II 113th CONGRESS 2d Session S. 2400 IN THE SENATE OF THE UNITED STATES May 22, 2014 Mr. Bennet (for himself, Mr. Crapo , and Mr. Johnson of South Dakota ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide for improvement of field emergency medical services, and for other purposes.

1. Short title; table of contents (a) Short title This Act may be cited as the Field EMS Innovation Act . (b) Table of contents The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. Sec. 3. Recognition of HHS as primary Federal agency for emergency medical services and trauma care. Sec. 4. Emergency medical services. Sec. 5. Enhancing research in field EMS. Sec. 6. Emergency Medical Services Trust Fund. Sec. 7. Authorization of appropriations. Sec. 8. Statutory construction. 2. Findings Congress finds the following: (1) All persons throughout the United States should have access to and receive high-quality emergency medical care as part of a coordinated emergency medical services system. (2) Properly functioning emergency medical services (referred to in this section as EMS ) systems, 24 hours per day, 7 days per week, are essential to ensure access to emergency medical care and transport for all patients with emergency medical conditions. Such coordinated EMS systems are also necessary for response to catastrophic incidents. (3) Ensuring high-quality and cost-effective EMS systems requires readiness, preparedness, medical direction, oversight, and innovation throughout the continuum of emergency medical care through Federal, State, and local multijurisdictional collaboration and sufficient resources for EMS agencies and providers. (4) At the Federal level, EMS responsibilities and resources of several Federal agencies consistent with their expertise and authority must emphasize the critical importance of Federal agency collaboration and coordination for all emergency medical services. (5) At the State and local level, EMS systems and agencies require the coordination and improved capabilities of multiple and diverse stakeholders. (6) Emergency medical services encompass the provision of care provided to patients with emergency medical conditions throughout the continuum, including emergency medical care and trauma care provided in the field, hospital, and rehabilitation settings. (7) Field EMS comprises essential emergency medical services, including medical care or medical transport provided to patients prior to or outside medical facilities and other clinical settings. The primary purpose of field emergency medical services is to ensure that emergency medical patients receive the right care at the right place in the right amount of time. (8) 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 24 hours a day, 7 days a week, and during catastrophic incidents. To ensure disaster and all-hazards preparedness for EMS operations as part of the Nation’s comprehensive disaster preparedness, Federal funding for preparedness activities, including catastrophic training and drills, must be provided to governmental and nongovernmental EMS agencies to ensure a greater capability within each of these areas. (9) Numerous recommendations from several significant national reports and documents have demonstrated the need in multiple areas for substantial improvement of emergency medical services provided in the field, including recommendations in the EMS Agenda for the Future of the National Highway Traffic Safety Administration and the Health Resources and Services Administration, the Institute of Medicine report The Future of Emergency Care in the United States Health System , and the EMS Education Agenda for the Future: A Systems Approach , and recommendations of the National EMS Workforce Injury and Illness Surveillance Program, the National EMS Advisory Council of the Department of Transportation, and the Federal Interagency Committee on Emergency Medical Services. (10) To substantially improve field EMS, advancements must be made in several essential areas including readiness, innovation, preparedness, education and workforce development, safety, financing, quality, standards, and research. (11) The recognition of a primary programmatic Federal agency for emergency medical services within the Department of Health and Human Services was recommended by the Institute of Medicine and is necessary to provide a more streamlined, cost-efficient, and comprehensive approach for field EMS and a focal point for practitioners and agencies to interface with the Federal Government. (12) 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 Department of Health and Human Services pursuant to their respective jurisdictions. (13) The essential role of the National Highway Traffic Safety Administration in the continued development of the National EMS Information System and in overseeing transportation issues related to field EMS such as EMS and ambulance vehicle safety standards should be maintained. (14) The Federal Interagency Committee on Emergency Medical Services must continue in its essential role in coordinating the Federal activities related to the full spectrum of EMS. 3. Recognition of HHS as primary Federal agency for emergency medical services and trauma care Title XXVIII of the Public Health Service Act ( 42 U.S.C. 300hh et seq. ) is amended by adding at the end the following: D Office of EMS and Trauma 2831. Recognition of HHS as primary Federal agency for emergency medical services and trauma care; establishment of Office of EMS and Trauma (a) Primary Federal agency The Department of Health and Human Services shall serve as the primary Federal agency with responsibility for programs and activities relating to emergency medical services and trauma care. (b) Office of EMS and Trauma (1) Establishment There is established within the Department of Health and Human Services an Office of Emergency Medical Services and Trauma, also to be known as the Office of EMS and Trauma . The Office of EMS and Trauma shall be headed by a director appointed by the Secretary (referred to in this section as the Director ). (2) Role of Office within HHS (A) In general The Office of EMS and Trauma shall have— (i) the responsibilities delegated to the Office of EMS and Trauma pursuant to paragraph (3); and (ii) such responsibilities and authorities as may be delegated or transferred to the Office of EMS and Trauma pursuant to subparagraph (B). (B) Additional responsibilities and authorities In addition to the responsibilities and authorities specified in subparagraph (A), the Secretary may delegate or transfer to the Office of EMS and Trauma any other responsibility or authority of the Department of Health and Human Services relating to emergency medical services and trauma care (except that the Secretary may not delegate or transfer such responsibilities or authorities that are otherwise granted to a specific agency within the Department in statute), including such services and care relating to— (i) the full continuum of emergency medical services, including field EMS and trauma and hospital emergency medical care; and (ii) improving the quality, innovation, or cost effectiveness of emergency medical services. (C) Location of office in HHS The Secretary shall locate the Office of EMS and Trauma within the organizational structure of the Department of Health and Human Services in a manner that achieves each of the following: (i) Recognition of the importance and unique life-saving services associated with field EMS, trauma care, and hospital emergency care as a significant Federal priority. (ii) Integration of the essential services described in clause (i) with the larger health care system and within the disaster preparedness system, including through regionalization of such services and by enhancing daily readiness capabilities to ensure adequate disaster readiness capabilities, consistent with the National Health Security Strategy. (iii) Consolidation, co-location, and cost efficiencies in administering programs and activities related to field EMS, trauma care, and hospital emergency medical care. (iv) Establishment of a Federal focal point for leadership and improved coordination, support, and oversight of field EMS, trauma care, and hospital emergency medical care. (v) Sufficient level and stature such that— (I) such Office is able to fulfill its role, responsibilities, and authorities; and (II) the Director of such Office reports directly to the Secretary or an official within the Department who reports directly to the Secretary. (vi) Establishment of a visible and identifiable point of contact with which the public; EMS agencies and practitioners; State and local government agencies; EMS educational institutions; EMS, trauma, and hospital emergency care professional associations; and all other parties may interact. (3) Responsibilities The Secretary shall, at a minimum, delegate responsibility to the Office of EMS and Trauma to carry out section 330J and parts A, B, C, D, H, and I (except subsection (c)(1) of section 1294) of title XII. (c) National EMS strategy The Secretary, acting through the Director, and in consultation with the Assistant Secretary for Preparedness and Response and the Administrator of the Health Resources and Services Administration, shall develop and implement a cohesive national EMS strategy to strengthen the development of the full continuum of EMS at the Federal, State, and local levels. In establishing such a strategy, the Secretary shall— (1) solicit and consider the recommendations of the National Emergency Medical Services Advisory Council as well as relevant stakeholders; (2) consult and collaborate with the Federal Interagency Committee on Emergency Medical Services to ensure consistency of such national EMS strategy within the larger Federal strategy regarding all of emergency medical services and national preparedness and response; (3) address issues related to EMS patient and practitioner safety, standardization of EMS practitioner licensing and credentialing, field EMS quality and medical oversight, regionalization of field EMS and trauma and emergency care services, availability of field EMS and trauma care and emergency medical services throughout the Nation, and integration of field EMS practitioners into the broader health care system, including— (A) promotion of the adoption by States of the education standards identified in the Emergency Medical Services Education Agenda for the Future: A Systems Approach and any revisions thereto, including the standardization of licensing and credentialing of field EMS practitioners and standards of care, based on best practices and evidence-based medicine, including by— (i) the identification of differences in the levels of care, scope of practice, and licensure and credentialing requirements among the States; and (ii) the adoption by the States of national standards for such levels of care, scope of practice and licensure and credentialing requirements; (B) promotion of a culture of safety, including— (i) the adoption of an anonymous error reporting system designed to identify systemic problems in field EMS patient and practitioner safety and ensure a single means of collecting and reporting relevant error data by field EMS agencies and States; (ii) the establishment of field EMS patient and practitioner safety goals and the specific means to improve field EMS practitioner and patient safety to achieve such goals; and (iii) the adoption of more uniform national ambulance vehicle safety and manufacturing standards as developed by the National Fire Protection Administration or coordinated by the National Highway Traffic Safety Administration; (C) the integration and utilization of field EMS practitioners as part of the larger health care system, including— (i) the potential utilization of field EMS practitioners for the provision of care to patients with nonemergent medical conditions, such as through mobile integrated health care services or community paramedicine; and (ii) strategies to implement the recommendations provided by the National Health Care Workforce Commission, pursuant to section 5101(d)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 294q(d)(2) ); and (D) such other issues as the Secretary considers appropriate; (4) incorporate into such strategy the preparedness and response objectives identified by the Secretary of Homeland Security and the Assistant Secretary for Preparedness and Response in order— (A) to ensure the capability and capacity of the full spectrum of EMS to respond to terrorist attacks, disasters, catastrophic events, and mass casualty events; and (B) to coordinate with the Secretary of Homeland Security accordingly; (5) complete the development of such strategy not later than 18 months after the date of enactment of this Act; (6) communicate such strategy to the relevant congressional committees of jurisdiction; (7) implement such strategy, to the extent practicable, not later than 3 years after the date of enactment of the Field EMS Innovation Act ; and (8) update such strategy not less than every 3 years. (d) Definitions In this section, the terms field EMS , emergency medical services , and medical oversight have the meaning given such terms in section 1291. . 4. Emergency medical services Title XII of the Public Health Service Act ( 42 U.S.C. 300d et seq. ) is amended by adding at the end the following: I Emergency medical services 1291. Definitions In this part: (1) The term ambulance diversion means the practice of hospitals of denying access to an incoming ambulance and requesting that the ambulance proceed to another facility due to a stated lack of capacity at the initial facility, resulting in delayed access to definitive care. (2) The term Director means the Director of the Office of EMS and Trauma established under section 2831. (3) The term EMS means emergency medical services. (4) The term FICEMS means the Federal Interagency Committee on Emergency Medical Services. (5) The term field EMS means emergency medical services provided to patients (including transport by ground, air, or otherwise) prior to or outside a medical facility or other clinical setting. (6) The term field EMS agency means an organization providing field EMS, including— (A) governmental (including fire-based agencies), nongovernmental (including hospital-based or private agencies), and volunteer organizations; and (B) organizations that provide field EMS by ground, air, or otherwise. (7) The term emergency medical services or EMS means emergency medical care, trauma care, and related services provided to patients at any point in the continuum of health care services, including emergency medical dispatch and emergency medical care, trauma care, and related services provided in the field, during transport, or in a medical facility or other clinical setting. (8) The term field EMS patient care reports means the information that a field EMS agency typically creates regarding a patient’s medical condition and treatment in the course of providing emergency medical services to that patient. (9) The term medical oversight means the supervision by a physician of the medical aspects of an EMS system or agency and its providers, including prospective, concurrent, and respective components of field EMS and the education of EMS providers. (10) The term NEMSAC means the National Emergency Medical Services Advisory Council. (11) The term NEMSIS means the National EMS Information System. (12) The term NHTSA means the National Highway Traffic Safety Administration. (13) 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, requiring 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. (14) The term State EMS Office means an office designated by the State with primary responsibility for oversight of the State’s EMS system, such as responsibility for oversight of EMS coordination, licensing or certifying EMS practitioners, and EMS system improvement. (15) The term STEMI means ST–Segment Elevation Myocardial Infarction. 1292. Field EMS Excellence, Quality, Universal Access, Innovation, and Preparedness (a) In general The Director shall establish the an EMS Excellence, Quality, Universal Access, Innovation, and Preparedness grant program, to be referred to as the EQUIP grant program — (1) to promote excellence in all aspects of the provision of field EMS by field EMS agencies; (2) to enhance the quality of emergency medical care provided to patients by field EMS practitioners through evidence-based, medically directed field emergency care; (3) to promote universal access to and availability of high-quality field EMS in all geographic locations of the Nation; (4) to spur innovation in the delivery of field EMS; and (5) to improve EMS agency readiness and preparedness for day-to-day emergency medical response. (b) Application (1) In general To be eligible to receive a grant under this section, an eligible entity shall submit an application to the Director in such form and manner, and containing such agreements, assurances, and information as the Director determines to be necessary to carry out this section. (2) Simple form The Director shall ensure that grant application requirements are not unduly burdensome to smaller and volunteer field EMS agencies or other agencies with limited resources. (3) Consistency with preparation goals The Director shall ensure that grant applications are consistent with national and relevant State preparedness plans and goals. (c) Use of funds Grants may be used by eligible entities— (1) to sustain field EMS practitioners to ensure 24 hours a day, 7 days a week readiness and preparedness at the local level; (2) to develop and implement initiatives related to delivery of medical services, including— (A) innovative clinical practices to improve the cost effectiveness and quality of care delivered to emergency patients in the field that results in improved patient outcomes and cost savings to the health system, including for high prevalence emergency medical conditions such as sudden cardiac arrest, STEMI, stroke, and trauma; and (B) delivery systems to improve patient outcomes, which may include implementing evidence-based protocols, interventions, systems, and technologies to reduce clinically meaningful response times; (3) to purchase and implement— (A) medical equipment and training for using such equipment; (B) communication systems to ensure seamless and interoperable communications with other first responders; and (C) information systems to comply with NEMSIS data collection and integrate field emergency care with electronic medical records; (4) to participate in federally sponsored field EMS research; (5) to establish or enhance comprehensive medical oversight and quality assurance programs that include the active participation by medical directors in field EMS medical direction and educational programs; and (6) for such other uses as the Director determines appropriate. (d) Administration of grants In establishing and administering the EQUIP grant program, the Director— (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; (iii) enhanced access to high-quality field EMS in under served geographic areas; (iv) unique needs of volunteer and rural field EMS agencies; (v) distribution among a variety of geographic areas, including urban, suburban, and rural; (vi) distribution of funds among types of EMS agencies, including governmental, nongovernmental and volunteer; (vii) implementation of evidence-based interventions that improve quality of care, patient outcomes, efficiency, or cost effectiveness; and (viii) such other factors as the Director determines necessary; (B) a peer-reviewed process to recommend grant allocations in accordance with the prioritization established by the Director, except that final award determinations shall be made by the Director; and (C) the provision of grant awards to eligible entities on an annual basis, except that the Director may reserve not more than 25 percent of the available appropriations for multiyear grants and no grant award may exceed a 2-year period; (2) shall consult with and take into consideration the recommendations of the Assistant Secretary for Preparedness and Response, FICEMS, NEMSAC, and relevant stakeholders; (3) shall ensure that funds used for day-to-day preparedness activities are consistent and aligned with Federal preparedness priorities; and (4) may contract with an independent, third-party, nonprofit organization to administer the grant program if the Director establishes conflict-of-interest requirements as part of any such contractual relationship. (e) Eligibility Eligible grant recipients are field EMS agencies that— (1) are licensed by or otherwise authorized in the State in which they operate; and (2) have medical oversight and quality improvement programs as defined by the Director. (f) Required use of guidelines As a condition on receipt of a grant under this section, the Director shall require the grant recipient to adopt and implement (to the extent applicable) the guidelines promoted, developed, and disseminated under subparagraphs (B) and (C) of section 1294(a)(1). (g) Annual report The Director shall submit an annual report on the EQUIP grant program under this section to Congress. 1293. Field EMS System Performance, Integration, and Accountability (a) In general The Director shall establish a Field EMS System Performance, Integration, and Accountability grant program, to be referred to as the SPIA grant program — (1) to improve field EMS system performance, integration, and accountability; (2) to ensure preparedness for field EMS at the State and local levels; (3) to enhance physician medical oversight of field EMS systems; (4) to improve coordination between regional field EMS systems and integration of such regional field EMS systems into the larger health care system; (5) to enhance data collection and analysis to improve, on a continuing basis, the field EMS system; and (6) to promote standardization of national EMS certification of emergency medical technicians and paramedics. (b) Use of funds Entities receiving grants under this section may use such grant funds— (1) to enhance EMS system readiness and preparedness for day-to-day emergency medical response; (2) to improve cross-border collaboration and planning among States; and (3) to collect data with regard to— (A) NEMSIS; (B) field EMS education; (C) field EMS workforce; (D) cardiac events, including STEMI and sudden cardiac arrest; (E) stroke; (F) disasters, including injuries and illnesses; (G) ambulance diversion and patient parking; (H) trauma (in a manner that is complementary and not duplicative of other trauma data collection, such as the National Trauma Data Bank); (I) data determined necessary by the State office of EMS for oversight and coordination of the State field EMS system; and (J) any other such data that the Director specifies; (4) to implement and evaluate system-wide quality improvement initiatives, including medical direction at the State, local, and regional levels; (5) to integrate field EMS with other health care services as part of a coordinated system of care provided to patients with emergency medical conditions to help ensure the right patient receives the right care by the right crew in the right vehicle and at the right medical facility in the right amount of time, including by enhancing regional emergency medical dispatch; (6) to incorporate national EMS certification for all levels of emergency medical technicians and paramedics; (7) to improve the State’s planning for ensuring a consistent, available EMS workforce; (8) to fund EMS regional and local oversight and planning organizations or develop regional systems of emergency medical care within the State to further enhance coordination and systemic development throughout the State; and (9) for such other uses as the Director determines appropriate. (c) Administration of grants In establishing and administering the SPIA grant program, the Director shall— (1) establish State EMS system performance standards to serve as guidance to States in improving EMS systems and in applying for grants under this section, taking into consideration— (A) the recommendations of the Assistant Secretary for Preparedness and Response, FICEMS, NEMSAC, and relevant stakeholders; (B) national, evidence-based guidelines; and (C) the needs and resource limitations of volunteer, smaller agencies, and agencies in rural areas; (2) provide technical assistance to State EMS offices in conducting comprehensive EMS planning with regard to evidence-based workforce and development competencies for field EMS management; (3) allocate, within the available funds, SPIA grants to a maximum of one grant per applicant according to a formula based on population and geographic area, as determined by the Director, for a period not to exceed 2 years; and (4) require that States allocate a portion of funds awarded under this section to regional and local oversight and planning EMS organizations within the State for the purpose of field EMS system development, maintenance, and improvement of coordination among regional organizations. (d) Application To be eligible to receive a grant under this section, an eligible entity shall submit an application to the Director in such form and manner, containing such agreements, assurances, and information as the Director determines to be necessary to carry out this section. (e) Eligibility The entities eligible for a grant under this section are the State EMS office in each of the several States, Indian tribes, and territories. (f) Required use of guidelines As a condition on receipt of a grant under this section, the Director shall require the grant recipient to adopt and implement (to the extent applicable) the guidelines promoted, developed, and disseminated under subparagraphs (B) and (C) of section 1294(a)(1). (g) Annual report The Director shall submit an annual report on the SPIA grant program under this section to Congress. 1294. Field EMS quality (a) Medical oversight (1) In general To improve medical oversight of field EMS and ensure continuity and quality for such medical oversight, the Director shall— (A) promote high-quality and comprehensive 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 roles of physicians who provide medical oversight for field EMS and other health care providers who support physicians in this role; (C) support efforts of relevant physician stakeholders in developing and disseminating guidelines for use by EMS medical directors and field EMS practitioners on a national basis; and (D) convene a Field EMS Medical Oversight Advisory Committee, comprised of representatives of relevant physician stakeholders, to advise the Director on ways and means to advance and support development and maintenance of quality medical oversight throughout the Nation's systems for field EMS. (2) Additional considerations In carrying out subparagraphs (B) and (C) of paragraph (1), the Director shall take into consideration— (A) existing guidelines developed by national professional physician associations, States, and other relevant governmental or nongovernmental entities; (B) the input of other relevant stakeholders, including health care providers who support physicians who provide medical oversight for field EMS; and (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-quality training, credentialing, and direction in connection with medical oversight of field EMS at the State, regional, and local levels while providing sufficient flexibility to account for historical and legitimate differences in field EMS among States, regions, and localities. (b) GAO study and report (1) In general The Comptroller General of the United States shall complete a study on— (A) medical and administrative liability issues that may impede— (i) medical direction provided by physicians directly regarding specific patients or medical oversight provided by physicians in establishing medical protocols, procedures, and other activities related to the provision of emergency medical care in field EMS; or (ii) the highest quality emergency medical care in field EMS provided by personnel other than physicians such as emergency medical technicians and paramedics; (B) reimbursement for any component of medical oversight; and (C) such other issues as the Comptroller General determines appropriate relating to improving the quality and medical oversight of emergency medical care in field EMS. (2) Report to Congress Not later than 18 months after the date of the enactment of the Field EMS Innovation Act , the Comptroller General shall complete the study under paragraph (1) and submit a report to Congress on the results of such study, including any recommendations. (c) Data collection and exchange (1) National EMS information system (A) In general The Administrator of NHTSA may maintain, improve, and expand the National EMS Information System, including the National EMS Database. (B) Consultation The Administrator of NHTSA shall carry out this paragraph in consultation with the Director. (C) Standardization In carrying out subparagraph (A), the Administrator of NHTSA shall promote the collection and reporting of data on field EMS in a standardized manner. (D) Availability of data The Administrator of NHTSA shall ensure that information in the National EMS Database (other than individually identifiable information) is available to Federal and State policymakers, EMS stakeholders, and researchers. (E) Technical assistance In carrying out subparagraph (A), the Administrator of NHTSA may provide technical assistance to State and local agencies, field EMS agencies, and other entities, as the Administrator determines appropriate, to assist in the collection, analysis, and reporting of data. (2) Report on data gaps (A) In general Not later than 1 year after the date of the enactment of the Field EMS Innovation Act , the Secretary of Health and Human Services, acting through the Director, in consultation with the Administrator of NHTSA, shall submit to Congress a report that— (i) identifies gaps in the collection of data related to the provision of field EMS; and (ii) includes recommendations for improving the collection, reporting, and analysis of such data. (B) Recommendations The recommendations required by subparagraph (A)(ii) shall— (i) take into consideration the recommendations of FICEMS and NEMSAC and relevant stakeholders; (ii) recommend methods for improving data collection and reporting and analysis without unduly burdening reporting entities and without duplicating existing data sources (such as data collected by the National Trauma Data Bank); (iii) address the quality and availability of data, and linkages with existing patient registries, related to the provision of field EMS and utilization of field EMS with respect to a variety of illnesses and injuries (in both the everyday provision of field EMS and catastrophic or disaster response), including— (I) cardiac events such as chest pain, sudden cardiac arrest, and STEMI; (II) stroke; (III) trauma; (IV) disaster and catastrophic incidents, such as incidents related to terrorism or natural or manmade disasters; and (V) ambulance diversion and patient parking; and (iv) include an analysis of the variety of services provided by field EMS agencies. (3) Report on data integration to promote quality of care Not later than 18 months after the date of enactment of the Field EMS Innovation Act , the Secretary, acting through the head of the Office of the National Coordinator for Health Information Technology and the Director, in collaboration with FICEMS and the Administrator of NHTSA as appropriate, and taking into consideration input from relevant stakeholders, shall submit a report (including recommendations) on issues, impediments, and potential solutions pertaining to the following objectives: (A) Incorporation of field EMS patient care reports into patient electronic health records, taking into consideration— (i) the extent to which field EMS patient care reports are created in electronic format and the potential for elements of such reports to be incorporated into patient electronic health records; (ii) the data elements of field EMS patient care reports that would promote quality and efficiency of care if incorporated into patient electronic health records; (iii) potential modifications to the Medicare and Medicaid programs under titles XVIII and XIX, respectively, of the Social Security Act ( 42 U.S.C. 1395 et seq. , 1396 et seq.) or other Federal health programs (including potential modifications to the HITECH Act (title XIII of division A and title IV of Division B of Public Law 111–5), including modifications to the entities included as eligible for incentive payments under section 1848(o), 1853(l) (to the extent that such section 1848(o) is applied), or 1903(t) of the Social Security Act (42 U.S.C. 1395w–4(o), 1395w–23(l), 1396b(t)), criteria for certified EHR technology for purposes of such sections, and objectives and measures for determining meaningful use of such technology for purposes of such sections) to provide appropriate reimbursement and financial incentives for EMS agencies— (I) to maintain field EMS patient care reports in a structured electronic format; and (II) to otherwise adopt and use electronic health records; and (iv) potential modifications to the HITECH Act to provide incentives to eligible hospitals under section 1886(n), 1853(m) (to the extent that such section 1886(n) is applied), or section 1814(l)(3) of the Social Security Act to incorporate appropriate data elements of field EMS patient care reports into patient electronic health records. (B) Incorporation of patient health information created subsequent to the receipt of field EMS emergency care into NEMSIS, 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 subsequent care and treatment) that would, if included in NEMSIS, be potentially useful in evaluating and improving the quality of EMS care; (ii) how best to integrate such information into NEMSIS; (iii) potential modifications to the HITECH Act to require eligible hospitals, as defined in section 1886(n)(6)(B) of the Social Security Act (42 U.S.C. 1395ww(n)(6)(B)), for purposes of incentive payments under 1886(b)(3)(B)(ix) and 1886(n) of such Act, to develop or report relevant data to NEMSIS or other appropriate State or private registries; and (iv) potential modifications to the Medicare and Medicaid programs under titles XVIII and XIX, respectively, of the Social Security Act or other Federal health programs to provide appropriate reimbursement and financial incentives for field EMS agencies to develop or report relevant data to NEMSIS or other appropriate State or private registries. (d) 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 personnel of a hospital to which the individual is transported for the purposes of relating information on the medical history, treatment, care, and outcome of such individual (including any health care personnel safety issues such as infectious disease). (B) Guidelines The Secretary shall establish guidelines for exchanges of information between field EMS practitioners treating an individual and personnel of a hospital to which the individual is transported to protect the privacy of the individual while ensuring the ability of such EMS practitioners and hospital personnel to communicate effectively to further the continuity and quality of emergency medical care provided to such individual. (2) NEMSIS data Nothing in HIPAA privacy and security law (as defined in section 3009(a)(2)) shall be construed as prohibiting— (A) a field EMS agency from submitting EMS data to the State EMS Office for the purpose of quality improvement and data collection by the State for submission to NEMSIS; or (B) the State EMS Office from submitting aggregated nonindividually identifiable EMS data to the National EMS Database maintained by NHTSA. 1295. Field EMS education grants (a) In general For the purpose of promoting field EMS as a health profession and ensuring the availability, quality, and capability of field EMS educators, practitioners, and medical directors, the Director may 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 personnel. In carrying out this section, the Director shall take into consideration recommendations of the Administrators of each of NHTSA, FICEMS, and NEMSAC, the National Health Care Workforce Commission established under section 5101 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 294q ), and relevant stakeholders. (b) Eligibility In this section, the term eligible entity means an educational organization, an educational institution, a professional association, and any other entity involved with the education of field EMS practitioners. (c) Use of funds The Director may award a grant to an eligible entity under paragraph (1) only if the entity agrees to use the grant to— (1) develop and implement education programs that— (A) train field EMS trainers and promote the adoption and implementation of the education standards identified in the Emergency Medical Services Education Agenda for the Future: A Systems Approach including any revisions thereto; (B) bridge the gap in knowledge and skills in field EMS and among field EMS and other allied health professions to develop a larger cadre of educational instructors and build a stronger and more flexible field EMS practitioner corps; or (C) provide training and retraining programs to provide displaced workers the opportunity to enter a field EMS profession; (2) develop and implement educational courses pertaining to— (A) instructor courses; (B) provision of medical direction of field EMS; (C) field EMS practitioners, including physicians, emergency medical technicians, paramedics, nurses, and other relevant clinicians providing emergency medical care in the field; (D) field EMS educational and clinical research; (E) bridge programs among field EMS, nursing, and other allied health professions; (F) field EMS management; (G) national, evidence-based guidelines; and (H) translation of the lessons learned in military medicine to field EMS; (3) evaluate education and training courses and methodologies to identify optimal educational modalities for field EMS practitioners; (4) improve the field EMS education infrastructure by increasing the number of field EMS instructors and the quality of their preparation by improving, enhancing, and modernizing the dissemination of EMS education, including distance learning, and by establishing quality improvement for EMS education programs; (5) enhance the opportunity for medical direction training and for promoting appropriate medical oversight of field emergency medical care; (6) improve systems to design, implement, and evaluate education for prospective and current field EMS providers; or (7) carrying out such other activities as the Director determines appropriate. (d) Priority The Director, in consultation with NHTSA and relevant stakeholders, and taking into consideration the recommendations of FICEMS and NEMSAC, shall establish a system of prioritization in awarding grants under this section to eligible entities. (e) Duration of grants Grants under this section shall be for a period of 1 to 3 years. (f) Application The Director may not award a grant to an eligible entity under this section unless the entity submits an application to the Director in such form, in such manner, and containing such agreements, assurances, and information as the Director may require. The Director shall ensure that the requirements for submitting an application under this section are not unduly burdensome. 1296. Evaluating innovative models for access and delivery of field EMS for patients (a) Evaluation (1) In general Not later than 1 year after the date of the enactment of the Field EMS Innovation Act , the Director, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, and taking into consideration the recommendations of NEMSAC and FICEMS, shall complete an evaluation of— (A) the provision of and reimbursement for alternative delivery models for medical care through field EMS; and (B) the integration of field EMS patients with other medical providers and facilities as medically appropriate. (2) Specific issues In completing the evaluation under paragraph (1), the Director shall consider each of the following: (A) Alternative dispositions of patients, including— (i) transporting patients by ambulance to destinations other than a hospital such as the office of the patient’s physician, an urgent care center, or the facilities of another health care provider; (ii) when medically necessary, the evaluation, treatment, or referral of patients to other medically appropriate health care providers; (iii) the provision of medical care regardless of the decision to transport, such as reimbursement models based on readiness rather than transport and shared savings; and (iv) the provision of health care using patient centered mobile resources in the out-of-hospital environment, such as mobile integrated health care services and community paramedicine. (B) Issues related to medical liability and the requirements of section 1867 of the Social Security Act ( 42 U.S.C. 1395dd ; commonly referred to as EMTALA ) associated with transport to destinations other than a hospital emergency department. (C) Necessary protections to ensure that patients receive timely and appropriate care in the appropriate setting. (D) Whether there are any barriers to providing alternate dispositions to patients who are not in need of care in hospital emergency departments. (E) Other issues determined by the Director, including, when practicable, issues recommended by FICEMS or NEMSAC for evaluation under this subsection. (b) Demonstration projects (1) In general Beginning not later than 1 year after the date of the enactment of the Field EMS Innovation Act , the Director shall conduct or support at least 10 demonstration projects to— (A) evaluate the implementation and reimbursement of alternative dispositions of field EMS patients, including— (i) transporting patients by ambulance to alternate destinations when medically appropriate and in the patients’ best interests; (ii) when medically necessary, evaluating, treating, or referring patients to other medically appropriate providers; and (iii) when medically appropriate, treating patients through mobile integrated health care services or community paramedicine. (B) evaluate the implementation of reimbursement models based on readiness rather than transport or shared savings; and (C) determine whether such alternative dispositions and reimbursement models— (i) improve the safety, effectiveness, timeliness, and efficiency of EMS; and (ii) reduce overall utilization and expenditures under the Medicare program under title XVIII of the Social Security Act. (2) Evidence-based protocols The Director shall ensure that at least one demonstration project under paragraph (1) evaluates evidence-based protocols that give guidance on selection of the destination to which patients are transported. (3) Duration The period of a demonstration project under paragraph (1) shall not exceed 3 years. (4) Research The Director shall conduct or support further research that the Director determines to be necessary prior to or in conjunction with the demonstration projects under this subsection in order to evaluation the implementation of alternative dispositions of field EMS patients. (5) Funding Of the amount made available to carry out section 1115A of the Social Security Act (42 U.S.C. 1315a) for a fiscal year, the Secretary may transfer such sums as may be necessary to carry out this subsection. (c) Report to Congress Not later than 1 year after the completion of all demonstration projects under subsection (b), the Director shall submit to Congress a report on the results of activities under this section, including recommendations on the efficacy of alternative dispositions of field EMS patients. . 5. Enhancing research in field EMS (a) Models To be tested by Center for Medicare and Medicaid Innovation Section 1115A(b)(2)(B) of the Social Security Act ( 42 U.S.C. 1315a(b)(2)(B) ) is amended by adding at the end the following: (xxi) Enhancing health outcomes for patients receiving field emergency medical services and improving timely and efficient delivery of high-quality field emergency medical services, such as through— (I) regionalization of emergency care; (II) medical transport to alternate destinations; or (III) when medically necessary, the evaluation, treatment, or referral of patients to other medically appropriate health providers. . (b) Emergency medical research Section 498D of the Public Health Service Act ( 42 U.S.C. 289g–4 ) is amended— (1) by redesignating subsections (c) and (d) as subsections (d) and (e), respectively; and (2) by inserting after subsection (b) the following: (c) Field EMS emergency medical research (1) In general The Secretary shall conduct research and evaluation relating to field EMS through the Agency for Healthcare Research and Quality and the Center for Medicare and Medicaid Innovation. (2) Definition In this subsection, the term field EMS has the meaning given such term in section 1291. . (c) Field EMS practice center Subpart II of part D of title IX of the Public Health Service Act ( 42 U.S.C. 299b–33 et seq. ) is amended by adding at the end the following: 938. Field EMS practice center (a) Establishment The Director shall establish within the Office of Research and Evaluation a Field EMS Evidence-Based Practice Center (referred to in this section as the Center ). (b) Purpose The purpose of the Center is to conduct or support research to promote the highest quality of emergency medical care in field EMS and the most effective delivery system for the provision of such care, including— (1) comparative safety and effectiveness research; (2) other appropriate clinical or systems research; and (3) research addressing— (A) critical care transport; (B) off-shore operations; (C) tactical emergency medical services; (D) air medical services; and (E) the application of lessons learned in military field medicine in the delivery of emergency medical care in field EMS. (c) Definition In this section, the term field EMS has the meaning given such term in section 1291. . (d) Limitations on certain uses of research Section 1182 of the Social Security Act ( 42 U.S.C. 1320e–1 ) is amended by striking section 1181 each place it appears and inserting section 1181 of this Act or section 498D(c) or 938 of the Public Health Service Act . (e) Regulatory barriers For the purposes of research conducted pursuant to clause (xxi) of section 1115A(b)(2)(B) of the Social Security Act (as added by subsection (a)), subsection (c) of section 498D of the Public Health Service Act (as added by subsection (b)), section 938 of the Public Health Service Act (as added by subsection (c)), or any other research funded by the Department of Health and Human Services related to emergency medical services in the field in which informed consent is required but may not be attainable, the Secretary of Health and Human Services shall— (1) evaluate and consider the patient and research issues involved; and (2) address regulatory barriers to such research related to the need for informed consent in a manner that ensures adequate patient safety and notification, and submit recommendations to Congress for any changes to Federal statutes necessary to address such barriers. 6. Emergency Medical Services Trust Fund (a) Designation of income tax overpayments and additional contributions for emergency medical services Subchapter A of chapter 61 of the Internal Revenue Code of 1986 is amended by adding at the end the following new part: IX Designation of income tax overpayments and additional contributions for emergency medical services 6097. Designation by individuals (a) In general Every individual (other than a nonresident alien) may designate that— (1) a specified portion of any overpayment of tax for a taxable year, and (2) any amount contributed in addition to any payment of tax for such taxable year and any designation under paragraph (1), shall be used to fund the Emergency Medical Services Trust Fund. Designations under the preceding sentence shall be in an amount not less than $1, and the Secretary shall provide for elections in amounts of $1, $5, $10, or such other amount as the taxpayer designates. (b) Overpayments Treated as Refunded For purposes of this title, any portion of an overpayment of tax designated under subsection (a) shall be treated as— (1) being refunded to the taxpayer as of the last date prescribed for filing the return of tax imposed by chapter 1 (determined without regard to extensions) or, if later, the date the return is filed, and (2) a contribution made by such taxpayer on such date to the United States. (c) Manner and time of designation A designation under subsection (a) may be made with respect to any taxable year— (1) at the time of filing the return of the tax imposed by chapter 1 for such taxable year, or (2) at any other time (after the time of filing the return of the tax imposed by chapter 1 for such taxable year) specified in regulations prescribed by the Secretary. Such designation shall be made in such manner as the Secretary prescribes by regulations except that, if such designation is made at the time of filing the return of the tax imposed by chapter 1 for such taxable year, such designation shall be made either on the first page of the return or on the page bearing the signature of the taxpayer. . (b) Emergency Medical Services Trust Fund Subchapter A of chapter 98 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section: 9512. Emergency Medical Services Trust Fund (a) Creation of trust fund There is established in the Treasury of the United States a trust fund to be known as the Emergency Medical Services Trust Fund , consisting of such amounts as may be credited or paid to such trust fund as provided in subsection (b). (b) Transfers to trust fund There are hereby appropriated to the Emergency Medical Services Trust Fund amounts equivalent to the amounts of the overpayments of tax to which designations under section 6097 apply. (c) Expenditures from trust fund Amounts in the Emergency Medical Services Trust Fund shall be available, as provided in appropriation Acts, only for carrying out the provisions for which amounts are authorized to be appropriated under subsections (a) and (b) of section 7 of the Field EMS Innovation Act . . (c) Clerical amendments (1) Clerical amendment The table of parts for subchapter A of chapter 61 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Part IX. Designation of income tax overpayments and additional contributions for emergency medical services. . (2) The table of sections for subchapter A of chapter 98 of such Code is amended by adding at the end the following new item: Sec. 9512. Emergency Medical Services Trust Fund. . (d) Effective date The amendments made by this section shall apply to taxable years beginning after December 31, 2015. 7. Authorization of appropriations (a) In general Out of amounts in the Emergency Medical Services Trust Fund, there are authorized to be transferred— (1) to the Secretary of Health and Human Services— (A) $12,000,000, for the purpose of carrying out section 2831 of the Public Health Service Act (except for subsection (b)(3) of such section), section 1294 of such Act, and section 1296 of such Act (except for subsection (b) of such section) for each of fiscal years 2015 through 2019; (B) $200,000,000 for each of fiscal years 2015 through 2019, for the purpose of carrying out section 1292 of the Public Health Service Act; (C) $50,000,000 for each of fiscal years 2015 through 2019, for the purpose of carrying out section 1293 of the Public Health Service Act; (D) $15,000,000 for each of fiscal years 2015 through 2019, for the purpose of carrying out section 1295 of the Public Health Service Act; and (E) $40,000,000 for each of fiscal years 2015 through 2019, for the purpose of carrying out sections 498D(c) and 938 of the Public Health Service Act, as added by section 5; and (2) to the Secretary of Transportation, $4,000,000 for each of fiscal years 2015 through 2019, for the purpose of carrying out section 1292(c)(1) of the Public Health Service Act. (b) Excess amounts If, for any fiscal year, amounts in the Emergency Medical Services Trust Fund exceed the maximum amount authorized to be transferred under subsection (a), the Secretary of Health and Human Services may transfer such excess amounts for the purpose of carrying out section 330J, section 498D, and parts A, B, C, D, and H of title XII of the Public Health Service Act (42 U.S.C. 254c–15, 289g–4, 300d et seq., 300d–11 et seq., 300d–31 et seq., and 300d–81 et seq.). (c) Start-Up funding (1) In general Out of the discretionary funds available to the Secretary of Health and Human Services for each of fiscal years 2015 and 2016, $40,000,000 shall be used for carrying out the amendments made by subsections (a), (b), and (c) of section 5. (2) Relation to other funds The amount of discretionary funds allocated under paragraph (1) for the purpose of carrying out subsections (a), (b), and (c) of section 5 shall be in addition to, not in lieu of, the amount of discretionary funds that would otherwise be available for such purpose. (d) Administrative expenses Of the amounts made available under subsection (a), (b), or (c) to carry out each of the provisions listed in subsection (a), not more than 5 percent of each such amount may be used for Federal administrative expenses. 8. Statutory construction Nothing in this Act, including the amendments made by this Act shall be construed to supercede any statutory authority of any Federal agency that is not within the Department of Health and Human Services.