1.Short title; table of
contents
(a)This Act may be cited
as the Field EMS Quality, Innovation,
and Cost Effectiveness Improvements Act of 2010
.
(b)The table of
contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.
Sec. 4. Recognition of NHTSA as primary Federal agency for
field EMS.
Sec. 5. Field EMS Excellence, Quality, Universal Access,
Innovation and Preparedness.
Sec. 6. Field EMS System Performance, Integration and
Accountability.
Sec. 7. Field EMS quality.
Sec. 8. Field EMS education grants.
Sec. 9. Evaluating innovative models for access and delivery of
field EMS for patients.
Sec. 10. Enhancing research in field EMS.
Sec. 11. National Emergency Medical Services Advisory
Council.
Sec. 12. Emergency care coordination.
Sec. 13. Emergency Medical Services Trust Fund.
Sec. 14. Authorization of appropriations.
2.The Congress finds the following:
(1)All persons
throughout the country 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 (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 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 so as 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 for
emergency medical services provided in the field, including recommendations in
the EMS Agenda for the Future, the Institute of Medicine report The
Future of Emergency Care in the United Health System
, and the National
EMS Education Agenda for the Future: A Systems Approach and recommendations by
the National EMS Workforce Injury and Illness Surveillance Program, the
Department of Transportation’s National EMS Advisory Council (NEMSAC), and the
Federal Interagency Committee on Emergency Medical Services (FICEMS).
(10)To substantially
improve field EMS advancements must be made in several essential areas
including in readiness, innovation, preparedness, education and workforce
development, safety, financing, quality, standards, and research.
(11)The recognition
of a primary Federal agency specifically for field EMS is necessary to provide
a more streamlined, cost-efficient, and comprehensive approach for field EMS as
well as provide a focal point for practitioners and agencies to interface with
the Federal Government.
(12)The long-standing
role and capability of the National Highway Traffic Safety Administration
(NHTSA) to promote the development of field EMS should be enhanced to serve in
a federally recognized leadership role for field EMS, and enable NHTSA to serve
as a full and equal partner with other Federal agencies that oversee other
aspects of the EMS system and national preparedness and response.
(13)The Emergency
Care Coordinating Center (ECCC) should be statutorily created to ensure its
continued and essential leadership role in supporting the Federal Government’s
coordination of in-hospital emergency medical care activities, including by
promoting the regionalization of emergency medical care and promoting other
programs and resources that improve the seamless delivery of the Nation’s daily
emergency medical care and emergency behavioral care.
(14)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.
(15)The discretionary
National EMS Advisory Council (NEMSAC) created by the Department of
Transportation under the Federal Advisory Committee Act should be a statutorily
established council that ensures non-Federal input and recommendations to
NHTSA, FICEMS, and all Federal agencies involved with EMS.
(16)FICEMS must
continue in its essential role in coordinating the Federal activities related
to the full spectrum of EMS.
3.In this Act:
(1)The term
EMS means emergency medical services.
(2)The term
FICEMS means the Federal Interagency Committee on Emergency
Medical Services.
(3)The term
field EMS means emergency medical services provided to patients
(pursuant to transport by ground, air, or otherwise) prior to or outside a
medical facility or other clinical setting.
(4)The term
field EMS agency means an organization providing field EMS,
regardless of—
(A)whether such
organization is governmental, nongovernmental, or volunteer; and
(B)whether such
organization provides field EMS by ground, air, or otherwise.
(5)The term
emergency medical services or EMS means emergency
medical care and related services provided to patients at any point in the
continuum of health care services, including emergency medical dispatch and
medical care and related services provided in the field, during transport, or
in a medical facility or other clinical setting.
(6)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.
(7)The term
NEMSAC means the National Emergency Medical Services Advisory
Council established by section 12.
(8)The term NEMSIS means the
National EMS Information System.
(9)The term
NHTSA means the National Highway Traffic Safety
Administration.
(10)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.
(11)The term
STEMI means ST–Segment Elevation Myocardial Infarction.
4.Recognition of
NHTSA as primary Federal agency for field EMS
(a)Primary Federal
agency for field EMSNHTSA shall serve as the primary Federal
agency for field EMS to provide enhanced Federal support for the development of
patient-centered, medically directed, evidence-based, cost-effective, and safe
field emergency medical services that are accessible to patients throughout the
United States and which ensure 24 hours a day, 7 days a week readiness,
catastrophic preparedness, and continual innovation in quality and capability
for the betterment of patients. In this capacity, the Administrator of NHTSA
shall—
(1)provide enhanced
leadership for emergency medical services provided in the field;
(2)work in
partnership with the other Federal agencies involved with EMS in their
respective leadership roles in overseeing other aspects of the full spectrum of
emergency medical services and preparedness and response; and
(3)work in
collaboration with FICEMS, which coordinates all Federal EMS efforts, to ensure
a seamless Federal approach to a coordinated emergency medical services system
across the continuum of emergency medical care.
(b)Cohesive
national field EMS strategyThe Administrator of NHTSA shall,
pursuant to this Act, develop and implement a cohesive national strategy to
strengthen the development of field emergency medical services (EMS) at the
Federal, State, and local levels. In establishing such a strategy, the
Administrator shall—
(1)solicit and
consider the recommendations of the NEMSAC as well as relevant
stakeholders;
(2)consult and
collaborate with FICEMS to ensure consistency of such a field 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 operational improvements 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;
(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 non-emergent medical conditions; and
(ii)such other
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
that the Administrator considers appropriate;
(4)complete the
development of such strategy not later than 18 months after the date of
enactment of this Act;
(5)communicate such
strategy to the relevant congressional committees of jurisdiction;
(6)implement such strategy to the extent
practical not later than 3 years after the date of enactment of this Act;
and
(7)update such
strategy not less than every 3 years.
(c)Nothing in this Act shall be construed to preempt
any statutory authority otherwise provided for any other Federal agency.
5.Field EMS
Excellence, Quality, Universal Access, Innovation and Preparedness
(a)The Administrator shall establish 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 preparedness for everyday and catastrophic emergency medical
response.
(b)
(1)To be eligible to receive a grant under this section, an
eligible entity shall submit an application to the Administrator in such form
and manner, that contains such agreements, assurances, and information as the
Administrator determines to be reasonably necessary to carry out this
section.
(2)The Administrator shall ensure that grant application
requirements are not unduly burdensome to smaller and volunteer field EMS
agencies or other agencies with limited resources.
(c)Grants may be used by eligible entities to—
(1)sustain field EMS practitioners to ensure
24 hours a day, 7 days a week readiness and preparedness at the local
level;
(2)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)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)participate in
federally sponsored field EMS research;
(5)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)such other uses as
the Administrator may establish.
(d)In establishing and administering the EQUIP grant
program, the Administrator—
(1)shall establish a
grant making 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, non-governmental 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 Administrator considers necessary;
(B)a peer reviewed
process to recommend grant allocations in accordance with the prioritization
established by the Administrator except that final award determinations shall
be made by the Administrator; and
(C)the provision of
grant awards to eligible entities on an annual basis, except that the
Administrator may reserve not more than 25 percent of the available
appropriations for multi-year grants and no grant award may exceed a 2-year
period;
(2)shall consult with
and take into consideration the recommendations of FICEMS, NEMSAC and relevant
stakeholders;
(3)shall ensure that
funds used for catastrophic 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 Administrator 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
Administrator.
(f)The Administrator shall submit an annual report on the
EQUIP grant program under this section to the Congress.
6.Field EMS System
Performance, Integration and Accountability
(a)The Administrator shall establish 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 enhance
standardization of national EMS certification of emergency medical technicians
and paramedics.
(b)Grants may be used by eligible entities—
(1)to enhance
pandemic influenza and all hazards EMS preparedness and coordination of medical
first response;
(2)to improve
cross-border collaboration and planning among States;
(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 Administrator 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 Administrator may establish.
(c)In establishing and administering the SPIA grant
program, the Administrator shall—
(1)establish State
EMS system performance standards to serve as guidance to States in improving
their EMS systems and in applying for grants under this subsection. In
establishing such standards, the Administrator shall—
(A)take into the
consideration the recommendations of FICEMS, NEMSAC, and relevant
stakeholders;
(B)include national
evidence-based guidelines; and
(C)take into account
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 Administrator, for a period not to exceed 2 years; and
(4)require that
States allocate a portion of their grant funds 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
Administrators in such form and manner, that contains such agreements,
assurances and information as the Administrator determines to be reasonably
necessary to carry out this section.
(e)The
eligible entities for a grant under this section are the State EMS Office in
each of the several States, tribes, and territories.
(f)The Administrator
shall submit an annual report on the SPIA grant program under this section to
the Congress.
7.
(a)
(1)To improve medical oversight of field EMS and ensure
continuity and accountability for such medical oversight, the Administrator of
NHTSA shall—
(A)establish national
guidelines for training, credentialing, and direction in connection with
medical oversight; and
(B)promote
high-quality medical direction and maximization of participation and training
by physicians in medical direction.
(2)In establishing guidelines under paragraph
(1)(A), the Administrator of NHTSA shall take into consideration—
(A)nationally
recognized guidelines;
(B)relevant
stakeholder input; and
(C)the unique needs
associated with the provision of field EMS in rural areas or by
volunteers.
(3)The guidelines established under paragraph
(1)(A) 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.
(4)Required use of
guidelinesAs a condition on receipt of a grant under section 5
or 6, the Administrator of NHTSA shall require the grant recipient to adopt and
implement (to the extent applicable) the guidelines established under paragraph
(1)(A).
(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 medial 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 deems 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 this Act, the Comptroller General
shall complete the study under paragraph (1) and submit a report to the
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)In
carrying out subparagraph (A), the Administrator of NHTSA shall promote the
collection and reporting of data on field EMS in a standardized manner.
(C)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.
(D)In carrying out subparagraph (A), the Administrator of
NHTSA may provide technical assistance to State and local agencies, field EMS
agencies, and other entities deemed appropriate by the Administrator to assist
in the collection, analysis, and reporting of data.
(2)
(A)Not later than 12 months after the date of the enactment
of this Act, the Administrator of NHTSA, in consultation with the Secretary of
Health and Human Services, shall submit to the 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 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 careNot later than 18 months
after the date of the enactment of this Act, the Secretary of Health and Human
Services, acting through the head of the Office of the National Coordinator for
Health Information Technology, 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 presently 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 or other Federal health programs (including potential
modifications to the HITECH Act (title XIII of division A 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, 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)what 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) 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, 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) of the Public Health
Service Act (42 U.S.C. 300jj–19(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 of Health and Human Services
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) of the Public Health Service
Act (42 U.S.C. 300jj–19(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 non-individually identifiable EMS data to the
National EMS Database maintained by NHTSA.
8.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 Secretary of Health and Human Services, acting through the
Administrator of the Health Resources and Services Administration, 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 Secretary shall take into consideration input from the Administrator of
NHTSA, FICEMS, 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 Secretary of Health and Human Services 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 Secretary may identify.
(d)The Secretary of Health and Human Services,
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 Secretary of Health and Human Services
may not award a grant to an eligible entity under this section unless the
entity submits an application to the Secretary in such form, in such manner,
and containing such agreements, assurances, and information as the Secretary
may require. The Secretary shall ensure that the requirements for submitting an
application under this section are not unduly burdensome.
9.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
this Act, the Secretary of Health and Human Services, in consultation with the
Administrator of NHTSA, and taking into consideration the recommendations of
NEMSAC and FICEMS, shall complete an evaluation of—
(A)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)The evaluation under paragraph (1) shall consider each of
the following:
(A)Alternative
dispositions of low-acuity patients (as defined by the Secretary of Health and
Human Services) such as 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 as medically
necessary and appropriate.
(B)Medical liability
issues associated with transport to destinations other than a hospital
emergency department.
(C)Necessary
protections to ensure that patients receive the appropriate care in the
appropriate setting without delay.
(D)Whether there are
any barriers to providing alternate dispositions to low-acuity patients who are
not in need of care in hospital emergency departments.
(E)Other issues
determined by the Secretary of Health and Human Services, including, when
possible, 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 this Act, the Secretary of
Health and Human Services shall conduct or support up to 5 demonstration
projects to—
(A)evaluate the implementation of alternative
dispositions of low-acuity field EMS patients (such as transporting patients by
ambulance to alternate destinations when medically appropriate and in the
patients’ best interests); and
(B)determine whether such dispositions—
(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 Secretary of
Health and Human Services 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 36
months.
(4)If
the Secretary of Health and Human Services determines that further research is
necessary prior to or in conjunction with the demonstration projects under this
subsection in order to evaluation the implementation of alternative
dispositions of low-acuity field EMS patients, the Secretary shall conduct or
support such research.
(5)Authorization of
appropriationsOf the amount
made available to carry out section 1115A of the Social Security Act (42 U.S.C.
1315a) for a fiscal year, there are authorized to be appropriated 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 Secretary of Health and Human
Services shall submit to the Congress a report on the results of activities
under this section, including recommendations on the efficacy of alternative
dispositions of low-acuity field EMS patients.
10.Enhancing
research in field EMS
(a)Models To be
tested by Center for Medicare and Medicaid InnovationSection 1115A(b)(2)(B) of title XI 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
regionalization of emergency care or medical transport to alternate
destinations.
.
(b)Emergency
medical researchSection 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 researchThe 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.
.
(c)Field EMS
practice centerSubpart 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)For the purpose described in subsection
(b), the Director shall establish within the Agency a Field EMS Evidence-Based
Practice 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. Research conducted or supported pursuant to the preceding sentence shall
include—
(1)comparative
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; and
(D)the application of
lessons learned in military field medicine in the delivery of emergency medical
care in field EMS.
(c)In this section:
(1)The term
Center means the Field EMS Evidence-Based Practice Center
established under subsection (a).
(2)The term
field EMS has the meaning given to such term in section 3 of the
Field EMS Quality, Innovation, and Cost
Effectiveness Improvements Act of
2010.
.
(d)Limitations on
certain uses of researchSection 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 this
section 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.
11.National
Emergency Medical Services Advisory Council
(a)The
Administrator of NHTSA shall establish and administer a National Emergency
Medical Services Advisory Council.
(b)
(1)NEMSAC—
(A)shall provide
advice and recommendations regarding Federal field EMS programs and activities
to NHTSA, FICEMS, and other Federal agencies that deliver field EMS or support
State or local field EMS;
(B)may, upon request by any Federal agency,
provide that agency with recommendations on field EMS matters; and
(C)shall provide a
national forum for individuals and entities outside of the Federal Government
to deliberate on field EMS issues.
(2)In
carrying out paragraph (1), NEMSAC may gather data and provide advice and
recommendations on—
(A)the national
strategy under section 4(b);
(B)any grant program
established under this Act;
(C)any data
collection improvement activity under this Act;
(D)compliance with
any requirement imposed under this Act;
(E)any Federal field
EMS program or activity;
(F)strengthening
field EMS systems through enhanced workforce development, education, training,
exercises, equipment, medical oversight, or otherwise;
(G)improved Federal
coordination and support of EMS systems; and
(H)other field EMS
issues for which recommendations are solicited by the Administrator of NHTSA,
FICEMS, or other Federal agencies.
(c)Appointment,
terms, and members
(1)NEMSAC shall be composed of not more than 26 members,
each appointed by the Administrator of NHTSA.
(2)
(A)Except as provided in subparagraph (B), the Administrator
of NHTSA shall appoint the members of NEMSAC to serve for a term of 3
years.
(B)Of the initial members of NEMSAC—
(i)not
more than 8 shall be appointed for a term of 1 year;
(ii)not
more than 8 shall be appointed for a term of 2 years; and
(iii)not more than 10
shall be appointed for a term of 3 years.
(3)No
official or employee of the Federal Government may serve as a member of
NEMSAC.
(4)In
appointing the members of NEMSAC, the Administrator of NHTSA shall—
(A)select members
based on their individual expertise, not as representatives of specific
organizations;
(B)ensure that the
membership of NEMSAC—
(i)includes balanced
representation across the field EMS community; and
(ii)has
sufficient EMS expertise and geographic and demographic diversity to accurately
reflect the EMS community as a whole;
(C)to the extent
practical, ensure that the membership of NEMSAC includes representation
of—
(i)volunteer
EMS;
(ii)fire-based
EMS;
(iii)nongovernmental
EMS;
(iv)hospital-based
EMS;
(v)tribal EMS;
(vi)air
medical EMS;
(vii)local EMS
service director/administrators;
(viii)EMS medical
directors;
(ix)emergency
physicians;
(x)trauma
surgeons;
(xi)pediatric
emergency physicians;
(xii)State EMS
directors;
(xiii)State highway
safety directors;
(xiv)EMS
educators;
(xv)public safety
call-takers and dispatchers;
(xvi)EMS data
managers;
(xvii)EMS
researchers;
(xviii)emergency
nurses;
(xix)hospital
administration;
(xx)public
health;
(xxi)emergency
management;
(xxii)State homeland
security directors;
(xxiii)State or local
legislative bodies; and
(xxiv)consumers not
directly affiliated with an emergency medical system or health care
organization; and
(D)appoint at least 2
members without regard to the categories listed in subparagraph (C).
(5)A vacancy in the membership of NEMSAC
shall—
(A)not affect the
powers of NEMSAC; and
(B)be filled in the
manner in which the original appointment was made.
(6)Each member of NEMSAC shall serve without pay, but shall
be reimbursed for travel and per diem in lieu of subsistence expenses during
the performance of duties of NEMSAC while away from home or his or her regular
place of business, in accordance with applicable provisions under subchapter I
of chapter 57 of title 5, United States Code.
(7)The Administrator of NHTSA shall select the
Chairperson of NEMSAC from its members.
(d)Beginning
with the first calendar year following the enactment of this Act, NEMSAC shall
meet at least twice per calendar year.
(e)Personnel;
reimbursement for services
(1)Detail of NHTSA
personnelThe Administrator
of NHTSA shall detail to NEMSAC, without reimbursement, such personnel of NHTSA
as the Administrator determines necessary to carry out this section.
(2)Reimbursement
for certain servicesIf NEMSAC performs services at the request
of a Federal agency, such agency shall reimburse NHTSA for the actual cost of
such services. The Administrator of NHTSA shall establish the method for
calculating and providing reimbursement under the preceding sentence.
(f)Federal Advisory
Committee ActExcept as inconsistent with this section, NEMSAC
shall operate in accordance with the Federal Advisory Committee Act (5 U.S.C.
App.).
(g)Notwithstanding
section 14 of the Federal Advisory Committee Act (5 U.S.C. App.), NEMSAC shall
be of permanent duration.
(h)Functions,
Personnel, Assets, Liabilities, and Administrative ActionsAll functions, personnel, assets, and
liabilities of, and administrative actions applicable to, the National
Emergency Medical Services Advisory Council of the Department of
Transportation, as in existence on the day before the date of the enactment of
this Act, shall be transferred to the National Emergency Medical Services
Advisory Council established under this section.
(i)Each year, NEMSAC shall submit to NHTSA and FICEMS a
report describing NEMSAC’s activities, positions, and recommendations. The
Administrator of NHTSA shall promptly provide each such report to the
appropriate congressional committees of jurisdiction.
12.Emergency care
coordination
(a)Subtitle B of title
XXVIII of the Public Health Service Act (42 U.S.C. 300hh–10 et seq.) is amended
by adding at the end the following:
2816.Emergency care
coordination
(a)Emergency Care
Coordination Center
(1)The
Secretary shall establish, within the Office of the Assistant Secretary for
Preparedness and Response, an Emergency Care Coordination Center (in this
section referred to as the Center
), to be headed by a
Director.
(2)The
Secretary, acting through the Director of the Center, in coordination with the
Federal Interagency Committee on Emergency Medical Services, shall—
(A)promote and fund
research in emergency medicine and trauma health care;
(B)promote regional
partnerships and more effective emergency medical systems in order to enhance
appropriate triage, distribution, and care of routine community patients;
and
(C)promote local,
regional, and State emergency medical systems’ preparedness for and response to
public health events.
(b)Council of
Emergency Care
(1)The
Secretary, acting through the Director of the Center, shall establish a Council
of Emergency Care to provide advice and recommendations to the Director on
carrying out this section.
(2)The
Council shall be comprised of employees of the departments and agencies of the
Federal Government who are experts in emergency care and management.
(c)
(1)Not
later than 12 months after the date of the enactment of this section, the
Secretary shall submit to the Congress an annual report on the activities
carried out under this section.
(2)In
preparing a report under paragraph (1), the Secretary shall consider factors
including—
(A)emergency
department crowding and boarding; and
(B)delays in care
following
presentation.
.
(b)Functions,
Personnel, Assets, Liabilities, and Administrative ActionsAll
functions, personnel, assets, and liabilities of, and administrative actions
applicable to, the Emergency Care Coordination Center, as in existence on the
day before the date of the enactment of this Act, shall be transferred to the
Emergency Care Coordination Center established under section 2816(a) of the
Public Health Service Act, as added by subsection (a).
13.Emergency
Medical Services Trust Fund
(a)Designation of
income tax overpayments and additional contributions for emergency medical
servicesSubchapter A of
chapter 61 of the Internal Revenue Code of 1986 (relating to returns and
records) is amended by adding at the end the following new part:
IXDesignation of
income tax overpayments and additional contributions for emergency medical
services
6097.Designation by
individuals
(a)Every individual
(other than a nonresident alien)—
(1)may designate that
a specified portion of any overpayment of tax for a taxable year, and
(2)may designate that
an amount 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)Adjusted income
tax liabilityFor purposes of
this section, the term adjusted income tax liability means income
tax liability (as defined in section 6096(b)) reduced by any amount designated
under section 6096 (relating to designation of income tax payments to
Presidential Election Campaign Fund).
(c)Overpayments
Treated as RefundedFor 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.
(d)Manner and time
of designationA 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 FundSubchapter 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 section 6097.
(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 fundAmounts in
the Emergency Medical Services Trust Fund shall be available, as provided in
appropriation Acts, only for purposes of making expenditures to carry out
section 14(a)(2) of the Field EMS Quality,
Innovation, and Cost Effectiveness Improvements Act of 2010. If,
for any fiscal year, amounts remain in the Emergency Medical Services Trust
Fund after making such expenditures, such amounts shall be available, as
provided in appropriation Acts, to carry out sections 498D, 1203, and 1204 of
the Public Health Service Act; part D of title XII of such Act; and part H of
title XII of such
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, 2010.
14.Authorization of
appropriations
(a)Out of monies in the Emergency Medical Services Trust
Fund, there are authorized to be appropriated—
(1)$11,000,000 shall be for carrying out
sections 4, 7, 9(a), 9(c), and 11 of this Act, and section 2816 of the Public
Health Service Act (as added by section 12 of this Act) for each of fiscal
years 2013 through 2015;
(2)$200,000,000 shall
be for carrying out section 5 of this Act for each of fiscal years 2012 through
2015;
(3)$50,000,000 shall
be for carrying out section 6 of this Act for each of fiscal years 2012 through
2015;
(4)$15,000,000 shall
be for carrying out section 8 of this Act for each of fiscal years 2012 through
2015; and
(5)$45,000,000 shall
be for carrying out sections 498D(c) and 938 of the Public Health Service Act,
as added by subsections (b) and (c) of section 10 of this Act, for each of
fiscal years 2012 through 2015.
(b)
(1)There are authorized to be appropriated
$11,000,000 for each of fiscal years 2011 and 2012 to carry out the provisions
specified in subsection (a)(1).
(2)There are authorized to be appropriated
$50,000,000 for fiscal year 2012 to carry out the provisions specified in
paragraphs (2), (3), (4), and (5) of subsection (a), to be allocated in
proportion to the authorizations of appropriations specified in such
paragraphs. The amount of funds authorized to be appropriated under subsection
(a) for fiscal year 2012 (out of any monies in the Emergency Medical Services
Trust Fund) shall be reduced by the amount of any funds made available under
this paragraph.
(c)Of the amount made
available under subsection (a) or (b) to carry out each of the provisions
specified in subsection (a), not more than 5 percent of each such amount may be
used for Federal administrative expenses.