMS in under served geographic areas;
                            (iv) unique needs of volunteer and rural 
                        field EMS agencies;
                            (v) distribution among a variety of 
                        geographic areas, including urban, suburban, 
                        and rural;
                            (vi) distribution of funds among types of 
                        EMS agencies, including governmental, 
                        nongovernmental and volunteer;
                            (vii) implementation of evidence-based 
                        interventions that improve quality of care, 
                        patient outcomes, efficiency, or cost 
                        effectiveness; and
                            (viii) such other factors as the Director 
                        considers necessary;
                    (B) a peer-reviewed process to recommend grant 
                allocations in accordance with the prioritization 
                established by the Director except that final award 
                determinations shall be made by the Director; and
                    (C) the provision of grant awards to eligible 
                entities on an annual basis, except that the Director 
                may reserve not more than 25 percent of the available 
                appropriations for multiyear grants and no grant award 
                may exceed a 2-year period;
            (2) shall consult with and take into consideration the 
        recommendations of the Assistant Secretary for Preparedness and 
        Response, FICEMS, NEMSAC and relevant stakeholders;
            (3) shall ensure that funds used for day-to-day 
        preparedness activities are consistent and aligned with Federal 
        preparedness priorities; and
            (4) may contract with an independent, third-party, 
        nonprofit organization to administer the grant program if the 
        Director establishes conflict-of-interest requirements as part 
        of any such contractual relationship.
    (e) Eligibility.--Eligible grant recipients are field EMS agencies 
that--
            (1) are licensed by or otherwise authorized in the State in 
        which they operate; and
            (2) have medical oversight and quality improvement programs 
        as defined by the Director.
    (f) Annual Report.--The Director shall submit an annual report on 
the EQUIP grant program under this section to the Congress.

SEC. 6. FIELD EMS SYSTEM PERFORMANCE, INTEGRATION, AND ACCOUNTABILITY.

    (a) In General.--The Director of the Office of EMS and Trauma (in 
this section referred to as the ``Director'') shall establish the SPIA 
grant program--
            (1) to improve field EMS system performance, integration 
        and accountability;
            (2) to ensure preparedness for field EMS at the State and 
        local levels;
            (3) to enhance physician medical oversight of field EMS 
        systems;
            (4) to improve coordination between regional field EMS 
        systems and integration of such regional field EMS systems into 
        the larger health care system;
            (5) to enhance data collection and analysis to improve, on 
        a continuing basis, the field EMS system; and
            (6) to promote standardization of national EMS 
        certification of emergency medical technicians and paramedics.
    (b) Use of Funds.--Grants may be used by eligible entities--
            (1) to enhance EMS system readiness and preparedness for 
        day-to-day emergency medical response;
            (2) to improve cross-border collaboration and planning 
        among States; and
            (3) to collect data with regard to--
                    (A) NEMSIS;
                    (B) field EMS education;
                    (C) field EMS workforce;
                    (D) cardiac events, including STEMI and sudden 
                cardiac arrest;
                    (E) stroke;
                    (F) disasters, including injuries and illnesses;
                    (G) ambulance diversion and patient parking;
                    (H) trauma (in a manner that is complementary and 
                not duplicative of other trauma data collection such as 
                the National Trauma Data Bank);
                    (I) data determined necessary by the State office 
                of EMS for oversight and coordination of the State 
                field EMS system; and
                    (J) any other such data that the Director 
                specifies;
            (4) to implement and evaluate system-wide quality 
        improvement initiatives, including medical direction at the 
        State, local, and regional levels;
            (5) to integrate field EMS with other health care services 
        as part of a coordinated system of care provided to patients 
        with emergency medical conditions to help ensure the right 
        patient receives the right care by the right crew in the right 
        vehicle and at the right medical facility in the right amount 
        of time, including by enhancing regional emergency medical 
        dispatch;
            (6) to incorporate national EMS certification for all 
        levels of emergency medical technicians and paramedics;
            (7) to improve the State's planning for ensuring a 
        consistent, available EMS workforce;
            (8) to fund EMS regional and local oversight and planning 
        organizations or develop regional systems of emergency medical 
        care within the State to further enhance coordination and 
        systemic development throughout the State; and
            (9) for such other uses as the Director may establish.
    (c) Administration of Grants.--In establishing and administering 
the SPIA grant program, the Director shall--
            (1) establish State EMS system performance standards to 
        serve as guidance to States in improving their EMS systems and 
        in applying for grants under this subsection. In establishing 
        such standards, the Director shall--
                    (A) take into the consideration the recommendations 
                of the Assistant Secretary for Preparedness and 
                Response, FICEMS, NEMSAC, and relevant stakeholders;
                    (B) include national, evidence-based guidelines; 
                and
                    (C) take into account the needs and resource 
                limitations of volunteer, smaller agencies, and 
                agencies in rural areas.
            (2) provide technical assistance to State EMS offices in 
        conducting comprehensive EMS planning with regard to evidence-
        based workforce and development competencies for field EMS 
        management;
            (3) allocate, within the available funds, SPIA grants to a 
        maximum of one grant per applicant according to a formula based 
        on population and geographic area, as determined by the 
        Director, for a period not to exceed 2 years; and
            (4) require that States allocate a portion of their grant 
        funds to regional and local oversight and planning EMS 
        organizations within the State for the purpose of field EMS 
        system development, maintenance, and improvement of 
        coordination among regional organizations.
    (d) Application.--To be eligible to receive a grant under this 
section, an eligible entity shall submit an application to the Director 
in such form and manner, that contains such agreements, assurances, and 
information as the Director determines to be reasonably necessary to 
carry out this section.
    (e) Eligibility.--The eligible entities for a grant under this 
section are the State EMS office in each of the several States, tribes, 
and territories.
    (f) Annual Report.--The Director shall submit an annual report on 
the SPIA grant program under this section to the Congress.

SEC. 7. FIELD EMS QUALITY.

    (a) Medical Oversight.--
            (1) In general.--To improve medical oversight of field EMS 
        and ensure continuity and quality for such medical oversight, 
        the Director of the Office of EMS and Trauma (in this section 
        referred to as the ``Director'') shall--
                    (A) promote high-quality and comprehensive medical 
                oversight of--
                            (i) all medical care provided by field EMS 
                        practitioners; and
                            (ii) the education and training of field 
                        EMS practitioners;
                    (B) promote the development, adoption, and 
                utilization of national guidelines for the roles of 
                physicians who provide medical oversight for field EMS 
                and other health care providers who support physicians 
                in this role;
                    (C) support efforts of relevant physician 
                stakeholders in developing and disseminating guidelines 
                for use by EMS medical directors and field EMS 
                practitioners on a national basis; and
                    (D) convene a Field EMS Medical Oversight Advisory 
                Committee, comprised of representatives of relevant 
                physician stakeholders, to advise the Director on ways 
                and means to advance and support development and 
                maintenance of quality medical oversight throughout the 
                Nation's systems for field EMS.
            (2) Additional considerations.--In carrying out 
        subparagraphs (B) and (C) of paragraph (1) (relating to 
        supporting guidelines), the Director shall take into 
        consideration--
                    (A) existing guidelines developed by national 
                professional physician associations, States, and other 
                relevant governmental or nongovernmental entities;
                    (B) the input of other relevant stakeholders, 
                including health care providers who support physicians 
                who provide medical oversight for field EMS; and
                    (C) the unique needs associated with medical 
                oversight of provision of field EMS in rural areas or 
                by volunteers.
            (3) Flexibility.--The guidelines promoted under 
        subparagraphs (B) and (C) of paragraph (1) shall ensure high-
        quality training, credentialing, and direction in connection 
        with medical oversight of field EMS at the State, regional, and 
        local levels while providing sufficient flexibility to account 
        for historical and legitimate differences in field EMS among 
        States, regions, and localities.
            (4) Required use of guidelines.--As a condition on receipt 
        of a grant under section 5 or 6, the Director shall require the 
        grant recipient to adopt and implement (to the extent 
        applicable) the guidelines promoted under subparagraphs (B) and 
        (C) of paragraph (1).
    (b) GAO Study and Report.--
            (1) In general.--The Comptroller General of the United 
        States shall complete a study on--
                    (A) medical and administrative liability issues 
                that may impede--
                            (i) medical direction provided by 
                        physicians directly regarding specific patients 
                        or medical oversight provided by physicians in 
                        establishing medical protocols, procedures, and 
                        other activities related to the provision of 
                        emergency medical care in field EMS; or
                            (ii) the highest quality emergency medical 
                        care in field EMS provided by personnel other 
                        than physicians such as emergency medical 
                        technicians and paramedics;
                    (B) reimbursement for any component of medical 
                oversight; and
                    (C) such other issues as the Comptroller General 
                deems appropriate relating to improving the quality and 
                medical oversight of emergency medical care in field 
                EMS.
            (2) Report to congress.--Not later than 18 months after the 
        date of the enactment of this Act, the Comptroller General 
        shall complete the study under paragraph (1) and submit a 
        report to the Congress on the results of such study, including 
        any recommendations.
    (c) Data Collection and Exchange.--
            (1) National ems information system.--
                    (A) In general.--The Administrator of NHTSA may 
                maintain, improve, and expand the National EMS 
                Information System, including the National EMS 
                Database.
                    (B) Consultation.--The Administrator of NHTSA shall 
                carry out this paragraph in consultation with the 
                Director.
                    (C) Standardization.--In carrying out subparagraph 
                (A), the Administrator of NHTSA shall promote the 
                collection and reporting of data on field EMS in a 
                standardized manner.
                    (D) Availability of data.--The Administrator of 
                NHTSA shall ensure that information in the National EMS 
                Database (other than individually identifiable 
                information) is available to Federal and State 
                policymakers, EMS stakeholders, and researchers.
                    (E) Technical assistance.--In carrying out 
                subparagraph (A), the Administrator of NHTSA may 
                provide technical assistance to State and local 
                agencies, field EMS agencies, and other entities deemed 
                appropriate by the Administrator to assist in the 
                collection, analysis, and reporting of data.
            (2) Report on data gaps.--
                    (A) In general.--Not later than 12 months after the 
                date of the enactment of this Act, the Secretary of 
                Health and Human Services, acting through the Director, 
                in consultation with the Administrator of NHTSA, shall 
                submit to the Congress a report that--
                            (i) identifies gaps in the collection of 
                        data related to the provision of field EMS; and
                            (ii) includes recommendations for improving 
                        the collection, reporting, and analysis of such 
                        data.
                    (B) Recommendations.--The recommendations required 
                by subparagraph (A)(ii) shall--
                            (i) take into consideration the 
                        recommendations of FICEMS and NEMSAC and 
                        relevant stakeholders;
                            (ii) recommend methods for improving data 
                        collection and reporting and analysis without 
                        unduly burdening reporting entities and without 
                        duplicating existing data sources (such as data 
                        collected by the National Trauma Data Bank);
                            (iii) address the quality and availability 
                        of data, and linkages with existing patient 
                        registries, related to the provision of field 
                        EMS and utilization of field EMS with respect 
                        to a variety of illnesses and injuries (in both 
                        the everyday provision of field EMS and 
                        catastrophic or disaster response) including--
                                    (I) cardiac events such as chest 
                                pain, sudden cardiac arrest, and STEMI;
                                    (II) stroke;
                                    (III) trauma;
                                    (IV) disaster and catastrophic 
                                incidents, such as incidents related to 
                                terrorism or natural or manmade 
                                disasters; and
                                    (V) ambulance diversion and patient 
                                parking; and
                            (iv) include an analysis of the variety of 
                        services provided by field EMS agencies.
            (3) Report on data integration to promote quality of 
        care.--Not later than 18 months after the date of the enactment 
        of this Act, the Secretary of Health and Human Services, acting 
        through the head of the Office of the National Coordinator for 
        Health Information Technology, in collaboration with the 
        Director of the Office of EMS and Trauma, FICEMS, and the 
        Administrator of NHTSA as appropriate, and taking into 
        consideration input from relevant stakeholders, shall submit a 
        report (including recommendations) on issues, impediments, and 
        potential solutions pertaining to the following objectives:
                    (A) Incorporation of field EMS patient care reports 
                into patient electronic health records, taking into 
                consideration--
                            (i) the extent to which field EMS patient 
                        care reports are presently created in 
                        electronic format and the potential for 
                        elements of such reports to be incorporated 
                        into patient electronic health records;
                            (ii) the data elements of field EMS patient 
                        care reports that would promote quality and 
                        efficiency of care if incorporated into patient 
                        electronic health records;
                            (iii) potential modifications to the 
                        Medicare and Medicaid programs under titles 
                        XVIII and XIX, respectively, of the Social 
                        Security Act or other Federal health programs 
                        (including potential modifications to the 
                        HITECH Act (title XIII of division A of Public 
                        Law 111-5) including modifications to the 
                        entities included as eligible for incentive 
                        payments under section 1848(o), 1853(l) (to the 
                        extent that such section 1848(o) is applied), 
                        or 1903(t) of the Social Security Act, criteria 
                        for certified EHR technology for purposes of 
                        such sections, and objectives and measures for 
                        determining meaningful use of such technology 
                        for purposes of such sections) to provide 
                        appropriate reimbursement and financial 
                        incentives for EMS agencies--
                                    (I) to maintain field EMS patient 
                                care reports in a structured electronic 
                                format; and
                                    (II) to otherwise adopt and use 
                                electronic health records; and
                            (iv) potential modifications to the HITECH 
                        Act to provide incentives to eligible hospitals 
                        under section 1886(n), 1853(m) (to the extent 
                        that such section 1886(n) is applied), or 
                        section 1814(l)(3) of the Social Security Act 
                        to incorporate appropriate data elements of 
                        field EMS patient care reports into patient 
                        electronic health records.
                    (B) Incorporation of patient health information 
                created subsequent to the receipt of field EMS 
                emergency care into NEMSIS, taking into consideration--
                            (i) what types of medical information 
                        created subsequent to the receipt of field EMS 
                        emergency care (such as outcomes information or 
                        information regarding subsequent care and 
                        treatment) would, if included in NEMSIS, be 
                        potentially useful in evaluating and improving 
                        the quality of EMS care;
                            (ii) how best to integrate such information 
                        into NEMSIS;
                            (iii) potential modifications to the HITECH 
                        Act to require eligible hospitals, as defined 
                        in section 1886(n)(6)(B) of the Social Security 
                        Act, for purposes of incentive payments under 
                        1886(b)(3)(B)(ix) and 1886(n) of such Act, to 
                        develop or report relevant data to NEMSIS or 
                        other appropriate State or private registries; 
                        and
                            (iv) potential modifications to the 
                        Medicare and Medicaid programs under titles 
                        XVIII and XIX, respectively, of the Social 
                        Security Act or other Federal health programs 
                        to provide appropriate reimbursement and 
                        financial incentives for field EMS agencies to 
                        develop or report relevant data to NEMSIS or 
                        other appropriate State or private registries.
    (d) Clarification of HIPAA.--
            (1) Exchange of information related to the treatment of 
        patients.--
                    (A) In general.--Nothing in HIPAA privacy and 
                security law (as defined in section 3009(a)(2) of the 
                Public Health Service Act (42 U.S.C. 300jj-19(a)(2)) 
                shall be construed as prohibiting the exchange of 
                information between field EMS practitioners treating an 
                individual and personnel of a hospital to which the 
                individual is transported for the purposes of relating 
                information on the medical history, treatment, care, 
                and outcome of such individual (including any health 
                care personnel safety issues such as infectious 
                disease).
                    (B) Guidelines.--The Secretary of Health and Human 
                Services shall establish guidelines for exchanges of 
                information between field EMS practitioners treating an 
                individual and personnel of a hospital to which the 
                individual is transported to protect the privacy of the 
                individual while ensuring the ability of such EMS 
                practitioners and hospital personnel to communicate 
                effectively to further the continuity and quality of 
                emergency medical care provided to such individual.
            (2) NEMSIS data.--Nothing in HIPAA privacy and security law 
        (as defined in section 3009(a)(2) of the Public Health Service 
        Act (42 U.S.C. 300jj-19(a)(2)) shall be construed as 
        prohibiting--
                    (A) a field EMS agency from submitting EMS data to 
                the State EMS Office for the purpose of quality 
                improvement and data collection by the State for 
                submission to NEMSIS; or
                    (B) the State EMS Office from submitting aggregated 
                nonindividually identifiable EMS data to the National 
                EMS Database maintained by NHTSA.

SEC. 8. FIELD EMS EDUCATION GRANTS.

    (a) In General.--For the purpose of promoting field EMS as a health 
profession and ensuring the availability, quality, and capability of 
field EMS educators, practitioners, and medical directors, the Director 
of the Office of EMS and Trauma (in this section referred to as the 
``Director'') may make grants to eligible entities for the development, 
availability, and dissemination of field EMS education programs and 
courses that improve the quality and capability of field EMS personnel. 
In carrying out this section, the Director shall take into 
consideration input from the Administrator of NHTSA, FICEMS, NEMSAC, 
the National Health Care Workforce Commission established under section 
5101 of the Patient Protection and Affordable Care Act (42 U.S.C. 
294q), and relevant stakeholders.
    (b) Eligibility.--In this section, the term ``eligible entity'' 
means an educational organization, an educational institution, a 
professional association, and any other entity involved with the 
education of field EMS practitioners.
    (c) Use of Funds.--The Director may award a grant to an eligible 
entity under paragraph (1) only if the entity agrees to use the grant 
to--
            (1) develop and implement education programs that--
                    (A) train field EMS trainers and promote the 
                adoption and implementation of the education standards 
                identified in the ``Emergency Medical Services 
                Education Agenda for the Future: A Systems Approach'' 
                including any revisions thereto;
                    (B) bridge the gap in knowledge and skills in field 
                EMS and among field EMS and other allied health 
                professions to develop a larger cadre of educational 
                instructors and build a stronger and more flexible 
                field EMS practitioner corps; or
                    (C) provide training and retraining programs to 
                provide displaced workers the opportunity to enter a 
                field EMS profession;
            (2) develop and implement educational courses pertaining 
        to--
                    (A) instructor courses;
                    (B) provision of medical direction of field EMS;
                    (C) field EMS practitioners, including physicians, 
                emergency medical technicians, paramedics, nurses, and 
                other relevant clinicians providing emergency medical 
                care in the field;
                    (D) field EMS educational and clinical research;
                    (E) bridge programs among field EMS, nursing, and 
                other allied health professions;
                    (F) field EMS management;
                    (G) national, evidence-based guidelines; and
                    (H) translation of the lessons learned in military 
                medicine to field EMS;
            (3) evaluate education and training courses and 
        methodologies to identify optimal educational modalities for 
        field EMS practitioners;
            (4) improve the field EMS education infrastructure by 
        increasing the number of field EMS instructors and the quality 
        of their preparation by improving, enhancing, and modernizing 
        the dissemination of EMS education, including distance 
        learning, and by establishing quality improvement for EMS 
        education programs;
            (5) enhance the opportunity for medical direction training 
        and for promoting appropriate medical oversight of field 
        emergency medical care;
            (6) improve systems to design, implement, and evaluate 
        education for prospective and current field EMS providers; or
            (7) carrying out such other activities as the Director may 
        identify.
    (d) Priority.--The Director, in consultation with NHTSA and 
relevant stakeholders, and taking into consideration the 
recommendations of FICEMS and NEMSAC, shall establish a system of 
prioritization in awarding grants under this section to eligible 
entities.
    (e) Duration of Grants.--Grants under this section shall be for a 
period of 1 to 3 years.
    (f) Application.--The Director may not award a grant to an eligible 
entity under this section unless the entity submits an application to 
the Director in such form, in such manner, and containing such 
agreements, assurances, and information as the Director may require. 
The Director shall ensure that the requirements for submitting an 
application under this section are not unduly burdensome.

SEC. 9. EVALUATING INNOVATIVE MODELS FOR ACCESS AND DELIVERY OF FIELD 
              EMS FOR PATIENTS.

    (a) Evaluation.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Director of the Office of EMS 
        and Trauma, in consultation with the Administrator of the 
        Centers for Medicare & Medicaid Services (in this section 
        referred to as the ``Director''), and taking into consideration 
        the recommendations of NEMSAC and FICEMS, shall complete an 
        evaluation of--
                    (A) the provision of and reimbursement for 
                alternative delivery models for medical care through 
                field EMS; and
                    (B) the integration of field EMS patients with 
                other medical providers and facilities as medically 
                appropriate.
            (2) Specific issues.--The evaluation under paragraph (1) 
        shall consider each of the following:
                    (A) Alternative dispositions of patients, 
                including--
                            (i) transporting patients by ambulance to 
                        destinations other than a hospital such as the 
                        office of the patient's physician, an urgent 
                        care center, or the facilities of another 
                        health care provider;
                            (ii) when medically necessary, the 
                        evaluation, treatment, or referral of patients 
                        to other medically appropriate health care 
                        providers; and
                            (iii) the funding of the provision of 
                        medical care regardless of the decision to 
                        transport such as reimbursement models based on 
                        readiness rather than transport and shared 
                        savings.
                    (B) Issues related to medical liability and the 
                requirements of section 1867 of the Social Security Act 
                (42 U.S.C. 1395dd; commonly referred to as ``EMTALA'') 
                associated with transport to destinations other than a 
                hospital emergency department.
                    (C) Necessary protections to ensure that patients 
                receive timely and appropriate care in the appropriate 
                setting.
                    (D) Whether there are any barriers to providing 
                alternate dispositions to patients who are not in need 
                of care in hospital emergency departments.
                    (E) Other issues determined by the Director, 
                including, when possible, issues recommended by FICEMS 
                or NEMSAC for evaluation under this subsection.
    (b) Demonstration Projects.--
            (1) In general.--Beginning not later than 1 year after the 
        date of the enactment of this Act, the Director shall conduct 
        or support at least 10 demonstration projects to--
                    (A) evaluate the implementation and reimbursement 
                of alternative dispositions of field EMS patients, 
                including--
                            (i) transporting patients by ambulance to 
                        alternate destinations when medically 
                        appropriate and in the patients' best 
                        interests; and
                            (ii) when medically necessary, evaluating, 
                        treating, or referring patients to other 
                        medically appropriate providers;
                    (B) evaluate the implementation of reimbursement 
                models based on readiness rather than transport or 
                shared savings; and
                    (C) determine whether such alternative dispositions 
                and reimbursement models--
                            (i) improve the safety, effectiveness, 
                        timeliness, and efficiency of EMS; and
                            (ii) reduce overall utilization and 
                        expenditures under the Medicare program under 
                        title XVIII of the Social Security Act.
            (2) Evidence-based protocols.--The Director shall ensure 
        that at least one demonstration project under paragraph (1) 
        evaluates evidence-based protocols that give guidance on 
        selection of the destination to which patients are transported.
            (3) Duration.--The period of a demonstration project under 
        paragraph (1) shall not exceed 36 months.
            (4) Research.--If the Director determines that further 
        research is necessary prior to or in conjunction with the 
        demonstration projects under this subsection in order to 
        evaluation the implementation of alternative dispositions of 
        field EMS patients, the Director shall conduct or support such 
        research.
            (5) Authorization of appropriations.--Of the amount made 
        available to carry out section 1115A of the Social Security Act 
        (42 U.S.C. 1315a) for a fiscal year, there are authorized to be 
        appropriated such sums as may be necessary to carry out this 
        subsection.
    (c) Report to Congress.--Not later than 1 year after the completion 
of all demonstration projects under subsection (b), the Director shall 
submit to the Congress a report on the results of activities under this 
section, including recommendations on the efficacy of alternative 
dispositions of field EMS patients.

SEC. 10. ENHANCING RESEARCH IN FIELD EMS.

    (a) Models To Be Tested by Center for Medicare and Medicaid 
Innovation.--Section 1115A(b)(2)(B) of title XI of the Social Security 
Act (42 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end the 
following:
                            ``(xxi) Enhancing health outcomes for 
                        patients receiving field emergency medical 
                        services and improving timely and efficient 
                        delivery of high-quality field emergency 
                        medical services, such as through--
                                    ``(I) regionalization of emergency 
                                care;
                                    ``(II) medical transport to 
                                alternate destinations; or
                                    ``(III) when medically necessary, 
                                the evaluation, treatment, or referral 
                                of patients to other medically 
                                appropriate health providers.''.
    (b) Emergency Medical Research.--Section 498D of the Public Health 
Service Act (42 U.S.C. 289g-4) is amended--
            (1) by redesignating subsections (c) and (d) as subsections 
        (d) and (e), respectively; and
            (2) by inserting after subsection (b) the following:
    ``(c) Field EMS Emergency Medical Research.--The Secretary shall 
conduct research and evaluation relating to field EMS through the 
Agency for Healthcare Research and Quality and the Center for Medicare 
and Medicaid Innovation.''.
    (c) Field EMS Practice Center.--Subpart II of part D of title IX of 
the Public Health Service Act (42 U.S.C. 299b-33 et seq.) is amended by 
adding at the end the following:

``SEC. 938. FIELD EMS PRACTICE CENTER.

    ``(a) Establishment.--For the purpose described in subsection (b), 
the Director shall establish within the Office of Research and 
Evaluation a Field EMS Evidence-Based Practice Center.
    ``(b) Purpose.--The purpose of the Center is to conduct or support 
research to promote the highest quality of emergency medical care in 
field EMS and the most effective delivery system for the provision of 
such care. Research conducted or supported pursuant to the preceding 
sentence shall include--
            ``(1) comparative safety and effectiveness research;
            ``(2) other appropriate clinical or systems research; and
            ``(3) research addressing--
                    ``(A) critical care transport;
                    ``(B) off-shore operations;
                    ``(C) tactical emergency medical services;
                    ``(D) air medical services; and
                    ``(E) the application of lessons learned in 
                military field medicine in the delivery of emergency 
                medical care in field EMS.
    ``(c) Definition.--In this section:
            ``(1) The term `Center' means the Field EMS Evidence-Based 
        Practice Center established under subsection (a).
            ``(2) The term `field EMS' has the meaning given to such 
        term in section 3 of the Field EMS Quality, Innovation, and 
        Cost Effectiveness Improvements Act of 2013.''.
    (d) Limitations on Certain Uses of Research.--Section 1182 of the 
Social Security Act (42 U.S.C. 1320e-1) is amended by striking 
``section 1181'' each place it appears and inserting ``section 1181 of 
this Act or section 498D(c) or 938 of the Public Health Service Act''.
    (e) Regulatory Barriers.--For the purposes of research conducted 
pursuant to this section or any other research funded by the Department 
of Health and Human Services related to emergency medical services in 
the field in which informed consent is required but may not be 
attainable, the Secretary of Health and Human Services shall--
            (1) evaluate and consider the patient and research issues 
        involved; and
            (2) address regulatory barriers to such research related to 
        the need for informed consent in a manner that ensures adequate 
        patient safety and notification, and submit recommendations to 
        Congress for any changes to Federal statutes necessary to 
        address such barriers.

SEC. 11. EMERGENCY MEDICAL SERVICES TRUST FUND.

    (a) Designation of Income Tax Overpayments and Additional 
Contributions for Emergency Medical Services.--Subchapter A of chapter 
61 of the Internal Revenue Code of 1986 (relating to returns and 
records) is amended by adding at the end the following new part:

   ``PART IX--DESIGNATION OF INCOME TAX OVERPAYMENTS AND ADDITIONAL 
              CONTRIBUTIONS FOR EMERGENCY MEDICAL SERVICES

``SEC. 6097. DESIGNATION BY INDIVIDUALS.

    ``(a) In General.--Every individual (other than a nonresident 
alien)--
            ``(1) may designate that a specified portion of any 
        overpayment of tax for a taxable year, and
            ``(2) may designate that an amount in addition to any 
        payment of tax for such taxable year and any designation under 
        paragraph (1),
shall be used to fund the Emergency Medical Services Trust Fund. 
Designations under the preceding sentence shall be in an amount not 
less than $1 and the Secretary shall provide for elections in amounts 
of $1, $5, $10, or such other amount as the taxpayer designates.
    ``(b) Adjusted Income Tax Liability.--For purposes of this section, 
the term `adjusted income tax liability' means income tax liability (as 
defined in section 6096(b)) reduced by any amount designated under 
section 6096 (relating to designation of income tax payments to 
Presidential Election Campaign Fund).
    ``(c) Overpayments Treated as Refunded.--For purposes of this 
title, any portion of an overpayment of tax designated under subsection 
(a) shall be treated as--
            ``(1) being refunded to the taxpayer as of the last date 
        prescribed for filing the return of tax imposed by chapter 1 
        (determined without regard to extensions) or, if later, the 
        date the return is filed, and
            ``(2) a contribution made by such taxpayer on such date to 
        the United States.
    ``(d) Manner and Time of Designation.--A designation under 
subsection (a) may be made with respect to any taxable year--
            ``(1) at the time of filing the return of the tax imposed 
        by chapter 1 for such taxable year, or
            ``(2) at any other time (after the time of filing the 
        return of the tax imposed by chapter 1 for such taxable year) 
        specified in regulations prescribed by the Secretary.
Such designation shall be made in such manner as the Secretary 
prescribes by regulations except that, if such designation is made at 
the time of filing the return of the tax imposed by chapter 1 for such 
taxable year, such designation shall be made either on the first page 
of the return or on the page bearing the signature of the taxpayer.''.
    (b) Emergency Medical Services Trust Fund.--Subchapter A of chapter 
98 of the Internal Revenue Code of 1986 is amended by adding at the end 
the following new section:

``SEC. 9512. EMERGENCY MEDICAL SERVICES TRUST FUND.

    ``(a) Creation of Trust Fund.--There is established in the Treasury 
of the United States a trust fund to be known as the `Emergency Medical 
Services Trust Fund', consisting of such amounts as may be credited or 
paid to such trust fund as provided in section 6097.
    ``(b) Transfers to Trust Fund.--There are hereby appropriated to 
the Emergency Medical Services Trust Fund amounts equivalent to the 
amounts of the overpayments of tax to which designations under section 
6097 apply.
    ``(c) Expenditures From Trust Fund.--Amounts in the Emergency 
Medical Services Trust Fund shall be available, as provided in 
appropriation Acts, only for carrying out the provisions for which 
amounts are authorized to be appropriated under subsections (a) and (b) 
of section 12 of the Field EMS Quality, Innovation, and Cost 
Effectiveness Improvements Act of 2013.''.
    (c) Clerical Amendments.--
            (1) Clerical amendment.--The table of parts for subchapter 
        A of chapter 61 of the Internal Revenue Code of 1986 is amended 
        by adding at the end the following new item:

   ``Part IX. Designation of Income Tax Overpayments and Additional 
            Contributions for Emergency Medical Services.''.

            (2) The table of sections for subchapter A of chapter 98 of 
        such Code is amended by adding at the end the following new 
        item:

``Sec. 9512. Emergency Medical Services Trust Fund.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2013.

SEC. 12. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--Out of amounts in the Emergency Medical Services 
Trust Fund, there are authorized to be appropriated--
            (1) $12,000,000 shall be for carrying out sections 4 
        (excluding the provisions of law listed in subsection (b)(3) of 
        such section), 7, 9(a), 9(c), and 11 of this Act for each of 
        fiscal years 2014 through 2017;
            (2) $200,000,000 shall be for carrying out section 5 of 
        this Act for each of fiscal years 2014 through 2017;
            (3) $50,000,000 shall be for carrying out section 6 of this 
        Act for each of fiscal years 2014 through 2017;
            (4) $4,000,000 shall be for carrying out section 7(c)(1) of 
        this Act for each of fiscal years 2014 through 2017;
            (5) $15,000,000 shall be for carrying out section 8 of this 
        Act for each of fiscal years 2014 through 2017; and
            (6) $40,000,000 shall be for carrying out sections 498D(c) 
        and 938 of the Public Health Service Act, as added by 
        subsections (b) and (c) of section 10 of this Act, for each of 
        fiscal years 2014 through 2017.
    (b) Excess Amounts.--If, for any fiscal year, amounts in the 
Emergency Medical Services Trust Fund exceed the maximum amount 
authorized to be appropriated under subsection (a), such excess amounts 
are authorized to be appropriated to carry out section 330J, section 
498D, and parts A, B, C, D, and H of title XII of the Public Health 
Service Act (42 U.S.C. 254c-15, 289g-4, 300d et seq., 300d-11 et seq., 
300d-31 et seq., and 300d-81 et seq.).
    (c) Start-Up Funding.--
            (1) In general.--Out of the discretionary funds available 
        to the Secretary of Health and Human Services for each of 
        fiscal years 2014 and 2015, $40,000,000 shall be for carrying 
        out the provisions listed in subsection (a) or (b).
            (2) Relation to other funds.--The amount of discretionary 
        funds allocated under paragraph (1) for the purpose of carrying 
        out the provisions listed in subsection (a) or (b) shall be in 
        addition to, not in lieu of, the amount of discretionary funds 
        that would otherwise be available for such purpose.
    (d) Administrative Expenses.--Of the amounts made available under 
subsection (a), (b), or (c) to carry out each of the provisions listed 
in subsection (a), not more than 5 percent of each such amount may be 
used for Federal administrative expenses.
                                 <all>
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