H. R. 3590—401 
‘‘(c) PILOT PROJECTS.—The Secretary shall award a contract 
or grant under subsection (a) to an eligible entity that proposes 
a pilot project to design, implement, and evaluate an emergency 
medical and trauma system that— 
‘‘(1) coordinates with public health and safety services, 
emergency medical services, medical facilities, trauma centers, 
and other entities in a region to develop an approach to emer-
gency medical and trauma system access throughout the region, 
including 9–1–1 Public Safety Answering Points and emergency 
medical dispatch; 
‘‘(2) includes a mechanism, such as a regional medical 
direction or transport communications system, that operates 
throughout the region to ensure that the patient is taken to 
the medically appropriate facility (whether an initial facility 
or a higher-level facility) in a timely fashion; 
‘‘(3) allows for the tracking of prehospital and hospital 
resources, including inpatient bed capacity, emergency depart-
ment capacity, trauma center capacity, on-call specialist cov-
erage, ambulance diversion status, and the coordination of such 
tracking with regional communications and hospital destination 
decisions; and 
‘‘(4) includes a consistent region-wide prehospital, hospital, 
and interfacility data management system that— 
‘‘(A) submits data to the National EMS Information 
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, hospital destination decisions, 
including initial hospital and interfacility decisions, and 
relevant health 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 Sec-
retary an application at such time and in such manner as 
the Secretary may require. 
‘‘(2) APPLICATION
INFORMATION.—Each application shall 
include— 
‘‘(A) an assurance from the eligible entity that the 
proposed system— 
‘‘(i) has been coordinated with the applicable State 
Office of Emergency Medical Services (or equivalent 
State office); 
‘‘(ii) includes consistent indirect and direct medical 
oversight of prehospital, hospital, and interfacility 
transport throughout the region; 
‘‘(iii) coordinates prehospital treatment and triage, 
hospital 
destination, 
and 
interfacility 
transport 
throughout the region; 
‘‘(iv) includes a categorization or designation 
system for special medical facilities throughout the 
region that is integrated with transport and destination 
protocols; 
‘‘(v) includes a regional medical direction, patient 
tracking, and resource allocation system that supports 
day-to-day emergency care and surge capacity and is
H. R. 3590—402 
integrated with other components of the national and 
State emergency preparedness system; and 
‘‘(vi) addresses pediatric concerns related to 
integration, planning, preparedness, and coordination 
of emergency medical services for infants, children and 
adolescents; and 
‘‘(B) such other information as the Secretary may 
require. 
‘‘(e) REQUIREMENT OF MATCHING FUNDS.— 
‘‘(1) IN GENERAL.—The Secretary may not make a grant 
under this section unless the State (or consortia of States) 
involved agrees, with respect to the costs to be incurred by 
the State (or consortia) in carrying out the purpose for which 
such grant was made, to make available non-Federal contribu-
tions (in cash or in kind under paragraph (2)) toward such 
costs in an amount equal to not less than $1 for each $3 
of Federal funds provided in the grant. Such contributions 
may be made directly or through donations from public or 
private entities. 
‘‘(2) NON-FEDERAL CONTRIBUTIONS.—Non-Federal contribu-
tions required in paragraph (1) may be in cash or in kind, 
fairly evaluated, including equipment or services (and excluding 
indirect or overhead costs). Amounts provided by the Federal 
Government, or services assisted or subsidized to any signifi-
cant extent by the Federal Government, may not be included 
in determining the amount of such non-Federal contributions. 
‘‘(f) PRIORITY.—The Secretary shall give priority for the award 
of the contracts or grants described in subsection (a) to any eligible 
entity that serves a population in a medically underserved area 
(as defined in section 330(b)(3)). 
‘‘(g) REPORT.—Not later than 90 days after the completion 
of a pilot project under subsection (a), the recipient of such contract 
or grant described in shall submit to the Secretary a report con-
taining the results of an evaluation of the program, including an 
identification of— 
‘‘(1) the impact of the regional, accountable emergency care 
and trauma system on patient health outcomes for various 
critical care categories, such as trauma, stroke, cardiac emer-
gencies, neurological 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 financial sustain-
ability of the emergency care and trauma system; 
‘‘(4) the State and local legislation necessary to implement 
and to maintain the system; 
‘‘(5) the barriers to developing regionalized, accountable 
emergency care and trauma systems, as well as the methods 
to overcome such barriers; and 
‘‘(6) recommendations on the utilization of available funding 
for future regionalization efforts. 
‘‘(h) 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 (g).’’; and 
(3) in section 1232— 
(A) in subsection (a), by striking ‘‘appropriated’’ and 
all that follows through the period at the end and inserting
H. R. 3590—403 
‘‘appropriated $24,000,000 for each of fiscal years 2010 
through 2014.’’; and 
(B) by inserting after subsection (c) the following: 
‘‘(d) AUTHORITY.—For the purpose of carrying out parts A 
through C, beginning on the date of enactment of the Patient 
Protection and Affordable Care Act, the Secretary shall transfer 
authority in administering grants and related authorities under 
such parts from the Administrator of the Health Resources and 
Services Administration to the Assistant Secretary for Preparedness 
and Response.’’. 
(b) SUPPORT FOR EMERGENCY MEDICINE RESEARCH.—Part H 
of title IV of the Public Health Service Act (42 U.S.C. 289 et 
seq.) is amended by inserting after the section 498C the following: 
‘‘SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RESEARCH. 
‘‘(a) EMERGENCY MEDICAL RESEARCH.—The Secretary shall sup-
port Federal programs administered by the National Institutes 
of Health, the Agency for Healthcare Research and Quality, the 
Health Resources and Services Administration, the Centers for 
Disease Control and Prevention, and other agencies involved in 
improving the emergency care system to expand and accelerate 
research in emergency medical care systems and emergency medi-
cine, including— 
‘‘(1) the basic science of emergency medicine; 
‘‘(2) the model of service delivery and the components of 
such models that contribute to enhanced patient health out-
comes; 
‘‘(3) the translation of basic scientific research into 
improved practice; and 
‘‘(4) the development of timely and efficient delivery of 
health services. 
‘‘(b) PEDIATRIC EMERGENCY MEDICAL RESEARCH.—The Sec-
retary shall support Federal programs administered by the National 
Institutes of Health, the Agency for Healthcare Research and 
Quality, the Health Resources and Services Administration, the 
Centers for Disease Control and Prevention, and other agencies 
to coordinate and expand research in pediatric emergency medical 
care systems and pediatric emergency medicine, including— 
‘‘(1) an examination of the gaps and opportunities in pedi-
atric emergency care research and a strategy for the optimal 
organization and funding of such research; 
‘‘(2) the role of pediatric emergency services as an 
integrated component of the overall health system; 
‘‘(3) system-wide pediatric emergency care planning, 
preparedness, coordination, and funding; 
‘‘(4) pediatric training in professional education; and 
‘‘(5) research in pediatric emergency care, specifically on 
the efficacy, safety, and health outcomes of medications used 
for infants, children, and adolescents in emergency care settings 
in order to improve patient safety. 
‘‘(c) IMPACT RESEARCH.—The Secretary shall support research 
to determine the estimated economic impact of, and savings that 
result from, the implementation of coordinated emergency care sys-
tems. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated to carry out this section such sums as may 
be necessary for each of fiscal years 2010 through 2014.’’.
H. R. 3590—404 
SEC. 3505. TRAUMA CARE CENTERS AND SERVICE AVAILABILITY. 
(a) TRAUMA CARE CENTERS.— 
(1) GRANTS FOR TRAUMA CARE CENTERS.—Section 1241 of 
the Public Health Service Act (42 U.S.C. 300d–41) is amended 
by striking subsections (a) and (b) and inserting the following: 
‘‘(a) IN GENERAL.—The Secretary shall establish 3 programs 
to award grants to qualified public, nonprofit Indian Health Service, 
Indian tribal, and urban Indian trauma centers— 
‘‘(1) to assist in defraying substantial uncompensated care 
costs; 
‘‘(2) to further the core missions of such trauma centers, 
including by addressing costs associated with patient stabiliza-
tion and transfer, trauma education and outreach, coordination 
with local and regional trauma systems, essential personnel 
and other fixed costs, and expenses associated with employee 
and non-employee physician services; and 
‘‘(3) to provide emergency relief to ensure the continued 
and future availability of trauma services. 
‘‘(b) MINIMUM QUALIFICATIONS OF TRAUMA CENTERS.— 
‘‘(1) PARTICIPATION
IN
TRAUMA
CARE
SYSTEM
OPERATING 
UNDER CERTAIN PROFESSIONAL GUIDELINES.—Except as provided 
in paragraph (2), the Secretary may not award a grant to 
a trauma center under subsection (a) unless the trauma center 
is a participant in a trauma system that substantially complies 
with section 1213. 
‘‘(2) EXEMPTION.—Paragraph (1) shall not apply to trauma 
centers that are located in States with no existing trauma 
care system. 
‘‘(3) QUALIFICATION
FOR
SUBSTANTIAL
UNCOMPENSATED 
CARE COSTS.—The Secretary shall award substantial uncompen-
sated care grants under subsection (a)(1) only to trauma centers 
meeting at least 1 of the criteria in 1 of the following 3 cat-
egories: 
‘‘(A) CATEGORY A.—The criteria for category A are as 
follows: 
‘‘(i) At least 40 percent of the visits in the emer-
gency department of the hospital in which the trauma 
center is located were charity or self-pay patients. 
‘‘(ii) At least 50 percent of the visits in such emer-
gency department were Medicaid (under title XIX of 
the Social Security Act (42 U.S.C. 1396 et seq.)) and 
charity and self-pay patients combined. 
‘‘(B) CATEGORY B.—The criteria for category B are as 
follows: 
‘‘(i) At least 35 percent of the visits in the emer-
gency department were charity or self-pay patients. 
‘‘(ii) At least 50 percent of the visits in the emer-
gency department were Medicaid and charity and self- 
pay patients combined. 
‘‘(C) CATEGORY C.—The criteria for category C are as 
follows: 
‘‘(i) At least 20 percent of the visits in the emer-
gency department were charity or self-pay patients. 
‘‘(ii) At least 30 percent of the visits in the emer-
gency department were Medicaid and charity and self- 
pay patients combined.