I 

114TH CONGRESS 

1ST SESSION H. R. 2366 

To provide for improvement of field emergency medical services, and for 

other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2015 

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 Modernization and Innovation Act’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

Sec. 3. Aligning ambulance reimbursement with value-based and high-quality 

field EMS. 


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Sec. 4. Field emergency medical services. 

Sec. 5. Integration of field EMS into the National Health Information Infrastructure. 

Sec. 6. Clarification of leadership responsibility for routine emergency medical 

care. 

Sec. 7. Enhancing evidence-based care in field EMS. 

Sec. 8. Emergency medical services trust fund. 

Sec. 9. GAO study to identify impediments to quality improvement in field 

EMS. 

Sec. 10. Funding. 

Sec. 11. Statutory construction. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Patients with emergency medical conditions 

4 depend upon field emergency medical services (re5 ferred to in this section as ‘‘EMS’’) for essential life6 saving or unscheduled medical care. All people in the 

7 United States should have access to and receive 

8 high-quality emergency medical care as part of a co9 ordinated EMS system. 

10 (2) The Institute of Medicine, in its 2006 re11 port ‘‘Emergency Medical Services at the Cross12 roads’’, outlined its vision of a 21st century emer13 gency care system that is integrated, regionalized, 

14 accountable, and prepared for both routine emer15 gency medical care and public health emergencies. 

16 Such a modernized system would be characterized by 

17 a highly trained and capable field EMS practitioner 

18 workforce that delivers high-quality, evidence-based, 

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1 gency care in the field and across the emergency 

2 care continuum. 

3 (3) In such 2006 report, the Institute of Medi4 cine also outlined systemic problems plaguing field 

5 EMS that impede achievement of a 21st century 

6 emergency care system, including insufficient coordi7 nation, disparate response times, uncertain quality 

8 of care, lack of readiness for disasters, divided pro9 fessional identity of field EMS practitioners, and a 

10 limited evidence base for the emergency medical care 

11 provided in the field. 

12 (4) To modernize the field EMS system, the In13 stitute of Medicine recommended that advancements 

14 be made in several priority areas, including readi15 ness, innovation, preparedness, education and work16 force development, safety, financing, quality, stand17 ards, and research. The Institutes of Medicine also 

18 recommended recognition of a lead programmatic 

19 Federal agency for emergency medical services with20 in the Department of Health and Human Services to 

21 provide a more streamlined, cost-efficient, and com22 prehensive approach for field EMS, and a focal point 

23 for practitioners and agencies to interface with the 

24 Federal Government. 


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1 (5) Under an amendment made by the Pan2 demic and All-Hazards Preparedness Act (Public 

3 Law 109–417), the Secretary of Health and Human 

4 Services is already established as the lead of all Fed5 eral public health and medical response for public 

6 health emergencies and incidents. Preparedness and 

7 capability to deliver routine emergency medical care 

8 is a prerequisite for preparedness and capability to 

9 respond to public health emergencies and incidents. 

10 (6) In 2007, the Homeland Security Presi11 dential Directive HSPD–21 called for the establish12 ment within the Department of Health and Human 

13 Services of an Office for Emergency Medical Care to 

14 lead an enterprise to promote and fund research in 

15 emergency medicine and trauma care; promote re16 gional partnerships and more effective emergency 

17 medical systems in order to enhance appropriate 

18 triage, distribution, and care of routine community 

19 patients; and promote local, regional, and State 

20 emergency medical systems’ preparedness for and 

21 response to public health events. Under the Direc22 tive, the Office would address the full spectrum of 

23 issues that have an impact on care in hospital emer24 gency departments, including the entire continuum 


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1 of patient care from prehospital to disposition from 

2 emergency or trauma care. 

3 (7) Properly functioning EMS systems encom4 pass fully mobile resources that are able to address 

5 patient needs 24 hours per day, 7 days per week, 

6 365 days a year. Field EMS serves as an essential 

7 health care safety net by providing emergency, ur8 gent, and mobile medical care throughout the health 

9 care continuum, including medical and trauma care 

10 provided in the field, hospital, rehabilitation, and 

11 other settings. Ensuring high-quality and cost-effec12 tive emergency medical services systems requires 

13 readiness, preparedness, medical oversight, and inno14 vation throughout the continuum of emergency med15 ical care through Federal, State, and local multi-ju16 risdictional collaboration and sufficient resources for 

17 EMS agencies and practitioners. 

18 (8) Field EMS is the delivery of health care, 

19 not simply a transportation benefit having evolved 

20 from a patient transport model to a health care serv21 ice delivery model that provides a variety of targeted 

22 medical services to meet the specific needs of their 

23 communities. This includes the development of com24 munity paramedicine as a health care service pro25 vided by field EMS agencies and mobile integrated 


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1 health care as a health care service provided collabo2 ratively by a group of health care providers in a 

3 community, including local field EMS agencies. 

4 These new delivery models are filling gaps in patient 

5 care identified by a community’s health care pro6 viders, including preventing recurrent medical epi7 sodes through reliable post-discharge follow up and 

8 chronic disease management. Facilitating reimburse9 ment for such services, including under the Medicare 

10 program under title XVIII of the Social Security Act 

11 (42 U.S.C. 1395 et seq.), is necessary to the contin12 ued development and sustainability of such services. 

13 (9) Field EMS is uniquely positioned to support 

14 the transformation of health care to a value and out15 comes based model to improve the patient experience 

16 and the health of populations, and to reduce the per 

17 capita cost of health care. Field EMS provides high18 ly reliable patient assessment and intervention at 

19 any hour of any day in response to urgent or un20 scheduled episodes of illness or injury and effectively 

21 navigates patients to ensure they receive the right 

22 care, in the right place, and at the right time. Field 

23 EMS helps contain health care costs by navigating 

24 the patient down a cost-effective pathway that is evi25 dence-based. 


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1 (10) 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 

5 every day and during catastrophic incidents. To en6 sure disaster and all-hazards preparedness for field 

7 EMS operations as part of the Nation’s comprehen8 sive disaster preparedness, Federal funding for pre9 paredness activities, including catastrophic training 

10 and exercises, must be provided to governmental and 

11 nongovernmental field EMS agencies to ensure a 

12 greater capability within each of these areas. 

13 (11) The essential role of field EMS in disaster 

14 preparedness and response must be incorporated 

15 into the national preparedness and response strategy 

16 and implementation as provided and overseen by the 

17 Department of Homeland Security and the Depart18 ment of Health and Human Services, pursuant to 

19 their respective jurisdictions. Field EMS agencies 

20 must be capable of meeting the routine emergency 

21 care needs of patients to be capable of meeting the 

22 extraordinary medical needs during a catastrophic 

23 event. 


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1 SEC. 3. ALIGNING AMBULANCE REIMBURSEMENT WITH 

2 VALUE-BASED AND HIGH-QUALITY FIELD 

3 EMS. 

4 (a) FIELD EMS MEDICARE DEMONSTRATION PRO5 GRAM.—Section 1115A(b)(2) of the Social Security Act 

6 (42 U.S.C. 1315a(b)(2)) is amended— 

7 (1) in the last sentence of subparagraph (A), by 

8 inserting ‘‘, and shall include the model described in 

9 subparagraph (D)’’ before the period at the end; and 

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(D) DEMONSTRATION PROJECTS.— 

13 ‘‘(i) IN GENERAL.—The model de14 scribed in this subparagraph is a dem15 onstration program under title XVIII. Be16 ginning not later than 2 years after the 

17 date of the enactment of the Field EMS 

18 Modernization and Innovation Act, the 

19 CMI shall conduct not less than 10 dem20 onstration projects to— 

21 ‘‘(I) evaluate the implementation 

22 and reimbursement of alternative dis23 positions of field EMS patients, in24 cluding— 

25 ‘‘(aa) transporting individ26 uals by ambulance to alternate 


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1 destinations when medically ap2 propriate and in the individual’s 

3 best interests; 

4 ‘‘(bb) when medically nec5 essary, evaluating, treating, or 

6 referring individuals to other 

7 medically appropriate providers; 

8 and 

9 ‘‘(cc) when medically appro10 priate, treating individuals 

11 through community paramedicine 

12 or mobile integrated healthcare 

13 services; 

14 ‘‘(II) evaluate the implementation 

15 of alternative reimbursement models, 

16 including models based on readiness 

17 rather than transport or shared sav18 ings; and 

19 ‘‘(III) determine whether such al20 ternative dispositions and reimburse21 ment models— 

22 ‘‘(aa) improve the safety, ef23 fectiveness, timeliness, and effi24 ciency of emergency medical serv25 ices; and 


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1 ‘‘(bb) reduce overall utiliza2 tion and expenditures under title 

3 XVIII. 

4 ‘‘(ii) EVIDENCE-BASED PROTOCOLS.— 

5 The CMI shall ensure that at least one 

6 demonstration project under this subpara7 graph evaluates evidence-based protocols 

8 that give guidance on selection of the des9 tination to which individuals are trans10 ported. 

11 ‘‘(iii) DURATION.—The duration of a 

12 demonstration project under this subpara13 graph shall not exceed 3 years. 

14 ‘‘(iv) RESEARCH.—The Secretary 

15 shall conduct or support further research 

16 that the Secretary determines to be nec17 essary prior to, or in conjunction with, the 

18 demonstration projects under this subpara19 graph in order to evaluate the implementa20 tion of alternative dispositions of, and re21 imbursement models for transport of, field 

22 EMS patients. 

23 ‘‘(v) REPORT TO CONGRESS.—Not 

24 later than 1 year after the completion of 

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1 paragraph, the Secretary shall include in 

2 the annual report to Congress required 

3 under subsection (g) a report on the re4 sults of the projects conducted under this 

5 subparagraph, including information about 

6 the efficacy of alternative disposition of, 

7 and reimbursement models for transport 

8 of, field EMS patients. 

9 ‘‘(vi) DEFINITION OF FIELD EMS.—In 

10 this subparagraph, the terms ‘community 

11 paramedicine’, ‘field EMS’, ‘mobile inte12 grated healthcare’, and ‘readiness’ shall 

13 have the meanings given such terms in sec14 tion 1291 of the Public Health Service 

15 Act.’’. 

16 (b) FIELD EMS ALTERNATIVE DELIVERY PRO17 GRAM.—Section 1834(l) of the Social Security Act (42 

18 U.S.C. 1395m(l)) is amended by adding at the end the 

19 following new paragraph: 

20 ‘‘(16) FIELD EMS ALTERNATIVE DELIVERY

21 PROGRAM.— 

22 ‘‘(A) IN GENERAL.—Not later than 3 years 

23 after the date of the enactment of this para24 graph, the Secretary shall establish the Field 

25 EMS Alternative Delivery Program to establish 


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1 and promote the utilization of innovative pay2 ment models, including the models described in 

3 subparagraph (D), on a shared savings and vol4 untary basis, taking into consideration the re5 sults of the evaluation of models under subpara6 graph (G) and the demonstration projects con7 ducted under section 1115A(b)(2)(D). To the 

8 extent that the Secretary ascertains that an in9 novative payment model has been sufficiently 

10 demonstrated through the private sector or 

11 through the Center for Medicare and Medicaid 

12 Innovation under section 1115A and does not 

13 need to be evaluated under subparagraph (G), 

14 the Secretary may establish such innovative 

15 payment model on a shared savings and budget 

16 neutral basis pursuant to this subparagraph. 

17 ‘‘(B) VOLUNTARY NATURE OF PARTICIPA18 TION.—Providers and suppliers of ground am19 bulance services may voluntarily opt to utilize 

20 innovative payment models under the Field 

21 EMS Alternative Delivery Program. Nothing in 

22 this subparagraph shall be construed as author23 izing the Secretary to require participation in 

24 any innovative payment model under the Pro25 gram. 


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1 ‘‘(C) BUDGET NEUTRALITY.—The Sec2 retary shall implement the innovative payment 

3 models under this subparagraph in a budget 

4 neutral manner such that the cost of implemen5 tation of such models shall not exceed the 

6 amount that otherwise would have been pro7 vided in reimbursement under this title if such 

8 models had not been implemented. 

9 ‘‘(D) TYPES OF MODELS.—The following 

10 models are described in this clause: 

11 ‘‘(i) Community paramedicine that al12 lows for payment for health care assess13 ment and prevention services, or other care 

14 management services. 

15 ‘‘(ii) Mobile integrated healthcare 

16 services that allow for health care assess17 ment and prevention services, or other care 

18 management services within an integrated 

19 program of patient care. 

20 ‘‘(iii) Alternate patient dispositions re21 gardless of transport to the hospital, in22 cluding transport to alternate destinations 

23 and other patient dispositions such as 

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1 positions, including alternate destinations 

2 and treat and refer dispositions, would be 

3 subject to the discretion of the physician 

4 medical director responsible for providing 

5 medical oversight. 

6 ‘‘(iv) The provision of field EMS and 

7 reimbursement on a population health 

8 basis, such as through global capitation. 

9 ‘‘(v) Prevention-based models, such as 

10 injury prevention through home evalua11 tions for fall prevention or infection con12 trol. 

13 ‘‘(vi) Critical care models, particularly 

14 in geographic areas without proximate ac15 cess to hospital-based critical care, and in16 cluding a model that enables patient sta17 bilization by critical care transport teams 

18 with telemedicine support for maintaining 

19 the patient in the patient’s community. 

20 ‘‘(vii) Any other innovative shared 

21 savings model the Secretary determines 

22 relevant pursuant to subparagraph (G). 

23 ‘‘(E) QUALITY REPORTING.—As a condi24 tion of participation in the Field EMS Alter25 native Delivery Program, providers and supVerDate Sep 11 2014 01:01 May 28, 2015 Jkt 049200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2366.IH H2366

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1 pliers of ground ambulance services shall par2 ticipate in the Ambulance Quality Incentive 

3 Program described in paragraph (17). 

4 ‘‘(F) MEDICAL OVERSIGHT.—The Sec5 retary shall specify and require appropriate 

6 medical oversight with regard to the develop7 ment, demonstration, and implementation of in8 novative payment models under this paragraph 

9 to ensure high-quality care and patient safety. 

10 ‘‘(G) DEVELOPMENT AND EVALUATION OF

11 MODELS.— 

12 ‘‘(i) IN GENERAL.—The Secretary, in 

13 consultation with the Assistant Secretary 

14 for Preparedness and Response and taking 

15 into consideration the recommendations of 

16 the National EMS Advisory Council and 

17 the Federal Interagency Committee on 

18 EMS, shall undertake the development and 

19 evaluation of innovative models of field 

20 EMS delivery and reimbursement. 

21 ‘‘(ii) EVALUATION OF INNOVATIVE

22 MODEL OPTIONS.— 

23 ‘‘(I) IN GENERAL.—Not later 

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1 tion and Innovation Act, the Secretary 

2 shall complete an evaluation of— 

3 ‘‘(aa) the provision of and 

4 reimbursement for alternative de5 livery models for medical care 

6 through field EMS; and 

7 ‘‘(bb) the integration of field 

8 EMS patients with other medical 

9 providers and facilities as medi10 cally appropriate. 

11 ‘‘(II) CONSIDERATIONS.—In 

12 completing the evaluation under sub13 clause (I), the Secretary shall consider 

14 the following: 

15 ‘‘(aa) Alternative disposi16 tions of patients, including— 

17 ‘‘(AA) transporting in18 dividuals by ambulance to 

19 destinations other than a 

20 hospital, such as the office 

21 of the physician of the indi22 vidual, an urgent care cen23 ter, or the facility of another 

24 health care provider; 


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1 ‘‘(BB) when medically 

2 necessary, the evaluation, 

3 treatment, or referral of in4 dividuals to other medically 

5 appropriate health care pro6 viders; 

7 ‘‘(CC) the provision of 

8 medical care regardless of 

9 the decision to transport, 

10 such as reimbursement mod11 els based on readiness rath12 er than transport and 

13 shared savings; and 

14 ‘‘(DD) the provision of 

15 health care using patient16 centered mobile resources in 

17 the out-of-hospital environ18 ment, such as community 

19 paramedicine and mobile-in20 tegrated health care serv21 ices. 

22 ‘‘(bb) Issues related to med23 ical liability and the requirements 

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1 ated with transport to destina2 tions other than a hospital emer3 gency department. 

4 ‘‘(cc) Necessary protections 

5 to ensure that patients receive 

6 timely and appropriate care in 

7 the appropriate setting, including 

8 ongoing quality improvement and 

9 appropriate physician medical 

10 oversight. 

11 ‘‘(dd) Whether there are any 

12 barriers to providing alternate 

13 dispositions to individuals who 

14 are not in need of hospital-based 

15 care. 

16 ‘‘(ee) Other reimbursement 

17 related issues that span multiple 

18 delivery models including the cost 

19 of demonstrated evidence-based 

20 care, such as 12-lead electro21 cardiograms and continuous posi22 tive airway pressure, early rec23 ognition of time dependent dis24 eases, such as stroke and sepsis, 

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1 quality appropriate physician 

2 medical oversight. 

3 ‘‘(ff) Other issues, as deter4 mined by the Secretary, includ5 ing, when practicable, issues rec6 ommended by the Assistant Sec7 retary for Preparedness and Re8 sponse, the National EMS Advi9 sory Council, and the Federal 

10 Interagency Committee on EMS 

11 for evaluation under this sub12 paragraph. 

13 ‘‘(H) DEFINITIONS.—In this paragraph, 

14 the terms ‘community paramedicine’, ‘field 

15 EMS’, ‘medical oversight’, and ‘mobile inte16 grated healthcare’ have the meanings given 

17 such terms in section 1291 of the Public Health 

18 Service Act.’’. 

19 (c) AMBULANCE QUALITY INCENTIVE PROGRAM.— 

20 Section 1834(l) of the Social Security Act (42 U.S.C. 

21 1395m(l)), as amended by subsection (a), is further 

22 amended by adding at the end the following new para23 graph: 

24 ‘‘(17) AMBULANCE QUALITY INCENTIVE PRO25 GRAM.— 


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1 ‘‘(A) IN GENERAL.—Not later than Janu2 ary 1 of the first fiscal year that begins on or 

3 after the date that is 3 years after the date of 

4 the enactment of this paragraph, the Secretary 

5 shall establish an Ambulance Quality Incentive 

6 Program under which providers and suppliers 

7 of ground ambulance services under this sub8 section may receive incentive payments from the 

9 amount made available under subparagraph (F) 

10 for reporting on the quality measures identified 

11 by the Secretary under subparagraph (B). 

12 ‘‘(B) QUALITY MEASURES.— 

13 ‘‘(i) IN GENERAL.—The Secretary 

14 shall, by regulation, identify quality meas15 ures that have been endorsed by the entity 

16 with a contract under section 1890(a). 

17 Such measures shall include outcome and 

18 patient safety measures and be relevant to 

19 the provision of field emergency medical 

20 response and mobile medical care. 

21 ‘‘(ii) EXCEPTION.—In the case of a 

22 specified area or medical topic determined 

23 appropriate by the Secretary for which a 

24 feasible and practical measure has not 

25 been endorsed by the entity with a contract 


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1 under section 1890(a), the Secretary may 

2 specify a measure that is not so endorsed 

3 as long as due consideration is given to 

4 measures that have been endorsed or 

5 adopted by a consensus organization iden6 tified by the Secretary. 

7 ‘‘(iii) REVISING QUALITY MEAS8 URES.—Subject to clause (iv), the Sec9 retary may, by regulation, revise quality 

10 measures identified under this paragraph 

11 on an annual basis. 

12 ‘‘(iv) TIMEFRAME.—The Secretary 

13 shall publish the quality measures that will 

14 apply to a fiscal year not later than Janu15 ary 1 of the preceding fiscal year. 

16 ‘‘(C) VOLUNTARY NATURE OF REPORT17 ING.—Participation in the Ambulance Quality 

18 Incentive Program is voluntary for providers 

19 and suppliers electing not to participate in the 

20 Field EMS Alternative Delivery Program. 

21 ‘‘(D) CONSULTATION.—In carrying out the 

22 provisions of this paragraph (including in devel23 oping and revising the quality measures identi24 fied in subparagraph (B)), the Secretary 

25 shall— 


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1 ‘‘(i) solicit the input of relevant stake2 holders; 

3 ‘‘(ii) use the notice and comment pro4 cedures provided in section 553 of title 5, 

5 United States Code; and 

6 ‘‘(iii) take into account prior invest7 ments in technology systems to enable par8 ticipation in the program with minimal ad9 ditional capital investments. 

10 ‘‘(E) PUBLIC AVAILABILITY OF DATA SUB11 MITTED.—The Secretary shall establish proce12 dures for making data submitted under this 

13 paragraph available to the public on the website 

14 of the Centers for Medicare & Medicaid Serv15 ices. Such procedures shall ensure that a sup16 plier or provider has the opportunity to review 

17 the data that is to be made public with respect 

18 to the supplier or provider prior to such data 

19 being made public. 

20 ‘‘(F) BUDGET NEUTRAL FUNDING.— 

21 ‘‘(i) IN GENERAL.—The amount avail22 able for making payments under this para23 graph for any fiscal year shall be equal to 

24 the amount of savings for the preceding 

25 fiscal year resulting from the Field EMS 


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1 Alternative Delivery Program described in 

2 paragraph (16), as determined by the Sec3 retary. 

4 ‘‘(ii) PRIORITY FOR PARTICIPANTS IN

5 FIELD EMS ALTERNATIVE DELIVERY PRO6 GRAM.—To the extent that funds are avail7 able for making payments under this para8 graph for a fiscal year, the Secretary shall 

9 ensure that— 

10 ‘‘(I) providers and suppliers who 

11 participated in the program estab12 lished under paragraph (16) in the 

13 preceding fiscal year are paid before 

14 other providers and suppliers; and 

15 ‘‘(II) providers and suppliers who 

16 did not participate in the program es17 tablished under paragraph (16) in the 

18 preceding fiscal year may only receive 

19 payments if there are any funds re20 maining after the application of sub21 clause (I).’’. 

22 SEC. 4. FIELD EMERGENCY MEDICAL SERVICES. 

23 (a) IN GENERAL.—Title XII of the Public Health 

24 Service Act (42 U.S.C. 300d et seq.) is amended by adding 

25 at the end the following: 


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1 ‘‘PART I—FIELD EMERGENCY MEDICAL SERVICES 

2 ‘‘SEC. 1291. DEFINITIONS. 

3 ‘‘In this part: 

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

5 practice of hospitals denying access to an incoming 

6 ambulance and requesting that the ambulance pro7 ceed to another facility due to a stated lack of ca8 pacity at the initial facility, resulting in delayed ac9 cess to definitive care. 

10 ‘‘(2) The term ‘community paramedicine’ means 

11 a health care service provided by a field EMS agency 

12 for the provision of cost-effective health care assess13 ment and prevention services to fill gaps in the local 

14 health care system. 

15 ‘‘(3) The term ‘emergency medical response’ 

16 means— 

17 ‘‘(A) medical care provided to patients with 

18 emergency medical conditions prior to or out19 side a medical facility; 

20 ‘‘(B) emergency medical dispatch, rapid re21 sponse, and urgent or unscheduled patient as22 sessment and intervention; 

23 ‘‘(C) emergency, critical care, and inter-fa24 cility and air medical transport; or 

25 ‘‘(D) telephone consultation to 911 callers 

26 as an alternative to ambulance dispatch, or 


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1 other requests through a public safety answer2 ing point. 

3 ‘‘(4) The term ‘emergency medical services’ 

4 means emergency medical care, trauma care, and re5 lated services provided to patients at any point in 

6 the continuum of health care services, including 

7 emergency medical dispatch and emergency medical 

8 care, trauma care, and related services provided in 

9 the field, during transport, or in a medical facility 

10 or other clinical setting. 

11 ‘‘(5) The term ‘FICEMS’ means the Federal 

12 Interagency Committee on Emergency Medical Serv13 ices. 

14 ‘‘(6) The term ‘field EMS’ means emergency 

15 medical response and mobile medical services pro16 vided prior to or outside a medical facility. 

17 ‘‘(7) The term ‘field EMS agency’ means an or18 ganization providing field EMS, including— 

19 ‘‘(A) governmental (including fire-based 

20 agencies), nongovernmental (including hospital 

21 based or private agencies), and volunteer orga22 nizations; and 

23 ‘‘(B) organizations that provide field EMS 

24 by ground, air, or otherwise. 


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1 ‘‘(8) The term ‘field EMS practitioner’ means 

2 an individual licensed and credentialed to provide 

3 emergency and mobile medical care to patients with4 in the scope of such individual’s practice. 

5 ‘‘(9) The term ‘medical oversight’ means the 

6 supervision by a physician of the medical aspects of 

7 a field EMS system or agency and its practitioners, 

8 including prospective, concurrent, and respective 

9 components of field EMS and the education of field 

10 EMS practitioners. 

11 ‘‘(10) The term ‘mobile integrated health care’ 

12 means a health care service that is undertaken col13 laboratively by a group of health care providers, in14 cluding the local field EMS agency, in a community, 

15 for the provision of medical care to fill gaps in the 

16 local health care system. 

17 ‘‘(11) The term ‘mobile medical services’ means 

18 preventive medical assessment and care, chronic dis19 ease assessment and management support, post-dis20 charge follow-up assessment and management sup21 port, and post-assessment patient transport, ar22 ranged transportation, or referral to other commu23 nity health or social service resources. 

24 ‘‘(12) The term ‘NEMSAC’ means the National 

25 Emergency Medical Services Advisory Council. 


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1 ‘‘(13) The term ‘NEMSIS’ means the National 

2 EMS Information System. 

3 ‘‘(14) The term ‘NHTSA’ means the National 

4 Highway Traffic Safety Administration. 

5 ‘‘(15) The term ‘patient parking’ means the 

6 practice by hospitals of refusing to accept transfer 

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

8 regular emergency department bed is available, re9 quiring the crew to continue to provide patient care 

10 on the ambulance stretcher rather than in a patient 

11 bed in the hospital, until hospital staff will accept 

12 the transfer of care, resulting in delayed access to 

13 definitive care for the patient and denied access to 

14 emergency care for the community served by the 

15 field EMS Agency. 

16 ‘‘(16) The term ‘readiness’ means the standby 

17 costs of preparedness to respond to a health care 

18 need, 24 hours a day, 7 days a week, 365 days a 

19 year. 

20 ‘‘(17) The term ‘State EMS Office’ means an 

21 office designated by the State with primary responsi22 bility for oversight of the State’s emergency medical 

23 services system, such as responsibility for oversight 

24 of field EMS coordination, licensing or certifying 


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1 field EMS practitioners, and emergency medical 

2 services system improvement. 

3 ‘‘SEC. 1292. FIELD EMS PREPAREDNESS FOR PUBLIC 

4 HEALTH EMERGENCIES AND OTHER INCI5 DENTS. 

6 ‘‘(a) IN GENERAL.—The Assistant Secretary for Pre7 paredness and Response shall establish the Field EMS 

8 Preparedness Program to be administered by the Office 

9 of Emergency Medical Care for the purpose of improving 

10 field EMS agency all-hazards readiness and preparedness 

11 and public health emergencies and incidents. 

12 ‘‘(b) APPLICATION.— 

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

14 grant under this section, an eligible entity shall sub15 mit an application to the Assistant Secretary for 

16 Preparedness and Response in such form and man17 ner, and containing such agreements, assurances, 

18 and information as such Assistant Secretary re19 quires. 

20 ‘‘(2) SIMPLE FORM.—The Assistant Secretary 

21 for Preparedness and Response shall ensure that 

22 grant application requirements are not unduly bur23 densome to smaller and volunteer field EMS agen24 cies or other agencies with limited resources. 


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1 ‘‘(3) CONSISTENCY WITH PREPARATION

2 GOALS.—The Assistant Secretary for Preparedness 

3 and Response shall ensure that grant applications 

4 are consistent with national and relevant State pre5 paredness plans and goals. 

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

7 entities to achieve the preparedness goals described under 

8 paragraphs (1), (3), (4), (5), (6), and (8) of section 

9 2802(b) with respect to all-hazards, including chemical, bi10 ological, radiological, or nuclear threats, including the pur11 chase of equipment, training, and supplies. 

12 ‘‘(d) ADMINISTRATION OF GRANTS.—In carrying out 

13 this section, the Assistant Secretary for Preparedness and 

14 Response— 

15 ‘‘(1) shall establish a grantmaking process that 

16 includes— 

17 ‘‘(A) prioritization for the awarding of 

18 grants to eligible entities and consideration of 

19 the factors in reviewing grant applications by 

20 eligible entities, including— 

21 ‘‘(i) demonstrated financial need for 

22 funding; 

23 ‘‘(ii) utilization of public and private 

24 partnerships; 


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1 ‘‘(iii) improving the availability of 

2 field EMS in underserved regions to en3 hance the capability for medical response 

4 to public health emergencies and incidents; 

5 ‘‘(iv) unique needs of volunteer and 

6 rural field EMS agencies; 

7 ‘‘(v) distribution among a variety of 

8 geographic areas, including urban, subur9 ban, and rural; 

10 ‘‘(vi) distribution of funds among 

11 types of field EMS agencies, including gov12 ernmental, nongovernmental, and volunteer 

13 agencies; 

14 ‘‘(vii) implementation of regionalized 

15 systems of medical response to public 

16 health emergencies and incidents; and 

17 ‘‘(viii) such other factors as the As18 sistant Secretary for Preparedness and Re19 sponse determines necessary; 

20 ‘‘(B) a peer-reviewed process to rec21 ommend grant allocations in accordance with 

22 the prioritization established under subpara23 graph (A), except that final award determina24 tions shall be made by the Assistant Secretary 

25 for Preparedness and Response; and 


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1 ‘‘(C) the provision of grant awards to eligi2 ble entities on an annual basis, except that the 

3 Assistant Secretary for Preparedness and Re4 sponse may reserve not more than 25 percent 

5 of the available appropriations for multiyear 

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

7 period; and 

8 ‘‘(2) shall consult with and take into consider9 ation the recommendations of the FICEMS, 

10 NEMSAC, and relevant stakeholders. 

11 ‘‘(e) ELIGIBILITY.—To be eligible to receive a grant 

12 under this section, an entity shall be a field EMS agency 

13 that— 

14 ‘‘(1) is licensed by or otherwise authorized in 

15 the State in which it operates; and 

16 ‘‘(2) has medical oversight and quality improve17 ment programs, as determined by the Assistant Sec18 retary for Preparedness and Response. 

19 ‘‘(f) REQUIRED USE OF MEDICAL OVERSIGHT

20 GUIDELINES.—As a condition on receipt of a grant under 

21 this section, the Assistant Secretary for Preparedness and 

22 Response shall require each grant recipient to adopt and 

23 implement (to the extent applicable) the guidelines pro24 moted, developed, and disseminated under subparagraphs 


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1 (B) and (C) of subsection (a)(1) of section 1293 with re2 gard to medical oversight. 

3 ‘‘(g) ANNUAL REPORT.—The Assistant Secretary for 

4 Preparedness and Response shall submit an annual report 

5 on the Field EMS Preparedness Program under this sec6 tion to Congress. 

7 ‘‘SEC. 1293. FIELD EMS QUALITY IMPROVEMENT. 

8 ‘‘(a) ENHANCING PHYSICIAN MEDICAL OVER9 SIGHT.— 

10 ‘‘(1) IN GENERAL.—To improve medical over11 sight of field EMS and ensure continuity and quality 

12 for such medical oversight, the Assistant Secretary 

13 for Preparedness and Response shall— 

14 ‘‘(A) promote high-quality and comprehen15 sive medical oversight of— 

16 ‘‘(i) all medical care provided by field 

17 EMS practitioners; and 

18 ‘‘(ii) the education and training of 

19 field EMS practitioners; 

20 ‘‘(B) promote the development, adoption, 

21 and utilization of national guidelines for the 

22 role of physicians who provide medical oversight 

23 for field EMS and other health care providers 

24 who support physicians in such role; 


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1 ‘‘(C) support efforts of relevant physician 

2 stakeholders in developing and disseminating 

3 guidelines for use by field EMS medical direc4 tors and field EMS practitioners on a national 

5 basis; and 

6 ‘‘(D) convene a Field EMS Medical Over7 sight Advisory Committee, comprised of rep8 resentatives of relevant physician stakeholders, 

9 to advise the Assistant Secretary for Prepared10 ness and Response on ways and means to ad11 vance and support development and mainte12 nance of quality medical oversight throughout 

13 the Nation’s systems for field EMS. 

14 ‘‘(2) ADDITIONAL CONSIDERATIONS.—In car15 rying out subparagraphs (B) and (C) of paragraph 

16 (1), the Assistant Secretary for Preparedness and 

17 Response shall take into consideration— 

18 ‘‘(A) existing guidelines developed by na19 tional professional physician associations, 

20 States, and other relevant governmental or non21 governmental entities; 

22 ‘‘(B) the input of other relevant stake23 holders, including health care providers who 

24 support physicians who provide medical over25 sight for field EMS; and 


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1 ‘‘(C) the unique needs associated with 

2 medical oversight of provision of field EMS in 

3 rural areas or by volunteers. 

4 ‘‘(3) FLEXIBILITY.—The guidelines promoted, 

5 developed, and disseminated under subparagraphs 

6 (B) and (C) of paragraph (1) shall ensure high-qual7 ity training, credentialing, and direction in connec8 tion with medical oversight of field EMS at the 

9 State, regional, and local levels while providing suffi10 cient flexibility to account for historical and legiti11 mate differences in field EMS among States, re12 gions, and localities. 

13 ‘‘(b) PATIENT SAFETY IMPROVEMENT.—Field EMS 

14 agencies and practitioners shall be eligible to participate 

15 in the activities of patient safety organizations for the pur16 pose of improving patient safety and the quality of health 

17 care delivery. 

18 ‘‘(c) ANALYSIS OF DATA GAPS THAT HINDER HIGH19 QUALITY FIELD EMS CARE.— 

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

21 the date of the enactment of the Field EMS Mod22 ernization and Innovation Act, the Secretary, acting 

23 through the Assistant Secretary for Preparedness 

24 and Response, shall submit to Congress a report 

25 that— 


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1 ‘‘(A) identifies gaps in the collection of 

2 data related to the provision of field EMS; and 

3 ‘‘(B) includes recommendations for improv4 ing the collection, reporting, and analysis of 

5 such data, and integration of such data with 

6 other health care data. 

7 ‘‘(2) RECOMMENDATIONS.—The recommenda8 tions included in the report in accordance with para9 graph (1)(B) shall— 

10 ‘‘(A) take into consideration the rec11 ommendations of FICEMS, NEMSAC, and rel12 evant stakeholders; 

13 ‘‘(B) recommend methods for improving 

14 data collection, reporting, and analysis without 

15 unduly burdening reporting entities and without 

16 duplicating existing data sources (such as data 

17 collected by the National Trauma Data Bank); 

18 ‘‘(C) address the quality and availability of 

19 data, and linkages with existing patient reg20 istries, related to the provision of field EMS 

21 and utilization of field EMS with respect to a 

22 variety of illnesses and injuries (in both the ev23 eryday provision of field EMS and catastrophic 

24 or disaster response), including— 


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1 ‘‘(i) cardiac events such as chest pain, 

2 sudden cardiac arrest, and ST-segment ele3 vation myocardial infarction; 

4 ‘‘(ii) stroke; 

5 ‘‘(iii) trauma; 

6 ‘‘(iv) disaster and catastrophic inci7 dents, such as incidents related to ter8 rorism or natural or manmade disasters; 

9 and 

10 ‘‘(v) ambulance diversion and patient 

11 parking; 

12 ‘‘(D) include an analysis of the variety of 

13 services provided by field EMS agencies; and 

14 ‘‘(E) any recommendations that require 

15 statutory authorization from Congress. 

16 ‘‘(3) IMPLEMENTATION OF RECOMMENDATIONS

17 WITH EXISTING STATUTORY AUTHORITY.—The Sec18 retary, acting through the Office of the National Co19 ordinator for Health Information Technology, shall 

20 implement such recommendations for data collection 

21 to the extent that such authority exists and does not 

22 require further statutory authorization from Con23 gress. 


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1 ‘‘SEC. 1294. ACCOUNTABILITY FOR FIELD EMS SYSTEM PER2 FORMANCE. 

3 ‘‘(a) DEVELOPMENT OF FIELD EMS QUALITY AND

4 SYSTEM PERFORMANCE MEASURES.—The Assistant Sec5 retary for Preparedness and Response shall support— 

6 ‘‘(1) further development and refinement of 

7 measures to be utilized under the Ambulance Qual8 ity Incentive Program, as appropriate, including— 

9 ‘‘(A) quality measures to improve account10 ability for patient outcomes in field EMS; and 

11 ‘‘(B) performance measures to enhance the 

12 measurement of field EMS system performance; 

13 and 

14 ‘‘(2) a technical assistance center to provide as15 sistance and education to field EMS agencies, physi16 cian medical directors, and practitioners to partici17 pate effectively in quality and performance improve18 ment programs. 

19 ‘‘(b) CLARIFICATION OF HIPAA.— 

20 ‘‘(1) EXCHANGE OF INFORMATION RELATED TO

21 THE TREATMENT OF PATIENTS.— 

22 ‘‘(A) IN GENERAL.—Nothing in HIPAA 

23 privacy and security law (as defined in section 

24 3009(a)(2)) shall be construed as prohibiting 

25 the exchange of information between field EMS 

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1 sonnel of a hospital to which the individual has 

2 been treated for the purposes of relating infor3 mation on the medical history, treatment, care, 

4 and outcome of such individual (including any 

5 health care personnel safety issues, such as in6 fectious disease). 

7 ‘‘(B) GUIDELINES.—The Secretary shall 

8 establish guidelines for exchanges of informa9 tion between field EMS practitioners treating 

10 an individual and personnel of a hospital to 

11 which the individual has been treated to protect 

12 the privacy of the individual while ensuring the 

13 ability of such field EMS practitioners and hos14 pital personnel to communicate effectively to 

15 further the continuity and quality of medical 

16 care provided to such individual. 

17 ‘‘(2) NEMSIS DATA.—Nothing in HIPAA pri18 vacy and security law (as defined in section 

19 3009(a)(2)) shall be construed as prohibiting the ex20 change of non-individually identifiable data between 

21 the field EMS agency, a State, and the Federal Gov22 ernment, including the exchange of information by— 

23 ‘‘(A) a field EMS agency to the State 

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1 ment and data collection by the State for sub2 mission to NEMSIS; or 

3 ‘‘(B) the State EMS Office to the National 

4 EMS Database maintained by Assistant Sec5 retary for Preparedness and Response. 

6 ‘‘SEC. 1295. FIELD EMS WORKFORCE DEVELOPMENT. 

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

8 field EMS as a health profession and ensuring the avail9 ability, quality, and capability of field EMS educators, 

10 practitioners, managers, and medical directors, the Assist11 ant Secretary for Preparedness and Response shall make 

12 grants to eligible entities for the development, availability, 

13 and dissemination of field EMS education programs and 

14 courses that improve the quality and capability of field 

15 EMS practitioners, educators, managers, and physician 

16 medical directors. In carrying out this section, the Assist17 ant Secretary for Preparedness and Response shall take 

18 into consideration recommendations of FICEMS, 

19 NEMSAC, and relevant stakeholders. 

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

21 entity’ means an educational organization, an educational 

22 institution, a professional association, or any other entity 

23 involved in and experienced with the education of field 

24 EMS practitioners, physician medical directors, field EMS 

25 managers and administrators, and field EMS educators. 


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1 ‘‘(c) USE OF FUNDS.—The Assistant Secretary for 

2 Preparedness and Response may award a grant to an eligi3 ble entity under paragraph (1) only if the entity agrees 

4 to use the grant to— 

5 ‘‘(1) develop and implement education programs 

6 to— 

7 ‘‘(A) train field EMS instructors and pro8 mote the adoption and implementation of the 

9 education standards identified in the ‘Emer10 gency Medical Services Education Agenda for 

11 the Future: A Systems Approach’, including 

12 any revisions thereto or successor standards; 

13 ‘‘(B) provide training for information sys14 tem workers, such as information security, fo15 rensic analysts, data analysts, network engi16 neers, and similar roles to work in support of 

17 field EMS data systems; or 

18 ‘‘(C) provide training and retraining pro19 grams that prepare displaced workers to enter 

20 a field EMS profession, including veterans and 

21 military EMS practitioners; 

22 ‘‘(2) develop and implement educational courses 

23 pertaining to— 

24 ‘‘(A) improving the provision of quality 

25 medical oversight of field EMS; 


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1 ‘‘(B) expanding the knowledge and skills of 

2 field EMS practitioners, including those needed 

3 to provide community paramedicine and mobile 

4 integrated health care; 

5 ‘‘(C) undertaking field EMS educational 

6 and clinical research to develop investigators; 

7 ‘‘(D) tactical training for field EMS; or 

8 ‘‘(E) developing and expanding field EMS 

9 undergraduate and graduate programs; 

10 ‘‘(3) evaluate education and training courses 

11 and methodologies to identify optimal educational 

12 modalities for field EMS practitioners; 

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

15 oversight of field emergency medical care; or 

16 ‘‘(5) carry out such other activities as the As17 sistant Secretary for Preparedness and Response de18 termines appropriate. 

19 ‘‘(d) PRIORITY.—The Assistant Secretary for Pre20 paredness and Response, in consultation with relevant 

21 stakeholders, and taking into consideration the rec22 ommendations of FICEMS and NEMSAC, shall establish 

23 a system of prioritization in awarding grants under this 

24 section to eligible entities. 


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

3 ‘‘(f) APPLICATION.—The Assistant Secretary for Pre4 paredness and Response may not award a grant to an eli5 gible entity under this section unless the entity submits 

6 an application to such Assistant Secretary in such form, 

7 in such manner, and containing such agreements, assur8 ances, and information as the Assistant Secretary may re9 quire. The Assistant Secretary for Preparedness and Re10 sponse shall ensure that the requirements for submitting 

11 an application under this section are not unduly burden12 some. 

13 ‘‘SEC. 1296. NATIONAL EMERGENCY MEDICAL SERVICES 

14 STRATEGY. 

15 ‘‘(a) IN GENERAL.—The Secretary, acting through 

16 the Assistant Secretary for Preparedness and Response, 

17 shall develop and implement a cohesive national emer18 gency medical services strategy to strengthen the develop19 ment of field EMS and the full continuum of emergency 

20 medical care and systems at the Federal, State, and local 

21 levels to improve patient outcomes and access to high22 quality care in the field and develop financing models that 

23 support the evolution of value-based emergency medical 

24 care. In establishing such a strategy, the Assistant Sec25 retary for Preparedness and Response shall— 


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1 ‘‘(1) solicit and consider the 2007 and subse2 quent recommendations of the Institute of Medicine, 

3 the National EMS Advisory Council, and relevant 

4 stakeholders; 

5 ‘‘(2) consult and collaborate with the Federal 

6 Interagency Committee on EMS to ensure consist7 ency of such national emergency medical services 

8 strategy within the larger Federal strategy regarding 

9 national preparedness and response; 

10 ‘‘(3) address issues related to emergency med11 ical services system development, including— 

12 ‘‘(A) the regionalization of field EMS, 

13 trauma, and emergency medical services, par14 ticularly for time sensitive conditions such as 

15 trauma, ST–Segment Elevation Myocardial In16 farction, stroke, neonatal patients, and 

17 poisonings; 

18 ‘‘(B) the availability of field EMS and 

19 trauma care and emergency medical services 

20 throughout the Nation; 

21 ‘‘(C) the integration of emergency medical 

22 care from the perspective of patients across the 

23 emergency care continuum, and accountability 

24 for system performance; and 


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1 ‘‘(D) financing of field EMS agencies, in2 cluding appropriate medical oversight; 

3 ‘‘(4) promote the professional development of 

4 field EMS practitioners to deliver high-quality field 

5 EMS, including the adoption by States of the edu6 cation standards identified in the National EMS 

7 Education Standards and any revisions thereto or 

8 successor standards, including the standardization of 

9 licensing of field EMS practitioners and standards 

10 of care in accordance with the National EMS Scope 

11 of Practice Model and based on best practices and 

12 evidence-based medicine, including by— 

13 ‘‘(A) identifying differences in the levels of 

14 care, scope of practice, and licensure require15 ments among the States; and 

16 ‘‘(B) encouraging States to adopt national 

17 minimum standards for such levels of care and 

18 licensure requirements; 

19 ‘‘(5) promote a culture of safety, including 

20 through— 

21 ‘‘(A) the establishment of field EMS pa22 tient and practitioner safety goals and the spe23 cific means to improve field EMS practitioner 

24 and patient safety to achieve such goals; and 


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1 ‘‘(B) the adoption of uniform national am2 bulance vehicle safety and manufacturing 

3 standards; 

4 ‘‘(6) support the development of value-based re5 imbursement for new mobile resources and models of 

6 delivery that support the transformation of health 

7 care, including the full utilization of field EMS to 

8 deliver emergency medical response and mobile med9 ical services including— 

10 ‘‘(A) community paramedicine for the pro11 vision of cost-effective health care assessment 

12 and prevention services; 

13 ‘‘(B) mobile integrated health care under14 taken collaboratively by a group of providers in 

15 a community, including local field EMS agen16 cies, to fill gaps in the local health care system; 

17 ‘‘(C) integrated injury prevention strate18 gies or programs; and 

19 ‘‘(D) such other issues as the Secretary 

20 considers appropriate; 

21 ‘‘(7) incorporate into such strategy prepared22 ness and response objectives identified in the Na23 tional Health Security Strategy under section 2802 

24 in order— 


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1 ‘‘(A) to ensure the capability and capacity 

2 of the full spectrum of field EMS to respond to 

3 terrorist attacks, disasters, catastrophic events, 

4 and mass casualty events; and 

5 ‘‘(B) to coordinate with the Secretary of 

6 Homeland Security accordingly; 

7 ‘‘(8) promote research in emergency medical 

8 services and coordination across Federal agencies 

9 undertaking such research, taking into consideration 

10 the National EMS Research Agenda; 

11 ‘‘(9) complete the development of such strategy 

12 not later than 18 months after the date of enact13 ment of the Field EMS Modernization and Innova14 tion Act; 

15 ‘‘(10) communicate such strategy to the rel16 evant congressional committees of jurisdiction; 

17 ‘‘(11) implement such strategy, to the extent 

18 practicable, not later than 3 years after the date of 

19 enactment of the Field EMS Modernization and In20 novation Act; and 

21 ‘‘(12) update such strategy not less than every 

22 3 years. 

23 ‘‘SEC. 1297. OFFICE OF EMERGENCY MEDICAL CARE. 

24 ‘‘(a) ESTABLISHMENT OF OFFICE.—Pursuant to 

25 paragraph 41 of Homeland Security Presidential Directive 


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1 HSPD–21, dated October 18, 2007, the Secretary shall 

2 establish an Office of Emergency Medical Care under the 

3 direct authority of the Assistant Secretary for Prepared4 ness and Response, to carry out all of the responsibilities 

5 described in such paragraph of such directive. 

6 ‘‘(b) FUNCTIONS.—The Assistant Secretary for Pre7 paredness and Response, acting through the Office of 

8 Emergency Medical Care, shall administer the emergency 

9 medical services activities and programs under this part 

10 and the trauma programs under parts A through D and 

11 H and shall— 

12 ‘‘(1) promote and fund research in emergency 

13 medicine and trauma health care; 

14 ‘‘(2) promote regional partnerships and effec15 tive emergency medical systems in order to enhance 

16 appropriate triage, distribution, and care of routine 

17 community patients; 

18 ‘‘(3) promote local, regional, and State emer19 gency medical systems preparedness for and re20 sponse to public health events; 

21 ‘‘(4) address the full spectrum of issues that 

22 have an impact on care in emergency departments, 

23 including the entire continuum of patient care from 

24 prehospital to disposition from emergency or trauma 

25 care; and 


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1 ‘‘(5) coordinate with existing executive depart2 ments and agencies that perform functions related 

3 to emergency medical systems in order to ensure 

4 unified strategy, policy, and implementation. 

5 ‘‘(c) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, 

6 AND ADMINISTRATIVE ACTIONS.—All functions, per7 sonnel, assets, and liabilities of, and administrative actions 

8 applicable to, the Emergency Care Coordination Center, 

9 as in existence on the day before the date of the enactment 

10 of the Field EMS Modernization and Innovation Act, shall 

11 be transferred to the Office of Emergency Medical Care 

12 established under subsection (a).’’. 

13 (b) INCLUSION OF FIELD EMS IN PATIENT SAFETY

14 IMPROVEMENT.—Section 921(8)(A) of the Public Health 

15 Service Act (42 U.S.C. 299b–21(8)(A)) is amended— 

16 (1) in clause (i), by inserting ‘‘field EMS agen17 cy (as defined in section 1291),’’ after ‘‘clinical lab18 oratory,’’; and 

19 (2) in clause (ii), by inserting ‘‘field EMS (as 

20 defined in section 1291) medical director, emergency 

21 medical technician,’’ after ‘‘pharmacist,’’. 

22 SEC. 5. INTEGRATION OF FIELD EMS INTO THE NATIONAL 

23 HEALTH INFORMATION INFRASTRUCTURE. 

24 (a) NATIONAL EMS INFORMATION SYSTEM.— 


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1 (1) TRANSFER OF AUTHORITY.—The authority 

2 for the administration of the National EMS Infor3 mation System, including the National EMS Data4 base, shall be transferred from NHTSA to the Na5 tional Coordinator for Health Information Tech6 nology. 

7 (2) NATIONAL EMS INFORMATION SYSTEM.— 

8 Section 3001(c) of the Public Health Service Act 

9 (42 U.S.C. 300jj–11(c)) is amended by adding at 

10 the end the following: 

11 ‘‘(9) NATIONAL EMS INFORMATION SYSTEM.— 

12 ‘‘(A) STANDARDIZATION.—The National 

13 Coordinator shall promote the collection and re14 porting of data on field EMS (as defined in sec15 tion 1291) in a standardized manner. 

16 ‘‘(B) AVAILABILITY OF DATA.—The Na17 tional Coordinator shall ensure that information 

18 in the National EMS Database (other than in19 dividually identifiable information) is available 

20 to Federal and State policymakers, EMS stake21 holders, and researchers. 

22 ‘‘(C) TECHNICAL ASSISTANCE.—In car23 rying out subparagraph (A), the National Coor24 dinator may provide technical assistance to 

25 State and local agencies, field EMS agencies, 


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1 and other entities, as the National Coordinator 

2 determines appropriate, to assist in the collec3 tion, analysis, and reporting of data.’’. 

4 (b) ASSIMILATION OF PATIENT HEALTH INFORMA5 TION ACROSS THE EMERGENCY CARE CONTINUUM.—Not 

6 later than 18 months after the date of enactment of this 

7 Act, taking into account the definition of ‘‘health care pro8 vider’’ under section 3000 of the Public Health Service 

9 Act (42 U.S.C. 300jj), the Secretary shall promulgate a 

10 regulation that specifically includes ‘‘emergency medical 

11 service provider’’ under the definition of ‘‘health care pro12 vider’’ for purposes of title XXX of the Public Health 

13 Service Act, to enable and facilitate the integration and 

14 assimilation of field EMS data systems as part of the elec15 tronic exchange and use of health information and the en16 terprise integration of such information. 

17 (c) GAO EVALUATION.— 

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

19 the United States, in consultation with the National 

20 Coordinator for Health Information Technology, the 

21 Assistant Secretary for Preparedness and Response, 

22 and the Federal Interagency Committee on Emer23 gency Medical Services, as appropriate, and taking 

24 into consideration input from relevant stakeholders, 

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1 ments, and potential solutions pertaining to integra2 tion of field EMS into the National Health Informa3 tion Infrastructure. 

4 (2) REPORT.—The Comptroller General of the 

5 United States shall submit a report to Congress de6 tailing the extent to which the Secretary of Health 

7 and Human Services (referred to in this subsection 

8 as the ‘‘Secretary’’) has authority to implement solu9 tions to achieve such integration and the extent to 

10 which statutory changes are required to achieve such 

11 integration. 

12 (3) CONTENTS.—The evaluation under para13 graph (1) and report under paragraph (2) shall ad14 dress— 

15 (A) the integration of patient health infor16 mation regarding care provided to patients in 

17 field EMS into each patient’s electronic health 

18 care record; 

19 (B) the bi-directional integration and data 

20 sharing among providers and entities providing 

21 patient care related to performance measures as 

22 part of quality initiatives; 

23 (C) the means by which to achieve contem24 poraneous field EMS practitioner access to a 

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1 ical location while preparing to provide or pro2 viding care to that patient in the field, for the 

3 purpose of enhancing care delivery and 

4 populating the electronic health care record in 

5 real time; and 

6 (D) incorporation of patient health infor7 mation created subsequent to the receipt of 

8 field EMS care into the National EMS Infor9 mation System, taking into consideration— 

10 (i) the types of medical information 

11 created subsequent to the receipt of field 

12 EMS emergency care (such as outcomes 

13 information or information regarding sub14 sequent care and treatment) that would, if 

15 included in the National EMS Information 

16 System, be potentially useful in evaluating 

17 and improving the quality of EMS care; 

18 (ii) how best to integrate such infor19 mation into the National EMS Information 

20 System; 

21 (iii) potential modifications to the 

22 Health Information Technology for Eco23 nomic and Clinical Health Act (title XIII 

24 of division A and title IV of division B of 

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1 pitals (as defined in section 1886(n)(6)(B) 

2 of the Social Security Act (42 U.S.C. 

3 1395ww(n)(6)(B))) to develop or report 

4 relevant data to the National EMS Infor5 mation System or other appropriate State 

6 or private registries for the purpose of de7 termining whether such a hospital shall 

8 be— 

9 (I) subject to a reduction in the 

10 applicable percentage increase other11 wise applicable to such hospital under 

12 section 1886(b)(3)(B)(ix) of such Act; 

13 or 

14 (II) eligible for an incentive pay15 ment under section 1886(n) of such 

16 Act; 

17 (iv) potential modifications to the 

18 Medicare and Medicaid programs under ti19 tles XVIII and XIX, respectively, of the 

20 Social Security Act (42 U.S.C. 1395 et 

21 seq.; 1396 et seq.) or other Federal health 

22 programs to provide appropriate reim23 bursement and financial incentives for field 

24 EMS agencies to develop or report relevant 

25 data to the National EMS Information 


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1 System or other appropriate State or pri2 vate registries; and 

3 (v) any other changes to improve inte4 gration of patient health information 

5 across the continuum of emergency medical 

6 care and bidirectional integration and data 

7 sharing related to performance measures 

8 that the Secretary has authority to imple9 ment or that requires a statutory change 

10 by Congress to enable the Secretary such 

11 authority to implement. 

12 SEC. 6. CLARIFICATION OF LEADERSHIP RESPONSIBILITY 

13 FOR ROUTINE EMERGENCY MEDICAL CARE. 

14 (a) IN GENERAL.—Pursuant to the designation of 

15 the Secretary of Health and Human Services (referred to 

16 in this section as the ‘‘Secretary’’) under section 2801 of 

17 the Public Health Service Act (42 U.S.C. 300hh) to lead 

18 all Federal public health and medical response to public 

19 health emergencies and incidents under the National Re20 sponse Plan (developed pursuant to section 504(a)(6) of 

21 the Homeland Security Act of 2002), and pursuant to the 

22 Secretary’s responsibility for administration of titles 

23 XVIII, XIX, and XXI of the Social Security Act (42 

24 U.S.C. 1395 et seq.; 1396 et seq.; 1397aa et seq.), such 

25 leadership responsibilities shall be construed to include the 


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1 provision of routine emergency medical care across the full 

2 continuum of such care provided (including field EMS (as 

3 defined in section 1291 of the Public Health Service Act 

4 (as added by section 4)), trauma, and hospital emergency 

5 medical care) as a necessary prerequisite to ensure the 

6 adequacy of such response to public health emergencies 

7 and incidents under the National Response Plan and the 

8 integration and provision of emergency medical care pro9 vided to beneficiaries of such titles of the Social Security 

10 Act. 

11 (b) EMERGENCY MEDICAL CARE SYSTEM.—In ac12 cordance with subsection (a), the Secretary shall be re13 sponsible for— 

14 (1) improving the emergency medical care sys15 tem providing routine emergency medical care to pa16 tients with emergency medical conditions to enhance 

17 the capacity of the existing public health and emer18 gency medical system to prepare for and sustain 

19 such public health and medical response to public 

20 health emergencies and incidents; and 

21 (2) the quality, innovation, and cost-effective22 ness of field EMS, including such services provided 

23 to individuals who are beneficiaries of the Medicare, 

24 Medicaid or State Children’s Health Insurance Pro25 gram under titles XVIII, XIX, and XXI, respectively 


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1 of the Social Security Act (42 U.S.C. 1395 et seq.; 

2 1396 et seq.; 1397aa et seq.). 

3 SEC. 7. ENHANCING EVIDENCE-BASED CARE IN FIELD EMS. 

4 (a) FIELD EMS EMERGENCY MEDICAL RE5 SEARCH.— 

6 (1) IN GENERAL.—The Secretary of Health and 

7 Human Services (referred to in this subsection as 

8 the ‘‘Secretary’’) shall undertake a comprehensive 

9 evaluation of the extent to which research and eval10 uation relating to field EMS is conducted by the Na11 tional Institutes of Health, the Agency for 

12 Healthcare Research Quality, the Center for Medi13 care & Medicaid Innovation, the Health Resources 

14 and Services Administration, the Centers for Disease 

15 Control and Prevention, and the Patient-Centered 

16 Outcomes Research Institute, and any other agen17 cies or departments within the Department of 

18 Health and Human Services, as the Secretary deter19 mines appropriate. 

20 (2) REPORT TO CONGRESS.—Not later than 1 

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

22 Secretary shall submit to Congress a report that in23 cludes— 

24 (A) information related to the extent of 

25 federally sponsored research in field EMS; 


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1 (B) identification of any impediments to 

2 enhancing research in emergency medicine to 

3 improve patient outcomes; and 

4 (C) opportunities to enhance such research 

5 within existing funding levels. 

6 (3) DEFINITION.—In this subsection, the term 

7 ‘‘field EMS’’ has the meaning given such term in 

8 section 1291 of the Public Health Service Act, as 

9 added by section 4. 

10 (b) FIELD EMS CENTER OF EXCELLENCE.—Sub11 part II of part D of title IX of the Public Health Service 

12 Act (42 U.S.C. 299b–33 et seq.) is amended by adding 

13 at the end the following: 

14 ‘‘SEC. 938. FIELD EMS CENTER OF EXCELLENCE. 

15 ‘‘(a) ESTABLISHMENT.—The Director shall establish 

16 within the Office of Planning, Research & Evaluation a 

17 Field EMS Evidence-Based Center of Excellence (referred 

18 to in this section as the ‘Center’). 

19 ‘‘(b) PURPOSE.—The purpose of the Center is to con20 duct or support research to promote the highest quality 

21 of emergency medical care in field EMS and the most ef22 fective delivery system for the provision of such care, in23 cluding— 

24 ‘‘(1) comparative safety and effectiveness re25 search, especially with regard to the highest cost and 


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1 most prevalent emergency medical conditions with 

2 the greatest opportunity to improve patient out3 comes and lower costs by care provided in the field; 

4 ‘‘(2) other appropriate clinical or systems re5 search on the effectiveness of existing and potential 

6 treatments provided in the field that translate into 

7 improved quality, outcomes, and patient satisfaction; 

8 ‘‘(3) specific research topics designed to save 

9 lives, lower costs, and improve outcomes for patients 

10 with emergency medical conditions, including— 

11 ‘‘(A) the clinical value and benefit of crit12 ical care ground and air transport, including 

13 the potential for bidirectional care that fills 

14 gaps in rural and other underserved geographic 

15 regions, especially where hospitals have closed; 

16 ‘‘(B) the application of lessons learned in 

17 military field medicine in the delivery of emer18 gency medical care in field EMS; 

19 ‘‘(C) the ability to intervene clinically in 

20 the early onset of an emergency medical condi21 tion that will improve patient outcomes; 

22 ‘‘(D) specific treatment modalities and pro23 tocols that are cost-effective and produce better 

24 outcomes, such as 12-lead electrocardiograms 

25 and continuous positive airway pressure; and 


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1 ‘‘(E) medical conditions most conducive to 

2 regionalization of emergency care that will be 

3 most effective in improving service delivery, out4 comes, and cost-effectiveness; and 

5 ‘‘(4) support research being conducted by aca6 demic medical centers, particularly those with cen7 ters of excellence formed around EMS research. 

8 ‘‘(c) DEFINITION.—In this section, the term ‘field 

9 EMS’ has the meaning given such term in section 1291.’’. 

10 (c) LIMITATIONS ON CERTAIN USES OF RE11 SEARCH.—Section 1182 of the Social Security Act (42 

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

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

14 Act, section 938 of the Public Health Service Act, or sec15 tion 7(a) of the Field EMS Modernization and Innovation 

16 Act’’. 

17 (d) REGULATORY BARRIERS.—For the purposes of 

18 research conducted pursuant to section 

19 1115A(b)(2)(D)(iv) of the Social Security Act (as added 

20 by section 3(a)(2)), subsection (a) of this section, section 

21 938 of the Public Health Service Act (as added by sub22 section (b)), or any other research funded by the Depart23 ment of Health and Human Services related to emergency 

24 medical services in the field in which informed consent is 


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1 required but may not be attainable, the Secretary of 

2 Health and Human Services shall— 

3 (1) evaluate and consider the patient and re4 search issues involved; and 

5 (2) address regulatory barriers to such research 

6 related to the need for informed consent in a man7 ner that ensures adequate patient safety and notifi8 cation, and submit recommendations to Congress for 

9 any changes to Federal statutes necessary to ad10 dress such barriers. 

11 SEC. 8. EMERGENCY MEDICAL SERVICES TRUST FUND. 

12 (a) DESIGNATION OF INCOME TAX OVERPAYMENTS

13 AND ADDITIONAL CONTRIBUTIONS FOR EMERGENCY

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

15 Internal Revenue Code of 1986 is amended by adding at 

16 the end the following new part: 

17 ‘‘PART IX—DESIGNATION OF INCOME TAX OVER18 PAYMENTS AND ADDITIONAL CONTRIBU19 TIONS FOR EMERGENCY MEDICAL SERVICES 

‘‘Sec. 6097. Designation by individuals. 

20 ‘‘SEC. 6097. DESIGNATION BY INDIVIDUALS. 

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

22 nonresident alien) may designate that— 

23 ‘‘(1) a specified portion of any overpayment of 

24 tax for a taxable year, and 


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1 ‘‘(2) any amount contributed in addition to any 

2 payment of tax for such taxable year and any des3 ignation under paragraph (1), 

4 shall be used to fund the Emergency Medical Services 

5 Trust Fund. Designations under the preceding sentence 

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

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

8 such other amount as the taxpayer designates. 

9 ‘‘(b) OVERPAYMENTS TREATED AS REFUNDED.— 

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

11 of tax designated under subsection (a) shall be treated 

12 as— 

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

14 last date prescribed for filing the return of tax im15 posed by chapter 1 (determined without regard to 

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

17 and 

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

19 such date to the United States. 

20 ‘‘(c) MANNER AND TIME OF DESIGNATION.—A des21 ignation under subsection (a) may be made with respect 

22 to any taxable year— 

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

24 imposed by chapter 1 for such taxable year, or 


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

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

3 taxable year) specified in regulations prescribed by 

4 the Secretary. 

5 Such designation shall be made in such manner as the 

6 Secretary prescribes by regulations except that, if such 

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

8 tax imposed by chapter 1 for such taxable year, such des9 ignation shall be made either on the first page of the re10 turn or on the page bearing the signature of the tax11 payer.’’. 

12 (b) EMERGENCY MEDICAL SERVICES TRUST

13 FUND.—Subchapter A of chapter 98 of the Internal Rev14 enue Code of 1986 is amended by adding at the end the 

15 following new section: 

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

17 ‘‘(a) CREATION OF TRUST FUND.—There is estab18 lished in the Treasury of the United States a trust fund 

19 to be known as the ‘Emergency Medical Services Trust 

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

21 paid to such trust fund as provided in subsection (b). 

22 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here23 by appropriated to the Emergency Medical Services Trust 

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1 ments of tax to which designations under section 6097 

2 apply. 

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

4 in the Emergency Medical Services Trust Fund shall be 

5 available, as provided in appropriation Acts, only for car6 rying out the provisions for which amounts are authorized 

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

8 10 of the Field EMS Innovation Act.’’. 

9 (c) CLERICAL AMENDMENTS.— 

10 (1) CLERICAL AMENDMENT.—The table of 

11 parts for subchapter A of chapter 61 of the Internal 

12 Revenue Code of 1986 is amended by adding at the 

13 end the following new item: 

‘‘PART IX. DESIGNATION OF INCOME TAX OVER-PAYMENTS AND ADDITIONAL

CONTRIBUTIONS FOR EMERGENCY MEDICAL SERVICES’’. 

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

15 chapter 98 of such Code is amended by adding at 

16 the end the following new item: 

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

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

18 this section shall apply to taxable years beginning after 

19 December 31, 2015. 

20 SEC. 9. GAO STUDY TO IDENTIFY IMPEDIMENTS TO QUAL21 ITY IMPROVEMENT IN FIELD EMS. 

22 (a) IN GENERAL.—The Comptroller General of the 

23 United States shall complete a study on impediments to 


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1 the ability of field EMS practitioners, physician medical 

2 directors, and agencies to improve the quality of medical 

3 care provided to patients including— 

4 (1) medical and administrative liability issues 

5 that may impede— 

6 (A) medical oversight provided by physi7 cians directly regarding specific patients and 

8 medical oversight provided by physicians in es9 tablishing medical protocols, procedures, and 

10 other activities related to the provision of emer11 gency medical care in field EMS; and 

12 (B) the highest quality emergency medical 

13 care in field EMS provided by personnel other 

14 than physicians, such as emergency medical 

15 technicians and paramedics; 

16 (2) the types and levels of reimbursement nec17 essary to ensure the highest quality of care overseen 

18 by physician medical directors, including— 

19 (A) the actual costs of all components of 

20 medical oversight in high-performing EMS sys21 tems with demonstrated improvement in out22 comes, such as those evidenced by cardiac rates 

23 and traumatic injury survival rates; 

24 (B) the costs of medical oversight for part25 time or volunteer medical directors; 


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1 (C) recommended payment model options 

2 for medical oversight that will enhance quality 

3 of care; and 

4 (D) the sufficiency, or lack of sufficiency, 

5 of reimbursement under the Medicare program 

6 under title XVIII of the Social Security Act (42 

7 U.S.C. 1395 et seq.) to providers and suppliers 

8 of ambulance services to enable high-quality 

9 and appropriate medical oversight; 

10 (3) issues that may adversely impact the ability 

11 of field EMS practitioners to deliver high-quality 

12 care including— 

13 (A) issues affecting the direct patient care 

14 provided by field EMS practitioners such as 

15 personal and patient safety, fatigue, and train16 ing; and 

17 (B) issues affecting the ability to recruit 

18 and maintain a highly qualified field EMS prac19 titioner workforce such as salary, hours, and 

20 benefits; and 

21 (4) such other issues as the Comptroller Gen22 eral determines appropriate relating to improving 

23 the quality and medical oversight of emergency med24 ical care in field EMS. 


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1 (b) REPORT TO CONGRESS.—Not later than 18 

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

3 Comptroller General of the United States shall complete 

4 the study under subsection (a) and submit a report to 

5 Congress on the results of such study, including any rec6 ommendations. 

7 (c) DEFINITIONS.—In this subsection, the terms 

8 ‘‘emergency medical care’’ and ‘‘field EMS’’ have the 

9 meanings given such terms in section 1291 of the Public 

10 Health Service Act (as added by section 4). 

11 SEC. 10. FUNDING. 

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

13 Medical Services Trust Fund, there are authorized to be 

14 transferred to the Secretary of Health and Human Serv15 ices— 

16 (1) $12,000,000 for each of fiscal years 2016 

17 through 2021, for the purpose of carrying out the 

18 additional duties required under part I of the Public 

19 Health Service Act (as added by section 4); 

20 (2) $200,000,000 for each of fiscal years 2016 

21 through 2021, for the purpose of carrying out sec22 tion 1292 of the Public Health Service Act, as added 

23 by section 4; 

24 (3) $15,000,000 for each of fiscal years 2016 

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1 tion 1295 of the Public Health Service Act, as added 

2 by section 4; 

3 (4) $40,000,000 for each of fiscal years 2016 

4 through 2021, for the purpose of carrying out sec5 tion 7(a) of this Act and 938 of the Public Health 

6 Service Act, as added by section 7(b); and 

7 (5) $4,000,000 for each of fiscal years 2016 

8 through 2021, for the purpose of carrying out sec9 tion 3001(c)(9) of the Public Health Service Act 

10 with respect to the National EMS Information Sys11 tem, as added by section 5(a)(2). 

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

13 amounts in the Emergency Medical Services Trust Fund 

14 exceed the maximum amount authorized to be transferred 

15 under subsection (a), the Secretary of Health and Human 

16 Services may transfer such excess amounts for the purpose 

17 of carrying out section 330J, section 498D, section 7(a), 

18 and parts A, B, C, D, and H of title XII of the Public 

19 Health Service Act (42 U.S.C. 254c–15, 289g–4, 300d et 

20 seq., 300d–11 et seq., 300d–31 et seq., and 300d–81 et 

21 seq.). 

22 (c) START-UP FUNDING.— 

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

24 funds available to the Secretary of Health and 

25 Human Services for each of fiscal years 2016 and 


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1 2017, up to $40,000,000 may be used for carrying 

2 out the amendments made by sections 3 and 4. 

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

4 of discretionary funds allocated under paragraph (1) 

5 shall be in addition to, not in lieu of, the amount of 

6 discretionary funds that would otherwise be available 

7 for such purposes. 

8 (d) ADMINISTRATIVE EXPENSES.—Not more than 5 

9 percent of each amount made available under paragraphs 

10 (1) through (5) of subsection (a) may be used for adminis11 trative expenses. 

12 SEC. 11. STATUTORY CONSTRUCTION. 

13 Nothing in this Act, including the amendments made 

14 by this Act, shall be construed to supersede any statutory 

15 authority of any Federal agency that is not within the De16 partment of Health and Human Services. 

Æ 


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