[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 2091 Introduced in Senate (IS)]







105th CONGRESS
  2d Session
                                S. 2091

  To amend title XVIII of the Social Security Act to ensure medicare 
   reimbursement for certain ambulance services, and to improve the 
  efficiency of the emergency medical system, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 19, 1998

   Mr. Grams introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to ensure medicare 
   reimbursement for certain ambulance services, and to improve the 
  efficiency of the emergency medical system, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Emergency Medical Services 
Efficiency Act of 1998''.

        TITLE I--MEDICARE COVERAGE OF CERTAIN AMBULANCE SERVICES

SEC. 101. MEDICARE COVERAGE OF CERTAIN AMBULANCE SERVICES.

    (a) Coverage.--Section 1861(s)(7) of the Social Security Act (42 
U.S.C. 1395x(s)(7)) is amended by striking ``regulations;'' and 
inserting ``regulations, except that such regulations shall not fail to 
treat ambulance services as medical and other health services solely 
because the ultimate diagnosis of the individual receiving the 
ambulance services results in the conclusion that ambulance services 
were not necessary, as long as the request for ambulance services is 
made after the sudden onset of a medical condition that is manifested 
by symptoms of such sufficient severity, including severe pain, that a 
prudent layperson, who possesses an average knowledge of health and 
medicine, could reasonably expect to result, without immediate medical 
attention, in--
            ``(A) placing the individual's health in serious jeopardy;
            ``(B) serious impairment to the individual's bodily 
        functions; or
            ``(C) serious dysfunction of any bodily organ or part of 
        the individual;''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services provided on or after the date of enactment 
of this Act.

  TITLE II--STATE EMERGENCY MEDICAL SERVICES AGENCY PARTICIPATION IN 
                        CERTAIN FEDERAL PROGRAMS

SEC. 201. TELEMEDICINE AND DISTANCE LEARNING SERVICES IN RURAL AREAS.

    (a) In General.--Section 2333(c)(1) of chapter 1 of subtitle D of 
title XXIII of the Food, Agriculture, Conservation, and Trade Act of 
1990 (7 U.S.C. 950aaa-2(c)(1)) is amended by adding at the end the 
following flush sentence:
        ``For purposes of this paragraph, the term `entities' shall 
        include State emergency medical services agencies.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act.

SEC. 202. INFORMATICS, TELEMEDICINE, AND EDUCATION DEMONSTRATION 
              PROJECT.

    (a) In General.--Section 4207(c) of the Balanced Budget Act of 1997 
(42 U.S.C. 1395b-1(c) note.) is amended by adding at the end the 
following flush sentence:
        ``A State emergency medical services agency may participate in 
        the consortium under this section.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act.

     TITLE III--FEDERAL COMMISSION FOR EMERGENCY AMBULANCE SERVICES

SEC. 301. DEFINITION OF EMERGENCY AMBULANCE SERVICES.

    In this title, the term ``emergency ambulance services''--
            (1) means resources used by a qualified public, private, or 
        nonprofit entity to deliver medical care under emergency 
        conditions--
                    (A) that occur as a result of the condition of a 
                patient; or
                    (B) that occur as a result of a natural disaster or 
                similar situation; and
            (2) includes services delivered by an emergency ambulance 
        employee that is licensed or certified by a State as an 
        emergency medical technician, a paramedic, a registered nurse, 
        a physician assistant, or a physician.

SEC. 302. ESTABLISHMENT OF COMMISSION.

    (a) Establishment.--There is established a commission to be known 
as the Federal Commission for Emergency Ambulance Services (in this 
title referred to as the ``Commission'').
    (b) Membership.--
            (1) Composition.--The Commission shall be composed of 21 
        members, of whom--
                    (A) 1 shall be an individual who is appointed by 
                the Majority Leader of the Senate;
                    (B) 1 shall be an individual who is appointed by 
                the Minority Leader of the Senate;
                    (C) 1 shall be an individual who is appointed by 
                the Speaker of the House of Representatives;
                    (D) 1 shall be an individual who is appointed by 
                the Minority Leader of the House of Representatives;
                    (E) 1 shall be a member of the American Academy of 
                Pediatrics, appointed by the President from a list of 
                nominations submitted by the American Academy of 
                Pediatrics;
                    (F) 1 shall be a member of the American Ambulance 
                Association, appointed by the President from a list of 
                nominations submitted by the American Ambulance 
                Association;
                    (G) 1 shall be a member of the American College of 
                Emergency Physicians, appointed by the President from a 
                list of nominations submitted by the American College 
                of Emergency Physicians;
                    (H) 1 shall be a member of the Committee on Trauma 
                within the American College of Surgeons, appointed by 
                the President from a list of nominations submitted by 
                the American College of Surgeons;
                    (I) 1 shall be a member of the American Hospital 
                Association, appointed by the President from a list of 
                nominations submitted by the American Hospital 
                Association;
                    (J) 1 shall be a member of the Committee on EMS-F30 
                within the American Society for Testing and Material, 
                appointed by the President from a list of nominations 
                submitted by the American Society for Testing and 
                Material;
                    (K) 1 shall be a member of the Associated Public 
                Safety Communications Officials International, 
appointed by the President from a list of nominations submitted by the 
Associated Public Safety Communications Officials International;
                    (L) 1 shall be a member of the Association of Air 
                Medical Services, appointed by the President from a 
                list of nominations submitted by the Association of Air 
                Medical Services;
                    (M) 1 shall be a member of the Emergency Nurses 
                Association, appointed by the President from a list of 
                nominations submitted by the Emergency Nurses 
                Association;
                    (N) 1 shall be a member of the International 
                Association of Fire Chiefs, appointed by the President 
                from a list of nominations submitted by the 
                International Association of Fire Chiefs;
                    (O) 1 shall be a member of the International 
                Association of Fire Fighters, appointed by the 
                President from a list of nominations submitted by the 
                International Association of Fire Fighters;
                    (P) 1 shall each be a member of a governing body of 
                an Indian tribe (as that term is defined in section 
                4(e) of the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450b(e)), appointed by the 
                President;
                    (Q) 1 shall be a member of the National Association 
                of Emergency Medical Services Physicians, appointed by 
                the President from a list of nominations submitted by 
                the National Association of Emergency Medical Services 
                Physicians;
                    (R) 1 shall be a member of the National Association 
                of State Emergency Medical Services Directors, 
                appointed by the President from a list of nominations 
                submitted by the National Association of State 
                Emergency Medical Services Directors;
                    (S) 1 shall be a member of the National Association 
                of Emergency Medical Technicians, appointed by the 
                President from a list of nominations submitted by the 
                National Association of Emergency Medical Technicians;
                    (T) 1 shall be a member of the National Rural 
                Health Association, appointed by the President from a 
                list of nominations submitted by the National Rural 
                Health Association; and
                    (U) 1 shall be a member of the National Volunteer 
                Fire Council, appointed by the President from a list of 
                nominations submitted by the National Volunteer Fire 
                Council.
            (2) Additional requirements.--
                    (A) Geographical representation and urban and rural 
                representation.--In making appointments of members 
                under paragraph (1), the appointing officials described 
                in such paragraph shall, through consultation and 
                collaboration with each other, select--
                            (i) members who are geographically 
                        representative of the United States; and
                            (ii) members who are representative of 
                        rural areas and urban areas.
                    (B) Special rule.--The appointing officials 
                described paragraph (1) shall ensure that, of the 
                members appointed--
                            (i) 11 shall be representative of rural 
                        areas; and
                            (ii) 11 shall be representative of urban 
                        areas.
            (3) Date.--The appointments of the members of the 
        Commission shall be made not later than January 1, 1999.
    (c) Period of Appointment; Vacancies.--
            (1) Period of appointment.--Members shall be appointed for 
        a term of 4 years.
            (2) Vacancy.--
                    (A) In general.--Any vacancy in the Commission 
                shall not affect the powers of the Commission, but 
                shall be filled in the same manner as the original 
                appointment.
                    (B) Filling unexpired terms.--An individual chosen 
                to fill a vacancy under this paragraph shall be 
                appointed for the unexpired term of the member 
                replaced.
    (d) Initial Meeting.--Not later than 30 days after the date on 
which all members of the Commission have been appointed, the Commission 
shall hold its first meeting.
    (e) Meetings.--The Commission shall meet at the call of the 
Chairperson.
    (f) Quorum.--A majority of the members of the Commission shall 
constitute a quorum, but a lesser number of members may hold hearings.
    (g) Chairperson and Vice Chairperson.--The Commission shall select 
a Chairperson and Vice Chairperson from among the members of the 
Commission.

SEC. 303. DUTIES OF THE COMMISSION.

    (a) Study.--The Commission shall conduct a thorough study of all 
matters relating to emergency ambulance services, including any 
existing or proposed Federal department or agency rules that impact 
such services.
    (b) Recommendations.--The Commission shall develop recommendations 
regarding the improvement of all matters relating to emergency 
ambulance services, including any existing or proposed Federal 
department or agency rules that impact such services.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act and annually thereafter, the Commission shall submit a report 
to the President and Congress containing a detailed statement of the 
results of the matters studied by the Commission pursuant to subsection 
(a), together with the Commission's recommendations formulated pursuant 
to subsection (b).

SEC. 304. POWERS OF THE COMMISSION.

    (a) Hearings.--The Commission may hold such hearings, sit and act 
at such times and places, take such testimony, and receive such 
evidence as the Commission considers necessary to carry out the 
purposes of this title.
    (b) Information From Federal Agencies.--The Commission may secure 
directly from any Federal department or agency such information as the 
Commission considers necessary to carry out the provisions of this 
title. Upon request of the Chairperson of the Commission, the head of 
such department or agency shall furnish such information to the 
Commission.
    (c) Postal Services.--The Commission may use the United States 
mails in the same manner and under the same conditions as other 
departments and agencies of the Federal Government.
    (d) Gifts.--The Commission may accept, use, and dispose of gifts or 
donations of services or property.

SEC. 305. COMMISSION PERSONNEL MATTERS.

    (a) Compensation of Members.--Members of the Commission shall 
receive no additional pay, allowances, or benefits by reason of the 
service of the members on the Commission.
    (b) Travel Expenses.--The members of the Commission shall be 
allowed travel expenses, including per diem in lieu of subsistence, at 
rates authorized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while away from the homes or 
regular places of business of the members in the performance of 
services for the Commission.
    (c) Staff.--
            (1) In general.--The Chairperson of the Commission may, 
        without regard to the civil service laws and regulations, 
        appoint and terminate an executive director and such other 
        additional personnel as may be necessary to enable the 
        Commission to perform the duties of the Commission. The 
        employment of an executive director shall be subject to 
        confirmation by the Commission.
            (2) Compensation.--The Chairperson of the Commission may 
        fix the compensation of the executive director and other 
        personnel without regard to the provisions of chapter 51 and 
        subchapter III of chapter 53 of title 5, United States Code, 
        relating to classification of positions and General Schedule 
        pay rates, except that the rate of pay for the executive 
        director and other personnel may not exceed the rate payable 
        for level V of the Executive Schedule under section 5316 of 
        such title.
    (d) Detail of Government Employees.--Any Federal Government 
employee may be detailed to the Commission without compensation in 
addition to that received for service as an employee of the United 
States, and such detail shall be without interruption or loss of civil 
service status or privilege.
    (e) Procurement of Temporary and Intermittent Services.--The 
Chairperson of the Commission may procure temporary and intermittent 
services under section 3109(b) of title 5, United States Code, at rates 
for individuals that do not exceed the daily equivalent of the annual 
rate of basic pay prescribed for level V of the Executive Schedule 
under section 5316 of such title.

SEC. 306. FUNDING.

    The Secretary of Labor, the Secretary of Commerce, and the 
Secretary of Health and Human Services shall equally provide to the 
Commission, out of funds otherwise available to such Secretaries, such 
sums as are necessary to carry out the purposes of the Commission under 
this title.

SEC. 307. APPLICABILITY OF FEDERAL ADVISORY COMMITTEE ACT.

    Section 14 of the Federal Advisory Committee Act (5 U.S.C. App.) 
shall not apply to the Commission.

TITLE IV--STUDY AND REPORT REGARDING CONSOLIDATION OF FEDERAL AUTHORITY 
                    OVER EMERGENCY MEDICAL SERVICES

SEC. 401. STUDY AND REPORT REGARDING CONSOLIDATION OF FEDERAL AUTHORITY 
              OVER EMERGENCY MEDICAL SERVICES.

    (a) Study and Recommendations.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a thorough study and make recommendations 
        on all matters relating to the transfer of all functions (other 
        than the functions referred to in paragraph (2)) of Federal 
        agencies relating to emergency medical services to a single 
        Federal agency (and if appropriate, to a specific office within 
        such agency), including the transfer of appropriations and 
        personnel associated with such services to such agency.
            (2) Exceptions.--The recommendations formulated pursuant to 
        paragraph (1) shall not provide for the transfer of any 
        function--
                    (A) of the Department of Defense; or
                    (B) related to a Federal health care program (as 
                defined in section 1128B(f) of the Social Security Act 
                (42 U.S.C. 1320a-7b(f))).
    (b) Report.--Not later than 1 year after the date of enactment of 
this Act, the Comptroller General of the United States shall submit a 
report to the President and Congress containing a detailed statement of 
the results of the matters studied and recommendations formulated by 
the Comptroller General pursuant to subsection (b), together with any 
legislative recommendations that the Comptroller General determines to 
be appropriate for carrying out the recommendations.
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