I 

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. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Field EMS Quality, Innovation, and Cost Effectiveness 

6 Improvements Act of 2013’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

mstockstill on DSK4VPTVN1PROD with BILLS

2 

•HR 809 IH

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. 

1 SEC. 2. FINDINGS. 

2 The Congress finds the following: 

3 (1) All persons throughout the country should 

4 have access to and receive high-quality emergency 

5 medical care as part of a coordinated emergency 

6 medical services system. 

7 (2) Properly functioning emergency medical 

8 services (EMS) systems, 24 hours per day, 7 days 

9 per week, are essential to ensure access to emer10 gency medical care and transport for all patients 

11 with emergency medical conditions. Such coordi12 nated EMS systems are also necessary for response 

13 to catastrophic incidents. 

14 (3) Ensuring high-quality and cost-effective 

15 EMS systems requires readiness, preparedness, med16 ical direction, oversight, and innovation throughout 

17 the continuum of emergency medical care through 

18 Federal, State, and local multijurisdictional collabomstockstill on DSK4VPTVN1PROD with BILLS

3 

•HR 809 IH

1 ration and sufficient resources for EMS agencies 

2 and providers. 

3 (4) At the Federal level, EMS responsibilities 

4 and resources of several Federal agencies consistent 

5 with their expertise and authority must emphasize 

6 the critical importance of Federal agency collabora7 tion and coordination for all emergency medical serv8 ices. 

9 (5) At the State and local level, EMS systems 

10 and agencies require the coordination and improved 

11 capabilities of multiple and diverse stakeholders. 

12 (6) Emergency medical services encompass the 

13 provision of care provided to patients with emer14 gency medical conditions throughout the continuum, 

15 including emergency medical care and trauma care 

16 provided in the field, hospital, and rehabilitation set17 tings. 

18 (7) Field EMS comprises essential emergency 

19 medical services, including medical care or medical 

20 transport provided to patients prior to or outside 

21 medical facilities and other clinical settings. The pri22 mary purpose of field emergency medical services is 

23 to ensure that emergency medical patients receive 

24 the right care at the right place in the right amount 

25 of time. 

mstockstill on DSK4VPTVN1PROD with BILLS

4 

•HR 809 IH

1 (8) Coordinated and high-quality field EMS is 

2 essential to the Nation’s security. Field EMS is an 

3 essential public service provided by governmental 

4 and nongovernmental agencies and practitioners 24 

5 hours a day, 7 days a week, and during catastrophic 

6 incidents. To ensure disaster and all-hazards pre7 paredness for EMS operations as part of the Na8 tion’s comprehensive disaster preparedness, Federal 

9 funding for preparedness activities, including cata10 strophic training and drills, must be provided to gov11 ernmental and nongovernmental EMS agencies so as 

12 to ensure a greater capability within each of these 

13 areas. 

14 (9) Numerous recommendations from several 

15 significant national reports and documents have 

16 demonstrated the need in multiple areas for substan17 tial improvement of emergency medical services pro18 vided in the field, including recommendations in the 

19 EMS Agenda for the Future, the Institute of Medi20 cine report ‘‘The Future of Emergency Care in the 

21 United Health System’’, and the National EMS 

22 Education Agenda for the Future: A Systems Ap23 proach and recommendations by the National EMS 

24 Workforce Injury and Illness Surveillance Program, 

25 the Department of Transportation’s National EMS 

mstockstill on DSK4VPTVN1PROD with BILLS

5 

•HR 809 IH

1 Advisory Council (NEMSAC), and the Federal 

2 Interagency Committee on Emergency Medical Serv3 ices (FICEMS). 

4 (10) To substantially improve field EMS, ad5 vancements must be made in several essential areas 

6 including readiness, innovation, preparedness, edu7 cation and workforce development, safety, financing, 

8 quality, standards, and research. 

9 (11) The recognition of a primary pro10 grammatic Federal agency for emergency medical 

11 services within the Department of Health and 

12 Human Services was recommended by the Institute 

13 of Medicine and is necessary to provide a more 

14 streamlined, cost-efficient, and comprehensive ap15 proach for field EMS and a focal point for practi16 tioners and agencies to interface with the Federal 

17 Government. 

18 (12) The essential role of field EMS in disaster 

19 preparedness and response must be incorporated 

20 into the national preparedness and response strategy 

21 and implementation as provided and overseen by the 

22 Department of Homeland Security and the Depart23 ment of Health and Human Services pursuant to 

24 their respective jurisdictions. 

mstockstill on DSK4VPTVN1PROD with BILLS

6 

•HR 809 IH

1 (13) The essential role of NHTSA in the con2 tinued development of NEMSIS and in overseeing 

3 transportation issues related to field EMS such as 

4 EMS and ambulance vehicle safety standards should 

5 be maintained. 

6 (14) FICEMS must continue in its essential 

7 role in coordinating the Federal activities related to 

8 the full spectrum of EMS. 

9 SEC. 3. DEFINITIONS. 

10 In this Act: 

11 (1) The term ‘‘ambulance diversion’’ means the 

12 practice by hospitals of denying access to an incom13 ing ambulance by requesting it to proceed to another 

14 facility due to a stated lack of capacity at the initial 

15 facility, resulting in delayed access to definitive care. 

16 (2) The term ‘‘EMS’’ means emergency medical 

17 services. 

18 (3) The term ‘‘FICEMS’’ means the Federal 

19 Interagency Committee on Emergency Medical Serv20 ices. 

21 (4) The term ‘‘field EMS’’ means emergency 

22 medical services provided to patients (including 

23 transport by ground, air, or otherwise) prior to or 

24 outside a medical facility or other clinical setting. 

mstockstill on DSK4VPTVN1PROD with BILLS

7 

•HR 809 IH

1 (5) The term ‘‘field EMS agency’’ means an or2 ganization providing field EMS, regardless of— 

3 (A) whether such organization is govern4 mental, nongovernmental, or volunteer; and 

5 (B) whether such organization provides 

6 field EMS by ground, air, or otherwise. 

7 (6) The term ‘‘emergency medical services’’ or 

8 ‘‘EMS’’ means emergency medical care, trauma 

9 care, and related services provided to patients at any 

10 point in the continuum of health care services, in11 cluding emergency medical dispatch and emergency 

12 medical care, trauma care, and related services pro13 vided in the field, during transport, or in a medical 

14 facility or other clinical setting. 

15 (7) The term ‘‘field EMS patient care reports’’ 

16 means the information that a field EMS agency 

17 typically creates regarding a patient’s medical condi18 tion and treatment in the course of providing emer19 gency medical services to that patient. 

20 (8) The term ‘‘medical oversight’’ means the 

21 supervision by a physician of the medical aspects of 

22 an EMS system or agency and its providers includ23 ing prospective, concurrent, and respective compo24 nents of field EMS and the education of EMS pro25 viders. 

mstockstill on DSK4VPTVN1PROD with BILLS

8 

•HR 809 IH

1 (9) The term ‘‘NEMSAC’’ means the National 

2 Emergency Medical Services Advisory Council. 

3 (10) The term ‘‘NEMSIS’’ means the National 

4 EMS Information System. 

5 (11) The term ‘‘NHTSA’’ means the National 

6 Highway Traffic Safety Administration. 

7 (12) The term ‘‘patient parking’’ means the 

8 practice by hospitals of refusing to accept transfer 

9 of a patient’s care from an ambulance crew until a 

10 regular emergency department bed is available, re11 quiring the crew to continue to provide patient care 

12 on the ambulance stretcher other than a patient bed 

13 in the hospital until hospital staff will accept the 

14 transfer of care, resulting in delayed access to defin15 itive care. 

16 (13) The term ‘‘State EMS Office’’ means an 

17 office designated by the State with primary responsi18 bility for oversight of the State’s EMS system, such 

19 as responsibility for oversight of EMS coordination, 

20 licensing or certifying EMS practitioners, and EMS 

21 system improvement. 

22 (14) The term ‘‘STEMI’’ means ST–Segment 

23 Elevation Myocardial Infarction. 

mstockstill on DSK4VPTVN1PROD with BILLS

9 

•HR 809 IH

1 SEC. 4. RECOGNITION OF HHS AS PRIMARY FEDERAL 

2 AGENCY FOR EMERGENCY MEDICAL SERV3 ICES AND TRAUMA CARE. 

4 (a) PRIMARY FEDERAL AGENCY.—The Department 

5 of Health and Human Services shall serve as the primary 

6 Federal agency with responsibility for programs and ac7 tivities relating to emergency medical services and trauma 

8 care. 

9 (b) OFFICE OF EMS AND TRAUMA.— 

10 (1) ESTABLISHMENT.—There is established an 

11 Office of Emergency Medical Services and Trauma, 

12 to be known as the Office of EMS and Trauma, 

13 within the Department of Health and Human Serv14 ices. The Office of EMS and Trauma shall be head15 ed by a director appointed by the Secretary of 

16 Health and Human Services. 

17 (2) ROLE OF OFFICE WITHIN HHS.— 

18 (A) IN GENERAL.—The Office of EMS and 

19 Trauma shall have— 

20 (i) the responsibilities delegated to the 

21 Office of EMS and Trauma pursuant to 

22 paragraph (3); 

23 (ii) the responsibilities and authorities 

24 vested in the Office of EMS and Trauma 

25 by other provisions of this Act; and 

mstockstill on DSK4VPTVN1PROD with BILLS

10 

•HR 809 IH

1 (iii) such responsibilities and authori2 ties as may be delegated or transferred to 

3 the Office of EMS and Trauma pursuant 

4 to subparagraph (B). 

5 (B) ADDITIONAL RESPONSIBILITIES AND

6 AUTHORITIES.—In addition to the responsibil7 ities and authorities specified in clauses (i) and 

8 (ii) of subparagraph (A), the Secretary of 

9 Health and Human Services may delegate or 

10 transfer to the Office of EMS and Trauma any 

11 other responsibility or authority of the Depart12 ment of Health and Human Services relating to 

13 emergency medical services and trauma care, 

14 including such services and care relating to— 

15 (i) the full continuum of emergency 

16 medical services, including field EMS and 

17 trauma and hospital emergency medical 

18 care; or 

19 (ii) improving the quality, innovation, 

20 or cost effectiveness of emergency medical 

21 services. 

22 (C) LOCATION OF OFFICE IN HHS.—The 

23 Secretary shall locate the Office of EMS and 

24 Trauma within the organizational structure of 

mstockstill on DSK4VPTVN1PROD with BILLS

11 

•HR 809 IH

1 the Department of Health and Human Services 

2 in a manner that achieves each of the following: 

3 (i) Recognition of the importance and 

4 unique life-saving services associated with 

5 field EMS, trauma care, and hospital 

6 emergency care as a significant Federal 

7 priority. 

8 (ii) Integration of these essential serv9 ices with the larger health care system and 

10 within the disaster preparedness system, 

11 including through regionalization of such 

12 services and by enhancing daily readiness 

13 capabilities to ensure adequate disaster 

14 readiness capabilities, consistent with the 

15 National Health Security Strategy. 

16 (iii) Consolidation, co-location, and 

17 cost efficiencies in administering programs 

18 and activities related to field EMS, trauma 

19 care, and hospital emergency medical care. 

20 (iv) Establishment of a Federal focal 

21 point for leadership and improved coordi22 nation, support, and oversight of field 

23 EMS, trauma care and hospital emergency 

24 medical care. 

mstockstill on DSK4VPTVN1PROD with BILLS

12 

•HR 809 IH

1 (v) Sufficient level and stature such 

2 that— 

3 (I) such Office is able to fulfill its 

4 role, responsibilities, and authorities; 

5 and 

6 (II) the Director of such Office 

7 reports directly to the Secretary or an 

8 official within the Department who re9 ports directly to the Secretary. 

10 (vi) Establishment of a visible and 

11 identifiable point of contact with which the 

12 public; EMS agencies and practitioners; 

13 State and local government agencies; EMS 

14 educational institutions; EMS, trauma, 

15 and hospital emergency care professional 

16 associations; and all other parties may 

17 interact. 

18 (3) RESPONSIBILITIES.—The Secretary of 

19 Health and Human Services shall, at a minimum, 

20 delegate responsibility to the Office of EMS and 

21 Trauma to carry out— 

22 (A) sections 5 and 6 (relating to the 

23 EQUIP and SPIA grant programs, respec24 tively); 

mstockstill on DSK4VPTVN1PROD with BILLS

13 

•HR 809 IH

1 (B) section 330J of the Public Health 

2 Service Act (42 U.S.C. 254c–15; relating to 

3 rural emergency service training and equipment 

4 assistance program); 

5 (C) part A (42 U.S.C. 300d et seq.), part 

6 B (42 U.S.C. 300d–11 et seq.), part C (42 

7 U.S.C. 300d–31 et seq.), part D (42 U.S.C. 

8 300d–41 et seq.), and part H (42 U.S.C. 300d– 

9 81 et seq.) of title XII of the Public Health 

10 Service Act (relating to trauma care); 

11 (D) section 8 (relating to the field EMS 

12 education grant program); and 

13 (E) section 9 (relating to evaluating inno14 vative models for access and delivery of field 

15 EMS for patients). 

16 (c) NATIONAL EMS STRATEGY.—The Secretary of 

17 Health and Human Services, acting through the Director 

18 of the Office of EMS and Trauma, and in consultation 

19 with the Assistant Secretary for Preparedness and Re20 sponse and the Administrator of the Health Resources and 

21 Services Administration, shall develop and implement a 

22 cohesive national EMS strategy to strengthen the develop23 ment of the full continuum of EMS at the Federal, State, 

24 and local levels. In establishing such a strategy, the Sec25 retary shall— 

mstockstill on DSK4VPTVN1PROD with BILLS

14 

•HR 809 IH

1 (1) solicit and consider the recommendations of 

2 the NEMSAC as well as relevant stakeholders; 

3 (2) consult and collaborate with FICEMS to 

4 ensure consistency of such national EMS strategy 

5 within the larger Federal strategy regarding all of 

6 emergency medical services and national prepared7 ness and response; 

8 (3) address issues related to EMS patient and 

9 practitioner safety, standardization of EMS practi10 tioner licensing and credentialing, field EMS quality 

11 and medical oversight, regionalization of field EMS 

12 and trauma and emergency care services, availability 

13 of field EMS and trauma care and emergency med14 ical services throughout the Nation, and integration 

15 of field EMS practitioners into the broader health 

16 care system, including— 

17 (A) promotion of the adoption by States of 

18 the education standards identified in the 

19 ‘‘Emergency Medical Services Education Agen20 da for the Future: A Systems Approach’’ and 

21 any revisions thereto, including the standardiza22 tion of licensing and credentialing of field EMS 

23 practitioners and standards of care, based on 

24 best practices and evidence-based medicine, in25 cluding by— 

mstockstill on DSK4VPTVN1PROD with BILLS

15 

•HR 809 IH

1 (i) the identification of differences in 

2 the levels of care, scope of practice, and li3 censure and credentialing requirements 

4 among the States; and 

5 (ii) the adoption by the States of na6 tional standards for such levels of care, 

7 scope of practice and licensure and 

8 credentialing requirements; 

9 (B) promotion of a culture of safety, in10 cluding— 

11 (i) the adoption of an anonymous 

12 error reporting system designed to identify 

13 systemic problems in field EMS patient 

14 and practitioner safety and ensure a single 

15 means of collecting and reporting relevant 

16 error data by field EMS agencies and 

17 States; 

18 (ii) the establishment of field EMS 

19 patient and practitioner safety goals and 

20 the specific means to improve field EMS 

21 practitioner and patient safety to achieve 

22 such goals; and 

23 (iii) the adoption of more uniform na24 tional ambulance vehicle safety and manu25 facturing standards as developed by the 

mstockstill on DSK4VPTVN1PROD with BILLS

16 

•HR 809 IH

1 National Fire Protection Administration or 

2 coordinated by NHTSA; 

3 (C) the integration and utilization of field 

4 EMS practitioners as part of the larger health 

5 care system including— 

6 (i) the potential utilization of field 

7 EMS practitioners for the provision of care 

8 to patients with nonemergent medical con9 ditions; and 

10 (ii) strategies to implement the rec11 ommendations provided by the National 

12 Health Care Workforce Commission, pur13 suant to section 5101(d)(2) of the Patient 

14 Protection and Affordable Care Act (42 

15 U.S.C. 294q(d)(2); and 

16 (D) such other issues as the Secretary con17 siders appropriate; 

18 (4) incorporate into such strategy the prepared19 ness and response objectives identified by the Sec20 retary of Homeland Security and the Assistant Sec21 retary for Preparedness and Response in order— 

22 (A) to ensure the capability and capacity 

23 of the full spectrum of EMS to respond to ter24 rorist attacks, disasters, catastrophic events, 

25 and mass casualty events; and 

mstockstill on DSK4VPTVN1PROD with BILLS

17 

•HR 809 IH

1 (B) to coordinate with the Secretary of 

2 Homeland Security accordingly; 

3 (5) complete the development of such strategy 

4 not later than 18 months after the date of enact5 ment of this Act; 

6 (6) communicate such strategy to the relevant 

7 congressional committees of jurisdiction; 

8 (7) implement such strategy to the extent prac9 tical not later than 3 years after the date of enact10 ment of this Act; and 

11 (8) update such strategy not less than every 3 

12 years. 

13 (d) STATUTORY CONSTRUCTION.—Nothing in this 

14 Act shall be construed to supercede any statutory author15 ity of any Federal agency that is not within the Depart16 ment of Health and Human Services. 

17 SEC. 5. FIELD EMS EXCELLENCE, QUALITY, UNIVERSAL AC18 CESS, INNOVATION, AND PREPAREDNESS. 

19 (a) IN GENERAL.—The Director of the Office of 

20 EMS and Trauma (in this section referred to as the ‘‘Di21 rector’’), shall establish the EQUIP grant program— 

22 (1) to promote excellence in all aspects of the 

23 provision of field EMS by field EMS agencies; 

24 (2) to enhance the quality of emergency medical 

25 care provided to patients by field EMS practitioners 

mstockstill on DSK4VPTVN1PROD with BILLS

18 

•HR 809 IH

1 through evidence-based, medically directed field 

2 emergency care; 

3 (3) to promote universal access to and avail4 ability of high-quality field EMS in all geographic lo5 cations of the Nation; 

6 (4) to spur innovation in the delivery of field 

7 EMS; and 

8 (5) to improve EMS agency readiness and pre9 paredness for day-to-day emergency medical re10 sponse. 

11 (b) APPLICATION.— 

12 (1) IN GENERAL.—To be eligible to receive a 

13 grant under this section, an eligible entity shall sub14 mit an application to the Director in such form and 

15 manner, that contains such agreements, assurances, 

16 and information as the Director determines to be 

17 reasonably necessary to carry out this section. 

18 (2) SIMPLE FORM.—The Director shall ensure 

19 that grant application requirements are not unduly 

20 burdensome to smaller and volunteer field EMS 

21 agencies or other agencies with limited resources. 

22 (3) CONSISTENCY WITH PREPARATION

23 GOALS.—The Director shall ensure that grant appli24 cations are consistent with national and relevant 

25 State preparedness plans and goals. 

mstockstill on DSK4VPTVN1PROD with BILLS

19 

•HR 809 IH

1 (c) USE OF FUNDS.—Grants may be used by eligible 

2 entities to— 

3 (1) sustain field EMS practitioners to ensure 

4 24 hours a day, 7 days a week readiness and pre5 paredness at the local level; 

6 (2) develop and implement initiatives related to 

7 delivery of medical services, including— 

8 (A) innovative clinical practices to improve 

9 the cost effectiveness and quality of care deliv10 ered to emergency patients in the field that re11 sults in improved patient outcomes and cost 

12 savings to the health system, including for high 

13 prevalence emergency medical conditions such 

14 as sudden cardiac arrest, STEMI, stroke, and 

15 trauma; and 

16 (B) delivery systems to improve patient 

17 outcomes, which may include implementing evi18 dence-based protocols, interventions, systems, 

19 and technologies to reduce clinically meaningful 

20 response times; 

21 (3) purchase and implement— 

22 (A) medical equipment and training for 

23 using such equipment; 

mstockstill on DSK4VPTVN1PROD with BILLS

20 

•HR 809 IH

1 (B) communication systems to ensure 

2 seamless and interoperable communications 

3 with other first responders; and 

4 (C) information systems to comply with 

5 NEMSIS data collection and integrate field 

6 emergency care with electronic medical records; 

7 (4) participate in federally sponsored field EMS 

8 research; 

9 (5) establish or enhance comprehensive medical 

10 oversight and quality assurance programs that in11 clude the active participation by medical directors in 

12 field EMS medical direction and educational pro13 grams; and 

14 (6) such other uses as the Director may estab15 lish. 

16 (d) ADMINISTRATION OF GRANTS.—In establishing 

17 and administering the EQUIP grant program, the Direc18 tor— 

19 (1) shall establish a grantmaking process that 

20 includes— 

21 (A) prioritization for the awarding of 

22 grants to eligible entities and consideration of 

23 the factors in reviewing grant applications by 

24 eligible entities including— 

mstockstill on DSK4VPTVN1PROD with BILLS

21 

•HR 809 IH

1 (i) demonstrated financial need for 

2 funding; 

3 (ii) utilization of public and private 

4 partnerships; 

5 (iii) enhanced access to high-quality 

6 field EMS in under served geographic 

7 areas; 

8 (iv) unique needs of volunteer and 

9 rural field EMS agencies; 

10 (v) distribution among a variety of ge11 ographic areas, including urban, suburban, 

12 and rural; 

13 (vi) distribution of funds among types 

14 of EMS agencies, including governmental, 

15 nongovernmental and volunteer; 

16 (vii) implementation of evidence-based 

17 interventions that improve quality of care, 

18 patient outcomes, efficiency, or cost effec19 tiveness; and 

20 (viii) such other factors as the Direc21 tor considers necessary; 

22 (B) a peer-reviewed process to recommend 

23 grant allocations in accordance with the 

24 prioritization established by the Director except 

mstockstill on DSK4VPTVN1PROD with BILLS

22 

•HR 809 IH

1 that final award determinations shall be made 

2 by the Director; and 

3 (C) the provision of grant awards to eligi4 ble entities on an annual basis, except that the 

5 Director may reserve not more than 25 percent 

6 of the available appropriations for multiyear 

7 grants and no grant award may exceed a 2-year 

8 period; 

9 (2) shall consult with and take into consider10 ation the recommendations of the Assistant Sec11 retary for Preparedness and Response, FICEMS, 

12 NEMSAC and relevant stakeholders; 

13 (3) shall ensure that funds used for day-to-day 

14 preparedness activities are consistent and aligned 

15 with Federal preparedness priorities; and 

16 (4) may contract with an independent, third17 party, nonprofit organization to administer the grant 

18 program if the Director establishes conflict-of-inter19 est requirements as part of any such contractual re20 lationship. 

21 (e) ELIGIBILITY.—Eligible grant recipients are field 

22 EMS agencies that— 

23 (1) are licensed by or otherwise authorized in 

24 the State in which they operate; and 

mstockstill on DSK4VPTVN1PROD with BILLS

23 

•HR 809 IH

1 (2) have medical oversight and quality improve2 ment programs as defined by the Director. 

3 (f) ANNUAL REPORT.—The Director shall submit an 

4 annual report on the EQUIP grant program under this 

5 section to the Congress. 

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

7 AND ACCOUNTABILITY. 

8 (a) IN GENERAL.—The Director of the Office of 

9 EMS and Trauma (in this section referred to as the ‘‘Di10 rector’’) shall establish the SPIA grant program— 

11 (1) to improve field EMS system performance, 

12 integration and accountability; 

13 (2) to ensure preparedness for field EMS at the 

14 State and local levels; 

15 (3) to enhance physician medical oversight of 

16 field EMS systems; 

17 (4) to improve coordination between regional 

18 field EMS systems and integration of such regional 

19 field EMS systems into the larger health care sys20 tem; 

21 (5) to enhance data collection and analysis to 

22 improve, on a continuing basis, the field EMS sys23 tem; and 

mstockstill on DSK4VPTVN1PROD with BILLS

24 

•HR 809 IH

1 (6) to promote standardization of national EMS 

2 certification of emergency medical technicians and 

3 paramedics. 

4 (b) USE OF FUNDS.—Grants may be used by eligible 

5 entities— 

6 (1) to enhance EMS system readiness and pre7 paredness for day-to-day emergency medical re8 sponse; 

9 (2) to improve cross-border collaboration and 

10 planning among States; and 

11 (3) to collect data with regard to— 

12 (A) NEMSIS; 

13 (B) field EMS education; 

14 (C) field EMS workforce; 

15 (D) cardiac events, including STEMI and 

16 sudden cardiac arrest; 

17 (E) stroke; 

18 (F) disasters, including injuries and ill19 nesses; 

20 (G) ambulance diversion and patient park21 ing; 

22 (H) trauma (in a manner that is com23 plementary and not duplicative of other trauma 

24 data collection such as the National Trauma 

25 Data Bank); 

mstockstill on DSK4VPTVN1PROD with BILLS

25 

•HR 809 IH

1 (I) data determined necessary by the State 

2 office of EMS for oversight and coordination of 

3 the State field EMS system; and 

4 (J) any other such data that the Director 

5 specifies; 

6 (4) to implement and evaluate system-wide 

7 quality improvement initiatives, including medical di8 rection at the State, local, and regional levels; 

9 (5) to integrate field EMS with other health 

10 care services as part of a coordinated system of care 

11 provided to patients with emergency medical condi12 tions to help ensure the right patient receives the 

13 right care by the right crew in the right vehicle and 

14 at the right medical facility in the right amount of 

15 time, including by enhancing regional emergency 

16 medical dispatch; 

17 (6) to incorporate national EMS certification 

18 for all levels of emergency medical technicians and 

19 paramedics; 

20 (7) to improve the State’s planning for ensuring 

21 a consistent, available EMS workforce; 

22 (8) to fund EMS regional and local oversight 

23 and planning organizations or develop regional sys24 tems of emergency medical care within the State to 

mstockstill on DSK4VPTVN1PROD with BILLS

26 

•HR 809 IH

1 further enhance coordination and systemic develop2 ment throughout the State; and 

3 (9) for such other uses as the Director may es4 tablish. 

5 (c) ADMINISTRATION OF GRANTS.—In establishing 

6 and administering the SPIA grant program, the Director 

7 shall— 

8 (1) establish State EMS system performance 

9 standards to serve as guidance to States in improv10 ing their EMS systems and in applying for grants 

11 under this subsection. In establishing such stand12 ards, the Director shall— 

13 (A) take into the consideration the rec14 ommendations of the Assistant Secretary for 

15 Preparedness and Response, FICEMS, 

16 NEMSAC, and relevant stakeholders; 

17 (B) include national, evidence-based guide18 lines; and 

19 (C) take into account the needs and re20 source limitations of volunteer, smaller agen21 cies, and agencies in rural areas. 

22 (2) provide technical assistance to State EMS 

23 offices in conducting comprehensive EMS planning 

24 with regard to evidence-based workforce and devel25 opment competencies for field EMS management; 

mstockstill on DSK4VPTVN1PROD with BILLS

27 

•HR 809 IH

1 (3) allocate, within the available funds, SPIA 

2 grants to a maximum of one grant per applicant ac3 cording to a formula based on population and geo4 graphic area, as determined by the Director, for a 

5 period not to exceed 2 years; and 

6 (4) require that States allocate a portion of 

7 their grant funds to regional and local oversight and 

8 planning EMS organizations within the State for the 

9 purpose of field EMS system development, mainte10 nance, and improvement of coordination among re11 gional organizations. 

12 (d) APPLICATION.—To be eligible to receive a grant 

13 under this section, an eligible entity shall submit an appli14 cation to the Director in such form and manner, that con15 tains such agreements, assurances, and information as the 

16 Director determines to be reasonably necessary to carry 

17 out this section. 

18 (e) ELIGIBILITY.—The eligible entities for a grant 

19 under this section are the State EMS office in each of 

20 the several States, tribes, and territories. 

21 (f) ANNUAL REPORT.—The Director shall submit an 

22 annual report on the SPIA grant program under this sec23 tion to the Congress. 

24 SEC. 7. FIELD EMS QUALITY. 

25 (a) MEDICAL OVERSIGHT.— 

mstockstill on DSK4VPTVN1PROD with BILLS

28 

•HR 809 IH

1 (1) IN GENERAL.—To improve medical over2 sight of field EMS and ensure continuity and quality 

3 for such medical oversight, the Director of the Office 

4 of EMS and Trauma (in this section referred to as 

5 the ‘‘Director’’) shall— 

6 (A) promote high-quality and comprehen7 sive medical oversight of— 

8 (i) all medical care provided by field 

9 EMS practitioners; and 

10 (ii) the education and training of field 

11 EMS practitioners; 

12 (B) promote the development, adoption, 

13 and utilization of national guidelines for the 

14 roles of physicians who provide medical over15 sight for field EMS and other health care pro16 viders who support physicians in this role; 

17 (C) support efforts of relevant physician 

18 stakeholders in developing and disseminating 

19 guidelines for use by EMS medical directors 

20 and field EMS practitioners on a national basis; 

21 and 

22 (D) convene a Field EMS Medical Over23 sight Advisory Committee, comprised of rep24 resentatives of relevant physician stakeholders, 

25 to advise the Director on ways and means to 

mstockstill on DSK4VPTVN1PROD with BILLS

29 

•HR 809 IH

1 advance and support development and mainte2 nance of quality medical oversight throughout 

3 the Nation’s systems for field EMS. 

4 (2) ADDITIONAL CONSIDERATIONS.—In car5 rying out subparagraphs (B) and (C) of paragraph 

6 (1) (relating to supporting guidelines), the Director 

7 shall take into consideration— 

8 (A) existing guidelines developed by na9 tional professional physician associations, 

10 States, and other relevant governmental or non11 governmental entities; 

12 (B) the input of other relevant stake13 holders, including health care providers who 

14 support physicians who provide medical over15 sight for field EMS; and 

16 (C) the unique needs associated with med17 ical oversight of provision of field EMS in rural 

18 areas or by volunteers. 

19 (3) FLEXIBILITY.—The guidelines promoted 

20 under subparagraphs (B) and (C) of paragraph (1) 

21 shall ensure high-quality training, credentialing, and 

22 direction in connection with medical oversight of 

23 field EMS at the State, regional, and local levels 

24 while providing sufficient flexibility to account for 

mstockstill on DSK4VPTVN1PROD with BILLS

30 

•HR 809 IH

1 historical and legitimate differences in field EMS 

2 among States, regions, and localities. 

3 (4) REQUIRED USE OF GUIDELINES.—As a con4 dition on receipt of a grant under section 5 or 6, the 

5 Director shall require the grant recipient to adopt 

6 and implement (to the extent applicable) the guide7 lines promoted under subparagraphs (B) and (C) of 

8 paragraph (1). 

9 (b) GAO STUDY AND REPORT.— 

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

11 the United States shall complete a study on— 

12 (A) medical and administrative liability 

13 issues that may impede— 

14 (i) medical direction provided by phy15 sicians directly regarding specific patients 

16 or medical oversight provided by physicians 

17 in establishing medical protocols, proce18 dures, and other activities related to the 

19 provision of emergency medical care in 

20 field EMS; or 

21 (ii) the highest quality emergency 

22 medical care in field EMS provided by per23 sonnel other than physicians such as emer24 gency medical technicians and paramedics; 

mstockstill on DSK4VPTVN1PROD with BILLS

31 

•HR 809 IH

1 (B) reimbursement for any component of 

2 medical oversight; and 

3 (C) such other issues as the Comptroller 

4 General deems appropriate relating to improv5 ing the quality and medical oversight of emer6 gency medical care in field EMS. 

7 (2) REPORT TO CONGRESS.—Not later than 18 

8 months after the date of the enactment of this Act, 

9 the Comptroller General shall complete the study 

10 under paragraph (1) and submit a report to the 

11 Congress on the results of such study, including any 

12 recommendations. 

13 (c) DATA COLLECTION AND EXCHANGE.— 

14 (1) NATIONAL EMS INFORMATION SYSTEM.— 

15 (A) IN GENERAL.—The Administrator of 

16 NHTSA may maintain, improve, and expand 

17 the National EMS Information System, includ18 ing the National EMS Database. 

19 (B) CONSULTATION.—The Administrator 

20 of NHTSA shall carry out this paragraph in 

21 consultation with the Director. 

22 (C) STANDARDIZATION.—In carrying out 

23 subparagraph (A), the Administrator of 

24 NHTSA shall promote the collection and remstockstill on DSK4VPTVN1PROD with BILLS

32 

•HR 809 IH

1 porting of data on field EMS in a standardized 

2 manner. 

3 (D) AVAILABILITY OF DATA.—The Admin4 istrator of NHTSA shall ensure that informa5 tion in the National EMS Database (other than 

6 individually identifiable information) is available 

7 to Federal and State policymakers, EMS stake8 holders, and researchers. 

9 (E) TECHNICAL ASSISTANCE.—In carrying 

10 out subparagraph (A), the Administrator of 

11 NHTSA may provide technical assistance to 

12 State and local agencies, field EMS agencies, 

13 and other entities deemed appropriate by the 

14 Administrator to assist in the collection, anal15 ysis, and reporting of data. 

16 (2) REPORT ON DATA GAPS.— 

17 (A) IN GENERAL.—Not later than 12 

18 months after the date of the enactment of this 

19 Act, the Secretary of Health and Human Serv20 ices, acting through the Director, in consulta21 tion with the Administrator of NHTSA, shall 

22 submit to the Congress a report that— 

23 (i) identifies gaps in the collection of 

24 data related to the provision of field EMS; 

25 and 

mstockstill on DSK4VPTVN1PROD with BILLS

33 

•HR 809 IH

1 (ii) includes recommendations for im2 proving the collection, reporting, and anal3 ysis of such data. 

4 (B) RECOMMENDATIONS.—The rec5 ommendations required by subparagraph (A)(ii) 

6 shall— 

7 (i) take into consideration the rec8 ommendations of FICEMS and NEMSAC 

9 and relevant stakeholders; 

10 (ii) recommend methods for improving 

11 data collection and reporting and analysis 

12 without unduly burdening reporting enti13 ties and without duplicating existing data 

14 sources (such as data collected by the Na15 tional Trauma Data Bank); 

16 (iii) address the quality and avail17 ability of data, and linkages with existing 

18 patient registries, related to the provision 

19 of field EMS and utilization of field EMS 

20 with respect to a variety of illnesses and 

21 injuries (in both the everyday provision of 

22 field EMS and catastrophic or disaster re23 sponse) including— 

mstockstill on DSK4VPTVN1PROD with BILLS

34 

•HR 809 IH

1 (I) cardiac events such as chest 

2 pain, sudden cardiac arrest, and 

3 STEMI; 

4 (II) stroke; 

5 (III) trauma; 

6 (IV) disaster and catastrophic in7 cidents, such as incidents related to 

8 terrorism or natural or manmade dis9 asters; and 

10 (V) ambulance diversion and pa11 tient parking; and 

12 (iv) include an analysis of the variety 

13 of services provided by field EMS agencies. 

14 (3) REPORT ON DATA INTEGRATION TO PRO15 MOTE QUALITY OF CARE.—Not later than 18 

16 months after the date of the enactment of this Act, 

17 the Secretary of Health and Human Services, acting 

18 through the head of the Office of the National Coor19 dinator for Health Information Technology, in col20 laboration with the Director of the Office of EMS 

21 and Trauma, FICEMS, and the Administrator of 

22 NHTSA as appropriate, and taking into consider23 ation input from relevant stakeholders, shall submit 

24 a report (including recommendations) on issues, immstockstill on DSK4VPTVN1PROD with BILLS

35 

•HR 809 IH

1 pediments, and potential solutions pertaining to the 

2 following objectives: 

3 (A) Incorporation of field EMS patient 

4 care reports into patient electronic health 

5 records, taking into consideration— 

6 (i) the extent to which field EMS pa7 tient care reports are presently created in 

8 electronic format and the potential for ele9 ments of such reports to be incorporated 

10 into patient electronic health records; 

11 (ii) the data elements of field EMS 

12 patient care reports that would promote 

13 quality and efficiency of care if incor14 porated into patient electronic health 

15 records; 

16 (iii) potential modifications to the 

17 Medicare and Medicaid programs under ti18 tles XVIII and XIX, respectively, of the 

19 Social Security Act or other Federal health 

20 programs (including potential modifica21 tions to the HITECH Act (title XIII of di22 vision A of Public Law 111–5) including 

23 modifications to the entities included as el24 igible for incentive payments under section 

25 1848(o), 1853(l) (to the extent that such 

mstockstill on DSK4VPTVN1PROD with BILLS

36 

•HR 809 IH

1 section 1848(o) is applied), or 1903(t) of 

2 the Social Security Act, criteria for cer3 tified EHR technology for purposes of 

4 such sections, and objectives and measures 

5 for determining meaningful use of such 

6 technology for purposes of such sections) 

7 to provide appropriate reimbursement and 

8 financial incentives for EMS agencies— 

9 (I) to maintain field EMS patient 

10 care reports in a structured electronic 

11 format; and 

12 (II) to otherwise adopt and use 

13 electronic health records; and 

14 (iv) potential modifications to the 

15 HITECH Act to provide incentives to eligi16 ble hospitals under section 1886(n), 

17 1853(m) (to the extent that such section 

18 1886(n) is applied), or section 1814(l)(3) 

19 of the Social Security Act to incorporate 

20 appropriate data elements of field EMS 

21 patient care reports into patient electronic 

22 health records. 

23 (B) Incorporation of patient health infor24 mation created subsequent to the receipt of 

mstockstill on DSK4VPTVN1PROD with BILLS

37 

•HR 809 IH

1 field EMS emergency care into NEMSIS, tak2 ing into consideration— 

3 (i) what types of medical information 

4 created subsequent to the receipt of field 

5 EMS emergency care (such as outcomes 

6 information or information regarding sub7 sequent care and treatment) would, if in8 cluded in NEMSIS, be potentially useful in 

9 evaluating and improving the quality of 

10 EMS care; 

11 (ii) how best to integrate such infor12 mation into NEMSIS; 

13 (iii) potential modifications to the 

14 HITECH Act to require eligible hospitals, 

15 as defined in section 1886(n)(6)(B) of the 

16 Social Security Act, for purposes of incen17 tive payments under 1886(b)(3)(B)(ix) and 

18 1886(n) of such Act, to develop or report 

19 relevant data to NEMSIS or other appro20 priate State or private registries; and 

21 (iv) potential modifications to the 

22 Medicare and Medicaid programs under ti23 tles XVIII and XIX, respectively, of the 

24 Social Security Act or other Federal health 

25 programs to provide appropriate reimmstockstill on DSK4VPTVN1PROD with BILLS

38 

•HR 809 IH

1 bursement and financial incentives for field 

2 EMS agencies to develop or report relevant 

3 data to NEMSIS or other appropriate 

4 State or private registries. 

5 (d) CLARIFICATION OF HIPAA.— 

6 (1) EXCHANGE OF INFORMATION RELATED TO

7 THE TREATMENT OF PATIENTS.— 

8 (A) IN GENERAL.—Nothing in HIPAA pri9 vacy and security law (as defined in section 

10 3009(a)(2) of the Public Health Service Act (42 

11 U.S.C. 300jj–19(a)(2)) shall be construed as 

12 prohibiting the exchange of information between 

13 field EMS practitioners treating an individual 

14 and personnel of a hospital to which the indi15 vidual is transported for the purposes of relat16 ing information on the medical history, treat17 ment, care, and outcome of such individual (in18 cluding any health care personnel safety issues 

19 such as infectious disease). 

20 (B) GUIDELINES.—The Secretary of 

21 Health and Human Services shall establish 

22 guidelines for exchanges of information between 

23 field EMS practitioners treating an individual 

24 and personnel of a hospital to which the indi25 vidual is transported to protect the privacy of 

mstockstill on DSK4VPTVN1PROD with BILLS

39 

•HR 809 IH

1 the individual while ensuring the ability of such 

2 EMS practitioners and hospital personnel to 

3 communicate effectively to further the con4 tinuity and quality of emergency medical care 

5 provided to such individual. 

6 (2) NEMSIS DATA.—Nothing in HIPAA pri7 vacy and security law (as defined in section 

8 3009(a)(2) of the Public Health Service Act (42 

9 U.S.C. 300jj–19(a)(2)) shall be construed as prohib10 iting— 

11 (A) a field EMS agency from submitting 

12 EMS data to the State EMS Office for the pur13 pose of quality improvement and data collection 

14 by the State for submission to NEMSIS; or 

15 (B) the State EMS Office from submitting 

16 aggregated nonindividually identifiable EMS 

17 data to the National EMS Database maintained 

18 by NHTSA. 

19 SEC. 8. FIELD EMS EDUCATION GRANTS. 

20 (a) IN GENERAL.—For the purpose of promoting 

21 field EMS as a health profession and ensuring the avail22 ability, quality, and capability of field EMS educators, 

23 practitioners, and medical directors, the Director of the 

24 Office of EMS and Trauma (in this section referred to 

25 as the ‘‘Director’’) may make grants to eligible entities 

mstockstill on DSK4VPTVN1PROD with BILLS

40 

•HR 809 IH

1 for the development, availability, and dissemination of 

2 field EMS education programs and courses that improve 

3 the quality and capability of field EMS personnel. In car4 rying out this section, the Director shall take into consid5 eration input from the Administrator of NHTSA, 

6 FICEMS, NEMSAC, the National Health Care Workforce 

7 Commission established under section 5101 of the Patient 

8 Protection and Affordable Care Act (42 U.S.C. 294q), and 

9 relevant stakeholders. 

10 (b) ELIGIBILITY.—In this section, the term ‘‘eligible 

11 entity’’ means an educational organization, an educational 

12 institution, a professional association, and any other entity 

13 involved with the education of field EMS practitioners. 

14 (c) USE OF FUNDS.—The Director may award a 

15 grant to an eligible entity under paragraph (1) only if the 

16 entity agrees to use the grant to— 

17 (1) develop and implement education programs 

18 that— 

19 (A) train field EMS trainers and promote 

20 the adoption and implementation of the edu21 cation standards identified in the ‘‘Emergency 

22 Medical Services Education Agenda for the Fu23 ture: A Systems Approach’’ including any revi24 sions thereto; 

mstockstill on DSK4VPTVN1PROD with BILLS

41 

•HR 809 IH

1 (B) bridge the gap in knowledge and skills 

2 in field EMS and among field EMS and other 

3 allied health professions to develop a larger 

4 cadre of educational instructors and build a 

5 stronger and more flexible field EMS practi6 tioner corps; or 

7 (C) provide training and retraining pro8 grams to provide displaced workers the oppor9 tunity to enter a field EMS profession; 

10 (2) develop and implement educational courses 

11 pertaining to— 

12 (A) instructor courses; 

13 (B) provision of medical direction of field 

14 EMS; 

15 (C) field EMS practitioners, including phy16 sicians, emergency medical technicians, para17 medics, nurses, and other relevant clinicians 

18 providing emergency medical care in the field; 

19 (D) field EMS educational and clinical re20 search; 

21 (E) bridge programs among field EMS, 

22 nursing, and other allied health professions; 

23 (F) field EMS management; 

24 (G) national, evidence-based guidelines; 

25 and 

mstockstill on DSK4VPTVN1PROD with BILLS

42 

•HR 809 IH

1 (H) translation of the lessons learned in 

2 military medicine to field EMS; 

3 (3) evaluate education and training courses and 

4 methodologies to identify optimal educational modal5 ities for field EMS practitioners; 

6 (4) improve the field EMS education infrastruc7 ture by increasing the number of field EMS instruc8 tors and the quality of their preparation by improv9 ing, enhancing, and modernizing the dissemination 

10 of EMS education, including distance learning, and 

11 by establishing quality improvement for EMS edu12 cation programs; 

13 (5) enhance the opportunity for medical direc14 tion training and for promoting appropriate medical 

15 oversight of field emergency medical care; 

16 (6) improve systems to design, implement, and 

17 evaluate education for prospective and current field 

18 EMS providers; or 

19 (7) carrying out such other activities as the Di20 rector may identify. 

21 (d) PRIORITY.—The Director, in consultation with 

22 NHTSA and relevant stakeholders, and taking into con23 sideration the recommendations of FICEMS and 

24 NEMSAC, shall establish a system of prioritization in 

25 awarding grants under this section to eligible entities. 

mstockstill on DSK4VPTVN1PROD with BILLS

43 

•HR 809 IH

1 (e) DURATION OF GRANTS.—Grants under this sec2 tion shall be for a period of 1 to 3 years. 

3 (f) APPLICATION.—The Director may not award a 

4 grant to an eligible entity under this section unless the 

5 entity submits an application to the Director in such form, 

6 in such manner, and containing such agreements, assur7 ances, and information as the Director may require. The 

8 Director shall ensure that the requirements for submitting 

9 an application under this section are not unduly burden10 some. 

11 SEC. 9. EVALUATING INNOVATIVE MODELS FOR ACCESS 

12 AND DELIVERY OF FIELD EMS FOR PATIENTS. 

13 (a) EVALUATION.— 

14 (1) IN GENERAL.—Not later than 1 year after 

15 the date of the enactment of this Act, the Director 

16 of the Office of EMS and Trauma, in consultation 

17 with the Administrator of the Centers for Medicare 

18 & Medicaid Services (in this section referred to as 

19 the ‘‘Director’’), and taking into consideration the 

20 recommendations of NEMSAC and FICEMS, shall 

21 complete an evaluation of— 

22 (A) the provision of and reimbursement for 

23 alternative delivery models for medical care 

24 through field EMS; and 

mstockstill on DSK4VPTVN1PROD with BILLS

44 

•HR 809 IH

1 (B) the integration of field EMS patients 

2 with other medical providers and facilities as 

3 medically appropriate. 

4 (2) SPECIFIC ISSUES.—The evaluation under 

5 paragraph (1) shall consider each of the following: 

6 (A) Alternative dispositions of patients, in7 cluding— 

8 (i) transporting patients by ambulance 

9 to destinations other than a hospital such 

10 as the office of the patient’s physician, an 

11 urgent care center, or the facilities of an12 other health care provider; 

13 (ii) when medically necessary, the 

14 evaluation, treatment, or referral of pa15 tients to other medically appropriate health 

16 care providers; and 

17 (iii) the funding of the provision of 

18 medical care regardless of the decision to 

19 transport such as reimbursement models 

20 based on readiness rather than transport 

21 and shared savings. 

22 (B) Issues related to medical liability and 

23 the requirements of section 1867 of the Social 

24 Security Act (42 U.S.C. 1395dd; commonly re25 ferred to as ‘‘EMTALA’’) associated with 

mstockstill on DSK4VPTVN1PROD with BILLS

45 

•HR 809 IH

1 transport to destinations other than a hospital 

2 emergency department. 

3 (C) Necessary protections to ensure that 

4 patients receive timely and appropriate care in 

5 the appropriate setting. 

6 (D) Whether there are any barriers to pro7 viding alternate dispositions to patients who are 

8 not in need of care in hospital emergency de9 partments. 

10 (E) Other issues determined by the Direc11 tor, including, when possible, issues rec12 ommended by FICEMS or NEMSAC for eval13 uation under this subsection. 

14 (b) DEMONSTRATION PROJECTS.— 

15 (1) IN GENERAL.—Beginning not later than 1 

16 year after the date of the enactment of this Act, the 

17 Director shall conduct or support at least 10 dem18 onstration projects to— 

19 (A) evaluate the implementation and reim20 bursement of alternative dispositions of field 

21 EMS patients, including— 

22 (i) transporting patients by ambulance 

23 to alternate destinations when medically 

24 appropriate and in the patients’ best inter25 ests; and 

mstockstill on DSK4VPTVN1PROD with BILLS

46 

•HR 809 IH

1 (ii) when medically necessary, evalu2 ating, treating, or referring patients to 

3 other medically appropriate providers; 

4 (B) evaluate the implementation of reim5 bursement models based on readiness rather 

6 than transport or shared savings; and 

7 (C) determine whether such alternative dis8 positions and reimbursement models— 

9 (i) improve the safety, effectiveness, 

10 timeliness, and efficiency of EMS; and 

11 (ii) reduce overall utilization and ex12 penditures under the Medicare program 

13 under title XVIII of the Social Security 

14 Act. 

15 (2) EVIDENCE-BASED PROTOCOLS.—The Direc16 tor shall ensure that at least one demonstration 

17 project under paragraph (1) evaluates evidence18 based protocols that give guidance on selection of 

19 the destination to which patients are transported. 

20 (3) DURATION.—The period of a demonstration 

21 project under paragraph (1) shall not exceed 36 

22 months. 

23 (4) RESEARCH.—If the Director determines 

24 that further research is necessary prior to or in con25 junction with the demonstration projects under this 

mstockstill on DSK4VPTVN1PROD with BILLS

47 

•HR 809 IH

1 subsection in order to evaluation the implementation 

2 of alternative dispositions of field EMS patients, the 

3 Director shall conduct or support such research. 

4 (5) AUTHORIZATION OF APPROPRIATIONS.—Of 

5 the amount made available to carry out section 

6 1115A of the Social Security Act (42 U.S.C. 1315a) 

7 for a fiscal year, there are authorized to be appro8 priated such sums as may be necessary to carry out 

9 this subsection. 

10 (c) REPORT TO CONGRESS.—Not later than 1 year 

11 after the completion of all demonstration projects under 

12 subsection (b), the Director shall submit to the Congress 

13 a report on the results of activities under this section, in14 cluding recommendations on the efficacy of alternative dis15 positions of field EMS patients. 

16 SEC. 10. ENHANCING RESEARCH IN FIELD EMS. 

17 (a) MODELS TO BE TESTED BY CENTER FOR MEDI18 CARE AND MEDICAID INNOVATION.—Section 

19 1115A(b)(2)(B) of title XI of the Social Security Act (42 

20 U.S.C. 1315a(b)(2)(B)) is amended by adding at the end 

21 the following: 

22 ‘‘(xxi) Enhancing health outcomes for 

23 patients receiving field emergency medical 

24 services and improving timely and efficient 

mstockstill on DSK4VPTVN1PROD with BILLS

48 

•HR 809 IH

1 delivery of high-quality field emergency 

2 medical services, such as through— 

3 ‘‘(I) regionalization of emergency 

4 care; 

5 ‘‘(II) medical transport to alter6 nate destinations; or 

7 ‘‘(III) when medically necessary, 

8 the evaluation, treatment, or referral 

9 of patients to other medically appro10 priate health providers.’’. 

11 (b) EMERGENCY MEDICAL RESEARCH.—Section 

12 498D of the Public Health Service Act (42 U.S.C. 289g– 

13 4) is amended— 

14 (1) by redesignating subsections (c) and (d) as 

15 subsections (d) and (e), respectively; and 

16 (2) by inserting after subsection (b) the fol17 lowing: 

18 ‘‘(c) FIELD EMS EMERGENCY MEDICAL RE19 SEARCH.—The Secretary shall conduct research and eval20 uation relating to field EMS through the Agency for 

21 Healthcare Research and Quality and the Center for Medi22 care and Medicaid Innovation.’’. 

23 (c) FIELD EMS PRACTICE CENTER.—Subpart II of 

24 part D of title IX of the Public Health Service Act (42 

mstockstill on DSK4VPTVN1PROD with BILLS

49 

•HR 809 IH

1 U.S.C. 299b–33 et seq.) is amended by adding at the end 

2 the following: 

3 ‘‘SEC. 938. FIELD EMS PRACTICE CENTER. 

4 ‘‘(a) ESTABLISHMENT.—For the purpose described 

5 in subsection (b), the Director shall establish within the 

6 Office of Research and Evaluation a Field EMS Evidence7 Based Practice Center. 

8 ‘‘(b) PURPOSE.—The purpose of the Center is to con9 duct or support research to promote the highest quality 

10 of emergency medical care in field EMS and the most ef11 fective delivery system for the provision of such care. Re12 search conducted or supported pursuant to the preceding 

13 sentence shall include— 

14 ‘‘(1) comparative safety and effectiveness re15 search; 

16 ‘‘(2) other appropriate clinical or systems re17 search; and 

18 ‘‘(3) research addressing— 

19 ‘‘(A) critical care transport; 

20 ‘‘(B) off-shore operations; 

21 ‘‘(C) tactical emergency medical services; 

22 ‘‘(D) air medical services; and 

23 ‘‘(E) the application of lessons learned in 

24 military field medicine in the delivery of emer25 gency medical care in field EMS. 

mstockstill on DSK4VPTVN1PROD with BILLS

50 

•HR 809 IH

1 ‘‘(c) DEFINITION.—In this section: 

2 ‘‘(1) The term ‘Center’ means the Field EMS 

3 Evidence-Based Practice Center established under 

4 subsection (a). 

5 ‘‘(2) The term ‘field EMS’ has the meaning 

6 given to such term in section 3 of the Field EMS 

7 Quality, Innovation, and Cost Effectiveness Improve8 ments Act of 2013.’’. 

9 (d) LIMITATIONS ON CERTAIN USES OF RE10 SEARCH.—Section 1182 of the Social Security Act (42 

11 U.S.C. 1320e–1) is amended by striking ‘‘section 1181’’ 

12 each place it appears and inserting ‘‘section 1181 of this 

13 Act or section 498D(c) or 938 of the Public Health Serv14 ice Act’’. 

15 (e) REGULATORY BARRIERS.—For the purposes of 

16 research conducted pursuant to this section or any other 

17 research funded by the Department of Health and Human 

18 Services related to emergency medical services in the field 

19 in which informed consent is required but may not be at20 tainable, the Secretary of Health and Human Services 

21 shall— 

22 (1) evaluate and consider the patient and re23 search issues involved; and 

24 (2) address regulatory barriers to such research 

25 related to the need for informed consent in a manmstockstill on DSK4VPTVN1PROD with BILLS

51 

•HR 809 IH

1 ner that ensures adequate patient safety and notifi2 cation, and submit recommendations to Congress for 

3 any changes to Federal statutes necessary to ad4 dress such barriers. 

5 SEC. 11. EMERGENCY MEDICAL SERVICES TRUST FUND. 

6 (a) DESIGNATION OF INCOME TAX OVERPAYMENTS

7 AND ADDITIONAL CONTRIBUTIONS FOR EMERGENCY

8 MEDICAL SERVICES.—Subchapter A of chapter 61 of the 

9 Internal Revenue Code of 1986 (relating to returns and 

10 records) is amended by adding at the end the following 

11 new part: 

12 ‘‘PART IX—DESIGNATION OF INCOME TAX OVER13 PAYMENTS AND ADDITIONAL CONTRIBU14 TIONS FOR EMERGENCY MEDICAL SERVICES 

15 ‘‘SEC. 6097. DESIGNATION BY INDIVIDUALS. 

16 ‘‘(a) IN GENERAL.—Every individual (other than a 

17 nonresident alien)— 

18 ‘‘(1) may designate that a specified portion of 

19 any overpayment of tax for a taxable year, and 

20 ‘‘(2) may designate that an amount in addition 

21 to any payment of tax for such taxable year and any 

22 designation under paragraph (1), 

23 shall be used to fund the Emergency Medical Services 

24 Trust Fund. Designations under the preceding sentence 

25 shall be in an amount not less than $1 and the Secretary 

mstockstill on DSK4VPTVN1PROD with BILLS

52 

•HR 809 IH

1 shall provide for elections in amounts of $1, $5, $10, or 

2 such other amount as the taxpayer designates. 

3 ‘‘(b) ADJUSTED INCOME TAX LIABILITY.—For pur4 poses of this section, the term ‘adjusted income tax liabil5 ity’ means income tax liability (as defined in section 

6 6096(b)) reduced by any amount designated under section 

7 6096 (relating to designation of income tax payments to 

8 Presidential Election Campaign Fund). 

9 ‘‘(c) OVERPAYMENTS TREATED AS REFUNDED.—For 

10 purposes of this title, any portion of an overpayment of 

11 tax designated under subsection (a) shall be treated as— 

12 ‘‘(1) being refunded to the taxpayer as of the 

13 last date prescribed for filing the return of tax im14 posed by chapter 1 (determined without regard to 

15 extensions) or, if later, the date the return is filed, 

16 and 

17 ‘‘(2) a contribution made by such taxpayer on 

18 such date to the United States. 

19 ‘‘(d) MANNER AND TIME OF DESIGNATION.—A des20 ignation under subsection (a) may be made with respect 

21 to any taxable year— 

22 ‘‘(1) at the time of filing the return of the tax 

23 imposed by chapter 1 for such taxable year, or 

24 ‘‘(2) at any other time (after the time of filing 

25 the return of the tax imposed by chapter 1 for such 

mstockstill on DSK4VPTVN1PROD with BILLS

53 

•HR 809 IH

1 taxable year) specified in regulations prescribed by 

2 the Secretary. 

3 Such designation shall be made in such manner as the 

4 Secretary prescribes by regulations except that, if such 

5 designation is made at the time of filing the return of the 

6 tax imposed by chapter 1 for such taxable year, such des7 ignation shall be made either on the first page of the re8 turn or on the page bearing the signature of the tax9 payer.’’. 

10 (b) EMERGENCY MEDICAL SERVICES TRUST

11 FUND.—Subchapter A of chapter 98 of the Internal Rev12 enue Code of 1986 is amended by adding at the end the 

13 following new section: 

14 ‘‘SEC. 9512. EMERGENCY MEDICAL SERVICES TRUST FUND. 

15 ‘‘(a) CREATION OF TRUST FUND.—There is estab16 lished in the Treasury of the United States a trust fund 

17 to be known as the ‘Emergency Medical Services Trust 

18 Fund’, consisting of such amounts as may be credited or 

19 paid to such trust fund as provided in section 6097. 

20 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here21 by appropriated to the Emergency Medical Services Trust 

22 Fund amounts equivalent to the amounts of the overpay23 ments of tax to which designations under section 6097 

24 apply. 

mstockstill on DSK4VPTVN1PROD with BILLS

54 

•HR 809 IH

1 ‘‘(c) EXPENDITURES FROM TRUST FUND.—Amounts 

2 in the Emergency Medical Services Trust Fund shall be 

3 available, as provided in appropriation Acts, only for car4 rying out the provisions for which amounts are authorized 

5 to be appropriated under subsections (a) and (b) of section 

6 12 of the Field EMS Quality, Innovation, and Cost Effec7 tiveness Improvements Act of 2013.’’. 

8 (c) CLERICAL AMENDMENTS.— 

9 (1) CLERICAL AMENDMENT.—The table of 

10 parts for subchapter A of chapter 61 of the Internal 

11 Revenue Code of 1986 is amended by adding at the 

12 end the following new item: 

‘‘PART IX. DESIGNATION OF INCOME TAX OVERPAYMENTS AND ADDITIONAL

CONTRIBUTIONS FOR EMERGENCY MEDICAL SERVICES.’’. 

13 (2) The table of sections for subchapter A of 

14 chapter 98 of such Code is amended by adding at 

15 the end the following new item: 

‘‘Sec. 9512. Emergency Medical Services Trust Fund.’’. 

16 (d) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply to taxable years beginning after 

18 December 31, 2013. 

19 SEC. 12. AUTHORIZATION OF APPROPRIATIONS. 

20 (a) IN GENERAL.—Out of amounts in the Emergency 

21 Medical Services Trust Fund, there are authorized to be 

22 appropriated— 

mstockstill on DSK4VPTVN1PROD with BILLS

55 

•HR 809 IH

1 (1) $12,000,000 shall be for carrying out sec2 tions 4 (excluding the provisions of law listed in sub3 section (b)(3) of such section), 7, 9(a), 9(c), and 11 

4 of this Act for each of fiscal years 2014 through 

5 2017; 

6 (2) $200,000,000 shall be for carrying out sec7 tion 5 of this Act for each of fiscal years 2014 

8 through 2017; 

9 (3) $50,000,000 shall be for carrying out sec10 tion 6 of this Act for each of fiscal years 2014 

11 through 2017; 

12 (4) $4,000,000 shall be for carrying out section 

13 7(c)(1) of this Act for each of fiscal years 2014 

14 through 2017; 

15 (5) $15,000,000 shall be for carrying out sec16 tion 8 of this Act for each of fiscal years 2014 

17 through 2017; and 

18 (6) $40,000,000 shall be for carrying out sec19 tions 498D(c) and 938 of the Public Health Service 

20 Act, as added by subsections (b) and (c) of section 

21 10 of this Act, for each of fiscal years 2014 through 

22 2017. 

23 (b) EXCESS AMOUNTS.—If, for any fiscal year, 

24 amounts in the Emergency Medical Services Trust Fund 

25 exceed the maximum amount authorized to be appromstockstill on DSK4VPTVN1PROD with BILLS

56 

•HR 809 IH

1 priated under subsection (a), such excess amounts are au2 thorized to be appropriated to carry out section 330J, sec3 tion 498D, and parts A, B, C, D, and H of title XII of 

4 the Public Health Service Act (42 U.S.C. 254c–15, 289g– 

5 4, 300d et seq., 300d–11 et seq., 300d–31 et seq., and 

6 300d–81 et seq.). 

7 (c) START-UP FUNDING.— 

8 (1) IN GENERAL.—Out of the discretionary 

9 funds available to the Secretary of Health and 

10 Human Services for each of fiscal years 2014 and 

11 2015, $40,000,000 shall be for carrying out the pro12 visions listed in subsection (a) or (b). 

13 (2) RELATION TO OTHER FUNDS.—The amount 

14 of discretionary funds allocated under paragraph (1) 

15 for the purpose of carrying out the provisions listed 

16 in subsection (a) or (b) shall be in addition to, not 

17 in lieu of, the amount of discretionary funds that 

18 would otherwise be available for such purpose. 

19 (d) ADMINISTRATIVE EXPENSES.—Of the amounts 

20 made available under subsection (a), (b), or (c) to carry 

21 out each of the provisions listed in subsection (a), not 

22 more than 5 percent of each such amount may be used 

23 for Federal administrative expenses. 

Æ 

mstockstill on DSK4VPTVN1PROD with BILLS