```

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2366 Introduced in House (IH)]

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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Aligning ambulance reimbursement with value-based and high-
                            quality field EMS.
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.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Patients with emergency medical conditions depend upon 
        field emergency medical services (referred to in this section 
        as ``EMS'') for essential life-saving or unscheduled medical 
        care. All people in the United States should have access to and 
        receive high-quality emergency medical care as part of a 
        coordinated EMS system.
            (2) The Institute of Medicine, in its 2006 report 
        ``Emergency Medical Services at the Crossroads'', outlined its 
        vision of a 21st century emergency care system that is 
        integrated, regionalized, accountable, and prepared for both 
        routine emergency medical care and public health emergencies. 
        Such a modernized system would be characterized by a highly 
        trained and capable field EMS practitioner workforce that 
        delivers high-quality, evidence-based, innovative, value-based, 
        and patient-centered emergency care in the field and across the 
        emergency care continuum.
            (3) In such 2006 report, the Institute of Medicine also 
        outlined systemic problems plaguing field EMS that impede 
        achievement of a 21st century emergency care system, including 
        insufficient coordination, disparate response times, uncertain 
        quality of care, lack of readiness for disasters, divided 
        professional identity of field EMS practitioners, and a limited 
        evidence base for the emergency medical care provided in the 
        field.
            (4) To modernize the field EMS system, the Institute of 
        Medicine recommended that advancements be made in several 
        priority areas, including readiness, innovation, preparedness, 
        education and workforce development, safety, financing, 
        quality, standards, and research. The Institutes of Medicine 
        also recommended recognition of a lead programmatic Federal 
        agency for emergency medical services within the Department of 
        Health and Human Services to provide a more streamlined, cost-
        efficient, and comprehensive approach for field EMS, and a 
        focal point for practitioners and agencies to interface with 
        the Federal Government.
            (5) Under an amendment made by the Pandemic and All-Hazards 
        Preparedness Act (Public Law 109-417), the Secretary of Health 
        and Human Services is already established as the lead of all 
        Federal public health and medical response for public health 
        emergencies and incidents. Preparedness and capability to 
        deliver routine emergency medical care is a prerequisite for 
        preparedness and capability to respond to public health 
        emergencies and incidents.
            (6) In 2007, the Homeland Security Presidential Directive 
        HSPD-21 called for the establishment within the Department of 
        Health and Human Services of an Office for Emergency Medical 
        Care to lead an enterprise to promote and fund research in 
        emergency medicine and trauma care; promote regional 
        partnerships and more effective emergency medical systems in 
        order to enhance appropriate triage, distribution, and care of 
        routine community patients; and promote local, regional, and 
        State emergency medical systems' preparedness for and response 
        to public health events. Under the Directive, the Office would 
        address the full spectrum of issues that have an impact on care 
        in hospital emergency departments, including the entire 
        continuum of patient care from prehospital to disposition from 
        emergency or trauma care.
            (7) Properly functioning EMS systems encompass fully mobile 
        resources that are able to address patient needs 24 hours per 
        day, 7 days per week, 365 days a year. Field EMS serves as an 
        essential health care safety net by providing emergency, 
        urgent, and mobile medical care throughout the health care 
        continuum, including medical and trauma care provided in the 
        field, hospital, rehabilitation, and other settings. Ensuring 
        high-quality and cost-effective emergency medical services 
        systems requires readiness, preparedness, medical oversight, 
        and innovation throughout the continuum of emergency medical 
        care through Federal, State, and local multi-jurisdictional 
        collaboration and sufficient resources for EMS agencies and 
        practitioners.
            (8) Field EMS is the delivery of health care, not simply a 
        transportation benefit having evolved from a patient transport 
        model to a health care service delivery model that provides a 
        variety of targeted medical services to meet the specific needs 
        of their communities. This includes the development of 
        community paramedicine as a health care service provided by 
        field EMS agencies and mobile integrated health care as a 
        health care service provided collaboratively by a group of 
        health care providers in a community, including local field EMS 
        agencies. These new delivery models are filling gaps in patient 
        care identified by a community's health care providers, 
        including preventing recurrent medical episodes through 
        reliable post-discharge follow up and chronic disease 
        management. Facilitating reimbursement for such services, 
        including under the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.), is necessary to 
        the continued development and sustainability of such services.
            (9) Field EMS is uniquely positioned to support the 
        transformation of health care to a value and outcomes based 
        model to improve the patient experience and the health of 
        populations, and to reduce the per capita cost of health care. 
        Field EMS provides highly reliable patient assessment and 
        intervention at any hour of any day in response to urgent or 
        unscheduled episodes of illness or injury and effectively 
        navigates patients to ensure they receive the right care, in 
        the right place, and at the right time. Field EMS helps contain 
        health care costs by navigating the patient down a cost-
        effective pathway that is evidence-based.
            (10) Coordinated and high-quality field EMS is essential to 
        the Nation's security. Field EMS is an essential public service 
        provided by governmental and nongovernmental agencies and 
        practitioners every day and during catastrophic incidents. To 
        ensure disaster and all-hazards preparedness for field EMS 
        operations as part of the Nation's comprehensive disaster 
        preparedness, Federal funding for preparedness activities, 
        including catastrophic training and exercises, must be provided 
        to governmental and nongovernmental field EMS agencies to 
        ensure a greater capability within each of these areas.
            (11) The essential role of field EMS in disaster 
        preparedness and response must be incorporated into the 
        national preparedness and response strategy and implementation 
        as provided and overseen by the Department of Homeland Security 
        and the Department of Health and Human Services, pursuant to 
        their respective jurisdictions. Field EMS agencies must be 
        capable of meeting the routine emergency care needs of patients 
        to be capable of meeting the extraordinary medical needs during 
        a catastrophic event.

SEC. 3. ALIGNING AMBULANCE REIMBURSEMENT WITH VALUE-BASED AND HIGH-
              QUALITY FIELD EMS.

    (a) Field EMS Medicare Demonstration Program.--Section 1115A(b)(2) 
of the Social Security Act (42 U.S.C. 1315a(b)(2)) is amended--
            (1) in the last sentence of subparagraph (A), by inserting 
        ``, and shall include the model described in subparagraph (D)'' 
        before the period at the end; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Demonstration projects.--
                            ``(i) In general.--The model described in 
                        this subparagraph is a demonstration program 
                        under title XVIII. Beginning not later than 2 
                        years after the date of the enactment of the 
                        Field EMS Modernization and Innovation Act, the 
                        CMI shall conduct not less than 10 
                        demonstration projects to--
                                    ``(I) evaluate the implementation 
                                and reimbursement of alternative 
                                dispositions of field EMS patients, 
                                including--
                                            ``(aa) transporting 
                                        individuals by ambulance to 
                                        alternate destinations when 
                                        medically appropriate and in 
                                        the individual's best 
                                        interests;
                                            ``(bb) when medically 
                                        necessary, evaluating, 
                                        treating, or referring 
                                        individuals to other medically 
                                        appropriate providers; and
                                            ``(cc) when medically 
                                        appropriate, treating 
                                        individuals through community 
                                        paramedicine or mobile 
                                        integrated healthcare services;
                                    ``(II) evaluate the implementation 
                                of alternative reimbursement models, 
                                including models based on readiness 
                                rather than transport or shared 
                                savings; and
                                    ``(III) determine whether such 
                                alternative dispositions and 
                                reimbursement models--
                                            ``(aa) improve the safety, 
                                        effectiveness, timeliness, and 
                                        efficiency of emergency medical 
                                        services; and
                                            ``(bb) reduce overall 
                                        utilization and expenditures 
                                        under title XVIII.
                            ``(ii) Evidence-based protocols.--The CMI 
                        shall ensure that at least one demonstration 
                        project under this subparagraph evaluates 
                        evidence-based protocols that give guidance on 
                        selection of the destination to which 
                        individuals are transported.
                            ``(iii) Duration.--The duration of a 
                        demonstration project under this subparagraph 
                        shall not exceed 3 years.
                            ``(iv) Research.--The Secretary shall 
                        conduct or support further research that the 
                        Secretary determines to be necessary prior to, 
                        or in conjunction with, the demonstration 
                        projects under this subparagraph in order to 
                        evaluate the implementation of alternative 
                        dispositions of, and reimbursement models for 
                        transport of, field EMS patients.
                            ``(v) Report to congress.--Not later than 1 
                        year after the completion of all demonstration 
                        projects under this subparagraph, the Secretary 
                        shall include in the annual report to Congress 
                        required under subsection (g) a report on the 
                        results of the projects conducted under this 
                        subparagraph, including information about the 
                        efficacy of alternative disposition of, and 
                        reimbursement models for transport of, field 
                        EMS patients.
                            ``(vi) Definition of field ems.--In this 
                        subparagraph, the terms `community 
                        paramedicine', `field EMS', `mobile integrated 
                        healthcare', and `readiness' shall have the 
                        meanings given such terms in section 1291 of 
                        the Public Health Service Act.''.
    (b) Field EMS Alternative Delivery Program.--Section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)) is amended by adding at the 
end the following new paragraph:
            ``(16) Field ems alternative delivery program.--
                    ``(A) In general.--Not later than 3 years after the 
                date of the enactment of this paragraph, the Secretary 
                shall establish the Field EMS Alternative Delivery 
                Program to establish and promote the utilization of 
                innovative payment models, including the models 
                described in subparagraph (D), on a shared savings and 
                voluntary basis, taking into consideration the results 
                of the evaluation of models under subparagraph (G) and 
                the demonstration projects conducted under section 
                1115A(b)(2)(D). To the extent that the Secretary 
                ascertains that an innovative payment model has been 
                sufficiently demonstrated through the private sector or 
                through the Center for Medicare and Medicaid Innovation 
                under section 1115A and does not need to be evaluated 
                under subparagraph (G), the Secretary may establish 
                such innovative payment model on a shared savings and 
                budget neutral basis pursuant to this subparagraph.
                    ``(B) Voluntary nature of participation.--Providers 
                and suppliers of ground ambulance services may 
                voluntarily opt to utilize innovative payment models 
                under the Field EMS Alternative Delivery Program. 
                Nothing in this subparagraph shall be construed as 
                authorizing the Secretary to require participation in 
                any innovative payment model under the Program.
                    ``(C) Budget neutrality.--The Secretary shall 
                implement the innovative payment models under this 
                subparagraph in a budget neutral manner such that the 
                cost of implementation of such models shall not exceed 
                the amount that otherwise would have been provided in 
                reimbursement under this title if such models had not 
                been implemented.
                    ``(D) Types of models.--The following models are 
                described in this clause:
                            ``(i) Community paramedicine that allows 
                        for payment for health care assessment and 
                        prevention services, or other care management 
                        services.
                            ``(ii) Mobile integrated healthcare 
                        services that allow for health care assessment 
                        and prevention services, or other care 
                        management services within an integrated 
                        program of patient care.
                            ``(iii) Alternate patient dispositions 
                        regardless of transport to the hospital, 
                        including transport to alternate destinations 
                        and other patient dispositions such as treating 
                        and referring patients to appropriate follow up 
                        care. Such alternate dispositions, including 
                        alternate destinations and treat and refer 
                        dispositions, would be subject to the 
                        discretion of the physician medical director 
                        responsible for providing medical oversight.
                            ``(iv) The provision of field EMS and 
                        reimbursement on a population health basis, 
                        such as through global capitation.
                            ``(v) Prevention-based models, such as 
                        injury prevention through home evaluations for 
                        fall prevention or infection control.
                            ``(vi) Critical care models, particularly 
                        in geographic areas without proximate access to 
                        hospital-based critical care, and including a 
                        model that enables patient stabilization by 
                        critical care transport teams with telemedicine 
                        support for maintaining the patient in the 
                        patient's community.
                            ``(vii) Any other innovative shared savings 
                        model the Secretary determines relevant 
                        pursuant to subparagraph (G).
                    ``(E) Quality reporting.--As a condition of 
                participation in the Field EMS Alternative Delivery 
                Program, providers and suppliers of ground ambulance 
                services shall participate in the Ambulance Quality 
                Incentive Program described in paragraph (17).
                    ``(F) Medical oversight.--The Secretary shall 
                specify and require appropriate medical oversight with 
                regard to the development, demonstration, and 
                implementation of innovative payment models under this 
                paragraph to ensure high-quality care and patient 
                safety.
                    ``(G) Development and evaluation of models.--
                            ``(i) In general.--The Secretary, in 
                        consultation with the Assistant Secretary for 
                        Preparedness and Response and taking into 
                        consideration the recommendations of the 
                        National EMS Advisory Council and the Federal 
                        Interagency Committee on EMS, shall undertake 
                        the development and evaluation of innovative 
                        models of field EMS delivery and reimbursement.
                            ``(ii) Evaluation of innovative model 
                        options.--
                                    ``(I) In general.--Not later than 1 
                                year after the date of the enactment of 
                                the Field EMS Modernization and 
                                Innovation Act, the Secretary shall 
                                complete an evaluation of--
                                            ``(aa) the provision of and 
                                        reimbursement for alternative 
                                        delivery models for medical 
                                        care through field EMS; and
                                            ``(bb) the integration of 
                                        field EMS patients with other 
                                        medical providers and 
                                        facilities as medically 
                                        appropriate.
                                    ``(II) Considerations.--In 
                                completing the evaluation under 
                                subclause (I), the Secretary shall 
                                consider the following:
                                            ``(aa) Alternative 
                                        dispositions of patients, 
                                        including--

                                                    ``(AA) transporting 
                                                individuals by 
                                                ambulance to 
                                                destinations other than 
                                                a hospital, such as the 
                                                office of the physician 
                                                of the individual, an 
                                                urgent care center, or 
                                                the facility of another 
                                                health care provider;

                                                    ``(BB) when 
                                                medically necessary, 
                                                the evaluation, 
                                                treatment, or referral 
                                                of individuals to other 
                                                medically appropriate 
                                                health care providers;

                                                    ``(CC) the 
                                                provision of medical 
                                                care regardless of the 
                                                decision to transport, 
                                                such as reimbursement 
                                                models based on 
                                                readiness rather than 
                                                transport and shared 
                                                savings; and

                                                    ``(DD) the 
                                                provision of health 
                                                care using patient-
                                                centered mobile 
                                                resources in the out-
                                                of-hospital 
                                                environment, such as 
                                                community paramedicine 
                                                and mobile-integrated 
                                                health care services.

                                            ``(bb) Issues related to 
                                        medical liability and the 
                                        requirements of section 1867 
                                        (commonly referred to as 
                                        `EMTALA') associated with 
                                        transport to destinations other 
                                        than a hospital emergency 
                                        department.
                                            ``(cc) Necessary 
                                        protections to ensure that 
                                        patients receive timely and 
                                        appropriate care in the 
                                        appropriate setting, including 
                                        ongoing quality improvement and 
                                        appropriate physician medical 
                                        oversight.
                                            ``(dd) Whether there are 
                                        any barriers to providing 
                                        alternate dispositions to 
                                        individuals who are not in need 
                                        of hospital-based care.
                                            ``(ee) Other reimbursement 
                                        related issues that span 
                                        multiple delivery models 
                                        including the cost of 
                                        demonstrated evidence-based 
                                        care, such as 12-lead 
                                        electrocardiograms and 
                                        continuous positive airway 
                                        pressure, early recognition of 
                                        time dependent diseases, such 
                                        as stroke and sepsis, and 
                                        trauma, and providing high-
                                        quality appropriate physician 
                                        medical oversight.
                                            ``(ff) Other issues, as 
                                        determined by the Secretary, 
                                        including, when practicable, 
                                        issues recommended by the 
                                        Assistant Secretary for 
                                        Preparedness and Response, the 
                                        National EMS Advisory Council, 
                                        and the Federal Interagency 
                                        Committee on EMS for evaluation 
                                        under this subparagraph.
                    ``(H) Definitions.--In this paragraph, the terms 
                `community paramedicine', `field EMS', `medical 
                oversight', and `mobile integrated healthcare' have the 
                meanings given such terms in section 1291 of the Public 
                Health Service Act.''.
    (c) Ambulance Quality Incentive Program.--Section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)), as amended by subsection (a), 
is further amended by adding at the end the following new paragraph:
            ``(17) Ambulance quality incentive program.--
                    ``(A) In general.--Not later than January 1 of the 
                first fiscal year that begins on or after the date that 
                is 3 years after the date of the enactment of this 
                paragraph, the Secretary shall establish an Ambulance 
                Quality Incentive Program under which providers and 
                suppliers of ground ambulance services under this 
                subsection may receive incentive payments from the 
                amount made available under subparagraph (F) for 
                reporting on the quality measures identified by the 
                Secretary under subparagraph (B).
                    ``(B) Quality measures.--
                            ``(i) In general.--The Secretary shall, by 
                        regulation, identify quality measures that have 
                        been endorsed by the entity with a contract 
                        under section 1890(a). Such measures shall 
                        include outcome and patient safety measures and 
                        be relevant to the provision of field emergency 
                        medical response and mobile medical care.
                            ``(ii) Exception.--In the case of a 
                        specified area or medical topic determined 
                        appropriate by the Secretary for which a 
                        feasible and practical measure has not been 
                        endorsed by the entity with a contract under 
                        section 1890(a), the Secretary may specify a 
                        measure that is not so endorsed as long as due 
                        consideration is given to measures that have 
                        been endorsed or adopted by a consensus 
                        organization identified by the Secretary.
                            ``(iii) Revising quality measures.--Subject 
                        to clause (iv), the Secretary may, by 
                        regulation, revise quality measures identified 
                        under this paragraph on an annual basis.
                            ``(iv) Timeframe.--The Secretary shall 
                        publish the quality measures that will apply to 
                        a fiscal year not later than January 1 of the 
                        preceding fiscal year.
                    ``(C) Voluntary nature of reporting.--Participation 
                in the Ambulance Quality Incentive Program is voluntary 
                for providers and suppliers electing not to participate 
                in the Field EMS Alternative Delivery Program.
                    ``(D) Consultation.--In carrying out the provisions 
                of this paragraph (including in developing and revising 
                the quality measures identified in subparagraph (B)), 
                the Secretary shall--
                            ``(i) solicit the input of relevant 
                        stakeholders;
                            ``(ii) use the notice and comment 
                        procedures provided in section 553 of title 5, 
                        United States Code; and
                            ``(iii) take into account prior investments 
                        in technology systems to enable participation 
                        in the program with minimal additional capital 
                        investments.
                    ``(E) Public availability of data submitted.--The 
                Secretary shall establish procedures for making data 
                submitted under this paragraph available to the public 
                on the website of the Centers for Medicare & Medicaid 
                Services. Such procedures shall ensure that a supplier 
                or provider has the opportunity to review the data that 
                is to be made public with respect to the supplier or 
                provider prior to such data being made public.
                    ``(F) Budget neutral funding.--
                            ``(i) In general.--The amount available for 
                        making payments under this paragraph for any 
                        fiscal year shall be equal to the amount of 
                        savings for the preceding fiscal year resulting 
                        from the Field EMS Alternative Delivery Program 
                        described in paragraph (16), as determined by 
                        the Secretary.
                            ``(ii) Priority for participants in field 
                        ems alternative delivery program.--To the 
                        extent that funds are available for making 
                        payments under this paragraph for a fiscal 
                        year, the Secretary shall ensure that--
                                    ``(I) providers and suppliers who 
                                participated in the program established 
                                under paragraph (16) in the preceding 
                                fiscal year are paid before other 
                                providers and suppliers; and
                                    ``(II) providers and suppliers who 
                                did not participate in the program 
                                established under paragraph (16) in the 
                                preceding fiscal year may only receive 
                                payments if there are any funds 
                                remaining after the application of 
                                subclause (I).''.

SEC. 4. FIELD EMERGENCY MEDICAL SERVICES.

    (a) In General.--Title XII of the Public Health Service Act (42 
U.S.C. 300d et seq.) is amended by adding at the end the following:

               ``PART I--FIELD EMERGENCY MEDICAL SERVICES

``SEC. 1291. DEFINITIONS.

    ``In this part:
            ``(1) The term `ambulance diversion' means the practice of 
        hospitals denying access to an incoming ambulance and 
        requesting that the ambulance proceed to another facility due 
        to a stated lack of capacity at the initial facility, resulting 
        in delayed access to definitive care.
            ``(2) The term `community paramedicine' means a health care 
        service provided by a field EMS agency for the provision of 
        cost-effective health care assessment and prevention services 
        to fill gaps in the local health care system.
            ``(3) The term `emergency medical response' means--
                    ``(A) medical care provided to patients with 
                emergency medical conditions prior to or outside a 
                medical facility;
                    ``(B) emergency medical dispatch, rapid response, 
                and urgent or unscheduled patient assessment and 
                intervention;
                    ``(C) emergency, critical care, and inter-facility 
                and air medical transport; or
                    ``(D) telephone consultation to 911 callers as an 
                alternative to ambulance dispatch, or other requests 
                through a public safety answering point.
            ``(4) The term `emergency medical services' means emergency 
        medical care, trauma care, and related services provided to 
        patients at any point in the continuum of health care services, 
        including emergency medical dispatch and emergency medical 
        care, trauma care, and related services provided in the field, 
        during transport, or in a medical facility or other clinical 
        setting.
            ``(5) The term `FICEMS' means the Federal Interagency 
        Committee on Emergency Medical Services.
            ``(6) The term `field EMS' means emergency medical response 
        and mobile medical services provided prior to or outside a 
        medical facility.
            ``(7) The term `field EMS agency' means an organization 
        providing field EMS, including--
                    ``(A) governmental (including fire-based agencies), 
                nongovernmental (including hospital based or private 
                agencies), and volunteer organizations; and
                    ``(B) organizations that provide field EMS by 
                ground, air, or otherwise.
            ``(8) The term `field EMS practitioner' means an individual 
        licensed and credentialed to provide emergency and mobile 
        medical care to patients within the scope of such individual's 
        practice.
            ``(9) The term `medical oversight' means the supervision by 
        a physician of the medical aspects of a field EMS system or 
        agency and its practitioners, including prospective, 
        concurrent, and respective components of field EMS and the 
        education of field EMS practitioners.
            ``(10) The term `mobile integrated health care' means a 
        health care service that is undertaken collaboratively by a 
        group of health care providers, including the local field EMS 
        agency, in a community, for the provision of medical care to 
        fill gaps in the local health care system.
            ``(11) The term `mobile medical services' means preventive 
        medical assessment and care, chronic disease assessment and 
        management support, post-discharge follow-up assessment and 
        management support, and post-assessment patient transport, 
        arranged transportation, or referral to other community health 
        or social service resources.
            ``(12) The term `NEMSAC' means the National Emergency 
        Medical Services Advisory Council.
            ``(13) The term `NEMSIS' means the National EMS Information 
        System.
            ``(14) The term `NHTSA' means the National Highway Traffic 
        Safety Administration.
            ``(15) The term `patient parking' means the practice by 
        hospitals of refusing to accept transfer of a patient's care 
        from an ambulance crew until a regular emergency department bed 
        is available, requiring the crew to continue to provide patient 
        care on the ambulance stretcher rather than in a patient bed in 
        the hospital, until hospital staff will accept the transfer of 
        care, resulting in delayed access to definitive care for the 
        patient and denied access to emergency care for the community 
        served by the field EMS Agency.
            ``(16) The term `readiness' means the standby costs of 
        preparedness to respond to a health care need, 24 hours a day, 
        7 days a week, 365 days a year.
            ``(17) The term `State EMS Office' means an office 
        designated by the State with primary responsibility for 
        oversight of the State's emergency medical services system, 
        such as responsibility for oversight of field EMS coordination, 
        licensing or certifying field EMS practitioners, and emergency 
        medical services system improvement.

``SEC. 1292. FIELD EMS PREPAREDNESS FOR PUBLIC HEALTH EMERGENCIES AND 
              OTHER INCIDENTS.

    ``(a) In General.--The Assistant Secretary for Preparedness and 
Response shall establish the Field EMS Preparedness Program to be 
administered by the Office of Emergency Medical Care for the purpose of 
improving field EMS agency all-hazards readiness and preparedness and 
public health emergencies and incidents.
    ``(b) Application.--
            ``(1) In general.--To be eligible to receive a grant under 
        this section, an eligible entity shall submit an application to 
        the Assistant Secretary for Preparedness and Response in such 
        form and manner, and containing such agreements, assurances, 
        and information as such Assistant Secretary requires.
            ``(2) Simple form.--The Assistant Secretary for 
        Preparedness and Response shall ensure that grant application 
        requirements are not unduly burdensome to smaller and volunteer 
        field EMS agencies or other agencies with limited resources.
            ``(3) Consistency with preparation goals.--The Assistant 
        Secretary for Preparedness and Response shall ensure that grant 
        applications are consistent with national and relevant State 
        preparedness plans and goals.
    ``(c) Use of Funds.--Grants may be used by eligible entities to 
achieve the preparedness goals described under paragraphs (1), (3), 
(4), (5), (6), and (8) of section 2802(b) with respect to all-hazards, 
including chemical, biological, radiological, or nuclear threats, 
including the purchase of equipment, training, and supplies.
    ``(d) Administration of Grants.--In carrying out this section, the 
Assistant Secretary for Preparedness and Response--
            ``(1) shall establish a grantmaking process that includes--
                    ``(A) prioritization for the awarding of grants to 
                eligible entities and consideration of the factors in 
                reviewing grant applications by eligible entities, 
                including--
                            ``(i) demonstrated financial need for 
                        funding;
                            ``(ii) utilization of public and private 
                        partnerships;
                            ``(iii) improving the availability of field 
                        EMS in underserved regions to enhance the 
                        capability for medical response to public 
                        health emergencies and incidents;
                            ``(iv) unique needs of volunteer and rural 
                        field EMS agencies;
                            ``(v) distribution among a variety of 
                        geographic areas, including urban, suburban, 
                        and rural;
                            ``(vi) distribution of funds among types of 
                        field EMS agencies, including governmental, 
                        nongovernmental, and volunteer agencies;
                            ``(vii) implementation of regionalized 
                        systems of medical response to public health 
                        emergencies and incidents; and
                            ``(viii) such other factors as the 
                        Assistant Secretary for Preparedness and 
                        Response determines necessary;
                    ``(B) a peer-reviewed process to recommend grant 
                allocations in accordance with the prioritization 
                established under subparagraph (A), except that final 
                award determinations shall be made by the Assistant 
                Secretary for Preparedness and Response; and
                    ``(C) the provision of grant awards to eligible 
                entities on an annual basis, except that the Assistant 
                Secretary for Preparedness and Response may reserve not 
                more than 25 percent of the available appropriations 
                for multiyear grants and no grant award may exceed a 2-
                year period; and
            ``(2) shall consult with and take into consideration the 
        recommendations of the FICEMS, NEMSAC, and relevant 
        stakeholders.
    ``(e) Eligibility.--To be eligible to receive a grant under this 
section, an entity shall be a field EMS agency that--
            ``(1) is licensed by or otherwise authorized in the State 
        in which it operates; and
            ``(2) has medical oversight and quality improvement 
        programs, as determined by the Assistant Secretary for 
        Preparedness and Response.
    ``(f) Required Use of Medical Oversight Guidelines.--As a condition 
on receipt of a grant under this section, the Assistant Secretary for 
Preparedness and Response shall require each grant recipient to adopt 
and implement (to the extent applicable) the guidelines promoted, 
developed, and disseminated under subparagraphs (B) and (C) of 
subsection (a)(1) of section 1293 with regard to medical oversight.
    ``(g) Annual Report.--The Assistant Secretary for Preparedness and 
Response shall submit an annual report on the Field EMS Preparedness 
Program under this section to Congress.

``SEC. 1293. FIELD EMS QUALITY IMPROVEMENT.

    ``(a) Enhancing Physician Medical Oversight.--
            ``(1) In general.--To improve medical oversight of field 
        EMS and ensure continuity and quality for such medical 
        oversight, the Assistant Secretary for Preparedness and 
        Response shall--
                    ``(A) promote high-quality and comprehensive 
                medical oversight of--
                            ``(i) all medical care provided by field 
                        EMS practitioners; and
                            ``(ii) the education and training of field 
                        EMS practitioners;
                    ``(B) promote the development, adoption, and 
                utilization of national guidelines for the role of 
                physicians who provide medical oversight for field EMS 
                and other health care providers who support physicians 
                in such role;
                    ``(C) support efforts of relevant physician 
                stakeholders in developing and disseminating guidelines 
                for use by field EMS medical directors and field EMS 
                practitioners on a national basis; and
                    ``(D) convene a Field EMS Medical Oversight 
                Advisory Committee, comprised of representatives of 
                relevant physician stakeholders, to advise the 
                Assistant Secretary for Preparedness and Response on 
                ways and means to advance and support development and 
                maintenance of quality medical oversight throughout the 
                Nation's systems for field EMS.
            ``(2) Additional considerations.--In carrying out 
        subparagraphs (B) and (C) of paragraph (1), the Assistant 
        Secretary for Preparedness and Response shall take into 
        consideration--
                    ``(A) existing guidelines developed by national 
                professional physician associations, States, and other 
                relevant governmental or nongovernmental entities;
                    ``(B) the input of other relevant stakeholders, 
                including health care providers who support physicians 
                who provide medical oversight for field EMS; and
                    ``(C) the unique needs associated with medical 
                oversight of provision of field EMS in rural areas or 
                by volunteers.
            ``(3) Flexibility.--The guidelines promoted, developed, and 
        disseminated under subparagraphs (B) and (C) of paragraph (1) 
        shall ensure high-quality training, credentialing, and 
        direction in connection with medical oversight of field EMS at 
        the State, regional, and local levels while providing 
        sufficient flexibility to account for historical and legitimate 
        differences in field EMS among States, regions, and localities.
    ``(b) Patient Safety Improvement.--Field EMS agencies and 
practitioners shall be eligible to participate in the activities of 
patient safety organizations for the purpose of improving patient 
safety and the quality of health care delivery.
    ``(c) Analysis of Data Gaps That Hinder High-Quality Field EMS 
Care.--
            ``(1) In general.--Not later than 1 year after the date of 
        the enactment of the Field EMS Modernization and Innovation 
        Act, the Secretary, acting through the Assistant Secretary for 
        Preparedness and Response, shall submit to Congress a report 
        that--
                    ``(A) identifies gaps in the collection of data 
                related to the provision of field EMS; and
                    ``(B) includes recommendations for improving the 
                collection, reporting, and analysis of such data, and 
                integration of such data with other health care data.
            ``(2) Recommendations.--The recommendations included in the 
        report in accordance with paragraph (1)(B) shall--
                    ``(A) take into consideration the recommendations 
                of FICEMS, NEMSAC, and relevant stakeholders;
                    ``(B) recommend methods for improving data 
                collection, reporting, and analysis without unduly 
                burdening reporting entities and without duplicating 
                existing data sources (such as data collected by the 
                National Trauma Data Bank);
                    ``(C) address the quality and availability of data, 
                and linkages with existing patient registries, related 
                to the provision of field EMS and utilization of field 
                EMS with respect to a variety of illnesses and injuries 
                (in both the everyday provision of field EMS and 
                catastrophic or disaster response), including--
                            ``(i) cardiac events such as chest pain, 
                        sudden cardiac arrest, and ST-segment elevation 
                        myocardial infarction;
                            ``(ii) stroke;
                            ``(iii) trauma;
                            ``(iv) disaster and catastrophic incidents, 
                        such as incidents related to terrorism or 
                        natural or manmade disasters; and
                            ``(v) ambulance diversion and patient 
                        parking;
                    ``(D) include an analysis of the variety of 
                services provided by field EMS agencies; and
                    ``(E) any recommendations that require statutory 
                authorization from Congress.
            ``(3) Implementation of recommendations with existing 
        statutory authority.--The Secretary, acting through the Office 
        of the National Coordinator for Health Information Technology, 
        shall implement such recommendations for data collection to the 
        extent that such authority exists and does not require further 
        statutory authorization from Congress.

``SEC. 1294. ACCOUNTABILITY FOR FIELD EMS SYSTEM PERFORMANCE.

    ``(a) Development of Field EMS Quality and System Performance 
Measures.--The Assistant Secretary for Preparedness and Response shall 
support--
            ``(1) further development and refinement of measures to be 
        utilized under the Ambulance Quality Incentive Program, as 
        appropriate, including--
                    ``(A) quality measures to improve accountability 
                for patient outcomes in field EMS; and
                    ``(B) performance measures to enhance the 
                measurement of field EMS system performance; and
            ``(2) a technical assistance center to provide assistance 
        and education to field EMS agencies, physician medical 
        directors, and practitioners to participate effectively in 
        quality and performance improvement programs.
    ``(b) Clarification of HIPAA.--
            ``(1) Exchange of information related to the treatment of 
        patients.--
                    ``(A) In general.--Nothing in HIPAA privacy and 
                security law (as defined in section 3009(a)(2)) shall 
                be construed as prohibiting the exchange of information 
                between field EMS practitioners treating an individual 
                and personnel of a hospital to which the individual has 
                been treated for the purposes of relating information 
                on the medical history, treatment, care, and outcome of 
                such individual (including any health care personnel 
                safety issues, such as infectious disease).
                    ``(B) Guidelines.--The Secretary shall establish 
                guidelines for exchanges of information between field 
                EMS practitioners treating an individual and personnel 
                of a hospital to which the individual has been treated 
                to protect the privacy of the individual while ensuring 
                the ability of such field EMS practitioners and 
                hospital personnel to communicate effectively to 
                further the continuity and quality of medical care 
                provided to such individual.
            ``(2) NEMSIS data.--Nothing in HIPAA privacy and security 
        law (as defined in section 3009(a)(2)) shall be construed as 
        prohibiting the exchange of non-individually identifiable data 
        between the field EMS agency, a State, and the Federal 
        Government, including the exchange of information by--
                    ``(A) a field EMS agency to the State EMS Office 
                for the purpose of quality improvement and data 
                collection by the State for submission to NEMSIS; or
                    ``(B) the State EMS Office to the National EMS 
                Database maintained by Assistant Secretary for 
                Preparedness and Response.

``SEC. 1295. FIELD EMS WORKFORCE DEVELOPMENT.

    ``(a) In General.--For the purpose of promoting field EMS as a 
health profession and ensuring the availability, quality, and 
capability of field EMS educators, practitioners, managers, and medical 
directors, the Assistant Secretary for Preparedness and Response shall 
make grants to eligible entities for the development, availability, and 
dissemination of field EMS education programs and courses that improve 
the quality and capability of field EMS practitioners, educators, 
managers, and physician medical directors. In carrying out this 
section, the Assistant Secretary for Preparedness and Response shall 
take into consideration recommendations of FICEMS, NEMSAC, and relevant 
stakeholders.
    ``(b) Eligibility.--In this section, the term `eligible entity' 
means an educational organization, an educational institution, a 
professional association, or any other entity involved in and 
experienced with the education of field EMS practitioners, physician 
medical directors, field EMS managers and administrators, and field EMS 
educators.
    ``(c) Use of Funds.--The Assistant Secretary for Preparedness and 
Response may award a grant to an eligible entity under paragraph (1) 
only if the entity agrees to use the grant to--
            ``(1) develop and implement education programs to--
                    ``(A) train field EMS instructors and promote the 
                adoption and implementation of the education standards 
                identified in the `Emergency Medical Services Education 
                Agenda for the Future: A Systems Approach', including 
                any revisions thereto or successor standards;
                    ``(B) provide training for information system 
                workers, such as information security, forensic 
                analysts, data analysts, network engineers, and similar 
                roles to work in support of field EMS data systems; or
                    ``(C) provide training and retraining programs that 
                prepare displaced workers to enter a field EMS 
                profession, including veterans and military EMS 
                practitioners;
            ``(2) develop and implement educational courses pertaining 
        to--
                    ``(A) improving the provision of quality medical 
                oversight of field EMS;
                    ``(B) expanding the knowledge and skills of field 
                EMS practitioners, including those needed to provide 
                community paramedicine and mobile integrated health 
                care;
                    ``(C) undertaking field EMS educational and 
                clinical research to develop investigators;
                    ``(D) tactical training for field EMS; or
                    ``(E) developing and expanding field EMS 
                undergraduate and graduate programs;
            ``(3) evaluate education and training courses and 
        methodologies to identify optimal educational modalities for 
        field EMS practitioners;
            ``(4) enhance the opportunity for medical direction 
        training and for promoting appropriate medical oversight of 
        field emergency medical care; or
            ``(5) carry out such other activities as the Assistant 
        Secretary for Preparedness and Response determines appropriate.
    ``(d) Priority.--The Assistant Secretary for Preparedness and 
Response, in consultation with relevant stakeholders, and taking into 
consideration the recommendations of FICEMS and NEMSAC, shall establish 
a system of prioritization in awarding grants under this section to 
eligible entities.
    ``(e) Duration of Grants.--Grants under this section shall be for a 
period of 1 to 3 years.
    ``(f) Application.--The Assistant Secretary for Preparedness and 
Response may not award a grant to an eligible entity under this section 
unless the entity submits an application to such Assistant Secretary in 
such form, in such manner, and containing such agreements, assurances, 
and information as the Assistant Secretary may require. The Assistant 
Secretary for Preparedness and Response shall ensure that the 
requirements for submitting an application under this section are not 
unduly burdensome.

``SEC. 1296. NATIONAL EMERGENCY MEDICAL SERVICES STRATEGY.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Preparedness and Response, shall develop and implement a 
cohesive national emergency medical services strategy to strengthen the 
development of field EMS and the full continuum of emergency medical 
care and systems at the Federal, State, and local levels to improve 
patient outcomes and access to high-quality care in the field and 
develop financing models that support the evolution of value-based 
emergency medical care. In establishing such a strategy, the Assistant 
Secretary for Preparedness and Response shall--
            ``(1) solicit and consider the 2007 and subsequent 
        recommendations of the Institute of Medicine, the National EMS 
        Advisory Council, and relevant stakeholders;
            ``(2) consult and collaborate with the Federal Interagency 
        Committee on EMS to ensure consistency of such national 
        emergency medical services strategy within the larger Federal 
        strategy regarding national preparedness and response;
            ``(3) address issues related to emergency medical services 
        system development, including--
                    ``(A) the regionalization of field EMS, trauma, and 
                emergency medical services, particularly for time 
                sensitive conditions such as trauma, ST-Segment 
                Elevation Myocardial Infarction, stroke, neonatal 
                patients, and poisonings;
                    ``(B) the availability of field EMS and trauma care 
                and emergency medical services throughout the Nation;
                    ``(C) the integration of emergency medical care 
                from the perspective of patients across the emergency 
                care continuum, and accountability for system 
                performance; and
                    ``(D) financing of field EMS agencies, including 
                appropriate medical oversight;
            ``(4) promote the professional development of field EMS 
        practitioners to deliver high-quality field EMS, including the 
        adoption by States of the education standards identified in the 
        National EMS Education Standards and any revisions thereto or 
        successor standards, including the standardization of licensing 
        of field EMS practitioners and standards of care in accordance 
        with the National EMS Scope of Practice Model and based on best 
        practices and evidence-based medicine, including by--
                    ``(A) identifying differences in the levels of 
                care, scope of practice, and licensure requirements 
                among the States; and
                    ``(B) encouraging States to adopt national minimum 
                standards for such levels of care and licensure 
                requirements;
            ``(5) promote a culture of safety, including through--
                    ``(A) the establishment of field EMS patient and 
                practitioner safety goals and the specific means to 
                improve field EMS practitioner and patient safety to 
                achieve such goals; and
                    ``(B) the adoption of uniform national ambulance 
                vehicle safety and manufacturing standards;
            ``(6) support the development of value-based reimbursement 
        for new mobile resources and models of delivery that support 
        the transformation of health care, including the full 
        utilization of field EMS to deliver emergency medical response 
        and mobile medical services including--
                    ``(A) community paramedicine for the provision of 
                cost-effective health care assessment and prevention 
                services;
                    ``(B) mobile integrated health care undertaken 
                collaboratively by a group of providers in a community, 
                including local field EMS agencies, to fill gaps in the 
                local health care system;
                    ``(C) integrated injury prevention strategies or 
                programs; and
                    ``(D) such other issues as the Secretary considers 
                appropriate;
            ``(7) incorporate into such strategy preparedness and 
        response objectives identified in the National Health Security 
        Strategy under section 2802 in order--
                    ``(A) to ensure the capability and capacity of the 
                full spectrum of field EMS to respond to terrorist 
                attacks, disasters, catastrophic events, and mass 
                casualty events; and
                    ``(B) to coordinate with the Secretary of Homeland 
                Security accordingly;
            ``(8) promote research in emergency medical services and 
        coordination across Federal agencies undertaking such research, 
        taking into consideration the National EMS Research Agenda;
            ``(9) complete the development of such strategy not later 
        than 18 months after the date of enactment of the Field EMS 
        Modernization and Innovation Act;
            ``(10) communicate such strategy to the relevant 
        congressional committees of jurisdiction;
            ``(11) implement such strategy, to the extent practicable, 
        not later than 3 years after the date of enactment of the Field 
        EMS Modernization and Innovation Act; and
            ``(12) update such strategy not less than every 3 years.

``SEC. 1297. OFFICE OF EMERGENCY MEDICAL CARE.

    ``(a) Establishment of Office.--Pursuant to paragraph 41 of 
Homeland Security Presidential Directive HSPD-21, dated October 18, 
2007, the Secretary shall establish an Office of Emergency Medical Care 
under the direct authority of the Assistant Secretary for Preparedness 
and Response, to carry out all of the responsibilities described in 
such paragraph of such directive.
    ``(b) Functions.--The Assistant Secretary for Preparedness and 
Response, acting through the Office of Emergency Medical Care, shall 
administer the emergency medical services activities and programs under 
this part and the trauma programs under parts A through D and H and 
shall--
            ``(1) promote and fund research in emergency medicine and 
        trauma health care;
            ``(2) promote regional partnerships and effective emergency 
        medical systems in order to enhance appropriate triage, 
        distribution, and care of routine community patients;
            ``(3) promote local, regional, and State emergency medical 
        systems preparedness for and response to public health events;
            ``(4) address the full spectrum of issues that have an 
        impact on care in emergency departments, including the entire 
        continuum of patient care from prehospital to disposition from 
        emergency or trauma care; and
            ``(5) coordinate with existing executive departments and 
        agencies that perform functions related to emergency medical 
        systems in order to ensure unified strategy, policy, and 
        implementation.
    ``(c) Functions, Personnel, Assets, Liabilities, and Administrative 
Actions.--All functions, personnel, assets, and liabilities of, and 
administrative actions applicable to, the Emergency Care Coordination 
Center, as in existence on the day before the date of the enactment of 
the Field EMS Modernization and Innovation Act, shall be transferred to 
the Office of Emergency Medical Care established under subsection 
(a).''.
    (b) Inclusion of Field EMS in Patient Safety Improvement.--Section 
921(8)(A) of the Public Health Service Act (42 U.S.C. 299b-21(8)(A)) is 
amended--
            (1) in clause (i), by inserting ``field EMS agency (as 
        defined in section 1291),'' after ``clinical laboratory,''; and
            (2) in clause (ii), by inserting ``field EMS (as defined in 
        section 1291) medical director, emergency medical technician,'' 
        after ``pharmacist,''.

SEC. 5. INTEGRATION OF FIELD EMS INTO THE NATIONAL HEALTH INFORMATION 
              INFRASTRUCTURE.

    (a) National EMS Information System.--
            (1) Transfer of authority.--The authority for the 
        administration of the National EMS Information System, 
        including the National EMS Database, shall be transferred from 
        NHTSA to the National Coordinator for Health Information 
        Technology.
            (2) National ems information system.--Section 3001(c) of 
        the Public Health Service Act (42 U.S.C. 300jj-11(c)) is 
        amended by adding at the end the following:
            ``(9) National ems information system.--
                    ``(A) Standardization.--The National Coordinator 
                shall promote the collection and reporting of data on 
                field EMS (as defined in section 1291) in a 
                standardized manner.
                    ``(B) Availability of data.--The National 
                Coordinator shall ensure that information in the 
                National EMS Database (other than individually 
                identifiable information) is available to Federal and 
                State policymakers, EMS stakeholders, and researchers.
                    ``(C) Technical assistance.--In carrying out 
                subparagraph (A), the National Coordinator may provide 
                technical assistance to State and local agencies, field 
                EMS agencies, and other entities, as the National 
                Coordinator determines appropriate, to assist in the 
                collection, analysis, and reporting of data.''.
    (b) Assimilation of Patient Health Information Across the Emergency 
Care Continuum.--Not later than 18 months after the date of enactment 
of this Act, taking into account the definition of ``health care 
provider'' under section 3000 of the Public Health Service Act (42 
U.S.C. 300jj), the Secretary shall promulgate a regulation that 
specifically includes ``emergency medical service provider'' under the 
definition of ``health care provider'' for purposes of title XXX of the 
Public Health Service Act, to enable and facilitate the integration and 
assimilation of field EMS data systems as part of the electronic 
exchange and use of health information and the enterprise integration 
of such information.
    (c) GAO Evaluation.--
            (1) In general.--The Comptroller General of the United 
        States, in consultation with the National Coordinator for 
        Health Information Technology, the Assistant Secretary for 
        Preparedness and Response, and the Federal Interagency 
        Committee on Emergency Medical Services, as appropriate, and 
        taking into consideration input from relevant stakeholders, 
        shall undertake an evaluation of issues, impediments, and 
        potential solutions pertaining to integration of field EMS into 
        the National Health Information Infrastructure.
            (2) Report.--The Comptroller General of the United States 
        shall submit a report to Congress detailing the extent to which 
        the Secretary of Health and Human Services (referred to in this 
        subsection as the ``Secretary'') has authority to implement 
        solutions to achieve such integration and the extent to which 
        statutory changes are required to achieve such integration.
            (3) Contents.--The evaluation under paragraph (1) and 
        report under paragraph (2) shall address--
                    (A) the integration of patient health information 
                regarding care provided to patients in field EMS into 
                each patient's electronic health care record;
                    (B) the bi-directional integration and data sharing 
                among providers and entities providing patient care 
                related to performance measures as part of quality 
                initiatives;
                    (C) the means by which to achieve contemporaneous 
                field EMS practitioner access to a patient's medical 
                record without regard to physical location while 
                preparing to provide or providing care to that patient 
                in the field, for the purpose of enhancing care 
                delivery and populating the electronic health care 
                record in real time; and
                    (D) incorporation of patient health information 
                created subsequent to the receipt of field EMS care 
                into the National EMS Information System, taking into 
                consideration--
                            (i) the types of medical information 
                        created subsequent to the receipt of field EMS 
                        emergency care (such as outcomes information or 
                        information regarding subsequent care and 
                        treatment) that would, if included in the 
                        National EMS Information System, be potentially 
                        useful in evaluating and improving the quality 
                        of EMS care;
                            (ii) how best to integrate such information 
                        into the National EMS Information System;
                            (iii) potential modifications to the Health 
                        Information Technology for Economic and 
                        Clinical Health Act (title XIII of division A 
                        and title IV of division B of Public Law 111-5) 
                        to require eligible hospitals (as defined in 
                        section 1886(n)(6)(B) of the Social Security 
                        Act (42 U.S.C. 1395ww(n)(6)(B))) to develop or 
                        report relevant data to the National EMS 
                        Information System or other appropriate State 
                        or private registries for the purpose of 
                        determining whether such a hospital shall be--
                                    (I) subject to a reduction in the 
                                applicable percentage increase 
                                otherwise applicable to such hospital 
                                under section 1886(b)(3)(B)(ix) of such 
                                Act; or
                                    (II) eligible for an incentive 
                                payment under section 1886(n) of such 
                                Act;
                            (iv) potential modifications to the 
                        Medicare and Medicaid programs under titles 
                        XVIII and XIX, respectively, of the Social 
                        Security Act (42 U.S.C. 1395 et seq.; 1396 et 
                        seq.) or other Federal health programs to 
                        provide appropriate reimbursement and financial 
                        incentives for field EMS agencies to develop or 
                        report relevant data to the National EMS 
                        Information System or other appropriate State 
                        or private registries; and
                            (v) any other changes to improve 
                        integration of patient health information 
                        across the continuum of emergency medical care 
                        and bidirectional integration and data sharing 
                        related to performance measures that the 
                        Secretary has authority to implement or that 
                        requires a statutory change by Congress to 
                        enable the Secretary such authority to 
                        implement.

SEC. 6. CLARIFICATION OF LEADERSHIP RESPONSIBILITY FOR ROUTINE 
              EMERGENCY MEDICAL CARE.

    (a) In General.--Pursuant to the designation of the Secretary of 
Health and Human Services (referred to in this section as the 
``Secretary'') under section 2801 of the Public Health Service Act (42 
U.S.C. 300hh) to lead all Federal public health and medical response to 
public health emergencies and incidents under the National Response 
Plan (developed pursuant to section 504(a)(6) of the Homeland Security 
Act of 2002), and pursuant to the Secretary's responsibility for 
administration of titles XVIII, XIX, and XXI of the Social Security Act 
(42 U.S.C. 1395 et seq.; 1396 et seq.; 1397aa et seq.), such leadership 
responsibilities shall be construed to include the provision of routine 
emergency medical care across the full continuum of such care provided 
(including field EMS (as defined in section 1291 of the Public Health 
Service Act (as added by section 4)), trauma, and hospital emergency 
medical care) as a necessary prerequisite to ensure the adequacy of 
such response to public health emergencies and incidents under the 
National Response Plan and the integration and provision of emergency 
medical care provided to beneficiaries of such titles of the Social 
Security Act.
    (b) Emergency Medical Care System.--In accordance with subsection 
(a), the Secretary shall be responsible for--
            (1) improving the emergency medical care system providing 
        routine emergency medical care to patients with emergency 
        medical conditions to enhance the capacity of the existing 
        public health and emergency medical system to prepare for and 
        sustain such public health and medical response to public 
        health emergencies and incidents; and
            (2) the quality, innovation, and cost-effectiveness of 
        field EMS, including such services provided to individuals who 
        are beneficiaries of the Medicare, Medicaid or State Children's 
        Health Insurance Program under titles XVIII, XIX, and XXI, 
        respectively of the Social Security Act (42 U.S.C. 1395 et 
        seq.; 1396 et seq.; 1397aa et seq.).

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

    (a) Field EMS Emergency Medical Research.--
            (1) In general.--The Secretary of Health and Human Services 
        (referred to in this subsection as the ``Secretary'') shall 
        undertake a comprehensive evaluation of the extent to which 
        research and evaluation relating to field EMS is conducted by 
        the National Institutes of Health, the Agency for Healthcare 
        Research Quality, the Center for Medicare & Medicaid 
        Innovation, the Health Resources and Services Administration, 
        the Centers for Disease Control and Prevention, and the 
        Patient-Centered Outcomes Research Institute, and any other 
        agencies or departments within the Department of Health and 
        Human Services, as the Secretary determines appropriate.
            (2) Report to congress.--Not later than 1 year after the 
        date of enactment of this Act, the Secretary shall submit to 
        Congress a report that includes--
                    (A) information related to the extent of federally 
                sponsored research in field EMS;
                    (B) identification of any impediments to enhancing 
                research in emergency medicine to improve patient 
                outcomes; and
                    (C) opportunities to enhance such research within 
                existing funding levels.
            (3) Definition.--In this subsection, the term ``field EMS'' 
        has the meaning given such term in section 1291 of the Public 
        Health Service Act, as added by section 4.
    (b) Field EMS Center of Excellence.--Subpart II of part D of title 
IX of the Public Health Service Act (42 U.S.C. 299b-33 et seq.) is 
amended by adding at the end the following:

``SEC. 938. FIELD EMS CENTER OF EXCELLENCE.

    ``(a) Establishment.--The Director shall establish within the 
Office of Planning, Research & Evaluation a Field EMS Evidence-Based 
Center of Excellence (referred to in this section as the `Center').
    ``(b) Purpose.--The purpose of the Center is to conduct or support 
research to promote the highest quality of emergency medical care in 
field EMS and the most effective delivery system for the provision of 
such care, including--
            ``(1) comparative safety and effectiveness research, 
        especially with regard to the highest cost and most prevalent 
        emergency medical conditions with the greatest opportunity to 
        improve patient outcomes and lower costs by care provided in 
        the field;
            ``(2) other appropriate clinical or systems research on the 
        effectiveness of existing and potential treatments provided in 
        the field that translate into improved quality, outcomes, and 
        patient satisfaction;
            ``(3) specific research topics designed to save lives, 
        lower costs, and improve outcomes for patients with emergency 
        medical conditions, including--
                    ``(A) the clinical value and benefit of critical 
                care ground and air transport, including the potential 
                for bidirectional care that fills gaps in rural and 
                other underserved geographic regions, especially where 
                hospitals have closed;
                    ``(B) the application of lessons learned in 
                military field medicine in the delivery of emergency 
                medical care in field EMS;
                    ``(C) the ability to intervene clinically in the 
                early onset of an emergency medical condition that will 
                improve patient outcomes;
                    ``(D) specific treatment modalities and protocols 
                that are cost-effective and produce better outcomes, 
                such as 12-lead electrocardiograms and continuous 
                positive airway pressure; and
                    ``(E) medical conditions most conducive to 
                regionalization of emergency care that will be most 
                effective in improving service delivery, outcomes, and 
                cost-effectiveness; and
            ``(4) support research being conducted by academic medical 
        centers, particularly those with centers of excellence formed 
        around EMS research.
    ``(c) Definition.--In this section, the term `field EMS' has the 
meaning given such term in section 1291.''.
    (c) Limitations on Certain Uses of Research.--Section 1182 of the 
Social Security Act (42 U.S.C. 1320e-1) is amended by striking 
``section 1181'' each place it appears and inserting ``section 1181 of 
this Act, section 938 of the Public Health Service Act, or section 7(a) 
of the Field EMS Modernization and Innovation Act''.
    (d) Regulatory Barriers.--For the purposes of research conducted 
pursuant to section 1115A(b)(2)(D)(iv) of the Social Security Act (as 
added by section 3(a)(2)), subsection (a) of this section, section 938 
of the Public Health Service Act (as added by subsection (b)), or any 
other research funded by the Department of Health and Human Services 
related to emergency medical services in the field in which informed 
consent is required but may not be attainable, the Secretary of Health 
and Human Services shall--
            (1) evaluate and consider the patient and research issues 
        involved; and
            (2) address regulatory barriers to such research related to 
        the need for informed consent in a manner that ensures adequate 
        patient safety and notification, and submit recommendations to 
        Congress for any changes to Federal statutes necessary to 
        address such barriers.

SEC. 8. EMERGENCY MEDICAL SERVICES TRUST FUND.

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

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

``Sec. 6097. Designation by individuals.

``SEC. 6097. DESIGNATION BY INDIVIDUALS.

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

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

    ``(a) Creation of Trust Fund.--There is established in the Treasury 
of the United States a trust fund to be known as the `Emergency Medical 
Services Trust Fund', consisting of such amounts as may be credited or 
paid to such trust fund as provided in subsection (b).
    ``(b) Transfers to Trust Fund.--There are hereby appropriated to 
the Emergency Medical Services Trust Fund amounts equivalent to the 
amounts of the overpayments of tax to which designations under section 
6097 apply.
    ``(c) Expenditures From Trust Fund.--Amounts in the Emergency 
Medical Services Trust Fund shall be available, as provided in 
appropriation Acts, only for carrying out the provisions for which 
amounts are authorized to be appropriated under subsections (a) and (b) 
of section 10 of the Field EMS Innovation Act.''.
    (c) Clerical Amendments.--
            (1) Clerical amendment.--The table of parts for subchapter 
        A of chapter 61 of the Internal Revenue Code of 1986 is amended 
        by adding at the end the following new item:

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

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

``Sec. 9512. Emergency Medical Services Trust Fund.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2015.

SEC. 9. GAO STUDY TO IDENTIFY IMPEDIMENTS TO QUALITY IMPROVEMENT IN 
              FIELD EMS.

    (a) In General.--The Comptroller General of the United States shall 
complete a study on impediments to the ability of field EMS 
practitioners, physician medical directors, and agencies to improve the 
quality of medical care provided to patients including--
            (1) medical and administrative liability issues that may 
        impede--
                    (A) medical oversight provided by physicians 
                directly regarding specific patients and medical 
                oversight provided by physicians in establishing 
                medical protocols, procedures, and other activities 
                related to the provision of emergency medical care in 
                field EMS; and
                    (B) the highest quality emergency medical care in 
                field EMS provided by personnel other than physicians, 
                such as emergency medical technicians and paramedics;
            (2) the types and levels of reimbursement necessary to 
        ensure the highest quality of care overseen by physician 
        medical directors, including--
                    (A) the actual costs of all components of medical 
                oversight in high-performing EMS systems with 
                demonstrated improvement in outcomes, such as those 
                evidenced by cardiac rates and traumatic injury 
                survival rates;
                    (B) the costs of medical oversight for part-time or 
                volunteer medical directors;
                    (C) recommended payment model options for medical 
                oversight that will enhance quality of care; and
                    (D) the sufficiency, or lack of sufficiency, of 
                reimbursement under the Medicare program under title 
                XVIII of the Social Security Act (42 U.S.C. 1395 et 
                seq.) to providers and suppliers of ambulance services 
                to enable high-quality and appropriate medical 
                oversight;
            (3) issues that may adversely impact the ability of field 
        EMS practitioners to deliver high-quality care including--
                    (A) issues affecting the direct patient care 
                provided by field EMS practitioners such as personal 
                and patient safety, fatigue, and training; and
                    (B) issues affecting the ability to recruit and 
                maintain a highly qualified field EMS practitioner 
                workforce such as salary, hours, and benefits; and
            (4) such other issues as the Comptroller General determines 
        appropriate relating to improving the quality and medical 
        oversight of emergency medical care in field EMS.
    (b) Report to Congress.--Not later than 18 months after the date of 
the enactment of this Act, the Comptroller General of the United States 
shall complete the study under subsection (a) and submit a report to 
Congress on the results of such study, including any recommendations.
    (c) Definitions.--In this subsection, the terms ``emergency medical 
care'' and ``field EMS'' have the meanings given such terms in section 
1291 of the Public Health Service Act (as added by section 4).

SEC. 10. FUNDING.

    (a) In General.--Out of amounts in the Emergency Medical Services 
Trust Fund, there are authorized to be transferred to the Secretary of 
Health and Human Services--
            (1) $12,000,000 for each of fiscal years 2016 through 2021, 
        for the purpose of carrying out the additional duties required 
        under part I of the Public Health Service Act (as added by 
        section 4);
            (2) $200,000,000 for each of fiscal years 2016 through 
        2021, for the purpose of carrying out section 1292 of the 
        Public Health Service Act, as added by section 4;
            (3) $15,000,000 for each of fiscal years 2016 through 2021, 
        for the purpose of carrying out section 1295 of the Public 
        Health Service Act, as added by section 4;
            (4) $40,000,000 for each of fiscal years 2016 through 2021, 
        for the purpose of carrying out section 7(a) of this Act and 
        938 of the Public Health Service Act, as added by section 7(b); 
        and
            (5) $4,000,000 for each of fiscal years 2016 through 2021, 
        for the purpose of carrying out section 3001(c)(9) of the 
        Public Health Service Act with respect to the National EMS 
        Information System, as added by section 5(a)(2).
    (b) Excess Amounts.--If, for any fiscal year, amounts in the 
Emergency Medical Services Trust Fund exceed the maximum amount 
authorized to be transferred under subsection (a), the Secretary of 
Health and Human Services may transfer such excess amounts for the 
purpose of carrying out section 330J, section 498D, section 7(a), and 
parts A, B, C, D, and H of title XII of the Public Health Service Act 
(42 U.S.C. 254c-15, 289g-4, 300d et seq., 300d-11 et seq., 300d-31 et 
seq., and 300d-81 et seq.).
    (c) Start-Up Funding.--
            (1) In general.--Out of the discretionary funds available 
        to the Secretary of Health and Human Services for each of 
        fiscal years 2016 and 2017, up to $40,000,000 may be used for 
        carrying out the amendments made by sections 3 and 4.
            (2) Relation to other funds.--The amount of discretionary 
        funds allocated under paragraph (1) shall be in addition to, 
        not in lieu of, the amount of discretionary funds that would 
        otherwise be available for such purposes.
    (d) Administrative Expenses.--Not more than 5 percent of each 
amount made available under paragraphs (1) through (5) of subsection 
(a) may be used for administrative expenses.

SEC. 11. STATUTORY CONSTRUCTION.

    Nothing in this Act, including the amendments made by this Act, 
shall be construed to supersede any statutory authority of any Federal 
agency that is not within the Department of Health and Human Services.
                                 <all>
```