health care as a health care service provided collabo-
ratively by a group of health care providers in a 
community, including local field EMS agencies. 
These new delivery models are filling gaps in patient 
care identified by a community’s health care pro-
viders, including preventing recurrent medical epi-
sodes through reliable post-discharge follow up and 
chronic disease management. Facilitating reimburse-
ment for such services, including under the Medicare 
program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.), is necessary to the contin-
ued development and sustainability of such services. 
(9) Field EMS is uniquely positioned to support 
the transformation of health care to a value and out-
comes based model to improve the patient experience 
and the health of populations, and to reduce the per 
capita cost of health care. Field EMS provides high-
ly reliable patient assessment and intervention at 
any hour of any day in response to urgent or un-
scheduled episodes of illness or injury and effectively 
navigates patients to ensure they receive the right 
care, in the right place, and at the right time. Field 
EMS helps contain health care costs by navigating 
the patient down a cost-effective pathway that is evi-
dence-based. 
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(10) Coordinated and high-quality field EMS is 
essential to the Nation’s security. Field EMS is an 
essential public service provided by governmental 
and nongovernmental agencies and practitioners 
every day and during catastrophic incidents. To en-
sure disaster and all-hazards preparedness for field 
EMS operations as part of the Nation’s comprehen-
sive disaster preparedness, Federal funding for pre-
paredness activities, including catastrophic training 
and exercises, must be provided to governmental and 
nongovernmental field EMS agencies to ensure a 
greater capability within each of these areas. 
(11) The essential role of field EMS in disaster 
preparedness and response must be incorporated 
into the national preparedness and response strategy 
and implementation as provided and overseen by the 
Department of Homeland Security and the Depart-
ment of Health and Human Services, pursuant to 
their respective jurisdictions. Field EMS agencies 
must be capable of meeting the routine emergency 
care needs of patients to be capable of meeting the 
extraordinary medical needs during a catastrophic 
event. 
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SEC. 3. ALIGNING AMBULANCE REIMBURSEMENT WITH 
VALUE-BASED 
AND 
HIGH-QUALITY 
FIELD 
EMS. 
(a) FIELD EMS MEDICARE DEMONSTRATION PRO-
GRAM.—Section 1115A(b)(2) of the Social Security Act 
(42 U.S.C. 1315a(b)(2)) is amended— 
(1) in the last sentence of subparagraph (A), by 
inserting ‘‘, and shall include the model described in 
subparagraph (D)’’ before the period at the end; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) DEMONSTRATION PROJECTS.— 
‘‘(i) IN
GENERAL.—The model de-
scribed in this subparagraph is a dem-
onstration program under title XVIII. Be-
ginning not later than 2 years after the 
date of the enactment of the Field EMS 
Modernization and Innovation Act, the 
CMI shall conduct not less than 10 dem-
onstration projects to— 
‘‘(I) evaluate the implementation 
and reimbursement of alternative dis-
positions of field EMS patients, in-
cluding— 
‘‘(aa) transporting individ-
uals by ambulance to alternate 
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destinations when medically ap-
propriate and in the individual’s 
best interests; 
‘‘(bb) when medically nec-
essary, evaluating, treating, or 
referring individuals to other 
medically appropriate providers; 
and 
‘‘(cc) when medically appro-
priate, 
treating 
individuals 
through community paramedicine 
or mobile integrated healthcare 
services; 
‘‘(II) evaluate the implementation 
of alternative reimbursement models, 
including models based on readiness 
rather than transport or shared sav-
ings; and 
‘‘(III) determine whether such al-
ternative dispositions and reimburse-
ment models— 
‘‘(aa) improve the safety, ef-
fectiveness, timeliness, and effi-
ciency of emergency medical serv-
ices; and 
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‘‘(bb) reduce overall utiliza-
tion and expenditures under title 
XVIII. 
‘‘(ii) EVIDENCE-BASED PROTOCOLS.— 
The CMI shall ensure that at least one 
demonstration project under this subpara-
graph evaluates evidence-based protocols 
that give guidance on selection of the des-
tination to which individuals are trans-
ported. 
‘‘(iii) DURATION.—The duration of a 
demonstration project under this subpara-
graph shall not exceed 3 years. 
‘‘(iv) 
RESEARCH.—The 
Secretary 
shall conduct or support further research 
that the Secretary determines to be nec-
essary prior to, or in conjunction with, the 
demonstration projects under this subpara-
graph in order to evaluate the implementa-
tion of alternative dispositions of, and re-
imbursement models for transport of, field 
EMS patients. 
‘‘(v) REPORT
TO
CONGRESS.—Not 
later than 1 year after the completion of 
all demonstration projects under this sub-
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paragraph, the Secretary shall include in 
the annual report to Congress required 
under subsection (g) a report on the re-
sults of the projects conducted under this 
subparagraph, including information about 
the efficacy of alternative disposition of, 
and reimbursement models for transport 
of, field EMS patients. 
‘‘(vi) DEFINITION OF FIELD EMS.—In 
this subparagraph, the terms ‘community 
paramedicine’, ‘field EMS’, ‘mobile inte-
grated healthcare’, and ‘readiness’ shall 
have the meanings given such terms in sec-
tion 1291 of the Public Health Service 
Act.’’. 
(b) FIELD EMS ALTERNATIVE DELIVERY PRO-
GRAM.—Section 1834(l) of the Social Security Act (42 
U.S.C. 1395m(l)) is amended by adding at the end the 
following new paragraph: 
‘‘(16) FIELD
EMS
ALTERNATIVE
DELIVERY 
PROGRAM.— 
‘‘(A) IN GENERAL.—Not later than 3 years 
after the date of the enactment of this para-
graph, the Secretary shall establish the Field 
EMS Alternative Delivery Program to establish 
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and promote the utilization of innovative pay-
ment models, including the models described in 
subparagraph (D), on a shared savings and vol-
untary basis, taking into consideration the re-
sults of the evaluation of models under subpara-
graph (G) and the demonstration projects con-
ducted under section 1115A(b)(2)(D). To the 
extent that the Secretary ascertains that an in-
novative payment model has been sufficiently 
demonstrated through the private sector or 
through the Center for Medicare and Medicaid 
Innovation under section 1115A and does not 
need to be evaluated under subparagraph (G), 
the Secretary may establish such innovative 
payment model on a shared savings and budget 
neutral basis pursuant to this subparagraph. 
‘‘(B) VOLUNTARY NATURE OF PARTICIPA-
TION.—Providers and suppliers of ground am-
bulance services may voluntarily opt to utilize 
innovative payment models under the Field 
EMS Alternative Delivery Program. Nothing in 
this subparagraph shall be construed as author-
izing the Secretary to require participation in 
any innovative payment model under the Pro-
gram. 
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‘‘(C) BUDGET
NEUTRALITY.—The Sec-
retary shall implement the innovative payment 
models under this subparagraph in a budget 
neutral manner such that the cost of implemen-
tation of such models shall not exceed the 
amount that otherwise would have been pro-
vided in reimbursement under this title if such 
models had not been implemented. 
‘‘(D) TYPES OF MODELS.—The following 
models are described in this clause: 
‘‘(i) Community paramedicine that al-
lows for payment for health care assess-
ment and prevention services, or other care 
management services. 
‘‘(ii) Mobile integrated healthcare 
services that allow for health care assess-
ment and prevention services, or other care 
management services within an integrated 
program of patient care. 
‘‘(iii) Alternate patient dispositions re-
gardless of transport to the hospital, in-
cluding transport to alternate destinations 
and other patient dispositions such as 
treating and referring patients to appro-
priate follow up care. Such alternate dis-
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positions, including alternate destinations 
and treat and refer dispositions, would be 
subject to the discretion of the physician 
medical director responsible for providing 
medical oversight. 
‘‘(iv) The provision of field EMS and 
reimbursement on a population health 
basis, such as through global capitation. 
‘‘(v) Prevention-based models, such as 
injury prevention through home evalua-
tions for fall prevention or infection con-
trol. 
‘‘(vi) Critical care models, particularly 
in geographic areas without proximate ac-
cess to hospital-based critical care, and in-
cluding a model that enables patient sta-
bilization by critical care transport teams 
with telemedicine support for maintaining 
the patient in the patient’s community. 
‘‘(vii) Any other innovative shared 
savings model the Secretary determines 
relevant pursuant to subparagraph (G). 
‘‘(E) QUALITY REPORTING.—As a condi-
tion of participation in the Field EMS Alter-
native Delivery Program, providers and sup-
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pliers of ground ambulance services shall par-
ticipate in the Ambulance Quality Incentive 
Program described in paragraph (17). 
‘‘(F) MEDICAL
OVERSIGHT.—The Sec-
retary shall specify and require appropriate 
medical oversight with regard to the develop-
ment, demonstration, and implementation of in-
novative payment models under this paragraph 
to ensure high-quality care and patient safety. 
‘‘(G) DEVELOPMENT AND EVALUATION OF 
MODELS.— 
‘‘(i) IN GENERAL.—The Secretary, in 
consultation with the Assistant Secretary 
for Preparedness and Response and taking 
into consideration the recommendations of 
the National EMS Advisory Council and 
the Federal Interagency Committee on 
EMS, shall undertake the development and 
evaluation of innovative models of field 
EMS delivery and reimbursement. 
‘‘(ii) EVALUATION
OF
INNOVATIVE 
MODEL OPTIONS.— 
‘‘(I) IN
GENERAL.—Not later 
than 1 year after the date of the en-
actment of the Field EMS Moderniza-
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tion and Innovation Act, the Secretary 
shall complete an evaluation of— 
‘‘(aa) the provision of and 
reimbursement for alternative de-
livery models for medical care 
through field EMS; and 
‘‘(bb) the integration of field 
EMS patients with other medical 
providers and facilities as medi-
cally appropriate. 
‘‘(II) 
CONSIDERATIONS.—In 
completing the evaluation under sub-
clause (I), the Secretary shall consider 
the following: 
‘‘(aa) 
Alternative 
disposi-
tions of patients, including— 
‘‘(AA) transporting in-
dividuals by ambulance to 
destinations other than a 
hospital, such as the office 
of the physician of the indi-
vidual, an urgent care cen-
ter, or the facility of another 
health care provider; 
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‘‘(BB) when medically 
necessary, 
the 
evaluation, 
treatment, or referral of in-
dividuals to other medically 
appropriate health care pro-
viders; 
‘‘(CC) the provision of 
medical care regardless of 
the decision to transport, 
such as reimbursement mod-
els based on readiness rath-
er 
than 
transport 
and 
shared savings; and 
‘‘(DD) the provision of 
health care using patient- 
centered mobile resources in 
the out-of-hospital environ-
ment, such as community 
paramedicine and mobile-in-
tegrated health care serv-
ices. 
‘‘(bb) Issues related to med-
ical liability and the requirements 
of section 1867 (commonly re-
ferred to as ‘EMTALA’) associ-
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quality 
appropriate 
physician 
medical oversight. 
‘‘(ff) Other issues, as deter-
mined by the Secretary, includ-
ing, when practicable, issues rec-
ommended by the Assistant Sec-
retary for Preparedness and Re-
sponse, the National EMS Advi-
sory Council, and the Federal 
Interagency Committee on EMS 
for evaluation under this sub-
paragraph. 
‘‘(H) DEFINITIONS.—In this paragraph, 
the terms ‘community paramedicine’, ‘field 
EMS’, ‘medical oversight’, and ‘mobile inte-
grated healthcare’ have the meanings given 
such terms in section 1291 of the Public Health 
Service Act.’’. 
(c) AMBULANCE QUALITY INCENTIVE PROGRAM.— 
Section 1834(l) of the Social Security Act (42 U.S.C. 
1395m(l)), as amended by subsection (a), is further 
amended by adding at the end the following new para-
graph: 
‘‘(17) AMBULANCE
QUALITY
INCENTIVE
PRO-
GRAM.— 
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‘‘(A) IN GENERAL.—Not later than Janu-
ary 1 of the first fiscal year that begins on or 
after the date that is 3 years after the date of 
the enactment of this paragraph, the Secretary 
shall establish an Ambulance Quality Incentive 
Program under which providers and suppliers 
of ground ambulance services under this sub-
section may receive incentive payments from the 
amount made available under subparagraph (F) 
for reporting on the quality measures identified 
by the Secretary under subparagraph (B). 
‘‘(B) QUALITY MEASURES.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall, by regulation, identify quality meas-
ures that have been endorsed by the entity 
with a contract under section 1890(a). 
Such measures shall include outcome and 
patient safety measures and be relevant to 
the provision of field emergency medical 
response and mobile medical care. 
‘‘(ii) EXCEPTION.—In the case of a 
specified area or medical topic determined 
appropriate by the Secretary for which a 
feasible and practical measure has not 
been endorsed by the entity with a contract 
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under section 1890(a), the Secretary may 
specify a measure that is not so endorsed 
as long as due consideration is given to 
measures that have been endorsed or 
adopted by a consensus organization iden-
tified by the Secretary. 
‘‘(iii) 
REVISING
QUALITY
MEAS-
URES.—Subject to clause (iv), the Sec-
retary may, by regulation, revise quality 
measures identified under this paragraph 
on an annual basis. 
‘‘(iv) 
TIMEFRAME.—The 
Secretary 
shall publish the quality measures that will 
apply to a fiscal year not later than Janu-
ary 1 of the preceding fiscal year. 
‘‘(C) VOLUNTARY
NATURE
OF
REPORT-
ING.—Participation in the Ambulance Quality 
Incentive Program is voluntary for providers 
and suppliers electing not to participate in the 
Field EMS Alternative Delivery Program. 
‘‘(D) CONSULTATION.—In carrying out the 
provisions of this paragraph (including in devel-
oping and revising the quality measures identi-
fied in subparagraph (B)), the Secretary 
shall— 
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‘‘(i) solicit the input of relevant stake-
holders; 
‘‘(ii) use the notice and comment pro-
cedures provided in section 553 of title 5, 
United States Code; and 
‘‘(iii) take into account prior invest-
ments in technology systems to enable par-
ticipation in the program with minimal ad-
ditional capital investments. 
‘‘(E) PUBLIC AVAILABILITY OF DATA SUB-
MITTED.—The Secretary shall establish proce-
dures for making data submitted under this 
paragraph available to the public on the website 
of the Centers for Medicare & Medicaid Serv-
ices. Such procedures shall ensure that a sup-
plier or provider has the opportunity to review 
the data that is to be made public with respect 
to the supplier or provider prior to such data 
being made public. 
‘‘(F) BUDGET NEUTRAL FUNDING.— 
‘‘(i) IN GENERAL.—The amount avail-
able for making payments under this para-
graph for any fiscal year shall be equal to 
the amount of savings for the preceding 
fiscal year resulting from the Field EMS 
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Alternative Delivery Program described in 
paragraph (16), as determined by the Sec-
retary. 
‘‘(ii) PRIORITY FOR PARTICIPANTS IN 
FIELD EMS ALTERNATIVE DELIVERY PRO-
GRAM.—To the extent that funds are avail-
able for making payments under this para-
graph for a fiscal year, the Secretary shall 
ensure that— 
‘‘(I) providers and suppliers who 
participated in the program estab-
lished under paragraph (16) in the 
preceding fiscal year are paid before 
other providers and suppliers; and 
‘‘(II) providers and suppliers who 
did not participate in the program es-
tablished under paragraph (16) in the 
preceding fiscal year may only receive 
payments if there are any funds re-
maining after the application of sub-
clause (I).’’. 
SEC. 4. FIELD EMERGENCY MEDICAL SERVICES. 
(a) IN GENERAL.—Title XII of the Public Health 
Service Act (42 U.S.C. 300d et seq.) is amended by adding 
at the end the following: 
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‘‘PART I—FIELD EMERGENCY MEDICAL SERVICES 
‘‘SEC. 1291. DEFINITIONS. 
‘‘In this part: 
‘‘(1) The term ‘ambulance diversion’ means the 
practice of hospitals denying access to an incoming 
ambulance and requesting that the ambulance pro-
ceed to another facility due to a stated lack of ca-
pacity at the initial facility, resulting in delayed ac-
cess to definitive care. 
‘‘(2) The term ‘community paramedicine’ means 
a health care service provided by a field EMS agency 
for the provision of cost-effective health care assess-
ment and prevention services to fill gaps in the local 
health care system. 
‘‘(3) The term ‘emergency medical response’ 
means— 
‘‘(A) medical care provided to patients with 
emergency medical conditions prior to or out-
side a medical facility; 
‘‘(B) emergency medical dispatch, rapid re-
sponse, and urgent or unscheduled patient as-
sessment and intervention; 
‘‘(C) emergency, critical care, and inter-fa-
cility and air medical transport; or 
‘‘(D) telephone consultation to 911 callers 
as an alternative to ambulance dispatch, or 
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‘‘(8) The term ‘field EMS practitioner’ means 
an individual licensed and credentialed to provide 
emergency and mobile medical care to patients with-
in the scope of such individual’s practice. 
‘‘(9) The term ‘medical oversight’ means the 
supervision by a physician of the medical aspects of 
a field EMS system or agency and its practitioners, 
including prospective, concurrent, and respective 
components of field EMS and the education of field 
EMS practitioners. 
‘‘(10) The term ‘mobile integrated health care’ 
means a health care service that is undertaken col-
laboratively by a group of health care providers, in-
cluding the local field EMS agency, in a community, 
for the provision of medical care to fill gaps in the 
local health care system. 
‘‘(11) The term ‘mobile medical services’ means 
preventive medical assessment and care, chronic dis-
ease assessment and management support, post-dis-
charge follow-up assessment and management sup-
port, and post-assessment patient transport, ar-
ranged transportation, or referral to other commu-
nity health or social service resources. 
‘‘(12) The term ‘NEMSAC’ means the National 
Emergency Medical Services Advisory Council. 
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‘‘(13) The term ‘NEMSIS’ means the National 
EMS Information System. 
‘‘(14) The term ‘NHTSA’ means the National 
Highway Traffic Safety Administration. 
‘‘(15) The term ‘patient parking’ means the 
practice by hospitals of refusing to accept transfer 
of a patient’s care from an ambulance crew until a 
regular emergency department bed is available, re-
quiring the crew to continue to provide patient care 
on the ambulance stretcher rather than in a patient 
bed in the hospital, until hospital staff will accept 
the transfer of care, resulting in delayed access to 
definitive care for the patient and denied access to 
emergency care for the community served by the 
field EMS Agency. 
‘‘(16) The term ‘readiness’ means the standby 
costs of preparedness to respond to a health care 
need, 24 hours a day, 7 days a week, 365 days a 
year. 
‘‘(17) The term ‘State EMS Office’ means an 
office designated by the State with primary responsi-
bility for oversight of the State’s emergency medical 
services system, such as responsibility for oversight 
of field EMS coordination, licensing or certifying 
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field EMS practitioners, and emergency medical 
services system improvement. 
‘‘SEC. 1292. FIELD EMS PREPAREDNESS FOR PUBLIC 
HEALTH EMERGENCIES AND OTHER INCI-
DENTS. 
‘‘(a) IN GENERAL.—The Assistant Secretary for Pre-
paredness and Response shall establish the Field EMS 
Preparedness Program to be administered by the Office 
of Emergency Medical Care for the purpose of improving 
field EMS agency all-hazards readiness and preparedness 
and public health emergencies and incidents. 
‘‘(b) APPLICATION.— 
‘‘(1) IN GENERAL.—To be eligible to receive a 
grant under this section, an eligible entity shall sub-
mit an application to the Assistant Secretary for 
Preparedness and Response in such form and man-
ner, and containing such agreements, assurances, 
and information as such Assistant Secretary re-
quires. 
‘‘(2) SIMPLE FORM.—The Assistant Secretary 
for Preparedness and Response shall ensure that 
grant application requirements are not unduly bur-
densome to smaller and volunteer field EMS agen-
cies or other agencies with limited resources. 
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‘‘(3) 
CONSISTENCY
WITH
PREPARATION 
GOALS.—The Assistant Secretary for Preparedness 
and Response shall ensure that grant applications 
are consistent with national and relevant State pre-
paredness plans and goals. 
‘‘(c) USE OF FUNDS.—Grants may be used by eligible 
entities to achieve the preparedness goals described under 
paragraphs (1), (3), (4), (5), (6), and (8) of section 
2802(b) with respect to all-hazards, including chemical, bi-
ological, radiological, or nuclear threats, including the pur-
chase of equipment, training, and supplies. 
‘‘(d) ADMINISTRATION OF GRANTS.—In carrying out 
this section, the Assistant Secretary for Preparedness and 
Response— 
‘‘(1) shall establish a grantmaking process that 
includes— 
‘‘(A) prioritization for the awarding of 
grants to eligible entities and consideration of 
the factors in reviewing grant applications by 
eligible entities, including— 
‘‘(i) demonstrated financial need for 
funding; 
‘‘(ii) utilization of public and private 
partnerships; 
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‘‘(iii) improving the availability of 
field EMS in underserved regions to en-
hance the capability for medical response 
to public health emergencies and incidents; 
‘‘(iv) unique needs of volunteer and 
rural field EMS agencies; 
‘‘(v) distribution among a variety of 
geographic areas, including urban, subur-
ban, and rural; 
‘‘(vi) distribution of funds among 
types of field EMS agencies, including gov-
ernmental, nongovernmental, and volunteer 
agencies; 
‘‘(vii) implementation of regionalized 
systems of medical response to public 
health emergencies and incidents; and 
‘‘(viii) such other factors as the As-
sistant Secretary for Preparedness and Re-
sponse determines necessary; 
‘‘(B) a peer-reviewed process to rec-
ommend grant allocations in accordance with 
the prioritization established under subpara-
graph (A), except that final award determina-
tions shall be made by the Assistant Secretary 
for Preparedness and Response; and 
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‘‘(C) the provision of grant awards to eligi-
ble entities on an annual basis, except that the 
Assistant Secretary for Preparedness and Re-
sponse may reserve not more than 25 percent 
of the available appropriations for multiyear 
grants and no grant award may exceed a 2-year 
period; and 
‘‘(2) shall consult with and take into consider-
ation 
the 
recommendations 
of 
the 
FICEMS, 
NEMSAC, and relevant stakeholders. 
‘‘(e) ELIGIBILITY.—To be eligible to receive a grant 
under this section, an entity shall be a field EMS agency 
that— 
‘‘(1) is licensed by or otherwise authorized in 
the State in which it operates; and 
‘‘(2) has medical oversight and quality improve-
ment programs, as determined by the Assistant Sec-
retary for Preparedness and Response. 
‘‘(f) REQUIRED
USE
OF
MEDICAL
OVERSIGHT 
GUIDELINES.—As a condition on receipt of a grant under 
this section, the Assistant Secretary for Preparedness and 
Response shall require each grant recipient to adopt and 
implement (to the extent applicable) the guidelines pro-
moted, developed, and disseminated under subparagraphs 
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(B) and (C) of subsection (a)(1) of section 1293 with re-
gard to medical oversight. 
‘‘(g) ANNUAL REPORT.—The Assistant Secretary for 
Preparedness and Response shall submit an annual report 
on the Field EMS Preparedness Program under this sec-
tion to Congress. 
‘‘SEC. 1293. FIELD EMS QUALITY IMPROVEMENT. 
‘‘(a) 
ENHANCING
PHYSICIAN
MEDICAL
OVER-
SIGHT.— 
‘‘(1) IN GENERAL.—To improve medical over-
sight of field EMS and ensure continuity and quality 
for such medical oversight, the Assistant Secretary 
for Preparedness and Response shall— 
‘‘(A) promote high-quality and comprehen-
sive medical oversight of— 
‘‘(i) all medical care provided by field 
EMS practitioners; and 
‘‘(ii) the education and training of 
field EMS practitioners; 
‘‘(B) promote the development, adoption, 
and utilization of national guidelines for the 
role of physicians who provide medical oversight 
for field EMS and other health care providers 
who support physicians in such role; 
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‘‘(C) support efforts of relevant physician 
stakeholders in developing and disseminating 
guidelines for use by field EMS medical direc-
tors and field EMS practitioners on a national 
basis; and 
‘‘(D) convene a Field EMS Medical Over-
sight Advisory Committee, comprised of rep-
resentatives of relevant physician stakeholders, 
to advise the Assistant Secretary for Prepared-
ness and Response on ways and means to ad-
vance and support development and mainte-
nance of quality medical oversight throughout 
the Nation’s systems for field EMS. 
‘‘(2) ADDITIONAL
CONSIDERATIONS.—In car-
rying out subparagraphs (B) and (C) of paragraph 
(1), the Assistant Secretary for Preparedness and 
Response shall take into consideration— 
‘‘(A) existing guidelines developed by na-
tional 
professional 
physician 
associations, 
States, and other relevant governmental or non-
governmental entities; 
‘‘(B) the input of other relevant stake-
holders, including health care providers who 
support physicians who provide medical over-
sight for field EMS; and 
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‘‘(C) the unique needs associated with 
medical oversight of provision of field EMS in 
rural areas or by volunteers. 
‘‘(3) FLEXIBILITY.—The guidelines promoted, 
developed, and disseminated under subparagraphs 
(B) and (C) of paragraph (1) shall ensure high-qual-
ity training, credentialing, and direction in connec-
tion with medical oversight of field EMS at the 
State, regional, and local levels while providing suffi-
cient flexibility to account for historical and legiti-
mate differences in field EMS among States, re-
gions, and localities. 
‘‘(b) PATIENT SAFETY IMPROVEMENT.—Field EMS 
agencies and practitioners shall be eligible to participate 
in the activities of patient safety organizations for the pur-
pose of improving patient safety and the quality of health 
care delivery. 
‘‘(c) ANALYSIS OF DATA GAPS THAT HINDER HIGH- 
QUALITY FIELD EMS CARE.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of the Field EMS Mod-
ernization and Innovation Act, the Secretary, acting 
through the Assistant Secretary for Preparedness 
and Response, shall submit to Congress a report 
that— 
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‘‘(A) identifies gaps in the collection of 
data related to the provision of field EMS; and 
‘‘(B) includes recommendations for improv-
ing the collection, reporting, and analysis of 
such data, and integration of such data with 
other health care data. 
‘‘(2) RECOMMENDATIONS.—The recommenda-
tions included in the report in accordance with para-
graph (1)(B) shall— 
‘‘(A) take into consideration the rec-
ommendations of FICEMS, NEMSAC, and rel-
evant stakeholders; 
‘‘(B) recommend methods for improving 
data collection, reporting, and analysis without 
unduly burdening reporting entities and without 
duplicating existing data sources (such as data 
collected by the National Trauma Data Bank); 
‘‘(C) address the quality and availability of 
data, and linkages with existing patient reg-
istries, related to the provision of field EMS 
and utilization of field EMS with respect to a 
variety of illnesses and injuries (in both the ev-
eryday provision of field EMS and catastrophic 
or disaster response), including— 
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‘‘(i) cardiac events such as chest pain, 
sudden cardiac arrest, and ST-segment ele-
vation myocardial infarction; 
‘‘(ii) stroke; 
‘‘(iii) trauma; 
‘‘(iv) disaster and catastrophic inci-
dents, such as incidents related to ter-
rorism or natural or manmade disasters; 
and 
‘‘(v) ambulance diversion and patient 
parking; 
‘‘(D) include an analysis of the variety of 
services provided by field EMS agencies; and 
‘‘(E) any recommendations that require 
statutory authorization from Congress. 
‘‘(3) IMPLEMENTATION OF RECOMMENDATIONS 
WITH EXISTING STATUTORY AUTHORITY.—The Sec-
retary, acting through the Office of the National Co-
ordinator for Health Information Technology, shall 
implement such recommendations for data collection 
to the extent that such authority exists and does not 
require further statutory authorization from Con-
gress. 
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‘‘SEC. 1294. ACCOUNTABILITY FOR FIELD EMS SYSTEM PER-
FORMANCE. 
‘‘(a) DEVELOPMENT OF FIELD EMS QUALITY AND 
SYSTEM PERFORMANCE MEASURES.—The Assistant Sec-
retary for Preparedness and Response shall support— 
‘‘(1) further development and refinement of 
measures to be utilized under the Ambulance Qual-
ity Incentive Program, as appropriate, including— 
‘‘(A) quality measures to improve account-
ability for patient outcomes in field EMS; and 
‘‘(B) performance measures to enhance the 
measurement of field EMS system performance; 
and 
‘‘(2) a technical assistance center to provide as-
sistance and education to field EMS agencies, physi-
cian medical directors, and practitioners to partici-
pate effectively in quality and performance improve-
ment programs. 
‘‘(b) CLARIFICATION OF HIPAA.— 
‘‘(1) EXCHANGE OF INFORMATION RELATED TO 
THE TREATMENT OF PATIENTS.— 
‘‘(A) IN
GENERAL.—Nothing in HIPAA 
privacy and security law (as defined in section 
3009(a)(2)) shall be construed as prohibiting 
the exchange of information between field EMS 
practitioners treating an individual and per-
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sonnel of a hospital to which the individual has 
been treated for the purposes of relating infor-
mation on the medical history, treatment, care, 
and outcome of such individual (including any 
health care personnel safety issues, such as in-
fectious disease). 
‘‘(B) GUIDELINES.—The Secretary shall 
establish guidelines for exchanges of informa-
tion between field EMS practitioners treating 
an individual and personnel of a hospital to 
which the individual has been treated to protect 
the privacy of the individual while ensuring the 
ability of such field EMS practitioners and hos-
pital personnel to communicate effectively to 
further the continuity and quality of medical 
care provided to such individual. 
‘‘(2) NEMSIS DATA.—Nothing in HIPAA pri-
vacy and security law (as defined in section 
3009(a)(2)) shall be construed as prohibiting the ex-
change of non-individually identifiable data between 
the field EMS agency, a State, and the Federal Gov-
ernment, including the exchange of information by— 
‘‘(A) a field EMS agency to the State 
EMS Office for the purpose of quality improve-
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ment and data collection by the State for sub-
mission to NEMSIS; or 
‘‘(B) the State EMS Office to the National 
EMS Database maintained by Assistant Sec-
retary for Preparedness and Response. 
‘‘SEC. 1295. FIELD EMS WORKFORCE DEVELOPMENT. 
‘‘(a) IN GENERAL.—For the purpose of promoting 
field EMS as a health profession and ensuring the avail-
ability, quality, and capability of field EMS educators, 
practitioners, managers, and medical directors, the Assist-
ant Secretary for Preparedness and Response shall make 
grants to eligible entities for the development, availability, 
and dissemination of field EMS education programs and 
courses that improve the quality and capability of field 
EMS practitioners, educators, managers, and physician 
medical directors. In carrying out this section, the Assist-
ant Secretary for Preparedness and Response shall take 
into 
consideration 
recommendations 
of 
FICEMS, 
NEMSAC, and relevant stakeholders. 
‘‘(b) ELIGIBILITY.—In this section, the term ‘eligible 
entity’ means an educational organization, an educational 
institution, a professional association, or any other entity 
involved in and experienced with the education of field 
EMS practitioners, physician medical directors, field EMS 
managers and administrators, and field EMS educators. 
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‘‘(c) USE OF FUNDS.—The Assistant Secretary for 
Preparedness and Response may award a grant to an eligi-
ble entity under paragraph (1) only if the entity agrees 
to use the grant to— 
‘‘(1) develop and implement education programs 
to— 
‘‘(A) train field EMS instructors and pro-
mote the adoption and implementation of the 
education standards identified in the ‘Emer-
gency Medical Services Education Agenda for 
the Future: A Systems Approach’, including 
any revisions thereto or successor standards; 
‘‘(B) provide training for information sys-
tem workers, such as information security, fo-
rensic analysts, data analysts, network engi-
neers, and similar roles to work in support of 
field EMS data systems; or 
‘‘(C) provide training and retraining pro-
grams that prepare displaced workers to enter 
a field EMS profession, including veterans and 
military EMS practitioners; 
‘‘(2) develop and implement educational courses 
pertaining to— 
‘‘(A) improving the provision of quality 
medical oversight of field EMS; 
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‘‘(B) expanding the knowledge and skills of 
field EMS practitioners, including those needed 
to provide community paramedicine and mobile 
integrated health care; 
‘‘(C) undertaking field EMS educational 
and clinical research to develop investigators; 
‘‘(D) tactical training for field EMS; or 
‘‘(E) developing and expanding field EMS 
undergraduate and graduate programs; 
‘‘(3) evaluate education and training courses 
and methodologies to identify optimal educational 
modalities for field EMS practitioners; 
‘‘(4) enhance the opportunity for medical direc-
tion training and for promoting appropriate medical 
oversight of field emergency medical care; or 
‘‘(5) carry out such other activities as the As-
sistant Secretary for Preparedness and Response de-
termines appropriate. 
‘‘(d) PRIORITY.—The Assistant Secretary for Pre-
paredness and Response, in consultation with relevant 
stakeholders, and taking into consideration the rec-
ommendations of FICEMS and NEMSAC, shall establish 
a system of prioritization in awarding grants under this 
section to eligible entities. 
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‘‘(e) DURATION OF GRANTS.—Grants under this sec-
tion shall be for a period of 1 to 3 years. 
‘‘(f) APPLICATION.—The Assistant Secretary for Pre-
paredness and Response may not award a grant to an eli-
gible entity under this section unless the entity submits 
an application to such Assistant Secretary in such form, 
in such manner, and containing such agreements, assur-
ances, and information as the Assistant Secretary may re-
quire. The Assistant Secretary for Preparedness and Re-
sponse shall ensure that the requirements for submitting 
an application under this section are not unduly burden-
some. 
‘‘SEC. 1296. NATIONAL EMERGENCY MEDICAL SERVICES 
STRATEGY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Assistant Secretary for Preparedness and Response, 
shall develop and implement a cohesive national emer-
gency medical services strategy to strengthen the develop-
ment of field EMS and the full continuum of emergency 
medical care and systems at the Federal, State, and local 
levels to improve patient outcomes and access to high- 
quality care in the field and develop financing models that 
support the evolution of value-based emergency medical 
care. In establishing such a strategy, the Assistant Sec-
retary for Preparedness and Response shall— 
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‘‘(1) solicit and consider the 2007 and subse-
quent recommendations of the Institute of Medicine, 
the National EMS Advisory Council, and relevant 
stakeholders; 
‘‘(2) consult and collaborate with the Federal 
Interagency Committee on EMS to ensure consist-
ency of such national emergency medical services 
strategy within the larger Federal strategy regarding 
national preparedness and response; 
‘‘(3) address issues related to emergency med-
ical services system development, including— 
‘‘(A) the regionalization of field EMS, 
trauma, and emergency medical services, par-
ticularly for time sensitive conditions such as 
trauma, ST–Segment Elevation Myocardial In-
farction, 
stroke, 
neonatal 
patients, 
and 
poisonings; 
‘‘(B) the availability of field EMS and 
trauma care and emergency medical services 
throughout the Nation; 
‘‘(C) the integration of emergency medical 
care from the perspective of patients across the 
emergency care continuum, and accountability 
for system performance; and 
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‘‘(B) the adoption of uniform national am-
bulance vehicle safety and manufacturing 
standards; 
‘‘(6) support the development of value-based re-
imbursement for new mobile resources and models of 
delivery that support the transformation of health 
care, including the full utilization of field EMS to 
deliver emergency medical response and mobile med-
ical services including— 
‘‘(A) community paramedicine for the pro-
vision of cost-effective health care assessment 
and prevention services; 
‘‘(B) mobile integrated health care under-
taken collaboratively by a group of providers in 
a community, including local field EMS agen-
cies, to fill gaps in the local health care system; 
‘‘(C) integrated injury prevention strate-
gies or programs; and 
‘‘(D) such other issues as the Secretary 
considers appropriate; 
‘‘(7) incorporate into such strategy prepared-
ness and response objectives identified in the Na-
tional Health Security Strategy under section 2802 
in order— 
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‘‘(A) to ensure the capability and capacity 
of the full spectrum of field EMS to respond to 
terrorist attacks, disasters, catastrophic events, 
and mass casualty events; and 
‘‘(B) to coordinate with the Secretary of 
Homeland Security accordingly; 
‘‘(8) promote research in emergency medical 
services and coordination across Federal agencies 
undertaking such research, taking into consideration 
the National EMS Research Agenda; 
‘‘(9) complete the development of such strategy 
not later than 18 months after the date of enact-
ment of the Field EMS Modernization and Innova-
tion Act; 
‘‘(10) communicate such strategy to the rel-
evant congressional committees of jurisdiction; 
‘‘(11) implement such strategy, to the extent 
practicable, not later than 3 years after the date of 
enactment of the Field EMS Modernization and In-
novation Act; and 
‘‘(12) update such strategy not less than every 
3 years. 
‘‘SEC. 1297. OFFICE OF EMERGENCY MEDICAL CARE. 
‘‘(a) ESTABLISHMENT
OF OFFICE.—Pursuant to 
paragraph 41 of Homeland Security Presidential Directive 
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HSPD–21, dated October 18, 2007, the Secretary shall 
establish an Office of Emergency Medical Care under the 
direct authority of the Assistant Secretary for Prepared-
ness and Response, to carry out all of the responsibilities 
described in such paragraph of such directive. 
‘‘(b) FUNCTIONS.—The Assistant Secretary for Pre-
paredness and Response, acting through the Office of 
Emergency Medical Care, shall administer the emergency 
medical services activities and programs under this part 
and the trauma programs under parts A through D and 
H and shall— 
‘‘(1) promote and fund research in emergency 
medicine and trauma health care; 
‘‘(2) promote regional partnerships and effec-
tive emergency medical systems in order to enhance 
appropriate triage, distribution, and care of routine 
community patients; 
‘‘(3) promote local, regional, and State emer-
gency medical systems preparedness for and re-
sponse to public health events; 
‘‘(4) address the full spectrum of issues that 
have an impact on care in emergency departments, 
including the entire continuum of patient care from 
prehospital to disposition from emergency or trauma 
care; and 
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‘‘(5) coordinate with existing executive depart-
ments and agencies that perform functions related 
to emergency medical systems in order to ensure 
unified strategy, policy, and implementation. 
‘‘(c) FUNCTIONS, PERSONNEL, ASSETS, LIABILITIES, 
AND
ADMINISTRATIVE
ACTIONS.—All functions, per-
sonnel, assets, and liabilities of, and administrative actions 
applicable to, the Emergency Care Coordination Center, 
as in existence on the day before the date of the enactment 
of the Field EMS Modernization and Innovation Act, shall 
be transferred to the Office of Emergency Medical Care 
established under subsection (a).’’. 
(b) INCLUSION OF FIELD EMS IN PATIENT SAFETY 
IMPROVEMENT.—Section 921(8)(A) of the Public Health 
Service Act (42 U.S.C. 299b–21(8)(A)) is amended— 
(1) in clause (i), by inserting ‘‘field EMS agen-
cy (as defined in section 1291),’’ after ‘‘clinical lab-
oratory,’’; and 
(2) in clause (ii), by inserting ‘‘field EMS (as 
defined in section 1291) medical director, emergency 
medical technician,’’ after ‘‘pharmacist,’’. 
SEC. 5. INTEGRATION OF FIELD EMS INTO THE NATIONAL 
HEALTH INFORMATION INFRASTRUCTURE. 
(a) NATIONAL EMS INFORMATION SYSTEM.— 
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(1) TRANSFER OF AUTHORITY.—The authority 
for the administration of the National EMS Infor-
mation System, including the National EMS Data-
base, shall be transferred from NHTSA to the Na-
tional Coordinator for Health Information Tech-
nology. 
(2) NATIONAL
EMS
INFORMATION
SYSTEM.— 
Section 3001(c) of the Public Health Service Act 
(42 U.S.C. 300jj–11(c)) is amended by adding at 
the end the following: 
‘‘(9) NATIONAL EMS INFORMATION SYSTEM.— 
‘‘(A) STANDARDIZATION.—The National 
Coordinator shall promote the collection and re-
porting of data on field EMS (as defined in sec-
tion 1291) in a standardized manner. 
‘‘(B) AVAILABILITY
OF
DATA.—The Na-
tional Coordinator shall ensure that information 
in the National EMS Database (other than in-
dividually identifiable information) is available 
to Federal and State policymakers, EMS stake-
holders, and researchers. 
‘‘(C) TECHNICAL
ASSISTANCE.—In car-
rying out subparagraph (A), the National Coor-
dinator may provide technical assistance to 
State and local agencies, field EMS agencies, 
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and other entities, as the National Coordinator 
determines appropriate, to assist in the collec-
tion, analysis, and reporting of data.’’. 
(b) ASSIMILATION OF PATIENT HEALTH INFORMA-
TION ACROSS THE EMERGENCY CARE CONTINUUM.—Not 
later than 18 months after the date of enactment of this 
Act, taking into account the definition of ‘‘health care pro-
vider’’ under section 3000 of the Public Health Service 
Act (42 U.S.C. 300jj), the Secretary shall promulgate a 
regulation that specifically includes ‘‘emergency medical 
service provider’’ under the definition of ‘‘health care pro-
vider’’ for purposes of title XXX of the Public Health 
Service Act, to enable and facilitate the integration and 
assimilation of field EMS data systems as part of the elec-
tronic exchange and use of health information and the en-
terprise integration of such information. 
(c) GAO EVALUATION.— 
(1) IN GENERAL.—The Comptroller General of 
the United States, in consultation with the National 
Coordinator for Health Information Technology, the 
Assistant Secretary for Preparedness and Response, 
and the Federal Interagency Committee on Emer-
gency Medical Services, as appropriate, and taking 
into consideration input from relevant stakeholders, 
shall undertake an evaluation of issues, impedi-
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ments, and potential solutions pertaining to integra-
tion of field EMS into the National Health Informa-
tion Infrastructure. 
(2) REPORT.—The Comptroller General of the 
United States shall submit a report to Congress de-
tailing the extent to which the Secretary of Health 
and Human Services (referred to in this subsection 
as the ‘‘Secretary’’) has authority to implement solu-
tions to achieve such integration and the extent to 
which statutory changes are required to achieve such 
integration. 
(3) CONTENTS.—The evaluation under para-
graph (1) and report under paragraph (2) shall ad-
dress— 
(A) the integration of patient health infor-
mation regarding care provided to patients in 
field EMS into each patient’s electronic health 
care record; 
(B) the bi-directional integration and data 
sharing among providers and entities providing 
patient care related to performance measures as 
part of quality initiatives; 
(C) the means by which to achieve contem-
poraneous field EMS practitioner access to a 
patient’s medical record without regard to phys-
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ical location while preparing to provide or pro-
viding care to that patient in the field, for the 
purpose 
of 
enhancing 
care 
delivery 
and 
populating the electronic health care record in 
real time; and 
(D) incorporation of patient health infor-
mation created subsequent to the receipt of 
field EMS care into the National EMS Infor-
mation System, taking into consideration— 
(i) the types of medical information 
created subsequent to the receipt of field 
EMS emergency care (such as outcomes 
information or information regarding sub-
sequent care and treatment) that would, if 
included in the National EMS Information 
System, be potentially useful in evaluating 
and improving the quality of EMS care; 
(ii) how best to integrate such infor-
mation into the National EMS Information 
System; 
(iii) potential modifications to the 
Health Information Technology for Eco-
nomic and Clinical Health Act (title XIII 
of division A and title IV of division B of 
Public Law 111–5) to require eligible hos-
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pitals (as defined in section 1886(n)(6)(B) 
of the Social Security Act (42 U.S.C. 
1395ww(n)(6)(B))) to develop or report 
relevant data to the National EMS Infor-
mation System or other appropriate State 
or private registries for the purpose of de-
termining whether such a hospital shall 
be— 
(I) subject to a reduction in the 
applicable percentage increase other-
wise applicable to such hospital under 
section 1886(b)(3)(B)(ix) of such Act; 
or 
(II) eligible for an incentive pay-
ment under section 1886(n) of such 
Act; 
(iv) potential modifications to the 
Medicare and Medicaid programs under ti-
tles XVIII and XIX, respectively, of the 
Social Security Act (42 U.S.C. 1395 et 
seq.; 1396 et seq.) or other Federal health 
programs to provide appropriate reim-
bursement and financial incentives for field 
EMS agencies to develop or report relevant 
data to the National EMS Information 
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System or other appropriate State or pri-
vate registries; and 
(v) any other changes to improve inte-
gration of patient health information 
across the continuum of emergency medical 
care and bidirectional integration and data 
sharing related to performance measures 
that the Secretary has authority to imple-
ment or that requires a statutory change 
by Congress to enable the Secretary such 
authority to implement. 
SEC. 6. CLARIFICATION OF LEADERSHIP RESPONSIBILITY 
FOR ROUTINE EMERGENCY MEDICAL CARE. 
(a) IN GENERAL.—Pursuant to the designation of 
the Secretary of Health and Human Services (referred to 
in this section as the ‘‘Secretary’’) under section 2801 of 
the Public Health Service Act (42 U.S.C. 300hh) to lead 
all Federal public health and medical response to public 
health emergencies and incidents under the National Re-
sponse Plan (developed pursuant to section 504(a)(6) of 
the Homeland Security Act of 2002), and pursuant to the 
Secretary’s responsibility for administration of titles 
XVIII, XIX, and XXI of the Social Security Act (42 
U.S.C. 1395 et seq.; 1396 et seq.; 1397aa et seq.), such 
leadership responsibilities shall be construed to include the 
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provision of routine emergency medical care across the full 
continuum of such care provided (including field EMS (as 
defined in section 1291 of the Public Health Service Act 
(as added by section 4)), trauma, and hospital emergency 
medical care) as a necessary prerequisite to ensure the 
adequacy of such response to public health emergencies 
and incidents under the National Response Plan and the 
integration and provision of emergency medical care pro-
vided to beneficiaries of such titles of the Social Security 
Act. 
(b) EMERGENCY MEDICAL CARE SYSTEM.—In ac-
cordance with subsection (a), the Secretary shall be re-
sponsible for— 
(1) improving the emergency medical care sys-
tem providing routine emergency medical care to pa-
tients with emergency medical conditions to enhance 
the capacity of the existing public health and emer-
gency medical system to prepare for and sustain 
such public health and medical response to public 
health emergencies and incidents; and 
(2) the quality, innovation, and cost-effective-
ness of field EMS, including such services provided 
to individuals who are beneficiaries of the Medicare, 
Medicaid or State Children’s Health Insurance Pro-
gram under titles XVIII, XIX, and XXI, respectively 
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