services under Federal, State, local, or private
programs;
‘‘(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
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—
‘‘(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-
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
1994, 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 1995 through 1998.’’.
Subtitle E—Improved Access to
Rural Health Services
PART 1—RURAL EMERGENCY MEDICAL SERVICES
AMENDMENTS
SEC. 171. 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. OFFICE OF EMERGENCY MEDICAL SERVICES.
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish an office to be known as the Office of Emergency
Medical Services, which shall be headed by a director ap-
pointed 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;
‘‘(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 (3);
‘‘(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-
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-
ical emergency or during transport to a medical fa-
cility.’’.
SEC. 172. STATE OFFICES OF EMERGENCY MEDICAL
SERVICES.
(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 1232 as sec-
tion 1251;
(B) by redesignating sections 1231 and
1233 as sections 1241 and 1242, 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-
lows through ‘‘STATE PLANS’’ and inserting the
following:
‘‘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.—
‘‘(1) IN
GENERAL.—The Secretary may not
make a grant under subsection (a) unless the State
involved agrees, with respect to the costs to be in-
curred by the State in carrying out the purpose de-
scribed in such subsection, to provide non-Federal
contributions toward such costs in an amount that—
‘‘(A) for the first fiscal year of payments
under the grant, is not less than $1 for each $3
of Federal funds provided in the grant;
‘‘(B) for any second fiscal year of such
payments, is not less than $1 for each $1 of
Federal funds provided in the grant; and
‘‘(C) for any third fiscal year of such pay-
ments, is not less than $3 for each $1 of Fed-
eral funds provided in the grant.
‘‘(2) DETERMINATION
OF
AMOUNT
OF
NON-
FEDERAL CONTRIBUTION.—
‘‘(A) Subject to subparagraph (B), non-
Federal contributions required in paragraph (1)
may be in cash or in kind, fairly evaluated, in-
cluding plant, equipment, or services. Amounts
provided by the Federal Government, or serv-
ices assisted or subsidized to any significant ex-
tent by the Federal Government, may not be in-
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;
‘‘(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).