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Title I, Subtitle E
‘‘(D) representatives of businesses in such
area, including small businesses; and
‘‘(E) representatives of nonprofit private
entities in such area.
‘‘(2) OPTIONAL
PARTICIPANTS.—With respect
to compliance with this section, a grantee under sub-
section (a) may, for purposes of carrying out a
project under such subsection, enter into such agree-
ments with public and private entities in the quali-
fied health service area involved (in addition to the
entities specified in paragraph (1)) as the grantee
may elect.
‘‘(h) EXPENDITURES OF GRANT.—With respect to a
project under subsection (a), the purposes for which a
grant under such subsection may be expended include (but
are not limited to) expenditures to increase the efficiency
of the administrative processes of providers participating
in the project, paying the costs of hiring and compensating
staff, obtaining computers and other equipment (including
vehicles to transport individuals to programs providing
outpatient primary health services), and developing and
operating provider networks.
‘‘(i) MAINTENANCE OF EFFORT.—In the case of serv-
ices and populations that are the subject of a project
under subsection (a), the Secretary may make such a
164
Title I, Subtitle E
grant for a fiscal year only if the applicant involved agrees
that the applicant, and each entity making an agreement
under subsection (g), will maintain expenditures of non-
Federal amounts for such services and populations at a
level that is not less than the level of such expenditures
maintained by the applicant and the entity, respectively,
for the fiscal year preceding the first fiscal year for which
the applicant receives such a grant.
‘‘(j) REPORTS TO SECRETARY.—The Secretary may
make a grant under subsection (a) only if the applicant
involved agrees to submit to the Secretary such reports
on the project carried out under such subsection as the
Secretary may require.
‘‘(k) EVALUATIONS AND DISSEMINATION OF INFOR-
MATION.—The Secretary shall provide for evaluations of
projects carried out under subsection (a), and for the col-
lection and dissemination of information developed as a
result of such projects and as a result of similar projects.
‘‘(l) PLANNING GRANTS.—
‘‘(1) IN GENERAL.—The Secretary may make
grants to public and nonprofit private entities for
the purpose of developing plans to carry out projects
under subsection (a). Such a grant may be made
only if the applicant involved submits to the Sec-
retary information—
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Title I, Subtitle E
‘‘(A) providing a detailed statement of the
proposal of the applicant for carrying out the
project;
‘‘(B) identifying the geographic area in
which the project is to be carried out; and
‘‘(C) demonstrating that the area is a
qualified health service area and that the pro-
posal otherwise is in accordance with the re-
quirements established in this section for the
receipt of a grant under subsection (a).
‘‘(2) DURATION AND AMOUNT OF GRANT.—The
period during which payments are made under para-
graph (1) for the development of a plan under such
paragraph may not exceed 1 year, and the amount
of such payments may not exceed $100,000.
‘‘(m) APPLICATION FOR GRANT.—The Secretary may
make a grant under subsection (a) or (l) only if the appli-
cant for the grant submits an application to the Secretary
that—
‘‘(1) contains any agreements, assurances, and
information required in this section with respect to
the grant; and
‘‘(2) is in such form, is made in such manner,
and contains such other agreements, assurances, and
information as the Secretary determines to be nec-
166
Title I, Subtitle E
essary to carry out the purpose for which the grant
is to be provided.
‘‘(n) DEFINITIONS.—For purposes of this section:
‘‘(1) The term ‘designated population’ means
individuals described in subsection (b)(1)(C)(ii).
‘‘(2) The term ‘primary health services’ includes
preventive health services.
‘‘(3) The term ‘qualified health service area’
means a geographic area described in subsection (b).
‘‘(o) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) PLANNING FOR PROJECTS.—For the pur-
pose of grants under subsection (l), there is author-
ized to be appropriated $5,000,000 for fiscal year
1995, to remain available until expended.
‘‘(2) OPERATION OF PROJECTS.—For the pur-
pose of grants under subsection (a), there is author-
ized to be appropriated an aggregate $10,000,000
for the fiscal years 1996 through 1999.’’.
PART 3—COMMUNITY HEALTH NETWORKS
SEC. 1421. QUALIFICATIONS FOR COMMUNITY HEALTH
NETWORKS.
(a) COMMUNITY HEALTH NETWORK DEFINED.—For
purposes of part 7 of subtitle B of title I of Employee
Retirement Income Security Act of 1974 and this Act,
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Title I, Subtitle E
added by section 1211(a) of this title, the term ‘‘commu-
nity health network’’ means an arrangement that—
(1) is organized by health care providers (in-
cluding medical practitioners), community groups, or
both, and such other organizations as may be des-
ignated by the arrangement, to provide health care
services to an enrolled population in a service area,
(2) provides to its enrollees at least the benefits
included in standard coverage (consistent with sec-
tion 1102(c)),
(3) receives payment for such services on a pro-
spective capitated basis, which may vary only by
family composition, geographic area, and age,
(4) meets the requirements of subsection (b)
(relating to public accountability),
(5) meets the requirements of subsection (c)
(relating to coordination and integration of care),
(6) meets the requirements of subsection (d) to
the extent the arrangement is organized as a non-
profit entity, and
(7) meets the requirements of section 707 of
the Employee Retirement Income Security Act of
1974 (relating to maintenance of reserves), added by
section 1211.
168
Title I, Subtitle E
(b) PUBLIC ACCOUNTABILITY REQUIREMENTS.—The
public accountability requirements of this subsection, with
respect to a network, are as follows:
(1) PERFORMANCE
MEASURES.—The network
must establish and implement procedures for devel-
oping, compiling, evaluating, and reporting perform-
ance measures, statistics, and other information
on—
(A) the cost and financial performance of
network operations,
(B) the service utilization patterns of en-
rollees,
(C) the availability, accessibility, and ac-
ceptability of health care services to enrollees,
(D) ownership and governance of the net-
work, and
(E) demographic characteristics of enroll-
ees.
Such information shall be published annually and
disseminated to enrollees and the public.
(2) QUALITY ASSURANCE PROGRAM.—The net-
work must have an organizational arrangement for
an ongoing quality assurance program for all health
services it provides which—
(A) stresses health outcomes,
169
Title I, Subtitle E
(B) to the maximum extent possible, relies
primarily on evaluating and comparing practice
patterns (rather than routine case-by-case re-
view) to identify problems,
(C) provides review by physicians and
other health professionals of the outcomes and
process followed in the provision of health serv-
ices, and
(D) makes the coverage and utilization re-
view requirements of the plan, and the stand-
ards applied for such review, available to pro-
viders and the public.
(3) ENROLLMENT.—The network does not expel
or refuse to enroll any applicant or limit coverage of
services included in standard coverage for any appli-
cant because of the health status or requirements for
health services.
(4) CREDENTIALING.—The network must de-
velop and implement a process for the credentialing
(and renewal of credentials) of network providers
(including practitioners).
(5) GRIEVANCE PROCESS.—The network must
have an enrollee complaint and grievance resolution
process which shall meet any requirements of appli-
cable law.
170
Title I, Subtitle E
(c) COORDINATION AND INTEGRATION OF CARE RE-
QUIREMENTS.—The coordination and integration of care
requirements of this subsection, with respect to a network,
are as follows:
(1) COORDINATION
AND
INTEGRATION
OF
CARE.—The network must establish and implement
mechanisms for coordinating the delivery of care
across provider settings and over time, including at
least mechanisms for—
(A) linking patient registration and medi-
cal record information so that it is accessible to
all parts of the network and, consistent with
State law, assures the confidentiality of patient
information,
(B) assisting enrollees to obtain necessary
care, including preventive services, and
(C) coordinating the services furnished to
an enrollee when more than one practitioner or
provider is involved.
(2) OUT-OF-AREA
COVERAGE.—The network
must provide care within a defined service area es-
tablished by the arrangement and must provide for
reimbursement for standard coverage (consistent
with section 1102(c)) for enrollees who are tempo-
rarily outside such area.
171
Title I, Subtitle E
(3) COMMON MALPRACTICE POLICY.—Providers
(including practitioners) that provide standard cov-
erage to network enrollees must be covered for mal-
practice in accordance with documented criteria es-
tablished by the arrangement.
(4) RECORD KEEPING.—The network must use
a unified patient registration system and medical
records system that is accessible to all parts of the
network and assures confidentiality of patient infor-
mation, consistent with State law.
(d) REQUIREMENTS FOR NETWORKS ORGANIZED AS
NONPROFIT ENTITIES.—The requirements of this sub-
section, with respect to a network, are as follows:
(1) COMMUNITY
HEALTH
STATUS
IMPROVE-
MENT PROCESS.—The network develops and imple-
ments a community health status improvement proc-
ess, in cooperation with other existing networks and
community organizations from the same service
area, that—
(A) provides for an assessment of commu-
nity health status that identifies important
health status problems in such area,
(B) implements measures to address such
problems, and
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Title I, Subtitle F
(C) evaluates the efficiency and effective-
ness of such measures in addressing such prob-
lems.
The results of evaluations made pursuant to sub-
paragraph (C) shall be made publicly available on at
least an annual basis.
(2) ENROLLMENT.—The network enrolls indi-
viduals who are broadly representative of the various
age, social, and income groups within the area it
serves.
Subtitle F—Improved Access to
Rural Health Services
PART 
1—ESTABLISHMENT 
OF 
RURAL 
EMER-
GENCY ACCESS CARE HOSPITALS UNDER
MEDICARE
SEC. 1501. RURAL EMERGENCY ACCESS CARE HOSPITALS
DESCRIBED.
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended by adding at the
end the following new subsection:
173
Title I, Subtitle F
‘‘Rural Emergency Access Care Hospital; Rural
Emergency Access Care Hospital Services
‘‘(oo)(1) The term ‘rural emergency access care hos-
pital’ means, for a fiscal year, a facility with respect to
which the Secretary finds the following:
‘‘(A) The facility is located in a rural area (as
defined in section 1886(d)(2)(D)).
‘‘(B) The facility was a hospital under this title
at any time during the 5-year period that ends on
the date of the enactment of this subsection.
‘‘(C) The facility is in danger of closing due to
low inpatient utilization rates and negative operating
losses, and the closure of the facility would limit the
access of individuals residing in the facility’s service
area to emergency services.
‘‘(D) The facility has entered into (or plans to
enter into), with a hospital with a participation
agreement in effect under section 1866(a), and
under such agreement the hospital shall accept pa-
tients transferred to the hospital from the facility
and receives data from and transmits data to the fa-
cility.
‘‘(E) There is a practitioner who is qualified to
provide advanced cardiac life support services (as de-
174
Title I, Subtitle F
termined by the State in which the facility is lo-
cated) on-site at the facility on a 24-hour basis.
‘‘(F) A physician is available on-call to provide
emergency medical services on a 24-hour basis.
‘‘(G) The facility meets such staffing require-
ments as would apply under section 1861(e) to a
hospital located in a rural area, except that—
‘‘(i) the facility need not meet hospital
standards relating to the number of hours dur-
ing a day, or days during a week, in which the
facility must be open, except insofar as the fa-
cility is required to provide emergency care on
a 24-hour basis under subparagraphs (E) and
(F); and
‘‘(ii) the facility may provide any services
otherwise required to be provided by a full-time,
on-site dietitian, pharmacist, laboratory techni-
cian, medical technologist, or radiological tech-
nologist on a part-time, off-site basis.
‘‘(H) The facility meets the requirements appli-
cable to clinics and facilities under subparagraphs
(C) through (J) of paragraph (2) of section
1861(aa) and of clauses (ii) and (iv) of the second
sentence of such paragraph (or, in the case of the
requirements of subparagraph (E), (F), or (J) of
175
Title I, Subtitle F
such paragraph, would meet the requirements if any
reference in such subparagraph to a ‘nurse practi-
tioner’ or to ‘nurse practitioners’ was deemed to be
a reference to a ‘nurse practitioner or nurse’ or to
‘nurse practitioners or nurses’), except that in deter-
mining whether a facility meets the requirements of
this subparagraph, subparagraphs (E) and (F) of
that paragraph shall be applied as if any reference
to a ‘physician’ is a reference to a physician as de-
fined in section 1861(r)(1).
‘‘(2) The term ‘rural emergency access care hospital
services’ means the following services provided by a rural
emergency access care hospital:
‘‘(A) An appropriate medical screening exam-
ination (as described in section 1867(a)).
‘‘(B) Necessary stabilizing examination and
treatment services for an emergency medical condi-
tion and labor (as described in section 1867(b)).’’.
(b) REQUIRING RURAL EMERGENCY ACCESS CARE
HOSPITALS TO MEET HOSPITAL ANTI-DUMPING RE-
QUIREMENTS.—Section 1867(e)(5) of such Act (42 U.S.C.
1395dd(e)(5)) is amended by striking ‘‘1861(mm)(1))’’
and inserting ‘‘1861(mm)(1)) and a rural emergency ac-
cess care hospital (as defined in section 1861(oo)(1))’’.
176
Title I, Subtitle F
SEC. 1502. COVERAGE OF AND PAYMENT FOR SERVICES.
(a) COVERAGE UNDER PART B.—Section 1832(a)(2)
of the Social Security Act (42 U.S.C. 1395k(a)(2)) is
amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (I);
(2) by striking the period at the end of sub-
paragraph (J) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(K) rural emergency access care hospital
services (as defined in section 1861(oo)(2)).’’.
(b) PAYMENT BASED ON PAYMENT FOR OUTPATIENT
RURAL PRIMARY CARE HOSPITAL SERVICES.—
(1) IN GENERAL.—Section 1833(a)(6) of the
Social Security Act (42 U.S.C. 1395l(a)(6)) is
amended by striking ‘‘services,’’ and inserting ‘‘serv-
ices and rural emergency access care hospital serv-
ices,’’.
(2) PAYMENT
METHODOLOGY
DESCRIBED.—
Section 1834(g) of such Act (42 U.S.C. 1395m(g))
is amended—
(A) in the heading, by striking ‘‘SERV-
ICES’’ and inserting ‘‘SERVICES
AND RURAL
EMERGENCY ACCESS CARE HOSPITAL SERV-
ICES’’; and
177
Title I, Subtitle F
(B) in paragraph (1), by striking ‘‘during
a year before 1993’’ and inserting ‘‘during a
year before the prospective payment system de-
scribed in paragraph (2) is in effect’’;
(C) in paragraph (1), by adding at the end
the following:
‘‘The amount of payment shall be determined under
either method without regard to the amount of the
customary or other charge.’’;
(D) in paragraph (2), by striking ‘‘Janu-
ary 1, 1993,’’ and inserting ‘‘January 1,
1996,’’; and
(E) by adding at the end the following new
paragraph:
‘‘(3) APPLICATION OF METHODS TO PAYMENT
FOR
RURAL
EMERGENCY
ACCESS
CARE
HOSPITAL
SERVICES.—The amount of payment for rural emer-
gency access care hospital services provided during
a year shall be determined using the applicable
method provided under this subsection for determin-
ing payment for outpatient rural primary care hos-
pital services during the year.’’.
178
Title I, Subtitle F
SEC. 1503. EFFECTIVE DATE.
The amendments made by sections 1501 and 1502
shall apply to fiscal years beginning on or after October
1, 1994.
PART 2—RURAL MEDICAL EMERGENCIES AIR
TRANSPORT
SEC. 1511. GRANTS TO STATES REGARDING AIRCRAFT FOR
TRANSPORTING RURAL VICTIMS OF MEDICAL
EMERGENCIES.
Part E of title XII of the Public Health Service Act
(42 U.S.C. 300d–51 et seq.) is amended by adding at the
end thereof the following new section:
‘‘SEC. 1252. GRANTS FOR SYSTEMS TO TRANSPORT RURAL
VICTIMS OF MEDICAL EMERGENCIES.
‘‘(a) IN GENERAL.—The Secretary shall make grants
to States to assist such States in the creation or enhance-
ment of air medical transport systems that provide victims
of medical emergencies in rural areas with access to treat-
ments for the injuries or other conditions resulting from
such emergencies.
‘‘(b) APPLICATION AND PLAN.—
‘‘(1) APPLICATION.—To be eligible to receive a
grant under subsection (a), a State shall prepare
and submit to the Secretary an application in such
form, made in such manner, and containing such
agreements, assurances, and information, including
179
Title I, Subtitle F
a State plan as required in paragraph (2), as the
Secretary determines to be necessary to carry out
this section.
‘‘(2) STATE PLAN.—An application submitted
under paragraph (1) shall contain a State plan that
shall—
‘‘(A) describe the intended uses of the
grant proceeds and the geographic areas to be
served;
‘‘(B) demonstrate that the geographic
areas to be served, as described under subpara-
graph (A), are rural in nature;
‘‘(C) demonstrate that there is a lack of
facilities available and equipped to deliver ad-
vanced levels of medical care in the geographic
areas to be served;
‘‘(D) demonstrate that in utilizing the
grant proceeds for the establishment or en-
hancement of air medical services the State
would be making a cost-effective improvement
to existing ground-based or air emergency medi-
cal service systems;
‘‘(E) demonstrate that the State will not
utilize the grant proceeds to duplicate the capa-
bilities of existing air medical systems that are
180
Title I, Subtitle F
effectively meeting the emergency medical needs
of the populations they serve;
‘‘(F) demonstrate that in utilizing the
grant proceeds the State is likely to achieve a
reduction in the morbidity and mortality rates
of the areas to be served, as determined by the
Secretary;
‘‘(G) demonstrate that the State, in utiliz-
ing the grant proceeds, will—
‘‘(i) maintain the expenditures of the
State for air and ground medical transport
systems at a level equal to not less than
the level of such expenditures maintained
by the State for the fiscal year preceding
the fiscal year for which the grant is re-
ceived; and
‘‘(ii) ensure that recipients of direct
financial assistance from the State under
such grant will maintain expenditures of
such recipients for such systems at a level
at least equal to the level of such expendi-
tures maintained by such recipients for the
fiscal year preceding the fiscal year for
which the financial assistance is received;
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Title I, Subtitle F
‘‘(H) demonstrate that persons experienced
in the field of air medical service delivery were
consulted in the preparation of the State plan;
and
‘‘(I) contain such other information as the
Secretary may determine appropriate.
‘‘(c) CONSIDERATIONS IN AWARDING GRANTS.—In
determining whether to award a grant to a State under
this section, the Secretary shall—
‘‘(1) consider the rural nature of the areas to
be served with the grant proceeds and the services
to be provided with such proceeds, as identified in
the State plan submitted under subsection (b); and
‘‘(2) give preference to States with State plans
that demonstrate an effective integration of the pro-
posed air medical transport systems into a com-
prehensive network or plan for regional or statewide
emergency medical service delivery.
‘‘(d) 
STATE
ADMINISTRATION
AND
USE
OF
GRANT.—
‘‘(1) IN
GENERAL.—The Secretary may not
make a grant to a State under subsection (a) unless
the State agrees that such grant will be adminis-
tered by the State agency with principal responsibil-
ity for carrying out programs regarding the provi-
182
Title I, Subtitle F
sion of medical services to victims of medical emer-
gencies or trauma.
‘‘(2) PERMITTED
USES.—A State may use
amounts received under a grant awarded under this
section to award subgrants to public and private en-
tities operating within the State.
‘‘(3) OPPORTUNITY FOR PUBLIC COMMENT.—
The Secretary may not make a grant to a State
under subsection (a) unless that State agrees that,
in developing and carrying out the State plan under
subsection (b)(2), the State will provide public notice
with respect to the plan (including any revisions
thereto) and facilitate comments from interested
persons.
‘‘(e) NUMBER
OF GRANTS.—The Secretary shall
award grants under this section to not less than 7 States.
‘‘(f) REPORTS.—
‘‘(1) REQUIREMENT.—A State that receives a
grant under this section shall annually (during each
year in which the grant proceeds are used) prepare
and submit to the Secretary a report that shall con-
tain—
‘‘(A) a description of the manner in which
the grant proceeds were utilized;
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Title I, Subtitle F
‘‘(B) a description of the effectiveness of
the air medical transport programs assisted
with grant proceeds; and
‘‘(C) such other information as the Sec-
retary may require.
‘‘(2) TERMINATION OF FUNDING.—In reviewing
reports submitted under paragraph (1), if the Sec-
retary determines that a State is not using amounts
provided under a grant awarded under this section
in accordance with the State plan submitted by the
State under subsection (b), the Secretary may termi-
nate the payment of amounts under such grant to
the State until such time as the Secretary deter-
mines that the State comes into compliance with
such plan.
‘‘(g) DEFINITION.—As used in this section, the term
‘rural areas’ means geographic areas that are located out-
side of standard metropolitan statistical areas, as identi-
fied by the Secretary.
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There
are authorized to be appropriated to make grants under
this section, $15,000,000 for fiscal year 1994, and such
sums as may be necessary for each of the fiscal years 1996
and 1997.’’.
184
Title I, Subtitle F
PART 3—EMERGENCY MEDICAL SERVICES
AMENDMENTS
SEC. 1521. ESTABLISHMENT OF OFFICE OF EMERGENCY
MEDICAL SERVICES.
Title XII of the Public Health Service Act (42 U.S.C.
300d et seq.) is amended—
(1) in the heading for the title, by striking
‘‘TRAUMA CARE’’ and inserting ‘‘EMERGENCY
MEDICAL SERVICES’’;
(2) in the heading for part A, by striking
‘‘GENERAL’’ and all that follows and inserting
‘‘GENERAL AUTHORITIES AND DUTIES’’; and
(3) by amending section 1201 to read as fol-
lows:
‘‘SEC. 1201. ESTABLISHMENT OF OFFICE OF EMERGENCY
MEDICAL SERVICES.
‘‘(a) IN GENERAL.—The Secretary shall establish an
office to be known as the Office of Emergency Medical
Services, which shall be headed by a director appointed
by the Secretary. The Secretary shall carry out this title
acting through the Director of such Office.
‘‘(b) GENERAL AUTHORITIES AND DUTIES.—With
respect to emergency medical services (including trauma
care), the Secretary shall—
‘‘(1) conduct and support research, training,
evaluations, and demonstration projects;
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Title I, Subtitle F
‘‘(2) foster the development of appropriate,
modern systems of such services through the sharing
of information among agencies and individuals in-
volved in the study and provision of such services;
‘‘(3) sponsor workshops and conferences;
‘‘(4) as appropriate, disseminate to public and
private entities information obtained in carrying out
paragraphs (1) through (4);
‘‘(5) provide technical assistance to State and
local agencies;
‘‘(6) coordinate activities of the Department of
Health and Human Services; and
‘‘(7) as appropriate, coordinate activities of
such Department with activities of other Federal
agencies.
‘‘(c) CERTAIN REQUIREMENTS.—With respect to
emergency medical services (including trauma care), the
Secretary shall ensure that activities under subsection (b)
are carried out regarding—
‘‘(1) maintaining an adequate number of health
professionals with expertise in the provision of the
services, including hospital-based professionals and
prehospital-based professionals;
‘‘(2) developing, periodically reviewing, and re-
vising as appropriate, in collaboration with appro-
186
Title I, Subtitle F
priate public and private entities, guidelines for the
provision of such services (including, for various typ-
ical circumstances, guidelines on the number and va-
riety of professionals, on equipment, and on train-
ing);
‘‘(3) the appropriate use of available tech-
nologies, including communications technologies; and
‘‘(4) the unique needs of underserved inner-city
areas and underserved rural areas.
‘‘(d) GRANTS, COOPERATIVE AGREEMENTS, AND
CONTRACTS.—In carrying out subsections (b) and (c), the
Secretary may make grants and enter into cooperative
agreements and contracts.
‘‘(e) DEFINITIONS.—For purposes of this part:
‘‘(1) The term ‘hospital-based professional’
means a health professional (including an allied
health professional) who has expertise in providing
one or more emergency medical services and who
normally provides the services at a medical facility.
‘‘(2) The term ‘prehospital-based professional’
means a health professional (including an allied
health professional) who has expertise in providing
one or more emergency medical services and who
normally provides the services at the site of the med-
187
Title I, Subtitle F
ical emergency or during transport to a medical fa-
cility.’’.
SEC. 1522. STATE OFFICES OF EMERGENCY MEDICAL SERV-
ICES.
(a) TECHNICAL AMENDMENTS TO FACILITATE ES-
TABLISHMENT OF PROGRAM.—
(1) IN
GENERAL.—Title XII of the Public
Health Service Act (42 U.S.C. 300d et seq.) is
amended—
(A) by redesignating section 1239 as sec-
tion 1235;
(B) by redesignating sections 1231 and
1233 as sections 1236 and 1237, respectively;
and
(C) by redesignating sections 1211 through
1222 as sections 1221 through 1232, respec-
tively.
(2) MODIFICATIONS
IN
FORMAT
OF
TITLE
XII.—Title XII of the Public Health Service Act, as
amended by paragraph (1) of this subsection, is
amended—
(A) by striking ‘‘PART B’’ and all that fol-
low through ‘‘STATE PLANS’’ and inserting the
following:
188
Title I, Subtitle F
‘‘Subpart II—Formula Grants With Respect to
Modifications of State Plans’’;
(B) by striking ‘‘PART C—GENERAL PRO-
VISIONS’’ and inserting the following:
‘‘Subpart III—General Provisions’’;
(C) by redesignating sections 1202 and
1203 as sections 1211 and 1212, respectively;
and
(D) by inserting before section 1211 (as so
redesignated) the following:
‘‘PART B—TRAUMA CARE
‘‘Subpart I—Advisory Council; Clearinghouse’’.
(b) STATE OFFICES.—Title XII of the Public Health
Service Act, as amended by subsection (a) of this section,
is amended by inserting after section 1201 the following
new section:
‘‘SEC. 1202. STATE OFFICES OF EMERGENCY MEDICAL
SERVICES.
‘‘(a) PROGRAM
OF GRANTS.—The Secretary may
make grants to States for the purpose of improving the
availability and quality of emergency medical services
through the operation of State offices of emergency medi-
cal services.
‘‘(b) REQUIREMENT OF MATCHING FUNDS.—
190
Title I, Subtitle F
cluded in determining the amount of such non-
Federal contributions.
‘‘(B) The Secretary may not make a grant
under subsection (a) unless the State involved
agrees that—
‘‘(i) for the first fiscal year of pay-
ments under the grant, 100 percent or less
of the non-Federal contributions required
in paragraph (1) will be provided in the
form of in-kind contributions;
‘‘(ii) for any second fiscal year of such
payments, not more than 50 percent of
such non-Federal contributions will be pro-
vided in the form of in-kind contributions;
and
‘‘(iii) for any third fiscal year of such
payments, such non-Federal contributions
will be provided solely in the form of cash.
‘‘(c) CERTAIN REQUIRED ACTIVITIES.—The Sec-
retary may not make a grant under subsection (a) unless
the State involved agrees that activities carried out by an
office operated pursuant to such subsection will include—
‘‘(1) coordinating the activities carried out in
the State that relate to emergency medical services;
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Title I, Subtitle F
‘‘(2) activities regarding the matters described
in paragraphs (1) through (4) section 1201(b); and
‘‘(3) identifying Federal and State programs re-
garding emergency medical services and providing
technical assistance to public and nonprofit private
entities regarding participation in such programs.
‘‘(d) REQUIREMENT REGARDING ANNUAL BUDGET
FOR OFFICE.—The Secretary may not make a grant
under subsection (a) unless the State involved agrees that,
for any fiscal year for which the State receives such a
grant, the office operated pursuant to subsection (a) will
be provided with an annual budget of not less than
$50,000.
‘‘(e) CERTAIN USES OF FUNDS.—
‘‘(1) RESTRICTIONS.—The Secretary may not
make a grant under subsection (a) unless the State
involved agrees that—
‘‘(A) if research with respect to emergency
medical services is conducted pursuant to the
grant, not more than 10 percent of the grant
will be expended for such research; and
‘‘(B) the grant will not be expended to pro-
vide emergency medical services (including pro-
viding cash payments regarding such services).
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Title I, Subtitle F
‘‘(2) ESTABLISHMENT
OF
OFFICE.—Activities
for which a State may expend a grant under sub-
section (a) include paying the costs of establishing
an office of emergency medical services for purposes
of such subsection.
‘‘(f) REPORTS.—The Secretary may not make a
grant under subsection (a) unless the State involved
agrees to submit to the Secretary reports containing such
information as the Secretary may require regarding activi-
ties carried out under this section by the State.
‘‘(g) REQUIREMENT
OF APPLICATION.—The Sec-
retary may not make a grant under subsection (a) unless
an application for the grant is submitted to the Secretary
and the application is in such form, is made in such man-
ner, and contains such agreements, assurances, and infor-
mation as the Secretary determines to be necessary to
carry out this section.’’.
SEC. 1523. PROGRAMS FOR RURAL AREAS.
(a) IN GENERAL.—Title XII of the Public Health
Service Act, as amended by section 1522, is amended—
(1) by transferring section 1204 to part A;
(2) by redesignating such section as section
1203;
(3) by inserting such section after section 1202;
and
193
Title I, Subtitle F
(4) in section 1203 (as so redesignated)—
(A) by redesignating subsection (c) as sub-
section (d); and
(B) by inserting after subsection (b) the
following new subsection:
‘‘(c) DEMONSTRATION PROGRAM REGARDING TELE-
COMMUNICATIONS.—
‘‘(1) LINKAGES
FOR
RURAL
FACILITIES.—
Projects under subsection (a)(1) shall include dem-
onstration projects to establish telecommunications
between rural medical facilities and medical facilities
that have expertise or equipment that can be utilized
by the rural facilities through the telecommuni-
cations.
‘‘(2) MODES
OF
COMMUNICATION.—The Sec-
retary shall ensure that the telecommunications
technologies demonstrated under paragraph (1) in-
clude interactive video telecommunications, static
video imaging transmitted through the telephone
system, and facsimiles transmitted through such
system.’’.
(b) CONFORMING AMENDMENT.—Section 1203 of the
Public Health Service Act, as redesignated by subsection
(a)(2) of this section, is amended in the heading for the
194
Title I, Subtitle F
section by striking ‘‘ESTABLISHMENT’’ and all that fol-
lows and inserting ‘‘PROGRAMS FOR RURAL AREAS.’’.
SEC. 1524. FUNDING.
Title XII of the Public Health Service Act, as amend-
ed by the preceding provisions of this title, is amended—
(1) by redesignating parts C through F as parts
D through G, respectively;
(2) by inserting after subpart III of part B the
following:
‘‘PART C—FUNDING’’;
(3) by transferring section 1239 to part C (as
so added); and
(4) in such section, by striking subsections (a)
and (b) and inserting the following:
‘‘(a) 
EMERGENCY
MEDICAL
SERVICES
GEN-
ERALLY.—
‘‘(1) IN GENERAL.—For the purpose of carry-
ing out section 1201 other than with respect to trau-
ma care, there are authorized to be appropriated
$2,000,000 for fiscal year 1995, and such sums as
may be necessary for each of the fiscal years 1996
and 1997.
‘‘(2) STATE OFFICES.—For the purpose of car-
rying out section 1202, there are authorized to be
appropriated $3,000,000 for fiscal year 1995, and
195
Title I, Subtitle F
such sums as may be necessary for each of the fiscal
years 1996 and 1997.
‘‘(3) CERTAIN
TELECOMMUNICATIONS
DEM-
ONSTRATIONS.—For the purpose of carrying out sec-
tion 1203(c), there are authorized to be appro-
priated $10,000,000 for fiscal year 1995 and such
sums as may be necessary for each of the fiscal
years 1996 and 1997.
‘‘(b) TRAUMA CARE AND CERTAIN OTHER ACTIVI-
TIES.—
‘‘(1) IN GENERAL.—For the purpose of carry-
ing out part B, section 1201 with respect to trauma
care, and section 1203 (other than subsection (c) of
such section), there are authorized to be appro-
priated $60,000,000 for fiscal year 1995, and such
sums as may be necessary for each of the fiscal
years 1996 and 1997.
‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—
‘‘(A) For the purpose of carrying out sub-
part I of part B, section 1201 with respect to
trauma care, and section 1203 (other than sub-
section (c) of such section), the Secretary shall
make available 10 percent of the amounts ap-
propriated for a fiscal year under paragraph
(1).
196
Title I, Subtitle F
‘‘(B) For the purpose of carrying out sec-
tion 1203 (other than subsection (c) of such
section), the Secretary shall make available 10
percent of the amounts appropriated for a fiscal
year under paragraph (1).
‘‘(C)(i) For the purpose of making allot-
ments under section 1221(a), the Secretary
shall, subject to subsection (c), make available
80 percent of the amounts appropriated for a
fiscal year under paragraph (1).
‘‘(ii) Amounts paid to a State under sec-
tion 1221(a) for a fiscal year shall, for the pur-
poses for which the amounts were paid, remain
available for obligation until the end of the fis-
cal year immediately following the fiscal year
for which the amounts were paid.’’.
SEC. 1525. CONFORMING AMENDMENTS.
Title XII of the Public Health Service Act, as amend-
ed by the preceding provisions of this title, is amended—
(1) in section 1203(b), by striking ‘‘1214(c)(1)’’
and inserting ‘‘1224(c)(1)’’;
(2) in section 1211(b)(3), by striking ‘‘1213(c)’’
and inserting ‘‘1223(c)’’;
(3) in section 1221—
(A) in subsection (a)—
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Title I, Subtitle F
(i) by striking ‘‘1218’’ and inserting
‘‘1228’’; and
(ii) by striking ‘‘1217’’ and inserting
‘‘1227’’; and
(B) in subsection (b)—
(i) by striking ‘‘1233’’ and inserting
‘‘1237’’; and
(ii) by striking ‘‘1213’’ and inserting
‘‘1223’’;
(4) in section 1222—
(A) in subsection (a)—
(i) in paragraph (1), by striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and
(ii) in paragraph (2)(A), by striking
‘‘1211(c)’’ and inserting ‘‘1221(c)’’; and
(B) 
in 
subsection 
(b), 
by 
striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’;
(5) in section 1223—
(A) 
in 
subsection 
(a), 
by 
striking
‘‘1211(b)’’ and inserting ‘‘1221(b)’’;
(B) in subsection (b)—
(i) in paragraph (1), by striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and
(ii) in paragraph (3), by striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’; and
198
Title I, Subtitle F
(C) 
in 
subsection 
(d), 
by 
striking
‘‘1211(a)’’ and inserting ‘‘1221(a)’’;
(6) in section 1224—
(A) in each of subsections (a) through (c),
by striking ‘‘1211(a)’’ and inserting ‘‘1221(a)’’;
and
(B) 
in 
subsection 
(b), 
by 
striking
‘‘1213(a)(7)’’ and inserting ‘‘1223(a)(7)’’;
(7) in section 1225—
(A) in subsection (a)—
(i) by striking ‘‘1211(a)’’ and insert-
ing ‘‘1221(a)’’; and
(ii) by striking ‘‘1233’’ and inserting
‘‘1237’’; and
(B) 
in 
subsection 
(b), 
by 
striking
‘‘1211(b)’’ and inserting ‘‘1221(b)’’;
(8) in section 1226, in each of subsections (a)
through (c), by striking ‘‘1211(a)’’ and inserting
‘‘1221(a)’’;
(9) in section 1227—
(A) by striking ‘‘1211(a)’’ and inserting
‘‘1221(a)’’; and
(B) by striking ‘‘1214’’ and inserting
‘‘1224’’;
(10) in section 1228—
199
Title I, Subtitle F
(A) in each of subsections (a) through (c),
by striking ‘‘1211(a)’’ each place such term ap-
pears and inserting ‘‘1221(a)’’;
(B) in subsection (b), in each of para-
graphs 
(2)(A) 
and 
(3)(A), 
by 
striking
‘‘1232(a)’’ and inserting ‘‘1239(a)’’; and
(C) in subsection (c)(2)—
(i) by striking ‘‘1232(b)(3)’’ and in-
serting ‘‘1239(b)(3)’’; and
(ii) by striking ‘‘1217’’ and inserting
‘‘1227’’;
(11) in section 1229(a), by striking ‘‘1211(a)’’
each place such term appears and inserting
‘‘1221(a)’’;
(12) in section 1230(a), by striking ‘‘1211(a)’’
each place such term appears and inserting
‘‘1221(a)’’;
(13) in section 1231—
(A) in each of subsections (a) and (b), by
striking ‘‘1211(a)’’ each place such term ap-
pears and inserting ‘‘1221(a)’’; and
(B) in each of subsections (a) and (b), by
striking ‘‘1211(b)’’ and inserting ‘‘1221(b)’’;
(14) in section 1232, by striking ‘‘1211’’ and
inserting ‘‘1221’’;
200
Title I, Subtitle F
(15) in section 1236—
(A) in the matter preceding paragraph (1),
by striking ‘‘this title’’ and inserting ‘‘this
part’’; and
(B) in paragraph (1), by striking ‘‘1213’’
and inserting ‘‘1223’’;
(16) in section 1237—
(A) in each of subsections (a) and (b), by
striking ‘‘1211’’ each place such term appears
and inserting ‘‘1221’’;
(B) in subsection (b)—
(i) by striking ‘‘part B’’ and inserting
‘‘subpart II’’; and
(ii) by striking ‘‘1214(c)(1)’’ and in-
serting ‘‘1224(c)(1)’’; and
(C) in subsection (c), by striking ‘‘1213’’
and inserting ‘‘1223’’; and
(17) in section 1239(c)(1)—
(A) by striking ‘‘1211(a)’’ and inserting
‘‘1221(a)’’;
(B) by striking ‘‘1218(a)(2)’’ and inserting
‘‘1228(a)(2)’’; and
(C) by striking ‘‘part B’’ and inserting
‘‘subpart II’’.