1166 
‘‘(2) if the agreement made pursuant to para-
graph (1) is violated by the center, the center will be 
liable to the United States for an amount equal to the 
sum of— 
‘‘(A) the amount of assistance provided to 
the center under section 1241; and 
‘‘(B) an amount representing interest on the 
amount specified in subparagraph (A). 
‘‘(b) MAINTENANCE OF FINANCIAL SUPPORT.—With 
respect to activities for which funds awarded through a 
grant under section 1241 are authorized to be expended, the 
Secretary may not award such a grant unless the applicant 
agrees that, during the period in which the trauma center 
involved is receiving payments under the grant, the center 
will maintain access to trauma services at levels not less 
than the levels for the prior year, taking into account— 
‘‘(1) reasonable volume fluctuation that is not 
caused by intentional trauma boundary reduction; 
‘‘(2) downgrading of the level of services; and 
‘‘(3) whether such center diverts its incoming pa-
tients away from such center 5 percent or more of the 
time during which the center is in operation over the 
course of the year. 
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‘‘(c) TRAUMA CARE REGISTRY.—The Secretary may 
not award a grant to a trauma center under section 
1241(b)(1) unless the center agrees that— 
‘‘(1) not later than 6 months after the date on 
which the center submits a grant application to the 
Secretary, the center will establish and operate a reg-
istry of trauma cases in accordance with guidelines 
developed by the American College of Surgeons; and 
‘‘(2) in carrying out paragraph (1), the center 
will maintain information on the number of trauma 
cases treated by the center and, for each such case, the 
extent to which the center incurs uncompensated costs 
in providing trauma care.’’. 
(d) GENERAL PROVISIONS.—Section 1244 (42 U.S.C. 
300d–44) is amended to read as follows: 
‘‘SEC. 1244. GENERAL PROVISIONS. 
‘‘(a) LIMITATION ON DURATION OF SUPPORT.—The 
period during which a trauma center receives payments 
under a grant under section 1241(b)(1) shall be for 3 fiscal 
years, except that the Secretary may waive such require-
ment for the center and authorize the center to receive such 
payments for 1 additional fiscal year. 
‘‘(b) ELIGIBILITY.—The acquisition of, or eligibility 
for, a grant under section 1241(b) shall not preclude a trau-
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ma center’s eligibility for another grant described in such 
section. 
‘‘(c) FUNDING DISTRIBUTION.—Of the total amount 
appropriated for a fiscal year under section 1245— 
‘‘(1) 90 percent shall be used for grants under 
paragraph (1)(A) of section 1241(b); and 
‘‘(2) 10 percent shall be used for grants under 
paragraphs (1)(B) and (2) of section 1241(b). 
‘‘(d) REPORT.—Beginning 2 years after the date of the 
enactment of the America’s Affordable Health Choices Act 
of 2009, and every 2 years thereafter, the Secretary shall 
biennially— 
‘‘(1) report to Congress on the status of the 
grants made pursuant to section 1241; 
‘‘(2) evaluate and report to Congress on the over-
all financial stability of trauma centers in the United 
States; 
‘‘(3) report on the populations using trauma 
care centers and include aggregate patient data on 
income, race, ethnicity, and geography; and 
‘‘(4) evaluate the effectiveness and efficiency of 
trauma care center activities using standard public 
health measures and evaluation methodologies.’’. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—Section 
1245 (42 U.S.C. 300d–45) is amended to read as follows: 
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‘‘SEC. 1245. AUTHORIZATION OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—For the purpose of carrying out 
this part, there are authorized to be appropriated 
$100,000,000 for fiscal year 2010, and such sums as may 
be necessary for each of fiscal years 2011 through 2015. 
Such authorization of appropriations is in addition to any 
other authorization of appropriations or amounts that are 
available for such purpose. 
‘‘(b) REALLOCATION.—The Secretary shall reallocate 
for grants under section 1241(b)(1)(A) any funds appro-
priated for grants under paragraph (1)(B) or (2) of section 
1241(b), but not obligated due to insufficient applications 
eligible for funding.’’. 
SEC. 2542. EMERGENCY CARE COORDINATION. 
(a) IN GENERAL.—Subtitle B of title XXVIII (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 es-
tablish, 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 Fed-
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eral Interagency Committee on Emergency Medical 
Services, shall— 
‘‘(A) promote and fund research in emer-
gency medicine and trauma health care; 
‘‘(B) promote regional partnerships and 
more effective emergency medical systems in 
order to enhance appropriate triage, distribu-
tion, 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 rec-
ommendations to the Director on carrying out this 
section. 
‘‘(2) COMPOSITION.—The Council shall be com-
prised of employees of the departments and agencies 
of the Federal Government who are experts in emer-
gency care and management. 
‘‘(c) REPORT.— 
‘‘(1) SUBMISSION.—Not later than 12 months 
after the date of the enactment of the America’s Af-
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fordable Health Choices Act of 2009, 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 fac-
tors including— 
‘‘(A) emergency department crowding and 
boarding; and 
‘‘(B) delays in care following presentation. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2010 through 
2014.’’. 
(b) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, 
AND ADMINISTRATIVE ACTIONS.—All functions, personnel, 
assets, and liabilities of, and administrative actions appli-
cable 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 Coordina-
tion Center established under section 2816(a) of the Public 
Health Service Act, as added by subsection (a). 
SEC. 2543. PILOT PROGRAMS TO IMPROVE EMERGENCY 
MEDICAL CARE. 
Part B of title III (42 U.S.C. 243 et seq.) is amended 
by inserting after section 314 the following: 
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‘‘SEC. 315. REGIONALIZED COMMUNICATION SYSTEMS FOR 
EMERGENCY CARE RESPONSE. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Assistant Secretary for Preparedness and Response, shall 
award not fewer than 4 multiyear contracts or competitive 
grants to eligible entities to support demonstration pro-
grams that design, implement, and evaluate innovative 
models of regionalized, comprehensive, and accountable 
emergency care systems. 
‘‘(b) ELIGIBLE ENTITY; REGION.— 
‘‘(1) ELIGIBLE
ENTITY.—In this section, the 
term ‘eligible entity’ means a State or a partnership 
of 1 or more States and 1 or more local governments. 
‘‘(2) REGION.—In this section, the term ‘region’ 
means an area within a State, an area that lies with-
in multiple States, or a similar area (such as a 
multicounty area), as determined by the Secretary. 
‘‘(c) DEMONSTRATION PROGRAM.—The Secretary shall 
award a contract or grant under subsection (a) to an eligi-
ble entity that proposes a demonstration program to design, 
implement, and evaluate an emergency medical system 
that— 
‘‘(1) coordinates with public safety services, pub-
lic health services, emergency medical services, med-
ical facilities, and other entities within a region; 
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‘‘(2) coordinates an approach to emergency med-
ical system access throughout the region, including 9- 
1-1 public safety answering points and emergency 
medical dispatch; 
‘‘(3) includes a mechanism, such as a regional 
medical direction or transport communications sys-
tem, that operates throughout the region to ensure 
that the correct patient is taken to the medically ap-
propriate facility (whether an initial facility or a 
higher level facility) in a timely fashion; 
‘‘(4) allows for the tracking of prehospital and 
hospital resources, including inpatient bed capacity, 
emergency department capacity, on-call specialist cov-
erage, ambulance diversion status, and the coordina-
tion of such tracking with regional communications 
and hospital destination decisions; and 
‘‘(5) 
includes 
a 
consistent 
regionwide 
prehospital, hospital, and interfacility data manage-
ment system that— 
‘‘(A) complies with the National EMS In-
formation System, the National Trauma Data 
Bank, and others; 
‘‘(B) reports data to appropriate Federal 
and State databanks and registries; and 
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‘‘(C) contains information sufficient to 
evaluate key elements of prehospital care, hos-
pital destination decisions, including initial hos-
pital and interfacility decisions, and relevant 
outcomes of hospital care. 
‘‘(d) APPLICATION.— 
‘‘(1) IN GENERAL.—An eligible entity that seeks 
a contract or grant described in subsection (a) shall 
submit to the Secretary an application at such time 
and in such manner as the Secretary may require. 
‘‘(2) APPLICATION INFORMATION.—Each appli-
cation shall include— 
‘‘(A) an assurance from the eligible entity 
that the proposed system— 
‘‘(i) has been coordinated with the ap-
plicable State office of emergency medical 
services (or equivalent State office); 
‘‘(ii) is compatible with the applicable 
State emergency medical services system; 
‘‘(iii) includes consistent indirect and 
direct medical oversight of prehospital, hos-
pital, and interfacility transport throughout 
the region; 
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‘‘(iv) coordinates prehospital treatment 
and triage, hospital destination, and inter-
facility transport throughout the region; 
‘‘(v) includes a categorization or des-
ignation system for special medical facili-
ties throughout the region that is— 
‘‘(I) consistent with State laws 
and regulations; and 
‘‘(II) integrated with the protocols 
for transport and destination through-
out the region; and 
‘‘(vi) includes a regional medical direc-
tion system, a patient tracking system, and 
a resource allocation system that— 
‘‘(I) support day-to-day emer-
gency care system operation; 
‘‘(II) can manage surge capacity 
during a major event or disaster; and 
‘‘(III) are integrated with other 
components of the national and State 
emergency preparedness system; 
‘‘(B) an agreement to make available non- 
Federal contributions in accordance with sub-
section (e); and 
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