II 117th CONGRESS 2d Session S. 3910 IN THE SENATE OF THE UNITED STATES March 23, 2022 Mr. Sanders (for himself and Ms. Smith ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to establish a funding program for supporting EMS organizations, and for other purposes.

1. Short title This Act may be cited as the EMS Staffing and Support Act . 2. EMS organization funding Part P of title III of the Public Health Service Act ( 42 U.S.C. 280g et seq. ) is amended by adding at the end the following: 399V–7. EMS organization funding (a) Definitions In this section: (1) Indian Tribe; Tribal organization The terms Indian Tribe and Tribal organization have the meanings given such terms in section 4 of the Indian Self-Determination and Education Assistance Act. (2) EMS organization The term EMS organization means a public or private entity that provides medical transport and emergency medical services. (3) Emergency medical services The term emergency medical services has the meaning given such term in section 330J(e). (4) Qualified applicant The term qualified applicant means— (A) an EMS organization, other than an EMS organization that operates for profit; (B) a State, Indian Tribe, Tribal organization, county, or municipality; or (C) any other nonprofit organization that represents the interests of EMS organizations. (5) State The term State means any State of the United States, the District of Columbia, the Commonwealth of Puerto Rico, American Samoa, Guam, the United States Virgin Islands, the Commonwealth of the Northern Mariana Islands, and any other territory or possession of the United States. (b) Competitive grants (1) In general Beginning in fiscal year 2023, the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award grants on a competitive basis to qualified applicants to carry out activities described in subsection (d) in order to support EMS organizations in the United States. (2) Applications (A) In general A qualified applicant seeking a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require, including— (i) a description of the financial need of the qualified applicant (or each qualified applicant in the case of a joint application described in subparagraph (B)); and (ii) an analysis of the costs and benefits, with respect to improving medical transport and emergency medical services, of the activities to be carried out through the grant. (B) Joint applications A qualified applicant may submit a joint application with 1 or more other qualified applicants under this subsection. (C) Peer review of grant applications (i) In general The Secretary, after consultation with national emergency medical services organizations, shall appoint emergency medical service personnel to conduct peer reviews of applications received under this subsection. (ii) Applicability of Federal Advisory Committee Act The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to activities carried out under this subparagraph. (D) Prioritization of grant awards In awarding grants under this subsection, the Secretary shall consider each of the following: (i) The findings and recommendations of the peer reviews carried out under subparagraph (C). (ii) The degree to which an award will improve the coverage, response times, and ability of EMS organizations to provide medical transport and emergency medical services. (iii) The extent of the need of an applicant for a grant under this subsection and the need to protect the United States as a whole. (c) Contracts or compacts with Indian Tribes and Tribal organizations (1) In general Beginning in fiscal year 2023, the Secretary, acting through the Administrator of the Health Resources and Services Administration, shall award funding through contracts or compacts pursuant to the Indian Self-Determination and Education Assistance Act, distributed on a fair and equitable formula as developed through consultation with Indian Tribes and Tribal organizations, to Indian Tribes and Tribal organizations to carry out activities described in subsection (d) in order to support EMS organizations in Tribal communities. (2) Applications An Indian Tribe or Tribal organization seeking funding under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary requires through consultation with Indian Tribes and Tribal organizations. (d) Activities (1) In general Grants or other funding awarded under this section may be used to support EMS organizations through any of the following: (A) Hiring EMS organization personnel. (B) Recruiting and retaining volunteer EMS organization personnel. (C) Providing training or reimbursing personnel for training. (D) Conducting courses and implementing apprenticeship programs that qualify graduates to serve in an EMS organization in accordance with State and local requirements. (E) Purchasing necessary equipment. (F) Purchasing medicine and medical supplies. (G) Purchasing EMS vehicles. (H) Wellness and fitness programs for EMS organization personnel. (I) Modifying facilities. (J) Improving regional coordination among EMS organizations. (K) Establishing or supporting community paramedicine or mobile integrated health care initiatives. (L) Any other activity the Secretary determines appropriate. (2) Limitation No funds awarded under this section may be made available to an EMS organization that operates for profit or to otherwise support efforts to establish or provide emergency medical services, or medical transport, for profit. (e) Amount Each grant awarded under subsection (b), or funding through a contract or compact under subsection (c), shall be in an amount not to exceed $1,000,000. (f) Appropriations (1) Awards (A) In general There is authorized to be appropriated, and there is appropriated, to the Secretary to award grants, and funding through contracts or compacts, under this section— (i) for fiscal year 2023, $500,000,000; and (ii) for each fiscal year thereafter, the amount authorized under this subparagraph for the preceding fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) for the most recent 12-month period for which applicable data is available. (B) Contracts and compacts Of the amount appropriated under subparagraph (A) for each fiscal year, not less than 5 percent shall be set aside to carry out subsection (c). (2) Technical assistance There is authorized to be appropriated, and there is appropriated, to the Secretary to provide technical assistance to entities completing and submitting applications under this section— (A) for fiscal year 2023, $10,000,000; and (B) for each fiscal year thereafter, the amount authorized under this paragraph for the preceding fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) for the most recent 12-month period for which applicable data is available. . 3. Reports (a) In general Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, the Administrator of the Health Resources and Services Administration, the Assistant Secretary for Preparedness and Response, and EMS stakeholders, shall submit to Congress a report detailing the challenges, disparities, and inadequacies in providing Federal, State, and private (including commercial insurers) reimbursement for medical transport and emergency medical services and providing recommendations for improvement with respect to providing such reimbursement. (b) Rural EMS organizations Not later than 90 days after the date of enactment of this Act, the Secretary of Health and Human Services, in consultation with the Administrator of the Centers for Medicare & Medicaid Services, the Administrator of the Health Resources and Services Administration, the Assistant Secretary for Preparedness and Response, and EMS stakeholders, shall submit to Congress a report on the challenges specific to rural EMS organizations, including with respect to Federal, State, and private (including private insurers) reimbursement rates and policies, and develop an action plan to address those challenges through grants and other administrative action.