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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6528 Introduced in House (IH)]

111th CONGRESS
  2d Session
                                H. R. 6528

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

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           December 16, 2010

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

_______________________________________________________________________

                                 A BILL

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

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Field EMS Quality, 
Innovation, and Cost Effectiveness Improvements Act of 2010''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Recognition of NHTSA as primary Federal agency for field EMS.
Sec. 5. Field EMS Excellence, Quality, Universal Access, Innovation and 
                            Preparedness.
Sec. 6. Field EMS System Performance, Integration and Accountability.
Sec. 7. Field EMS quality.
Sec. 8. Field EMS education grants.
Sec. 9. Evaluating innovative models for access and delivery of field 
                            EMS for patients.
Sec. 10. Enhancing research in field EMS.
Sec. 11. National Emergency Medical Services Advisory Council.
Sec. 12. Emergency care coordination.
Sec. 13. Emergency Medical Services Trust Fund.
Sec. 14. Authorization of appropriations.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) All persons throughout the country should have access 
        to and receive high-quality emergency medical care as part of a 
        coordinated emergency medical services system.
            (2) Properly functioning emergency medical services (EMS) 
        systems, 24 hours per day, 7 days per week, are essential to 
        ensure access to emergency medical care and transport for all 
        patients with emergency medical conditions. Such coordinated 
        EMS systems are also necessary for response to catastrophic 
        incidents.
            (3) Ensuring high-quality and cost-effective EMS systems 
        requires readiness, preparedness, medical direction, oversight, 
        and innovation throughout the continuum of emergency medical 
        care through Federal, State, and local multijurisdictional 
        collaboration and sufficient resources for EMS agencies and 
        providers.
            (4) At the Federal level, EMS responsibilities and 
        resources of several Federal agencies consistent with their 
        expertise and authority must emphasize the critical importance 
        of Federal agency collaboration and coordination for all 
        emergency medical services.
            (5) At the State and local level, EMS systems and agencies 
        require the coordination and improved capabilities of multiple 
        and diverse stakeholders.
            (6) Emergency medical services encompass the provision of 
        care provided to patients with emergency medical conditions 
        throughout the continuum, including care provided in the field, 
        hospital, and rehabilitation settings.
            (7) Field EMS comprises essential emergency medical 
        services, including medical care or medical transport provided 
        to patients prior to or outside medical facilities and other 
        clinical settings. The primary purpose of field emergency 
        medical services is to ensure that emergency medical patients 
        receive the right care at the right place in the right amount 
        of time.
            (8) Coordinated and high-quality field EMS is essential to 
        the Nation's security. Field EMS is an essential public service 
        provided by governmental and nongovernmental agencies and 
        practitioners 24 hours a day, 7 days a week, and during 
        catastrophic incidents. To ensure disaster and all-hazards 
        preparedness for EMS operations as part of the Nation's 
        comprehensive disaster preparedness, Federal funding for 
        preparedness activities, including catastrophic training and 
        drills, must be provided to governmental and nongovernmental 
        EMS agencies so as to ensure a greater capability within each 
        of these areas.
            (9) Numerous recommendations from several significant 
        national reports and documents have demonstrated the need in 
        multiple areas for substantial improvement for emergency 
        medical services provided in the field, including 
        recommendations in the EMS Agenda for the Future, the Institute 
        of Medicine report ``The Future of Emergency Care in the United 
        Health System'', and the National EMS Education Agenda for the 
        Future: A Systems Approach and recommendations by the National 
        EMS Workforce Injury and Illness Surveillance Program, the 
        Department of Transportation's National EMS Advisory Council 
        (NEMSAC), and the Federal Interagency Committee on Emergency 
        Medical Services (FICEMS).
            (10) To substantially improve field EMS advancements must 
        be made in several essential areas including in readiness, 
        innovation, preparedness, education and workforce development, 
        safety, financing, quality, standards, and research.
            (11) The recognition of a primary Federal agency 
        specifically for field EMS is necessary to provide a more 
        streamlined, cost-efficient, and comprehensive approach for 
        field EMS as well as provide a focal point for practitioners 
        and agencies to interface with the Federal Government.
            (12) The long-standing role and capability of the National 
        Highway Traffic Safety Administration (NHTSA) to promote the 
        development of field EMS should be enhanced to serve in a 
        federally recognized leadership role for field EMS, and enable 
        NHTSA to serve as a full and equal partner with other Federal 
        agencies that oversee other aspects of the EMS system and 
        national preparedness and response.
            (13) The Emergency Care Coordinating Center (ECCC) should 
        be statutorily created to ensure its continued and essential 
        leadership role in supporting the Federal Government's 
        coordination of in-hospital emergency medical care activities, 
        including by promoting the regionalization of emergency medical 
        care and promoting other programs and resources that improve 
        the seamless delivery of the Nation's daily emergency medical 
        care and emergency behavioral care.
            (14) 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.
            (15) The discretionary National EMS Advisory Council 
        (NEMSAC) created by the Department of Transportation under the 
        Federal Advisory Committee Act should be a statutorily 
        established council that ensures non-Federal input and 
        recommendations to NHTSA, FICEMS, and all Federal agencies 
        involved with EMS.
            (16) FICEMS must continue in its essential role in 
        coordinating the Federal activities related to the full 
        spectrum of EMS.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) The term ``EMS'' means emergency medical services.
            (2) The term ``FICEMS'' means the Federal Interagency 
        Committee on Emergency Medical Services.
            (3) The term ``field EMS'' means emergency medical services 
        provided to patients (pursuant to transport by ground, air, or 
        otherwise) prior to or outside a medical facility or other 
        clinical setting.
            (4) The term ``field EMS agency'' means an organization 
        providing field EMS, regardless of--
                    (A) whether such organization is governmental, 
                nongovernmental, or volunteer; and
                    (B) whether such organization provides field EMS by 
                ground, air, or otherwise.
            (5) The term ``emergency medical services'' or ``EMS'' 
        means emergency medical care and related services provided to 
        patients at any point in the continuum of health care services, 
        including emergency medical dispatch and medical care and 
        related services provided in the field, during transport, or in 
        a medical facility or other clinical setting.
            (6) The term ``field EMS patient care reports'' means the 
        information that a field EMS agency typically creates regarding 
        a patient's medical condition and treatment in the course of 
        providing emergency medical services to that patient.
            (7) The term ``NEMSAC'' means the National Emergency 
        Medical Services Advisory Council established by section 12.
            (8) The term ``NEMSIS'' means the National EMS Information 
        System.
            (9) The term ``NHTSA'' means the National Highway Traffic 
        Safety Administration.
            (10) The term ``State EMS Office'' means an office 
        designated by the State with primary responsibility for 
        oversight of the State's EMS system, such as responsibility for 
        oversight of EMS coordination, licensing or certifying EMS 
        practitioners, and EMS system improvement.
            (11) The term ``STEMI'' means ST-Segment Elevation 
        Myocardial Infarction.

SEC. 4. RECOGNITION OF NHTSA AS PRIMARY FEDERAL AGENCY FOR FIELD EMS.

    (a) Primary Federal Agency for Field EMS.--NHTSA shall serve as the 
primary Federal agency for field EMS to provide enhanced Federal 
support for the development of patient-centered, medically directed, 
evidence-based, cost-effective, and safe field emergency medical 
services that are accessible to patients throughout the United States 
and which ensure 24 hours a day, 7 days a week readiness, catastrophic 
preparedness, and continual innovation in quality and capability for 
the betterment of patients. In this capacity, the Administrator of 
NHTSA shall--
            (1) provide enhanced leadership for emergency medical 
        services provided in the field;
            (2) work in partnership with the other Federal agencies 
        involved with EMS in their respective leadership roles in 
        overseeing other aspects of the full spectrum of emergency 
        medical services and preparedness and response; and
            (3) work in collaboration with FICEMS, which coordinates 
        all Federal EMS efforts, to ensure a seamless Federal approach 
        to a coordinated emergency medical services system across the 
        continuum of emergency medical care.
    (b) Cohesive National Field EMS Strategy.--The Administrator of 
NHTSA shall, pursuant to this Act, develop and implement a cohesive 
national strategy to strengthen the development of field emergency 
medical services (EMS) at the Federal, State, and local levels. In 
establishing such a strategy, the Administrator shall--
            (1) solicit and consider the recommendations of the NEMSAC 
        as well as relevant stakeholders;
            (2) consult and collaborate with FICEMS to ensure 
        consistency of such a field EMS strategy within the larger 
        Federal strategy regarding all of emergency medical services 
        and national preparedness and response;
            (3) address issues related to EMS patient and practitioner 
        safety, standardization of EMS practitioner licensing and 
        credentialing, field EMS operational improvements and 
        integration of field EMS practitioners into the broader health 
        care system including--
                    (A) promotion of the adoption by States of the 
                education standards identified in the ``Emergency 
                Medical Services Education Agenda for the Future: A 
                Systems Approach'' and any revisions thereto, including 
                the standardization of licensing and credentialing of 
                field EMS practitioners and standards of care, based on 
                best practices and evidence-based medicine, including 
                by--
                            (i) the identification of differences in 
                        the levels of care, scope of practice, and 
                        licensure and credentialing requirements among 
                        the States; and
                            (ii) the adoption by the States of national 
                        standards for such levels of care, scope of 
                        practice and licensure and credentialing 
                        requirements;
                    (B) promotion of a culture of safety, including--
                            (i) the adoption of an anonymous error 
                        reporting system designed to identify systemic 
                        problems in field EMS patient and practitioner 
                        safety and ensure a single means of collecting 
                        and reporting relevant error data by field EMS 
                        agencies and States;
                            (ii) the establishment of field EMS patient 
                        and practitioner safety goals and the specific 
                        means to improve field EMS practitioner and 
                        patient safety to achieve such goals; and
                            (iii) the adoption of more uniform national 
                        ambulance vehicle safety and manufacturing 
                        standards;
                    (C) the integration and utilization of field EMS 
                practitioners as part of the larger health care system 
                including--
                            (i) the potential utilization of field EMS 
                        practitioners for the provision of care to 
                        patients with non-emergent medical conditions; 
                        and
                            (ii) such other strategies to implement the 
                        recommendations provided by the National Health 
                        Care Workforce Commission, pursuant to section 
                        5101(d)(2) of the Patient Protection and 
                        Affordable Care Act (42 U.S.C. 294q(d)(2)); and
                    (D) such other issues that the Administrator 
                considers appropriate;
            (4) complete the development of such strategy not later 
        than 18 months after the date of enactment of this Act;
            (5) communicate such strategy to the relevant congressional 
        committees of jurisdiction;
            (6) implement such strategy to the extent practical not 
        later than 3 years after the date of enactment of this Act; and
            (7) update such strategy not less than every 3 years.
    (c) Statutory Construction.--Nothing in this Act shall be construed 
to preempt any statutory authority otherwise provided for any other 
Federal agency.

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

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

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

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

SEC. 7. FIELD EMS QUALITY.

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

SEC. 8. FIELD EMS EDUCATION GRANTS.

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

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

    (a) Evaluation.--
            (1) In general.--Not later than 1 year after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services, in consultation with the Administrator of NHTSA, and 
        taking into consideration the recommendations of NEMSAC and 
        FICEMS, shall complete an evaluation of--
                    (A) alternative delivery models for medical care 
                through field EMS; and
                    (B) the integration of field EMS patients with 
                other medical providers and facilities as medically 
                appropriate.
            (2) Specific issues.--The evaluation under paragraph (1) 
        shall consider each of the following:
                    (A) Alternative dispositions of low-acuity patients 
                (as defined by the Secretary of Health and Human 
                Services) such as transporting patients by ambulance to 
                destinations other than a hospital such as the office 
                of the patient's physician, an urgent care center, or 
                the facilities of another health care provider as 
                medically necessary and appropriate.
                    (B) Medical liability issues associated with 
                transport to destinations other than a hospital 
                emergency department.
                    (C) Necessary protections to ensure that patients 
                receive the appropriate care in the appropriate setting 
                without delay.
                    (D) Whether there are any barriers to providing 
                alternate dispositions to low-acuity patients who are 
                not in need of care in hospital emergency departments.
                    (E) Other issues determined by the Secretary of 
                Health and Human Services, including, when possible, 
                issues recommended by FICEMS or NEMSAC for evaluation 
                under this subsection.
    (b) Demonstration Projects.--
            (1) In general.--Beginning not later than 1 year after the 
        date of the enactment of this Act, the Secretary of Health and 
        Human Services shall conduct or support up to 5 demonstration 
        projects to--
                    (A) evaluate the implementation of alternative 
                dispositions of low-acuity field EMS patients (such as 
                transporting patients by ambulance to alternate 
                destinations when medically appropriate and in the 
                patients' best interests); and
                    (B) determine whether such dispositions--
                            (i) improve the safety, effectiveness, 
                        timeliness, and efficiency of EMS; and
                            (ii) reduce overall utilization and 
                        expenditures under the Medicare program under 
                        title XVIII of the Social Security Act.
            (2) Evidence-based protocols.--The Secretary of Health and 
        Human Services shall ensure that at least one demonstration 
        project under paragraph (1) evaluates evidence-based protocols 
        that give guidance on selection of the destination to which 
        patients are transported.
            (3) Duration.--The period of a demonstration project under 
        paragraph (1) shall not exceed 36 months.
            (4) Research.--If the Secretary of Health and Human 
        Services determines that further research is necessary prior to 
        or in conjunction with the demonstration projects under this 
        subsection in order to evaluation the implementation of 
        alternative dispositions of low-acuity field EMS patients, the 
        Secretary shall conduct or support such research.
            (5) Authorization of appropriations.--Of the amount made 
        available to carry out section 1115A of the Social Security Act 
        (42 U.S.C. 1315a) for a fiscal year, there are authorized to be 
        appropriated such sums as may be necessary to carry out this 
        subsection.
    (c) Report to Congress.--Not later than 1 year after the completion 
of all demonstration projects under subsection (b), the Secretary of 
Health and Human Services shall submit to the Congress a report on the 
results of activities under this section, including recommendations on 
the efficacy of alternative dispositions of low-acuity field EMS 
patients.

SEC. 10. ENHANCING RESEARCH IN FIELD EMS.

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

``SEC. 938. FIELD EMS PRACTICE CENTER.

    ``(a) Establishment.--For the purpose described in subsection (b), 
the Director shall establish within the Agency a Field EMS Evidence-
Based Practice Center.
    ``(b) Purpose.--The purpose of the Center is to conduct or support 
research to promote the highest quality of emergency medical care in 
field EMS and the most effective delivery system for the provision of 
such care. Research conducted or supported pursuant to the preceding 
sentence shall include--
            ``(1) comparative effectiveness research;
            ``(2) other appropriate clinical or systems research; and
            ``(3) research addressing--
                    ``(A) critical care transport;
                    ``(B) off-shore operations;
                    ``(C) tactical emergency medical services; and
                    ``(D) the application of lessons learned in 
                military field medicine in the delivery of emergency 
                medical care in field EMS.
    ``(c) Definition.--In this section:
            ``(1) The term `Center' means the Field EMS Evidence-Based 
        Practice Center established under subsection (a).
            ``(2) The term `field EMS' has the meaning given to such 
        term in section 3 of the Field EMS Quality, Innovation, and 
        Cost Effectiveness Improvements Act of 2010.''.
    (d) Limitations on Certain Uses of Research.--Section 1182 of the 
Social Security Act (42 U.S.C. 1320e-1) is amended by striking 
``section 1181'' each place it appears and inserting ``section 1181 of 
this Act or section 498D(c) or 938 of the Public Health Service Act''.
    (e) Regulatory Barriers.--For the purposes of research conducted 
pursuant to this section or any other research funded by the Department 
of Health and Human Services related to emergency medical services in 
the field in which informed consent is required but may not be 
attainable, the Secretary of Health and Human Services shall--
            (1) evaluate and consider the patient and research issues 
        involved; and
            (2) address regulatory barriers to such research related to 
        the need for informed consent in a manner that ensures adequate 
        patient safety and notification, and submit recommendations to 
        Congress for any changes to Federal statutes necessary to 
        address such barriers.

SEC. 11. NATIONAL EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL.

    (a) Establishment.--The Administrator of NHTSA shall establish and 
administer a National Emergency Medical Services Advisory Council.
    (b) Duties and Authorities.--
            (1) In general.--NEMSAC--
                    (A) shall provide advice and recommendations 
                regarding Federal field EMS programs and activities to 
                NHTSA, FICEMS, and other Federal agencies that deliver 
                field EMS or support State or local field EMS;
                    (B) may, upon request by any Federal agency, 
                provide that agency with recommendations on field EMS 
                matters; and
                    (C) shall provide a national forum for individuals 
                and entities outside of the Federal Government to 
                deliberate on field EMS issues.
            (2) Authority.--In carrying out paragraph (1), NEMSAC may 
        gather data and provide advice and recommendations on--
                    (A) the national strategy under section 4(b);
                    (B) any grant program established under this Act;
                    (C) any data collection improvement activity under 
                this Act;
                    (D) compliance with any requirement imposed under 
                this Act;
                    (E) any Federal field EMS program or activity;
                    (F) strengthening field EMS systems through 
                enhanced workforce development, education, training, 
                exercises, equipment, medical oversight, or otherwise;
                    (G) improved Federal coordination and support of 
                EMS systems; and
                    (H) other field EMS issues for which 
                recommendations are solicited by the Administrator of 
                NHTSA, FICEMS, or other Federal agencies.
    (c) Appointment, Terms, and Members.--
            (1) In general.--NEMSAC shall be composed of not more than 
        26 members, each appointed by the Administrator of NHTSA.
            (2) Terms.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the Administrator of NHTSA shall appoint the 
                members of NEMSAC to serve for a term of 3 years.
                    (B) Initial members.--Of the initial members of 
                NEMSAC--
                            (i) not more than 8 shall be appointed for 
                        a term of 1 year;
                            (ii) not more than 8 shall be appointed for 
                        a term of 2 years; and
                            (iii) not more than 10 shall be appointed 
                        for a term of 3 years.
            (3) Eligibility.--No official or employee of the Federal 
        Government may serve as a member of NEMSAC.
            (4) Selection.--In appointing the members of NEMSAC, the 
        Administrator of NHTSA shall--
                    (A) select members based on their individual 
                expertise, not as representatives of specific 
                organizations;
                    (B) ensure that the membership of NEMSAC--
                            (i) includes balanced representation across 
                        the field EMS community; and
                            (ii) has sufficient EMS expertise and 
                        geographic and demographic diversity to 
                        accurately reflect the EMS community as a 
                        whole;
                    (C) to the extent practical, ensure that the 
                membership of NEMSAC includes representation of--
                            (i) volunteer EMS;
                            (ii) fire-based EMS;
                            (iii) nongovernmental EMS;
                            (iv) hospital-based EMS;
                            (v) tribal EMS;
                            (vi) air medical EMS;
                            (vii) local EMS service director/
                        administrators;
                            (viii) EMS medical directors;
                            (ix) emergency physicians;
                            (x) trauma surgeons;
                            (xi) pediatric emergency physicians;
                            (xii) State EMS directors;
                            (xiii) State highway safety directors;
                            (xiv) EMS educators;
                            (xv) public safety call-takers and 
                        dispatchers;
                            (xvi) EMS data managers;
                            (xvii) EMS researchers;
                            (xviii) emergency nurses;
                            (xix) hospital administration;
                            (xx) public health;
                            (xxi) emergency management;
                            (xxii) State homeland security directors;
                            (xxiii) State or local legislative bodies; 
                        and
                            (xxiv) consumers not directly affiliated 
                        with an emergency medical system or health care 
                        organization; and
                    (D) appoint at least 2 members without regard to 
                the categories listed in subparagraph (C).
            (5) Vacancies.--A vacancy in the membership of NEMSAC 
        shall--
                    (A) not affect the powers of NEMSAC; and
                    (B) be filled in the manner in which the original 
                appointment was made.
            (6) No pay; travel expenses.--Each member of NEMSAC shall 
        serve without pay, but shall be reimbursed for travel and per 
        diem in lieu of subsistence expenses during the performance of 
        duties of NEMSAC while away from home or his or her regular 
        place of business, in accordance with applicable provisions 
        under subchapter I of chapter 57 of title 5, United States 
        Code.
            (7) Chairperson.--The Administrator of NHTSA shall select 
        the Chairperson of NEMSAC from its members.
    (d) Meetings.--Beginning with the first calendar year following the 
enactment of this Act, NEMSAC shall meet at least twice per calendar 
year.
    (e) Personnel; Reimbursement for Services.--
            (1) Detail of nhtsa personnel.--The Administrator of NHTSA 
        shall detail to NEMSAC, without reimbursement, such personnel 
        of NHTSA as the Administrator determines necessary to carry out 
        this section.
            (2) Reimbursement for certain services.--If NEMSAC performs 
        services at the request of a Federal agency, such agency shall 
        reimburse NHTSA for the actual cost of such services. The 
        Administrator of NHTSA shall establish the method for 
        calculating and providing reimbursement under the preceding 
        sentence.
    (f) Federal Advisory Committee Act.--Except as inconsistent with 
this section, NEMSAC shall operate in accordance with the Federal 
Advisory Committee Act (5 U.S.C. App.).
    (g) Duration.--Notwithstanding section 14 of the Federal Advisory 
Committee Act (5 U.S.C. App.), NEMSAC shall be of permanent duration.
    (h) Functions, Personnel, Assets, Liabilities, and Administrative 
Actions.--All functions, personnel, assets, and liabilities of, and 
administrative actions applicable to, the National Emergency Medical 
Services Advisory Council of the Department of Transportation, as in 
existence on the day before the date of the enactment of this Act, 
shall be transferred to the National Emergency Medical Services 
Advisory Council established under this section.
    (i) Annual Reports.--Each year, NEMSAC shall submit to NHTSA and 
FICEMS a report describing NEMSAC's activities, positions, and 
recommendations. The Administrator of NHTSA shall promptly provide each 
such report to the appropriate congressional committees of 
jurisdiction.

SEC. 12. EMERGENCY CARE COORDINATION.

    (a) In General.--Subtitle B of title XXVIII of the Public Health 
Service Act (42 U.S.C. 300hh-10 et seq.) is amended by adding at the 
end the following:

``SEC. 2816. EMERGENCY CARE COORDINATION.

    ``(a) Emergency Care Coordination Center.--
            ``(1) Establishment.--The Secretary shall establish, within 
        the Office of the Assistant Secretary for Preparedness and 
        Response, an Emergency Care Coordination Center (in this 
        section referred to as the `Center'), to be headed by a 
        Director.
            ``(2) Duties.--The Secretary, acting through the Director 
        of the Center, in coordination with the Federal Interagency 
        Committee on Emergency Medical Services, shall--
                    ``(A) promote and fund research in emergency 
                medicine and trauma health care;
                    ``(B) promote regional partnerships and more 
                effective emergency medical systems in order to enhance 
                appropriate triage, distribution, and care of routine 
                community patients; and
                    ``(C) promote local, regional, and State emergency 
                medical systems' preparedness for and response to 
                public health events.
    ``(b) Council of Emergency Care.--
            ``(1) Establishment.--The Secretary, acting through the 
        Director of the Center, shall establish a Council of Emergency 
        Care to provide advice and recommendations to the Director on 
        carrying out this section.
            ``(2) Composition.--The Council shall be comprised of 
        employees of the departments and agencies of the Federal 
        Government who are experts in emergency care and management.
    ``(c) Report.--
            ``(1) Submission.--Not later than 12 months after the date 
        of the enactment of this section, the Secretary shall submit to 
        the Congress an annual report on the activities carried out 
        under this section.
            ``(2) Considerations.--In preparing a report under 
        paragraph (1), the Secretary shall consider factors including--
                    ``(A) emergency department crowding and boarding; 
                and
                    ``(B) delays in care following presentation.''.
    (b) 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 
this Act, shall be transferred to the Emergency Care Coordination 
Center established under section 2816(a) of the Public Health Service 
Act, as added by subsection (a).

SEC. 13. EMERGENCY MEDICAL SERVICES TRUST FUND.

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

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

``SEC. 6097. DESIGNATION BY INDIVIDUALS.

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

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

    ``(a) Creation of Trust Fund.--There is established in the Treasury 
of the United States a trust fund to be known as the `Emergency Medical 
Services Trust Fund', consisting of such amounts as may be credited or 
paid to such trust fund as provided in section 6097.
    ``(b) Transfers to Trust Fund.--There are hereby appropriated to 
the Emergency Medical Services Trust Fund amounts equivalent to the 
amounts of the overpayments of tax to which designations under section 
6097 apply.
    ``(c) Expenditures From Trust Fund.--Amounts in the Emergency 
Medical Services Trust Fund shall be available, as provided in 
appropriation Acts, only for purposes of making expenditures to carry 
out section 14(a)(2) of the Field EMS Quality, Innovation, and Cost 
Effectiveness Improvements Act of 2010. If, for any fiscal year, 
amounts remain in the Emergency Medical Services Trust Fund after 
making such expenditures, such amounts shall be available, as provided 
in appropriation Acts, to carry out sections 498D, 1203, and 1204 of 
the Public Health Service Act; part D of title XII of such Act; and 
part H of title XII of such 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 Overpayments and Additional 
            Contributions for Emergency Medical Services.''.

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

``Sec. 9512. Emergency Medical Services Trust Fund.''.
    (d) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2010.

SEC. 14. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--Out of monies in the Emergency Medical Services 
Trust Fund, there are authorized to be appropriated--
            (1) $11,000,000 shall be for carrying out sections 4, 7, 
        9(a), 9(c), and 11 of this Act, and section 2816 of the Public 
        Health Service Act (as added by section 12 of this Act) for 
        each of fiscal years 2013 through 2015;
            (2) $200,000,000 shall be for carrying out section 5 of 
        this Act for each of fiscal years 2012 through 2015;
            (3) $50,000,000 shall be for carrying out section 6 of this 
        Act for each of fiscal years 2012 through 2015;
            (4) $15,000,000 shall be for carrying out section 8 of this 
        Act for each of fiscal years 2012 through 2015; and
            (5) $45,000,000 shall be for carrying out sections 498D(c) 
        and 938 of the Public Health Service Act, as added by 
        subsections (b) and (c) of section 10 of this Act, for each of 
        fiscal years 2012 through 2015.
    (b) Start-Up Funding.--
            (1) There are authorized to be appropriated $11,000,000 for 
        each of fiscal years 2011 and 2012 to carry out the provisions 
        specified in subsection (a)(1).
            (2) There are authorized to be appropriated $50,000,000 for 
        fiscal year 2012 to carry out the provisions specified in 
        paragraphs (2), (3), (4), and (5) of subsection (a), to be 
        allocated in proportion to the authorizations of appropriations 
        specified in such paragraphs. The amount of funds authorized to 
        be appropriated under subsection (a) for fiscal year 2012 (out 
        of any monies in the Emergency Medical Services Trust Fund) 
        shall be reduced by the amount of any funds made available 
        under this paragraph.
    (c) Administrative Expenses.--Of the amount made available under 
subsection (a) or (b) to carry out each of the provisions specified in 
subsection (a), not more than 5 percent of each such amount may be used 
for Federal administrative expenses.
                                 <all>
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