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that the recipient has made appropriate, measurable 
progress in preventing overweight and obesity. 
‘‘(e) REQUIREMENTS.— 
‘‘(1) IN GENERAL.—The Secretary may award 
a grant or contract under this section to an entity 
only if the entity demonstrates to the Secretary’s 
satisfaction that— 
‘‘(A) not later than 90 days after receiving 
the grant or contract, the entity will establish 
a steering committee to provide input on the as-
sessment of, and recommendations on improve-
ments to, the entity’s program funded through 
the grant or contract; and 
‘‘(B) the entity has conducted or will con-
duct an assessment of the overweight and obe-
sity problem in its community, including the ex-
tent of the problem and factors contributing to 
the problem. 
‘‘(2) MATCHING
REQUIREMENT.—The Sec-
retary may award a grant or contract to an eligible 
entity under this section only if the entity agrees to 
provide, from non-Federal sources, an amount equal 
to $1 (in cash or in kind) for each $9 provided 
through the grant or contract to carry out the activi-
ties supported by the grant or contract. 
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‘‘(3) PAYOR OF LAST RESORT.—The Secretary 
may award a grant or contract under this section to 
an entity only if the entity demonstrates to the satis-
faction of the Secretary that funds received through 
the grant or contract will not be expended for any 
activity to the extent that payment has been made, 
or can reasonably be expected to be made— 
‘‘(A) under any insurance policy; 
‘‘(B) under any Federal or State health 
benefits program (including titles XIX and XXI 
of the Social Security Act); or 
‘‘(C) by an entity which provides health 
services on a prepaid basis. 
‘‘(4) MAINTENANCE
OF
EFFORT.—The Sec-
retary may award a grant or contract under this sec-
tion to an entity only if the entity demonstrates to 
the satisfaction of the Secretary that— 
‘‘(A) funds received through the grant or 
contract will be expended only to supplement, 
and not supplant, non-Federal and Federal 
funds otherwise available to the entity for the 
activities to be funded through the grant or 
contract; and 
‘‘(B) with respect to such activities, the en-
tity will maintain expenditures of non-Federal 
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amounts for such activities at a level not less 
than the lesser of such expenditures maintained 
by the entity for the fiscal year preceding the 
fiscal year for which the entity receives the 
grant or contract. 
‘‘(f) PREFERENCES.—In awarding grants and con-
tracts under this section, the Secretary shall give pref-
erence to eligible entities that— 
‘‘(1) will serve communities with high levels of 
overweight and obesity and related chronic diseases; 
or 
‘‘(2) will plan or implement activities for the 
prevention of overweight and obesity in school or 
workplace settings. 
‘‘(g) REPORT.—The Secretary shall submit to the 
Congress an annual report on the program of grants and 
contracts awarded under this section. 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The term ‘evidence-based’ means that 
methodologically sound research has demonstrated a 
beneficial health effect in the judgment of the Sec-
retary and includes the Ways to Enhance Children’s 
Activity and Nutrition (We Can) program and cur-
riculum of the National Institutes of Health. 
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‘‘(2) The term ‘local educational agency’ has 
the meaning given to the term in section 9101 of the 
Elementary and Secondary Education Act of 1965. 
‘‘(i) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated $10,000,000 for fiscal year 2011 and such sums 
as may be necessary for each of fiscal years 2012 through 
2015.’’. 
SEC. 2536. REDUCING STUDENT-TO-SCHOOL NURSE RATIOS. 
(a) DEMONSTRATION GRANTS.— 
(1) IN GENERAL.—The Secretary of Education, 
in consultation with the Secretary of Health and 
Human Services and the Director of the Centers for 
Disease Control and Prevention, may make dem-
onstration grants to eligible local educational agen-
cies for the purpose of reducing the student-to- 
school nurse ratio in public elementary and sec-
ondary schools. 
(2) SPECIAL
CONSIDERATION.—In awarding 
grants under this section, the Secretary of Edu-
cation shall give special consideration to applications 
submitted by high-need local educational agencies 
that demonstrate the greatest need for new or addi-
tional nursing services among children in the public 
elementary and secondary schools served by the 
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agency, in part by providing information on current 
ratios of students to school nurses. 
(3) MATCHING FUNDS.—The Secretary of Edu-
cation may require recipients of grants under this 
subsection to provide matching funds from non-Fed-
eral sources, and shall permit the recipients to 
match funds in whole or in part with in-kind con-
tributions. 
(b) REPORT.—Not later than 24 months after the 
date on which assistance is first made available to local 
educational agencies under this section, the Secretary of 
Education shall submit to the Congress a report on the 
results of the demonstration grant program carried out 
under this section, including an evaluation of the effective-
ness of the program in improving the student-to-school 
nurse ratios described in subsection (a) and an evaluation 
of the impact of any resulting enhanced health of students 
on learning. 
(c) DEFINITIONS.—For purposes of this section: 
(1) The terms ‘‘elementary school’’, ‘‘local edu-
cational agency’’, and ‘‘secondary school’’ have the 
meanings given to those terms in section 9101 of the 
Elementary and Secondary Education Act of 1965 
(20 U.S.C. 7801). 
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(2) The term ‘‘eligible local educational agency’’ 
means a local educational agency in which the stu-
dent-to-school nurse ratio in the public elementary 
and secondary schools served by the agency is 750 
or more students to every school nurse. 
(3) The term ‘‘high-need local educational agen-
cy’’ means a local educational agency— 
(A) that serves not fewer than 10,000 chil-
dren from families with incomes below the pov-
erty line; or 
(B) for which not less than 20 percent of 
the children served by the agency are from fam-
ilies with incomes below the poverty line. 
(4) The term ‘‘nurse’’ means a licensed nurse, 
as defined under State law. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2011 through 2015. 
SEC. 2537. MEDICAL-LEGAL PARTNERSHIPS. 
(a) IN GENERAL.—The Secretary shall establish a 
nationwide demonstration project consisting of— 
(1) awarding grants to, and entering into con-
tracts with, medical-legal partnerships to assist pa-
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tients and their families to navigate health-related 
programs and activities; and 
(2) evaluating the effectiveness of such partner-
ships. 
(b) USE OF FUNDS.—Amounts received as a grant 
or contract under this section shall be used to assist pa-
tients and their families to navigate health care-related 
programs and activities and thereby achieve one or more 
of the following goals: 
(1) Enhancing access to health care services. 
(2) Improving health outcomes for low-income 
individuals. 
(3) Reducing health disparities. 
(4) Enhancing wellness and prevention of 
chronic conditions. 
(c) PROHIBITION.—No funds under this section may 
be used— 
(1) for any medical malpractice or other civil 
action or proceeding; or 
(2) to assist individuals who are not lawfully 
present in the United States. 
(d) REPORT.—Not later than 5 years after the date 
of the enactment of this Act, the Secretary shall submit 
a report to the Congress on the results of the demonstra-
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tion project under this section. Such report shall include 
the following: 
(1) A description of the extent to which med-
ical-legal partnerships funded through this section 
achieved the goals described in subsection (b). 
(2) Recommendations on the possibility of ex-
tending or expanding the demonstration project. 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘health disparities’’ has the 
meaning given to the term in section 3171 of the 
Public Health Service Act, as added by section 
2301. 
(2) The term ‘‘medical-legal partnership’’ 
means an entity— 
(A) that is a collaboration between— 
(i) a community health center, public 
hospital, children’s hospital, or other pro-
vider of health care services to a signifi-
cant number of low-income beneficiaries; 
and 
(ii) one or more attorneys; and 
(B) whose primary mission is to assist pa-
tients and their families navigate health care-re-
lated programs and activities. 
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(3) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2011 through 2015. 
PART 3—EMERGENCY CARE-RELATED 
PROGRAMS 
SEC. 2551. TRAUMA CARE CENTERS. 
(a) GRANTS FOR TRAUMA CARE CENTERS.—Section 
1241 (42 U.S.C. 300d–41) is amended to read as follows: 
‘‘SEC. 1241. GRANTS FOR CERTAIN TRAUMA CENTERS. 
‘‘(a) IN GENERAL.—The Secretary shall establish a 
trauma center program consisting of awarding grants 
under section (b). 
‘‘(b) GRANTS.—The Secretary shall award grants as 
follows: 
‘‘(1) EXISTING
CENTERS.—Grants to public, 
private nonprofit, Indian Health Service, Indian 
tribal, and urban Indian trauma centers— 
‘‘(A) to further the core missions of such 
centers; or 
‘‘(B) to provide emergency relief to ensure 
the continued and future availability of trauma 
services by trauma centers— 
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‘‘(i) at risk of closing or operating in 
an area where a closing has occurred with-
in their primary service area; or 
‘‘(ii) in need of financial assistance 
following a natural disaster or other cata-
strophic event, such as a terrorist attack. 
‘‘(2) NEW CENTERS.—Grants to local govern-
ments and public or private nonprofit entities to es-
tablish new trauma centers in urban areas with a 
substantial degree of trauma resulting from violent 
crimes. 
‘‘(c) MINIMUM QUALIFICATIONS OF TRAUMA CEN-
TERS.— 
‘‘(1) PARTICIPATION IN TRAUMA CARE SYSTEM 
OPERATING UNDER CERTAIN PROFESSIONAL GUIDE-
LINES.— 
‘‘(A) LIMITATION.—Subject to subpara-
graph (B), the Secretary may not award a 
grant to an existing trauma center under this 
section unless the center is a participant in a 
trauma care system that substantially complies 
with section 1213. 
‘‘(B) 
EXEMPTION.—Subparagraph 
(A) 
shall not apply to trauma centers that are lo-
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cated in States with no existing trauma care 
system. 
‘‘(2) DESIGNATION.—The Secretary may not 
award a grant under this section to an existing trau-
ma center unless the center is— 
‘‘(A) verified as a trauma center by the 
American College of Surgeons; or 
‘‘(B) designated as a trauma center by the 
applicable State health or emergency medical 
services authority.’’. 
(b) CONSIDERATIONS IN MAKING GRANTS.—Section 
1242 (42 U.S.C. 300d–42) is amended to read as follows: 
‘‘SEC. 1242. CONSIDERATIONS IN MAKING GRANTS. 
‘‘(a) CORE MISSION AWARDS.— 
‘‘(1) IN GENERAL.—In awarding grants under 
section 1241(b)(1)(A), the Secretary shall— 
‘‘(A) reserve a minimum of 25 percent of 
the amount allocated for such grants for level 
III and level IV trauma centers in rural or un-
derserved areas; 
‘‘(B) reserve a minimum of 25 percent of 
the amount allocated for such grants for level 
I and level II trauma centers in urban areas; 
and 
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‘‘(C) give preference to any application 
made by a trauma center— 
‘‘(i) in a geographic area where 
growth in demand for trauma services ex-
ceeds capacity; 
‘‘(ii) that demonstrates the financial 
support of the State or political subdivision 
involved; 
‘‘(iii) that has at least 1 graduate 
medical education fellowship in trauma or 
trauma-related specialties, including neuro-
logical surgery, surgical critical care, vas-
cular surgery, and spinal cord injury, for 
which demand is exceeding supply; or 
‘‘(iv) that demonstrates a substantial 
commitment to serving vulnerable popu-
lations. 
‘‘(2) FINANCIAL
SUPPORT.—For purposes of 
paragraph (1)(C)(ii), financial support may be dem-
onstrated by State or political subdivision funding 
for the trauma center’s capital or operating expenses 
(including through State trauma regional advisory 
coordination activities, Medicaid funding designated 
for trauma services, or other governmental funding). 
State funding derived from Federal support shall 
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not constitute State or local financial support for 
purposes of preferential treatment under this sub-
section. 
‘‘(3) USE OF FUNDS.—The recipient of a grant 
under section 1241(b)(1)(A) shall carry out, con-
sistent with furthering the core missions of the cen-
ter, one or more of the following activities: 
‘‘(A) Providing 24-hour-a-day, 7-day-a- 
week trauma care availability. 
‘‘(B) Reducing overcrowding related to 
throughput of trauma patients. 
‘‘(C) Enhancing trauma surge capacity. 
‘‘(D) Ensuring physician and essential per-
sonnel availability. 
‘‘(E) Trauma education and outreach. 
‘‘(F) Coordination with local and regional 
trauma care systems. 
‘‘(G) Such other activities as the Secretary 
may deem appropriate. 
‘‘(b) EMERGENCY
AWARDS; NEW
CENTERS.—In 
awarding grants under paragraphs (1)(B) and (2) of sec-
tion 1241(b), the Secretary shall— 
‘‘(1) give preference to any application sub-
mitted by an applicant that demonstrates the finan-
cial support (in accordance with subsection (a)(2)) 
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of the State or political subdivision involved for the 
activities to be funded through the grant for each 
fiscal year during which payments are made to the 
center under the grant; and 
‘‘(2) give preference to any application sub-
mitted for a trauma center that— 
‘‘(A) is providing or will provide trauma 
care in a geographic area in which the avail-
ability of trauma care has either significantly 
decreased as a result of a trauma center in the 
area permanently ceasing participation in a sys-
tem described in section 1241(c)(1) as of a date 
occurring during the 2-year period preceding 
the fiscal year for which the trauma center is 
applying to receive a grant, or in geographic 
areas where growth in demand for trauma serv-
ices exceeds capacity; 
‘‘(B) will, in providing trauma care during 
the 1-year period beginning on the date on 
which the application for the grant is sub-
mitted, incur substantial uncompensated care 
costs in an amount that renders the center un-
able to continue participation in such system 
and results in a significant decrease in the 
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availability of trauma care in the geographic 
area; 
‘‘(C) operates or will operate in rural areas 
where trauma care availability will significantly 
decrease if the center is forced to close or down-
grade service and substantial costs are contrib-
uting to a likelihood of such closure or 
downgradation; 
‘‘(D) is in a geographic location substan-
tially affected by a natural disaster or other 
catastrophic event such as a terrorist attack; or 
‘‘(E) will establish a new trauma service in 
an urban area with a substantial degree of 
trauma resulting from violent crimes. 
‘‘(c) DESIGNATIONS OF LEVELS OF TRAUMA CEN-
TERS IN CERTAIN STATES.—In the case of a State which 
has not designated 4 levels of trauma centers, any ref-
erence in this section to— 
‘‘(1) a level I or level II trauma center is 
deemed to be a reference to a trauma center within 
the highest 2 levels of trauma centers designated 
under State guidelines; and 
‘‘(2) a level III or IV trauma center is deemed 
to be a reference to a trauma center not within such 
highest 2 levels.’’. 
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(c) CERTAIN
AGREEMENTS.—Section 1243 (42 
U.S.C. 300d–43) is amended to read as follows: 
‘‘SEC. 1243. CERTAIN AGREEMENTS. 
‘‘(a) COMMITMENT REGARDING CONTINUED PAR-
TICIPATION IN TRAUMA CARE SYSTEM.—The Secretary 
may not award a grant to an applicant under section 
1241(b) unless the applicant agrees that— 
‘‘(1) the trauma center involved will continue 
participation, or in the case of a new center will par-
ticipate, 
in 
the 
system 
described 
in 
section 
1241(c)(1), 
except 
as 
provided 
in 
section 
1241(c)(1)(B), throughout the grant period begin-
ning on the date that the center first receives pay-
ments under the grant; and 
‘‘(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, 
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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 fis-
cal years, except that the Secretary may waive such re-
quirement for the center and authorize the center to re-
ceive 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 
trauma 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 Affordable Health Care for America 
Act, and every 2 years thereafter, the Secretary shall bien-
nially— 
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‘‘(1) report to Congress on the status of the 
grants made pursuant to section 1241; 
‘‘(2) evaluate and report to Congress on the 
overall 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: 
‘‘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 2011, and such sums as may 
be necessary for each of fiscal years 2012 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 sec-
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tion 1241(b), but not obligated due to insufficient applica-
tions eligible for funding.’’. 
SEC. 2552. 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 
Federal Interagency Committee on Emergency Med-
ical 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 
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‘‘(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 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 Affordable 
Health Care for America Act, the Secretary shall 
submit to the Congress an annual report on the ac-
tivities 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. 
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‘‘(d) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated such sums as may be necessary for each of fiscal 
years 2011 through 2015.’’. 
(b) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, 
AND
ADMINISTRATIVE
ACTIONS.—All functions, per-
sonnel, 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. 2553. 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: 
‘‘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 com-
petitive grants to eligible entities to support demonstration 
programs that design, implement, and evaluate innovative 
models of regionalized, comprehensive, and accountable 
emergency care systems. 
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‘‘(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 govern-
ments. 
‘‘(2) REGION.—In this section, the term ‘re-
gion’ means an area within a State, an area that lies 
within 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 eligible entity that proposes a demonstration program 
to design, implement, and evaluate an emergency medical 
system that— 
‘‘(1) coordinates with public safety services, 
public health services, emergency medical services, 
medical facilities, and other entities within a region; 
‘‘(2) coordinates an approach to emergency 
medical system access throughout the region, includ-
ing 9–1–1 public safety answering points and emer-
gency 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-
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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 
coverage, ambulance diversion status, and the co-
ordination of such tracking with regional commu-
nications 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 
‘‘(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 
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time and in such manner as the Secretary may re-
quire. 
‘‘(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, 
hospital, 
and 
interfacility 
transport 
throughout the region; 
‘‘(iv) coordinates prehospital treat-
ment and triage, hospital destination, and 
interfacility transport throughout the re-
gion; 
‘‘(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 
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‘‘(II) integrated with the proto-
cols for transport and destination 
throughout the region; and 
‘‘(vi) includes a regional medical di-
rection 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 
‘‘(C) such other information as the Sec-
retary may require. 
‘‘(e) MATCHING FUNDS.— 
‘‘(1) IN GENERAL.—With respect to the costs of 
the activities to be carried out each year with a con-
tract or grant under subsection (a), a condition for 
the receipt of the contract or grant is that the eligi-
ble entity involved agrees to make available (directly 
or through donations from public or private entities) 
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non-Federal contributions toward such costs in an 
amount that is not less than 25 percent of such 
costs. 
‘‘(2) DETERMINATION
OF
AMOUNT
CONTRIB-
UTED.—Non-Federal contributions required in para-
graph (1) may be in cash or in kind, fairly evalu-
ated, including plant, equipment, or services. 
Amounts provided by the Federal Government, or 
services assisted or subsidized to any significant ex-
tent by the Federal Government, may not be in-
cluded in determining the amount of such non-Fed-
eral contributions. 
‘‘(f) PRIORITY.—The Secretary shall give priority for 
the award of the contracts or grants described in sub-
section (a) to any eligible entity that serves a medically 
underserved population (as defined in section 330(b)(3)). 
‘‘(g) REPORT.—Not later than 90 days after the com-
pletion of a demonstration program under subsection (a), 
the recipient of such contract or grant described in such 
subsection shall submit to the Secretary a report con-
taining the results of an evaluation of the program, includ-
ing an identification of— 
‘‘(1) the impact of the regional, accountable 
emergency care system on patient outcomes for var-
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ious critical care categories, such as trauma, stroke, 
cardiac emergencies, and pediatric emergencies; 
‘‘(2) the system characteristics that contribute 
to the effectiveness and efficiency of the program (or 
lack thereof); 
‘‘(3) methods of assuring the long-term finan-
cial sustainability of the emergency care system; 
‘‘(4) the State and local legislation necessary to 
implement and to maintain the system; and 
‘‘(5) the barriers to developing regionalized, ac-
countable emergency care systems, as well as the 
methods to overcome such barriers. 
‘‘(h) EVALUATION.—The Secretary, acting through 
the Assistant Secretary for Preparedness and Response, 
shall enter into a contract with an academic institution 
or other entity to conduct an independent evaluation of 
the demonstration programs funded under subsection (a), 
including an evaluation of— 
‘‘(1) the performance of the eligible entities re-
ceiving the funds; and 
‘‘(2) the impact of the demonstration programs. 
‘‘(i) DISSEMINATION OF FINDINGS.—The Secretary 
shall, as appropriate, disseminate to the public and to the 
appropriate committees of the Congress, the information 
contained in a report made under subsection (h). 
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medical facilities and services between the Service, 
Indian Tribes, and Tribal Organizations and the De-
partment of Veterans Affairs and the Department of 
Defense. 
‘‘(2) 
CONSULTATION
BY
SECRETARY
RE-
QUIRED.—The Secretary may not finalize any ar-
rangement between the Service and a Department 
described in paragraph (1) without first consulting 
with the Indian Tribes which will be significantly af-
fected by the arrangement. 
‘‘(b) LIMITATIONS.—The Secretary shall not take 
any action under this section or under subchapter IV of 
chapter 81 of title 38, United States Code, which would 
impair— 
‘‘(1) the priority access of any Indian to health 
care services provided through the Service and the 
eligibility of any Indian to receive health services 
through the Service; 
‘‘(2) the quality of health care services provided 
to any Indian through the Service; 
‘‘(3) the priority access of any veteran to health 
care services provided by the Department of Vet-
erans Affairs; 
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