I
106TH CONGRESS
1ST SESSION
H. R. 2831
To amend title XVIII of the Social Security Act to ensure Medicare reim-
bursement for certain ambulance services, and to improve the efficiency
of the emergency medical system, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 9, 1999
Mr. LUTHER introduced the following bill; which was referred to the Com-
mittee on Commerce, and in addition to the Committees on Ways and
Means, and Agriculture, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to ensure
Medicare reimbursement for certain ambulance services,
and to improve the efficiency of the emergency medical
system, 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 Efficiency Act of 1999’’.
TITLE I—MEDICARE COVERAGE
OF 
CERTAIN 
AMBULANCE
SERVICES
SEC. 101. MEDICARE COVERAGE OF CERTAIN AMBULANCE
SERVICES.
(a) COVERAGE.—Section 1861(s)(7) of the Social Se-
curity Act (42 U.S.C. 1395x(s)(7)) is amended by striking
‘‘regulations;’’ and inserting ‘‘regulations, except that
such regulations shall not fail to treat ambulance services
as medical and other health services solely because the ul-
timate diagnosis of the individual receiving the ambulance
services results in the conclusion that ambulance services
were not necessary, as long as the request for ambulance
services is made after the sudden onset of a medical condi-
tion that is manifested by symptoms of such sufficient se-
verity, including severe pain, that a prudent layperson,
who possesses an average knowledge of health and medi-
cine, could reasonably expect to result, without immediate
medical attention, in—
‘‘(A) placing the individual’s health in serious
jeopardy;
‘‘(B) serious impairment to the individual’s
bodily functions; or
‘‘(C) serious dysfunction of any bodily organ or
part of the individual;’’.
amended by adding at the end the following flush sen-
tence:
‘‘A State emergency medical services agency may partici-
pate in the consortium under this section.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on the date of enactment
of this Act.
TITLE 
III—FEDERAL 
COMMIS-
SION FOR EMERGENCY AMBU-
LANCE SERVICES
SEC. 301. DEFINITION OF EMERGENCY AMBULANCE SERV-
ICES.
In this title, the term ‘‘emergency ambulance
services’’—
(1) means resources used by a qualified public,
private, or nonprofit entity to deliver medical care
under emergency conditions—
(A) that occur as a result of the condition
of a patient; or
(B) that occur as a result of a natural dis-
aster or similar situation; and
(2) includes services delivered by an emergency
ambulance employee that is licensed or certified by
a State as an emergency medical technician, a para-
medic, a registered nurse, a physician assistant, or
a physician.
SEC. 302. ESTABLISHMENT OF COMMISSION.
(a) ESTABLISHMENT.—There is established a com-
mission to be known as the Federal Commission for Emer-
gency Ambulance Services (in this title referred to as the
‘‘Commission’’).
(b) MEMBERSHIP.—
(1) COMPOSITION.—The Commission shall be
composed of 21 members, of whom—
(A) 1 shall be an individual who is ap-
pointed by the Majority Leader of the Senate;
(B) 1 shall be an individual who is ap-
pointed by the Minority Leader of the Senate;
(C) 1 shall be an individual who is ap-
pointed by the Speaker of the House of Rep-
resentatives;
(D) 1 shall be an individual who is ap-
pointed by the Minority Leader of the House of
Representatives;
(E) 1 shall be a member of the American
Academy of Pediatrics, appointed by the Presi-
dent from a list of nominations submitted by
the American Academy of Pediatrics;
(F) 1 shall be a member of the American
Ambulance Association, appointed by the Presi-
dent from a list of nominations submitted by
the American Ambulance Association;
(G) 1 shall be a member of the American
College of Emergency Physicians, appointed by
the President from a list of nominations sub-
mitted by the American College of Emergency
Physicians;
(H) 1 shall be a member of the Committee
on Trauma within the American College of Sur-
geons, appointed by the President from a list of
nominations submitted by the American College
of Surgeons;
(I) 1 shall be a member of the American
Hospital Association, appointed by the Presi-
dent from a list of nominations submitted by
the American Hospital Association;
(J) 1 shall be a member of the North
American EMS Employee Organization Net-
work, appointed by the President from a list of
nominations submitted by the North American
EMS Employee Organization Network;
(K) 1 shall be a member of the Associated
Public Safety Communications Officials Inter-
national, appointed by the President from a list
of nominations submitted by the Associated
Public Safety Communications Officials Inter-
national;
(L) 1 shall be a member of the Association
of Air Medical Services, appointed by the Presi-
dent from a list of nominations submitted by
the Association of Air Medical Services;
(M) 1 shall be a member of the Emergency
Nurses Association, appointed by the President
from a list of nominations submitted by the
Emergency Nurses Association;
(N) 1 shall be a member of the Inter-
national Association of Fire Chiefs, appointed
by the President from a list of nominations sub-
mitted by the International Association of Fire
Chiefs;
(O) 1 shall be a member of the Inter-
national Association of Fire Fighters, appointed
by the President from a list of nominations sub-
mitted by the International Association of Fire
Fighters;
(P) 1 shall each be a member of a gov-
erning body of an Indian tribe (as that term is
defined in section 4(e) of the Indian Self-Deter-
mination and Education Assistance Act (25
U.S.C. 450b(e))), appointed by the President;
(Q) 1 shall be a member of the National
Association of Emergency Medical Services
Physicians, appointed by the President from a
list of nominations submitted by the National
Association of Emergency Medical Services
Physicians;
(R) 1 shall be a member of the National
Association of State Emergency Medical Serv-
ices Directors, appointed by the President from
a list of nominations submitted by the National
Association of State Emergency Medical Serv-
ices Directors;
(S) 1 shall be a member of the National
Association of Emergency Medical Technicians,
appointed by the President from a list of nomi-
nations submitted by the National Association
of Emergency Medical Technicians;
(T) 1 shall be a member of the National
Rural Health Association, appointed by the
President from a list of nominations submitted
by the National Rural Health Association; and
(U) 1 shall be a member of the National
Volunteer Fire Council, appointed by the Presi-
dent from a list of nominations submitted by
the National Volunteer Fire Council.
(2) ADDITIONAL REQUIREMENTS.—
(A) GEOGRAPHICAL REPRESENTATION AND
URBAN
AND
RURAL
REPRESENTATION.—In
making appointments of members under para-
graph (1), the appointing officials described in
such paragraph shall, through consultation and
collaboration with each other, select—
(i) members who are geographically
representative of the United States; and
(ii) members who are representative of
rural areas and urban areas.
(B) SPECIAL RULE.—The appointing offi-
cials described in paragraph (1) shall ensure
that, of the members appointed—
(i) 11 shall be representative of rural
areas; and
(ii) 11 shall be representative of
urban areas.
(3) DATE.—The appointments of the members
of the Commission shall be made not later than Jan-
uary 1, 2000.
(c) PERIOD OF APPOINTMENT; VACANCIES.—
(1) PERIOD OF APPOINTMENT.—Members shall
be appointed for a term of 4 years.
(2) VACANCY.—
(A) IN
GENERAL.—Any vacancy in the
Commission shall not affect the powers of the
Commission, but shall be filled in the same
manner as the original appointment.
(B) FILLING UNEXPIRED TERMS.—An in-
dividual chosen to fill a vacancy under this
paragraph shall be appointed for the unexpired
term of the member replaced.
(d) INITIAL MEETING.—Not later than 30 days after
the date on which all members of the Commission have
been appointed, the Commission shall hold its first meet-
ing.
(e) MEETINGS.—The Commission shall meet at the
call of the Chairperson.
(f) QUORUM.—A majority of the members of the
Commission shall constitute a quorum, but a lesser num-
ber of members may hold hearings.
(g) CHAIRPERSON AND VICE CHAIRPERSON.—The
Commission shall select a Chairperson and Vice Chair-
person from among the members of the Commission.
SEC. 303. DUTIES OF THE COMMISSION.
(a) STUDY.—The Commission shall conduct a thor-
ough study of all matters relating to emergency ambulance
services, including any existing or proposed Federal de-
partment or agency rules that impact such services.
(b) RECOMMENDATIONS.—The Commission shall de-
velop recommendations regarding the improvement of all
matters relating to emergency ambulance services, includ-
ing any existing or proposed Federal department or agen-
cy rules that impact such services.
(c) REPORT.—Not later than 1 year after the date
of enactment of this Act and annually thereafter, the Com-
mission shall submit a report to the President and Con-
gress containing a detailed statement of the results of the
matters studied by the Commission pursuant to subsection
(a), together with the Commission’s recommendations for-
mulated pursuant to subsection (b).
SEC. 304. POWERS OF THE COMMISSION.
(a) HEARINGS.—The Commission may hold such
hearings, sit and act at such times and places, take such
testimony, and receive such evidence as the Commission
considers necessary to carry out the purposes of this title.
(b) INFORMATION FROM FEDERAL AGENCIES.—The
Commission may secure directly from any Federal depart-
ment or agency such information as the Commission con-
siders necessary to carry out the provisions of this title.
Upon request of the Chairperson of the Commission, the
head of such department or agency shall furnish such in-
formation to the Commission.
(c) POSTAL SERVICES.—The Commission may use
the United States mails in the same manner and under
the same conditions as other departments and agencies of
the Federal Government.
(d) GIFTS.—The Commission may accept, use, and
dispose of gifts or donations of services or property.
SEC. 305. COMMISSION PERSONNEL MATTERS.
(a) COMPENSATION OF MEMBERS.—Members of the
Commission shall receive no additional pay, allowances, or
benefits by reason of the service of the members on the
Commission.
(b) TRAVEL EXPENSES.—The members of the Com-
mission shall be allowed travel expenses, including per
diem in lieu of subsistence, at rates authorized for employ-
ees of agencies under subchapter I of chapter 57 of title
5, United States Code, while away from the homes or reg-
ular places of business of the members in the performance
of services for the Commission.
(c) STAFF.—
(1) IN
GENERAL.—The Chairperson of the
Commission may, without regard to the civil service
laws and regulations, appoint and terminate an exec-
utive director and such other additional personnel as
may be necessary to enable the Commission to per-
form the duties of the Commission. The employment
of an executive director shall be subject to confirma-
tion by the Commission.
(2) COMPENSATION.—The Chairperson of the
Commission may fix the compensation of the execu-
tive director and other personnel without regard to
the provisions of chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating
to classification of positions and General Schedule
pay rates, except that the rate of pay for the execu-
tive director and other personnel may not exceed the
rate payable for level V of the Executive Schedule
under section 5316 of such title.
(d) DETAIL
OF GOVERNMENT EMPLOYEES.—Any
Federal Government employee may be detailed to the
Commission without compensation in addition to that re-
ceived for service as an employee of the United States,
and such detail shall be without interruption or loss of
civil service status or privilege.
(e) PROCUREMENT OF TEMPORARY AND INTERMIT-
TENT SERVICES.—The Chairperson of the Commission
may procure temporary and intermittent services under
section 3109(b) of title 5, United States Code, at rates
for individuals that do not exceed the daily equivalent of
the annual rate of basic pay prescribed for level V of the
Executive Schedule under section 5316 of such title.
SEC. 306. FUNDING.
The Secretary of Labor, the Secretary of Commerce,
and the Secretary of Health and Human Services equally
shall provide to the Commission, out of funds otherwise
available to such Secretaries, such sums as are necessary
to carry out the purposes of the Commission under this
title.
SEC. 307. APPLICABILITY OF FEDERAL ADVISORY COM-
MITTEE ACT.
Section 14 of the Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Commission.
TITLE IV—STUDY AND REPORT
REGARDING CONSOLIDATION
OF 
FEDERAL 
AUTHORITY
OVER EMERGENCY MEDICAL
SERVICES
SEC. 401. STUDY AND REPORT REGARDING CONSOLIDA-
TION OF FEDERAL AUTHORITY OVER EMER-
GENCY MEDICAL SERVICES.
(a) STUDY AND RECOMMENDATIONS.—
(1) IN GENERAL.—The Comptroller General of
the United States shall conduct a thorough study
and make recommendations on all matters relating
to the transfer of all functions (other than the func-
tions referred to in paragraph (2)) of Federal agen-
cies relating to emergency medical services to a sin-
gle Federal agency (and if appropriate, to a specific
office within such agency), including the transfer of
appropriations and personnel associated with such
services to such agency.
(2) EXCEPTIONS.—The recommendations for-
mulated pursuant to paragraph (1) shall not provide
for the transfer of any function—
(A) of the Department of Defense; or
(B) related to a Federal health care pro-
gram (as defined in section 1128B(f) of the So-
cial Security Act (42 U.S.C. 1320a–7b(f))).
(b) REPORT.—Not later than 1 year after the date
of enactment of this Act, the Comptroller General of the
United States shall submit a report to the President and
Congress containing a detailed statement of the results of
the matters studied and recommendations formulated by
the Comptroller General pursuant to subsection (b), to-
gether with any legislative recommendations that the
Comptroller General determines to be appropriate for car-
rying out the recommendations.
Æ