[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3173 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 3173

   To amend the Public Health Service Act to establish demonstration 
    programs on regionalized systems for emergency care, to support 
          emergency medicine research, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 25, 2007

  Mr. Waxman introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to establish demonstration 
    programs on regionalized systems for emergency care, to support 
          emergency medicine research, 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 ``Improving Emergency Medical Care and 
Response Act of 2007''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress makes the following findings:
            (1) Emergency medical services play a critically important 
        role in health care, public health, and public safety by 
        frequently providing immediate lifesustaining care and making 
        decisions with limited time and information.
            (2) Between 1993 and 2003, the population of the United 
        States grew by 12 percent and hospital admissions increased by 
        13 percent, yet emergency department visits rose by more than 
        25 percent during this same period of time, from 90,300,000 
        visits in 1993 to 113,900,000 visits in 2003.
            (3) The demand for emergency care in the United States 
        continues to grow at a rapid pace.
            (4) In 2003, hospital emergency departments received nearly 
        114,000,000 visits, which is more than 1 visit for every 3 
        people in the United States; however, between 1993 and 2003, 
        the number of emergency departments declined by 425.
            (5) Many emergency medical services are highly fragmented, 
        overburdened, poorly equipped, and insufficiently prepared for 
        day-to-day operations and response to major disasters.
            (6) There are more than 6,000 Public Safety Answering 
        Points that receive 9-1-1 calls.
            (7) These Public Safety Answering Points are often operated 
        by police departments, fire departments, city or county 
        governments, or other local entities, which makes attempts to 
        coordinate efforts between locations very difficult.
            (8) Regionalized, accountable systems of emergency care 
        show substantial promise in improving the day-to-day system-
        wide coordination essential to ensure that Public Safety 
        Answering Points, emergency medical services organizations, 
        public safety agencies, public health agencies, medical 
        facilities, and others coordinate their activities to ensure 
        that patients receive the appropriate care at the scene, are 
        transported to the most appropriate facility in the shortest 
        time, and receive excellent care at the destination medical 
        facility.
            (9) Regionalized, accountable systems of emergency care 
        also show promise in management of the special problems of 
        disaster preparation and response, including management of 
        patient surge, tracking of patients, and coordination and 
        allocation of medical resources.
            (10) While there are potentially substantial benefits to be 
        derived from regionalized, accountable emergency care systems, 
        little is known about the most effective and efficient methods 
        of regional emergency care system development.
    (b) Purposes.--The purposes of this Act are to design, implement, 
and evaluate regionalized, comprehensive, and accountable systems of 
emergency care that--
            (1) support and improve the day-to-day operations and 
        coordination of a regional emergency medical care system;
            (2) increase disaster preparedness and medical surge 
        capacity;
            (3) include different models of regionalized emergency care 
        systems, including models for urban and rural communities;
            (4) can be implemented by private or public entities; and
            (5) meet quality and accountability standards for the 
        operation of emergency care systems and the impact of such 
        systems on patient outcomes.

SEC. 3. DESIGN AND IMPLEMENTATION OF REGIONALIZED SYSTEMS FOR EMERGENCY 
              CARE.

    Part B of title III of the Public Health Service Act (42 U.S.C. 243 
et seq.) is amended by inserting after section 314 the following:

``SEC. 315. REGIONALIZED COMMUNICATION SYSTEMS FOR EMERGENCY CARE 
              RESPONSE.

    ``(a) In General.--The Secretary, acting through the Assistant 
Secretary for Preparedness and Response, shall award not fewer than 4 
multiyear contracts or competitive grants to eligible entities to 
support demonstration programs that design, implement, and evaluate 
innovative models of regionalized, comprehensive, and accountable 
emergency care systems.
    ``(b) Eligible Entity; Region.--
            ``(1) Eligible entity.--In this section, the term `eligible 
        entity' means a State or a partnership of 1 or more States and 
        1 or more local governments.
            ``(2) Region.--In this section, the term `region' means an 
        area within a State, an area that lies within multiple States, 
        or a similar area (such as a multicounty area), as determined 
        by the Secretary.
    ``(c) Demonstration Program.--The Secretary shall award a contract 
or grant under subsection (a) to an eligible entity that proposes a 
demonstration program to design, implement, and evaluate an emergency 
medical system that--
            ``(1) coordinates with public safety services, public 
        health services, emergency medical services, medical 
        facilities, and other entities within a region;
            ``(2) coordinates an approach to emergency medical system 
        access throughout the region, including 9-1-1 Public Safety 
        Answering Points and emergency medical dispatch;
            ``(3) includes a mechanism, such as a regional medical 
        direction or transport communications system, that operates 
        throughout the region to ensure that the correct patient is 
        taken to the medically appropriate facility (whether an initial 
        facility or a higher-level facility) in a timely fashion;
            ``(4) allows for the tracking of prehospital and hospital 
        resources, including inpatient bed capacity, emergency 
        department capacity, on-call specialist coverage, ambulance 
        diversion status, and the coordination of such tracking with 
        regional communications and hospital destination decisions; and
            ``(5) includes a consistent region-wide prehospital, 
        hospital, and interfacility data management system that--
                    ``(A) complies with the National EMS Information 
                System, the National Trauma Data Bank, and others;
                    ``(B) reports data to appropriate Federal and State 
                databanks and registries; and
                    ``(C) contains information sufficient to evaluate 
                key elements of prehospital care, hospital destination 
                decisions, including initial hospital and interfacility 
                decisions, and relevant outcomes of hospital care.
    ``(d) Application.--
            ``(1) In general.--An eligible entity that seeks a contract 
        or grant described in subsection (a) shall submit to the 
        Secretary an application at such time and in such manner as the 
        Secretary may require.
            ``(2) Application information.--Each application shall 
        include--
                    ``(A) an assurance from the eligible entity that 
                the proposed system--
                            ``(i) has been coordinated with the 
                        applicable State Office of Emergency Medical 
                        Services (or equivalent State office);
                            ``(ii) is compatible with the applicable 
                        State emergency medical services system;
                            ``(iii) includes consistent indirect and 
                        direct medical oversight of prehospital, 
                        hospital, and interfacility transport 
                        throughout the region;
                            ``(iv) coordinates prehospital treatment 
                        and triage, hospital destination, and 
                        interfacility transport throughout the region;
                            ``(v) includes a categorization or 
                        designation system for special medical 
                        facilities throughout the region that is--
                                    ``(I) consistent with State laws 
                                and regulations; and
                                    ``(II) integrated with the 
                                protocols for transport and destination 
                                throughout the region; and
                            ``(vi) includes a regional medical 
                        direction system, a patient tracking system, 
                        and a resource allocation system that--
                                    ``(I) support day-to-day emergency 
                                care system operation;
                                    ``(II) can manage surge capacity 
                                during a major event or disaster; and
                                    ``(III) are integrated with other 
                                components of the national and State 
                                emergency preparedness system;
                    ``(B) an agreement to make available non-Federal 
                contributions in accordance with subsection (f); and
                    ``(C) such other information as the Secretary may 
                require.
    ``(e) Matching Funds.--
            ``(1) In general.--With respect to the costs of the 
        activities to be carried out each year with a contract or grant 
        under subsection (a), a condition for the receipt of the 
        contract or grant is that the eligible entity involved agrees 
        to make available (directly or through donations from public or 
        private entities) non-Federal contributions toward such costs 
        in an amount that is not less than 25 percent of such costs.
            ``(2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash or in 
        kind, fairly evaluated, including plant, equipment, or 
        services. Amounts provided by the Federal Government, or 
        services assisted or subsidized to any significant extent by 
        the Federal Government, may not be included in determining the 
        amount of such non-Federal contributions.
    ``(f) Priority.--The Secretary shall give priority for the award of 
the contracts or grants described subsection (a) to any eligible entity 
that serves a medically underserved population (as defined in section 
330(b)(3)).
    ``(g) Report.--Not later than 90 days after the completion of a 
demonstration program under subsection (a), the recipient of such 
contract or grant described in such subsection shall submit to the 
Secretary a report containing the results of an evaluation of the 
program, including an identification of--
            ``(1) the impact of the regional, accountable emergency 
        care system on patient outcomes for various critical care 
        categories, such as trauma, stroke, cardiac emergencies, and 
        pediatric emergencies;
            ``(2) the system characteristics that contribute to the 
        effectiveness and efficiency of the program (or lack thereof);
            ``(3) methods of assuring the long-term financial 
        sustainability of the emergency care system;
            ``(4) the State and local legislation necessary to 
        implement and to maintain the system; and
            ``(5) the barriers to developing regionalized, accountable 
        emergency care systems, as well as the methods to overcome such 
        barriers.
    ``(h) Evaluation.--The Secretary, acting through the Assistant 
Secretary for Preparedness and Response, shall enter into a contract 
with an academic institution or other entity to conduct an independent 
evaluation of the demonstration programs funded under subsection (a), 
including an evaluation of--
            ``(1) the performance of the eligible entities receiving 
        the funds; and
            ``(2) the impact of the demonstration programs.
    ``(i) Dissemination of Findings.--The Secretary shall, as 
appropriate, disseminate to the public and to the appropriate 
Committees of the Congress, the information contained in a report made 
under subsection (h).
    ``(j) Authorization of Appropriations.--
            ``(1) In general.--There are authorized to be appropriated 
        to carry out this section $12,000,000 for each of fiscal years 
        2008 through 2013.
            ``(2) Reservation.--Of the amount appropriated to carry out 
        this section for a fiscal year, the Secretary shall reserve 3 
        percent of such amount to carry out subsection (i) (relating to 
        an independent evaluation).''.

SEC. 4. SUPPORT FOR EMERGENCY MEDICINE RESEARCH.

    Part H of title IV of the Public Health Service Act (42 U.S.C. 289 
et seq.) is amended by inserting after the section 498C the following:

``SEC. 498D. SUPPORT FOR EMERGENCY MEDICINE RESEARCH.

    ``(a) Emergency Medical Research.--The Secretary shall support 
Federal programs administered by the National Institutes of Health, the 
Agency for Healthcare Research and Quality, the Health Resources and 
Services Administration, the Centers for Disease Control and 
Prevention, and other agencies involved in improving the emergency care 
system to expand and accelerate research in emergency medical care 
systems and emergency medicine, including--
            ``(1) the basic science of emergency medicine;
            ``(2) the model of service delivery and the components of 
        such models that contribute to enhanced patient outcomes;
            ``(3) the translation of basic scientific research into 
        improved practice; and
            ``(4) the development of timely and efficient delivery of 
        health services.
    ``(b) Impact Research.--The Secretary shall support research to 
determine the estimated economic impact of, and savings that result 
from, the implementation of coordinated emergency care systems.
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section such sums as may be necessary 
for each of fiscal years 2008 through 2013.''.
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