[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 238 Introduced in Senate (IS)]







105th CONGRESS
  1st Session
                                 S. 238

  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

                            January 30, 1997

 Mr. Grams (for himself and Mr. Graham) 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 1997''.

        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--AMBULANCE SERVICES ADVISORY GROUP FOR THE HEALTH CARE 
                        FINANCING ADMINISTRATION

SEC. 201. ESTABLISHMENT OF ADVISORY GROUP.

    (a) Establishment.--There is established an advisory group to be 
known as the Health Care Financing Administration Advisory Group for 
Ambulance Services (in this title referred to as the ``Advisory 
Group'').
    (b) Membership.--
            (1) Composition.--The Advisory Group shall be composed of 
        17 members of whom--
                    (A) 1 shall be appointed by the Director of each of 
                the 10 operating districts within the National Highway 
                and Traffic Safety Administration;
                    (B) 1 shall be appointed by the President;
                    (C) 2 shall be appointed by the Administrator of 
                the Health Care Financing Administration;
                    (D) 1 shall be appointed by the Majority Leader of 
                the Senate;
                    (E) 1 shall be appointed by the Minority Leader of 
                the Senate;
                    (F) 1 shall be appointed by the Speaker of the 
                House of Representatives; and
                    (G) 1 shall be appointed by the Minority Leader of 
                the House of Representatives.
            (2) Inclusion of certain disciplines on advisory group.--In 
        making appointments of members under paragraph (1), the 
        appointing officials described in each subparagraph of that 
        paragraph shall consult and collaborate with each other in 
        order to ensure that the following groups are represented on 
        the Advisory Group:
                    (A) Physicians who provide emergency medical 
                services.
                    (B) Individuals who provide emergency ground and 
                air transport services.
                    (C) Volunteer, private, and public emergency 
                medical service providers.
                    (D) Trauma care providers.
                    (E) Patient's rights advocates.
            (3) Background.--Except in the case of a member of the 
        Advisory Group described in paragraph (2)(E), any member of the 
        Advisory Group appointed under paragraph (1) should have 
        significant experience with the provision of ambulance services 
        under the medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (4) Date.--The appointments of the members of the Advisory 
        Group shall be made not later than January 1, 1998.
    (c) Period of Appointment; Vacancies.--Members shall be appointed 
for a term of 4 years. Any vacancy in the Advisory Group shall not 
affect its powers, but shall be filled in the same manner as the 
original appointment.
    (d) Initial Meeting.--Not later than 30 days after the date on 
which all members of the Advisory Group have been appointed, the 
Advisory Group shall hold its first meeting.
    (e) Meetings.--The Advisory Group shall meet at the call of the 
Chairperson.
    (f) Quorum.--A majority of the members of the Advisory Group shall 
constitute a quorum, but a lesser number of members may hold hearings.
    (g) Chairperson and Vice Chairperson.--The Advisory Group shall 
select a Chairperson and Vice Chairperson from among its members.

SEC. 202. DUTIES OF THE ADVISORY GROUP.

    (a) Study.--The Advisory Group shall conduct a thorough study of 
all matters relating to the provision of ambulance services under the 
medicare program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), which shall include matters relating to the 
reimbursement of such services under the medicare program.
    (b) Recommendations.--The Advisory Group shall develop 
recommendations regarding the improvement of all matters relating to 
the provision of ambulance services under the medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
    (c) Report.--Not later than 2 years after the date of enactment of 
this Act and annually thereafter, the Advisory Group shall submit a 
report to the Administrator of the Health Care Financing Administration 
which shall contain a detailed statement of the results of the matters 
studied by the Advisory Group pursuant to subsection (a), together with 
the Advisory Group's recommendations formulated pursuant to subsection 
(b).

SEC. 203. POWERS OF THE ADVISORY GROUP.

    (a) Hearings.--The Advisory Group may hold such hearings, sit and 
act at such times and places, take such testimony, and receive such 
evidence as the Advisory Group considers necessary to carry out the 
purposes of this title.
    (b) Information From Federal Agencies.--The Advisory Group may 
secure directly from any Federal department or agency such information 
as the Advisory Group considers necessary to carry out the provisions 
of this title. Upon request of the Chairperson of the Advisory Group, 
the head of such department or agency shall furnish such information to 
the Advisory Group.
    (c) Postal Services.--The Advisory Group 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 Advisory Group may accept, use, and dispose of 
gifts or donations of services or property.

SEC. 204. ADVISORY GROUP PERSONNEL MATTERS.

    (a) Compensation of Members.--Members of the Advisory Group shall 
receive no additional pay, allowances, or benefits by reason of their 
service on the Advisory Group.
    (b) Travel Expenses.--The members of the Advisory Group 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 their homes 
or regular places of business in the performance of services for the 
Advisory Group.
    (c) Staff.--
            (1) In general.--The Chairperson of the Advisory Group 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 Advisory 
        Group to perform its duties. The employment of an executive 
        director shall be subject to confirmation by the Advisory 
        Group.
            (2) Compensation.--The Chairperson of the Advisory Group 
        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 Advisory Group 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 Advisory Group may procure temporary and 
intermittent services under section 3109(b) of title 5, United States 
Code, at rates for individuals which 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. 205. FUNDING.

    The Secretary of Health and Human Services shall provide to the 
Advisory Group, out of funds otherwise available to such Secretary, 
such sums as are necessary to carry out the purposes of the Advisory 
Group under this title.

SEC. 206. APPLICABILITY OF FEDERAL ADVISORY COMMITTEE ACT.

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

  TITLE III--FEDERAL ADVISORY COUNCIL FOR EMERGENCY AMBULANCE SERVICES

SEC. 301. DEFINITION.

    As used 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 ADVISORY COUNCIL.

    (a) Establishment.--There is established an advisory council to be 
known as the Federal Advisory Council for Emergency Ambulance Services 
(in this title referred to as the ``Advisory Council'').
    (b) Membership.--
            (1) Composition.--The Advisory Council shall be composed of 
        23 members, of whom--
                    (A) 1 shall be a member of the International Fire 
                Chief's Association, appointed by the President from 
                nominations submitted by the Executive Director of the 
                International Fire Chief's Association;
                    (B) 1 shall be a member of the International 
                Association of Firefighters, appointed by the President 
                from nominations submitted by the general president of 
                the International Association of Firefighters;
                    (C) 1 shall be a member of the American Ambulance 
                Association, appointed by the President from 
                nominations submitted by the executive vice president 
                of the American Ambulance Association;
                    (D) 1 shall be a member of the National Association 
                of Emergency Medical Services Physicians, appointed by 
                the President from nominations submitted by the 
                executive director of the National Association of 
                Emergency Medical Services Physicians;
                    (E) 4 shall be appointed by the President, of 
                whom--
                            (i) 1 shall be a representative of a 
                        volunteer ambulance service;
                            (ii) 1 shall be a representative of a 
                        hospital-based ambulance service;
                            (iii) 1 shall be a representative of a 
                        private ambulance service; and
                            (iv) 1 shall be a representative of an air 
                        ambulance service;
                    (F) 1 shall be an individual who is appointed by 
                the Majority Leader of the Senate;
                    (G) 1 shall be an individual who is appointed by 
                the Minority Leader of the Senate;
                    (H) 1 shall be an individual who is appointed by 
                the Speaker of the House of Representatives;
                    (I) 1 shall be an individual who is appointed by 
                the Minority Leader of the House of Representatives;
                    (J) 2 shall be employees of the Occupational Safety 
                and Health Administration, appointed by the Secretary 
                of Labor;
                    (K) 1 shall be an employee of the United States 
                Coast Guard, appointed by the Secretary of 
                Transportation;
                    (L) 2 shall be employees of the National 
                Transportation Safety Board, appointed by the chairman 
                of the National Transportation Safety Board;
                    (M) 2 shall be employees of the National Highway 
                Traffic Safety Administration of the Department of 
                Transportation, appointed by the Secretary of 
                Transportation;
                    (N) 2 shall be employees of the Federal Emergency 
                Management Agency, appointed by the Director of the 
                Federal Emergency Management Agency; and
                    (O) 2 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)).
            (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 in subparagraph (A) shall ensure that, of the 
                members appointed--
                            (i) 11 shall be representative of rural 
                        areas;
                            (ii) 11 shall be representative of urban 
                        areas; and
                            (iii) 1 shall be representative of a rural 
                        area or an urban area, as provided for in 
                        subparagraph (C).
                    (C) Alternate representation.--The appointing 
                officials described in subparagraph (A) shall appoint 
                members under subparagraph (B)(iii) by alternating 
                between a member representing a rural area and a member 
                representing an urban area.
            (3) Date.--The appointments of the members of the Advisory 
        Council shall be made not later than January 1, 1998.
    (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 Advisory 
                Council shall not affect the powers of the Advisory 
                Council, 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 Advisory Council have been appointed, the 
Advisory Council shall hold its first meeting.
    (e) Meetings.--The Advisory Council shall meet at the call of the 
Chairperson.
    (f) Quorum.--A majority of the members of the Advisory Council 
shall constitute a quorum, but a lesser number of members may hold 
hearings.
    (g) Chairperson and Vice Chairperson.--The Advisory Council shall 
select a Chairperson and Vice Chairperson from among the members of the 
Advisory Council.

SEC. 303. DUTIES OF THE ADVISORY COUNCIL.

    (a) Study.--
            (1) In general.--The Advisory Council shall conduct a study 
        of--
                    (A) the workplace conditions and safety 
                requirements with regard to employees who provide 
                emergency ambulance services, including a review of the 
                emergency ambulance services regulations and standards 
                promulgated by the Secretary of Labor through the 
                Occupational Safety and Health Administration;
                    (B) the emergency management planning functions of 
                the Federal Emergency Management Agency; and
                    (C) the transportation-related functions of the 
                Department of Transportation related to the provision 
                of emergency ambulance services, including--
                            (i) the functions carried out under the 
                        Intelligent Vehicle-Highway Systems Act of 1991 
                        (part B of title VI of the Intermodal Surface 
                        Transportation Efficiency Act of 1991, Public 
                        Law 102-240); and
                            (ii) any other issue related to the 
                        provision of emergency ambulance services that 
                        the Secretary of Transportation recommends for 
                        study by the Advisory Council.
            (2) Interpretation of data.--As part of the study conducted 
        under this subsection, the Advisory Council shall use and 
        interpret the data collected by the Office of Emergency Medical 
        Services Data Collection of the Department of Transportation 
        established under section 402.
    (b) Recommendations.--The Advisory Council shall develop 
recommendations with regard to--
            (1) the improvement of workplace conditions of employees 
        who provide emergency ambulance services;
            (2) the appropriate application by the Occupational Safety 
        and Health Administration of occupational safety and health 
        standards and regulations to employees who are employed to 
        provide emergency ambulance services; and
            (3) addressing the issues, and improving the functions, 
        referred to in subparagraphs (B) and (C) of subsection (a)(1).
    (c) Report.--
            (1) Submission of report to agency officials.--Not later 
        than 2 years after the date of enactment of this Act and 
        annually thereafter, the Advisory Council shall prepare and 
        submit to the Secretary of Labor, the Secretary of Commerce, 
        and the Director of the Federal Emergency Management 
        Administration a report that includes--
                    (A) a detailed statement of the results of the 
                matters studied by the Advisory Council under 
                subsection (a); and
                    (B) the recommendations of the Advisory Council 
                developed under subsection (b).
            (2) Submission of report to congress.--Not later than 2 
        years after the date of enactment of this Act and annually 
        thereafter, the Advisory Council shall prepare and submit to 
        the appropriate committees of Congress the report described in 
        paragraph (2).

SEC. 304. POWERS OF THE ADVISORY COUNCIL.

    (a) Hearings.--The Advisory Council may hold such hearings, sit and 
act at such times and places, take such testimony, and receive such 
evidence as the Advisory Council considers necessary to carry out the 
purposes of this title.
    (b) Information From Federal Agencies.--The Advisory Council may 
secure directly from any Federal department or agency such information 
as the Advisory Council considers necessary to carry out the provisions 
of this title. Upon request of the Chairperson of the Advisory Council, 
the head of such department or agency shall furnish such information to 
the Advisory Council.
    (c) Postal Services.--The Advisory Council 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 Advisory Council may accept, use, and dispose of 
gifts or donations of services or property.

SEC. 305. ADVISORY COUNCIL PERSONNEL MATTERS.

    (a) Compensation of Members.--Members of the Advisory Council shall 
receive no additional pay, allowances, or benefits by reason of the 
service of the members on the Advisory Council.
    (b) Travel Expenses.--The members of the Advisory Council 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 Advisory Council.
    (c) Staff.--
            (1) In general.--The Chairperson of the Advisory Council 
        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 Advisory 
        Council to perform the duties of the Advisory Council. The 
        employment of an executive director shall be subject to 
        confirmation by the Advisory Council.
            (2) Compensation.--The Chairperson of the Advisory Council 
        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 Advisory Council 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 Advisory Council may procure temporary and 
intermittent services under section 3109(b) of title 5, United States 
Code, at rates for individuals which 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 Director 
of the Federal Emergency Management Agency shall provide to the 
Advisory Council, out of funds otherwise available to such agency 
heads, such sums as are necessary to carry out the purposes of the 
Advisory Council 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 Advisory Council.

     TITLE IV--DATA COLLECTION AND ADMINISTRATION BY DEPARTMENT OF 
                             TRANSPORTATION

SEC. 401. PROPOSAL FOR TRANSFER OF CERTAIN EMERGENCY MEDICAL SERVICES 
              FUNCTIONS.

    (a) Proposal.--
            (1) In general.--Not later than 180 days after the date of 
        enactment of this Act, the Secretary of Transportation, in 
        consultation with the Secretary of Health and Human Services 
        and the Chairman of the National Transportation Safety Board, 
        shall develop a proposal for transferring to the National 
        Highway Traffic Safety Administration of the Department of 
        Transportation any transportation-related functions of any 
        other Federal agency concerning emergency medical services, 
        other than the functions referred to in paragraph (2).
            (2) Exceptions.--The proposal prepared under 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 
                (including the medicare program under title 18 of the 
                Social Security Act (42 U.S.C. 1395 et seq.) and the 
                medicaid program under title 19 of the Social Security 
                Act (42 U.S.C. 1396 et seq.)).
    (b) Report.--Upon completion of the proposal under subsection (a), 
the Secretary of Transportation shall submit to Congress a report that 
contains the proposal, together with any legislative recommendations 
that the Secretary determines to be appropriate for carrying out the 
proposal.

SEC. 402. ESTABLISHMENT OF THE OFFICE OF EMERGENCY MEDICAL SERVICES 
              DATA COLLECTION.

    (a) Establishment.--There is established in the Department of 
Transportation an office to be known as the ``Office of Emergency 
Medical Services Data Collection'' (referred to in this section as the 
``Office''). The Office shall serve as a clearinghouse for data 
collected in accordance with the regulations promulgated under 
subsection (c).
    (b) Director.--The Secretary of Transportation shall appoint an 
individual to serve as the Director of the Office (referred to in this 
section as the ``Director'').
    (c) Regulations.--
            (1) In general.--The Secretary of Transportation, acting 
        through the Director, and in consultation with the Secretary of 
        Health and Human Services, the Chairman of the National 
        Transportation Safety Board, and appropriate representatives of 
        the agencies of States that have primary responsibility for 
        regulating emergency medical services, shall promulgate 
        regulations to establish a uniform data collection requirement 
        concerning the collection, on a nationwide basis, of data 
        relating to the provision of emergency medical services.
            (2) Use of existing information services.--In promulgating 
        the regulations under this subsection, the Secretary of 
        Transportation shall, to the maximum extent practicable, 
        provide for the use of information services that are in 
        existence at the time that the regulations are promulgated, 
        including State data collection services.
    (d) State Defined.--As used in this section, the term ``State'' 
means each of the several States of the United States, the District of 
Columbia, and the territories and possessions of the United States.
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