I 
113TH CONGRESS 
1ST SESSION H. R. 2651 
To improve the understanding and coordination of critical care health services. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 10, 2013 
Mr. PAULSEN (for himself, Mr. MATHESON, and Mr. RUPPERSBERGER) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce, and in addition to the Committee on Ways and Means, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
A BILL 
To improve the understanding and coordination of critical 
care health services. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Critical Care Assess-
ment and Improvement Act of 2013’’. 
SEC. 2. FINDINGS; PURPOSES. 
(a) FINDINGS.—Congress finds the following: 
(1) Critical care medicine is the care for pa-
tients whose illnesses or injuries present a signifi-
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cant danger to life, limb, or organ function and re-
quire comprehensive care and constant monitoring, 
usually in intensive care units (ICUs). 
(2) Each year, approximately five million Amer-
icans are admitted into adult medical, surgical, pedi-
atric, or neonatal ICUs. 
(3) Critical care medicine encompasses a wide 
array of diseases and health issues. The care pro-
vided in the ICU is highly specialized and complex 
due to the extreme severity of illness of its patient 
population, often involving multiple disease processes 
in different organ systems at the same time. 
(4) Critical care medicine consumes a signifi-
cant amount of financial resources, accounting for 
more than 17 percent of all hospital costs. 
(5) According to a recent study published in the 
Journal of Critical Care Medicine, despite the fact 
that cancer care and critical care place similar eco-
nomic burdens on society, proportionally 3.1 to 11.4 
times more research money was spent on cancer care 
research than critical care research. 
(6) According to a 2006 report by the Health 
Resources and Services Administration (‘‘HRSA’’), 
demand in the United States for critical care med-
ical services is on the rise, due in part to the grow-
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ing elderly population, as individuals over the age of 
65 consume a large percentage of critical care serv-
ices. 
(7) The HRSA report also found that the grow-
ing aging population will further exacerbate an exist-
ing shortage of intensivists, the physicians certified 
in critical care who primarily deliver care in inten-
sive care units, potentially compromising the quality 
and availability of care. Today, intensivist-led teams 
treat only one-third of critically ill patients despite 
substantial evidence that these teams lead to im-
proved outcomes. 
(8) Ensuring the strength of our critical care 
medical delivery infrastructure is integral to the im-
provement of the quality and delivery of health care 
in the United States. 
(b) PURPOSE.—The purpose of this Act is to assess 
the current state of the United States critical care medical 
delivery system and implement policies to improve the 
quality and effectiveness of care delivered to the critically 
ill and injured. 
SEC. 3. STUDIES ON CRITICAL CARE. 
(a) INSTITUTE OF MEDICINE STUDY.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
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retary’’) shall enter into an agreement with the In-
stitute of Medicine under which, not later than 1 
year after the date of the enactment of this Act, the 
Institute will— 
(A) conduct an analysis of the current 
state of critical care health services in the 
United States; 
(B) develop recommendations to bolster 
critical care capabilities to meet future demand; 
and 
(C) submit to Congress a report including 
the analysis and recommendations under sub-
paragraphs (A) and (B). 
(2) ISSUES TO BE STUDIED.—The agreement 
under paragraph (1) shall, at a minimum, provide 
for the following: 
(A) Analysis of the current critical care 
system in the United States, including— 
(i) the system’s capacity and re-
sources, including the size of the critical 
care workforce and the availability of 
health information technology and medical 
equipment; 
(ii) the system’s strengths, limitations, 
and future challenges; and 
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(iii) the system’s ability to provide 
adequate care for the critically ill or in-
jured in response to a national health 
emergency, including a pandemic or nat-
ural disaster. 
(B) Analysis and recommendations regard-
ing regionalizing critical care systems. 
(C) Analysis regarding the status of crit-
ical care research in the United States and rec-
ommendations for future research priorities. 
(b) HEALTH RESOURCES AND SERVICES ADMINIS-
TRATION STUDY.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Administrator of the Health Resources 
and Services Administration, shall review and update 
the Administration’s 2006 study entitled ‘‘The Crit-
ical Care Workforce: A Study of the Supply and De-
mand for Critical Care Physicians’’. 
(2) SCOPE.—In carrying out paragraph (1), the 
Secretary shall expand the scope of the study to ad-
dress the supply and demand of other providers 
within the spectrum of critical care delivery, includ-
ing critical care nurses, mid-level providers (such as 
physician assistants and nurse practitioners), inten-
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sive care unit pharmacists, and intensive care unit 
respiratory care practitioners. 
SEC. 4. NIH CRITICAL CARE COORDINATING COUNCIL. 
(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director of the National Institutes of Health, 
shall establish a council within the Institutes to be known 
as the Critical Care Coordinating Council (in this section 
referred to as the ‘‘Council’’). 
(b) MEMBERSHIP.—The Secretary shall ensure that 
the membership of the Council includes representatives of 
each of— 
(1) the National Heart, Lung, and Blood Insti-
tute; 
(2) the National Institute of Nursing Research; 
(3) the Eunice Kennedy Shriver National Insti-
tute of Child Health and Human Development; 
(4) the National Institute of General Medical 
Sciences; 
(5) the National Institute on Aging; and 
(6) any other national research institute or na-
tional center of the National Institutes of Health 
that the Secretary deems appropriate. 
(c) DUTIES.—The Council shall— 
(1) serve as the focal point and catalyst across 
the National Institutes of Health for advancing re-
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search and research training in the critical care set-
ting; 
(2) coordinate funding opportunities that in-
volve multiple national research institutes or na-
tional centers of the National Institutes of Health; 
(3) catalyze the development of new funding op-
portunities; 
(4) inform investigators about funding opportu-
nities in their areas of interest; 
(5) represent the National Institutes of Health 
in Government-wide efforts to improve the Nation’s 
critical care system; 
(6) coordinate the collection and analysis of in-
formation on current research of the National Insti-
tutes of Health relating to the care of the critically 
ill and injured and identify gaps in such research; 
(7) provide an annual report to the Director on 
the National Institutes of Health regarding research 
efforts of the Institutes relating to the care of the 
critically ill and injured; and 
(8) make recommendations in each such report 
on how to strengthen partnerships within the Na-
tional Institutes of Health and between the Insti-
tutes and public and private entities to expand col-
laborative, cross-cutting research. 
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SEC. 5. CENTERS FOR MEDICARE AND MEDICAID INNOVA-
TION 
CRITICAL 
CARE 
DEMONSTRATION 
PROJECT. 
(a) IN GENERAL.—Not later than one year after the 
date of the enactment of this Act, the Secretary, acting 
through the Center for Medicare and Medicaid Innovation 
created under section 1115A of the Social Security Act 
(42 U.S.C. 1315a), shall carry out a demonstration 
project designed to improve the quality and efficiency of 
care provided to critically ill and injured patients receiving 
critical care in intensive care units or other areas of acute 
care hospitals. 
(b) 
ACTIVITIES
UNDER
DEMONSTRATION 
PROJECT.—The 
activities 
conducted 
under 
the 
demonstration project under subsection (a) may, in addi-
tion to any other activity specified by the Center for Medi-
care and Medicaid Innovation, include activities that seek 
to— 
(1) improve the coordination and transitions of 
care to and from an intensive care unit and the next 
point of care; 
(2) incorporate value-based purchasing meth-
odologies; or novel informatics, monitoring or other 
methodologies to eliminate error, improve outcomes, 
and reduce waste from the delivery of critical care; 
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(3) improve prediction models that help health 
care providers and hospitals identify patients at high 
risk for requiring critical care services and stream-
line care delivery to prevent unexpected hospital re-
admissions for critical illnesses; and 
(4) utilize bundled payment approaches and in-
centive care redesign, such as efforts to facilitate 
and support comprehensive team delivered care. 
Æ 
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