113 S2400 IS: Field EMS Innovation Act
U.S. Senate
2014-05-22
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.
Short title; table of
contents
(a)
This Act may be cited
as the Field EMS Innovation Act
.
(b)
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.
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
careTitle XXVIII of the Public Health Service Act (42 U.S.C. 300hh et seq.) is amended by adding at the
end the following:
D2831.Recognition of
HHS as primary Federal agency for emergency medical services and trauma
care; establishment of Office of EMS and Trauma
(a)
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)
(1)
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)
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)
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)
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)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 servicesTitle XII of the Public Health Service Act (42 U.S.C. 300d et seq.) is amended by adding at the end
the following:IEmergency medical services1291.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)
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)
(1)
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)
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)
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)
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)
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 guidelinesAs 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)
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)
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)
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)
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)
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)
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 guidelinesAs 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)
The Director shall
submit an annual report on the SPIA grant program under this section to
Congress.
1294.
(a)
(1)
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)
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)
(1)
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)
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)
The Administrator of NHTSA may maintain, improve, and
expand the National EMS Information System, including the National EMS
Database.
(B)
The
Administrator of NHTSA shall carry out this paragraph in consultation with
the
Director.
(C)
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)
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)
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)
(A)
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)
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)
(1)
Exchange of
information related to the treatment of patients
(A)
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)
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)
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)
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)
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)
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)
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)
Grants under this section shall be for a period of 1 to 3
years.
(f)
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)
(1)
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)
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)
(1)
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)
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)
The
period of a demonstration project under paragraph (1) shall not exceed 3
years.
(4)
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)
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)
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)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)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)
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)
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)
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)
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)
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)
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)
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)
(1)
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)The amendments made by this section shall apply to taxable
years beginning after December 31, 2015.
7.
Authorization of
appropriations
(a)
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)
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)
(1)
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)
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)
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.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.