I
103D CONGRESS
1ST SESSION
H. R. 1766
To amend the Public Health Service Act to establish an Office of Emergency
Medical Services, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
APRIL 21, 1993
Mr. GUNDERSON (for himself, Mr. ROBERTS, Mr. SLATTERY, Mr. THOMAS of
Wyoming, Mr. LANCASTER, Ms. SNOWE, and Mr. KYL) introduced the
following bill; which was referred to the Committee on Energy and Com-
merce
A BILL
To amend the Public Health Service Act to establish an
Office of Emergency Medical Services, and for other
purposes.
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 ‘‘Emergency Medical
Services Amendments Act of 1993’’.
SEC. 2. ESTABLISHMENT OF OFFICE OF EMERGENCY MEDI-
CAL 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;
‘‘(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-
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. 3. 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 1232 as sec-
tion 1235;
(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-
low 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);
‘‘(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).
‘‘(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. 4. PROGRAMS FOR RURAL AREAS.
(a) IN GENERAL.—Title XII of the Public Health
Service Act, as amended by section 3 of this Act, 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
(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
section by striking ‘‘ESTABLISHMENT’’ and all that
follows and inserting ‘‘PROGRAMS FOR RURAL
AREAS.’’.
SEC. 5. FUNDING.
Title XII of the Public Health Service Act, as amend-
ed by the preceding provisions of this Act, is amended—
(1) by inserting after subpart III of part B the
following:
‘‘PART C—FUNDING’’;
(2) by transferring section 1235 to part C (as
so added); and
(3) 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 1993, and such sums as
may be necessary for each of the fiscal years 1994
and 1995.
‘‘(2) STATE OFFICES.—For the purpose of car-
rying out section 1202, there are authorized to be
appropriated $3,000,000 for fiscal year 1993, and
such sums as may be necessary for each of the fiscal
years 1994 and 1995.
‘‘(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 1993 and such
sums as may be necessary for each of the fiscal
years 1994 and 1995.
‘‘(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 1993, and such
sums as may be necessary for each of the fiscal
years 1994 and 1995.
‘‘(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).
‘‘(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. 6. CONFORMING AMENDMENTS.
Title XII of the Public Health Service Act, as amend-
ed by the preceding provisions of this Act, 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)—
(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
‘‘1242’’; 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
(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
‘‘1242’’; 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—
(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 ‘‘1251(a)’’; and
(C) in subsection (c)(2)—
(i) by striking ‘‘1232(b)(3)’’ and in-
serting ‘‘1251(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’’;
(15) in section 1241—
(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 1242—
(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 1251(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’’.
SEC. 7. EFFECTIVE DATE.
The amendments made by this Act shall take effect
October 1, 1992, or upon the date of the enactment of
this Act, whichever occurs later.
Æ
HR 1766 IH——2