1.Short title; table of
contents
(a)This Act may be cited
as the Field EMS Quality, Innovation,
and Cost Effectiveness Improvements Act of 2011
.
(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 HHS as primary Federal agency for
emergency medical services and trauma care.
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. Emergency Medical Services Trust Fund.
Sec. 12. 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 emergency medical care and trauma care
provided in the field, hospital, and rehabilitation settings.
(7)Field EMS
comprises essential emergency medical services, including medical care or
medical transport provided to patients prior to or outside medical facilities
and other clinical settings. The primary purpose of field emergency medical
services is to ensure that emergency medical patients receive the right care at
the right place in the right amount of time.
(8)Coordinated and
high-quality field EMS is essential to the Nation’s security. Field EMS is an
essential public service provided by governmental and nongovernmental agencies
and practitioners 24 hours a day, 7 days a week, and during catastrophic
incidents. To ensure disaster and all-hazards preparedness for EMS operations
as part of the Nation’s comprehensive disaster preparedness, Federal funding
for preparedness activities, including catastrophic training and drills, must
be provided to governmental and nongovernmental EMS agencies 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 of
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 readiness, innovation, preparedness, education and workforce
development, safety, financing, quality, standards, and research.
(11)The recognition of a primary programmatic
Federal agency for emergency medical services within the Department of Health
and Human Services was recommended by the Institute of Medicine and is
necessary to provide a more streamlined, cost-efficient, and comprehensive
approach for field EMS and a focal point for practitioners and agencies to
interface with the Federal Government.
(12)The essential
role of field EMS in disaster preparedness and response must be incorporated
into the national preparedness and response strategy and implementation as
provided and overseen by the Department of Homeland Security and the Department
of Health and Human Services pursuant to their respective jurisdictions.
(13)The essential
role of NHTSA in the continued development of NEMSIS and in overseeing
transportation issues related to field EMS such as EMS and ambulance vehicle
safety standards should be maintained.
(14)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
ambulance diversion means the practice by hospitals of denying
access to an incoming ambulance by requesting it to proceed to another facility
due to a stated lack of capacity at the initial facility, resulting in delayed
access to definitive care.
(2)The term
EMS means emergency medical services.
(3)The term
FICEMS means the Federal Interagency Committee on Emergency
Medical Services.
(4)The term
field EMS means emergency medical services provided to patients
(including transport by ground, air, or otherwise) prior to or outside a
medical facility or other clinical setting.
(5)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.
(6)The term
emergency medical services or EMS means emergency
medical care, trauma care, and related services provided to patients at any
point in the continuum of health care services, including emergency medical
dispatch and emergency medical care, trauma care, and related services provided
in the field, during transport, or in a medical facility or other clinical
setting.
(7)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.
(8)The term
medical oversight means the supervision by a physician of the
medical aspects of an EMS system or agency and its providers including
prospective, concurrent, and respective components of field EMS and the
education of EMS providers.
(9)The term
NEMSAC means the National Emergency Medical Services Advisory
Council.
(10)The term NEMSIS means the
National EMS Information System.
(11)The term
NHTSA means the National Highway Traffic Safety
Administration.
(12)The term
patient parking means the practice by hospitals of refusing to
accept transfer of a patient’s care from an ambulance crew until a regular
emergency department bed is available, requiring the crew to continue to
provide patient care on the ambulance stretcher other than a patient bed in the
hospital until hospital staff will accept the transfer of care, resulting in
delayed access to definitive care.
(13)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.
(14)The term
STEMI means ST–Segment Elevation Myocardial Infarction.
4.Recognition of
HHS as primary Federal agency for emergency medical services and trauma
care
(a)The Department of
Health and Human Services shall serve as the primary Federal agency with
responsibility for programs and activities relating to emergency medical
services and trauma care.
(b)
(1)There is established an Office of Emergency
Medical Services and Trauma, to be known as the Office of EMS and Trauma,
within the Department of Health and Human Services. The Office of EMS and
Trauma shall be headed by a director appointed by the Secretary of Health and
Human Services.
(2)Role of Office
within HHS
(A)The Office of EMS and Trauma shall have—
(i)the
responsibilities delegated to the Office of EMS and Trauma pursuant to
paragraph (3);
(ii)the
responsibilities and authorities vested in the Office of EMS and Trauma by
other provisions of this Act; and
(iii)such
responsibilities and authorities as may be delegated or transferred to the
Office of EMS and Trauma pursuant to subparagraph (B).
(B)Additional
responsibilities and authoritiesIn addition to the
responsibilities and authorities specified in clauses (i) and (ii) of
subparagraph (A), the Secretary of Health and Human Services may delegate or
transfer to the Office of EMS and Trauma any other responsibility or authority
of the Department of Health and Human Services relating to emergency medical
services and trauma care, including such services and care relating to—
(i)the full continuum
of emergency medical services, including field EMS and trauma and hospital
emergency medical care; or
(ii)improving the
quality, innovation, or cost effectiveness of emergency medical services.
(C)Location of
office in HHSThe Secretary shall locate the Office of EMS and
Trauma within the organizational structure of the Department of Health and
Human Services in a manner that achieves each of the following:
(i)Recognition of the
importance and unique life-saving services associated with field EMS, trauma
care, and hospital emergency care as a significant Federal priority.
(ii)Integration of
these essential services with the larger health care system and within the
disaster preparedness system, including through regionalization of such
services and by enhancing daily readiness capabilities to ensure adequate
disaster readiness capabilities, consistent with the National Health Security
Strategy.
(iii)Consolidation,
co-location, and cost efficiencies in administering programs and activities
related to field EMS, trauma care, and hospital emergency medical care.
(iv)Establishment of
a Federal focal point for leadership and improved coordination, support, and
oversight of field EMS, trauma care and hospital emergency medical care.
(v)Sufficient level
and stature such that—
(I)such Office is
able to fulfill its role, responsibilities, and authorities; and
(II)the Director of
such Office reports directly to the Secretary or an official within the
Department who reports directly to the Secretary.
(vi)Establishment of
a visible and identifiable point of contact with which the public; EMS agencies
and practitioners; State and local government agencies; EMS educational
institutions; EMS, trauma, and hospital emergency care professional
associations; and all other parties may interact.
(3)The Secretary of Health and Human Services
shall, at a minimum, delegate responsibility to the Office of EMS and Trauma to
carry out—
(A)sections 5 and 6
(relating to the EQUIP and SPIA grant programs, respectively); and
(B)section 330J of
the Public Health Service Act (42 U.S.C. 254c–15; relating to rural emergency
service training and equipment assistance program);
(C)part A (42 U.S.C. 300d et seq.), part B (42
U.S.C. 300d–11 et seq.), part C (42 U.S.C. 300d–31 et seq.), part D (42 U.S.C.
300d–41 et seq.), and part H (42 U.S.C. 300d–81 et seq.) of title XII of the
Public Health Service Act (relating to trauma care);
(D)section 8 (relating to the field EMS
education grant program); and
(E)section 9 (relating to evaluating
innovative models for access and delivery of field EMS for patients).
(c)The Secretary of Health and Human Services, acting
through the Director of the Office of EMS and Trauma, and in consultation with
the Assistant Secretary for Preparedness and Response and the Administrator of
the Health Resources and Services Administration, shall develop and implement a
cohesive national EMS strategy to strengthen the development of the full
continuum of EMS at the Federal, State, and local levels. In establishing such
a strategy, the Secretary shall—
(1)solicit and
consider the recommendations of the NEMSAC as well as relevant
stakeholders;
(2)consult and
collaborate with FICEMS to ensure consistency of such national EMS strategy
within the larger Federal strategy regarding all of emergency medical services
and national preparedness and response;
(3)address issues related to EMS patient and
practitioner safety, standardization of EMS practitioner licensing and
credentialing, field EMS quality and medical oversight, regionalization of
field EMS and trauma and emergency care services, availability of field EMS and
trauma care and emergency medical services throughout the Nation, and
integration of field EMS practitioners into the broader health care system,
including—
(A)promotion of the
adoption by States of the education standards identified in the
Emergency Medical Services Education Agenda for the Future: A Systems
Approach
and any revisions thereto, including the standardization of
licensing and credentialing of field EMS practitioners and standards of care,
based on best practices and evidence-based medicine, including by—
(i)the
identification of differences in the levels of care, scope of practice, and
licensure and credentialing requirements among the States; and
(ii)the
adoption by the States of national standards for such levels of care, scope of
practice and licensure and credentialing requirements;
(B)promotion of a
culture of safety, including—
(i)the
adoption of an anonymous error reporting system designed to identify systemic
problems in field EMS patient and practitioner safety and ensure a single means
of collecting and reporting relevant error data by field EMS agencies and
States;
(ii)the
establishment of field EMS patient and practitioner safety goals and the
specific means to improve field EMS practitioner and patient safety to achieve
such goals; and
(iii)the adoption of
more uniform national ambulance vehicle safety and manufacturing standards as
developed by the National Fire Protection Administration or coordinated by
NHTSA;
(C)the integration
and utilization of field EMS practitioners as part of the larger health care
system including—
(i)the
potential utilization of field EMS practitioners for the provision of care to
patients with nonemergent medical conditions; and
(ii)strategies to
implement the recommendations provided by the National Health Care Workforce
Commission, pursuant to section 5101(d)(2) of the Patient Protection and
Affordable Care Act (42 U.S.C. 294q(d)(2); and
(D)such other issues
as the Secretary considers appropriate;
(4)incorporate into
such strategy the preparedness and response objectives identified by the
Secretary of Homeland Security and the Assistant Secretary for Preparedness and
Response in order—
(A)to ensure the
capability and capacity of the full spectrum of EMS to respond to terrorist
attacks, disasters, catastrophic events, and mass casualty events; and
(B)to coordinate with
the Secretary of Homeland Security accordingly;
(5)complete the
development of such strategy not later than 18 months after the date of
enactment of this Act;
(6)communicate such
strategy to the relevant congressional committees of jurisdiction;
(7)implement such strategy to the extent
practical not later than 3 years after the date of enactment of this Act;
and
(8)update such
strategy not less than every 3 years.
(d)Nothing in this Act shall be construed to supercede
any statutory authority of any Federal agency that is not within the Department
of Health and Human Services.
5.Field EMS
Excellence, Quality, Universal Access, Innovation, and Preparedness
(a)The Director of the Office of EMS and Trauma (in this
section referred to as the Director
), 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 readiness and
preparedness for day-to-day emergency medical response.
(b)
(1)To be eligible to receive a grant under this section, an
eligible entity shall submit an application to the Director in such form and
manner, that contains such agreements, assurances, and information as the
Director determines to be reasonably necessary to carry out this
section.
(2)The Director shall ensure that grant application
requirements are not unduly burdensome to smaller and volunteer field EMS
agencies or other agencies with limited resources.
(3)Consistency with
preparation goalsThe Director shall ensure that grant
applications are consistent with national and relevant State preparedness plans
and goals.
(c)Grants may be used by eligible entities 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 Director may establish.
(d)In establishing and administering the EQUIP grant
program, the Director—
(1)shall establish a
grantmaking process that includes—
(A)prioritization for
the awarding of grants to eligible entities and consideration of the factors in
reviewing grant applications by eligible entities including—
(i)demonstrated
financial need for funding;
(ii)utilization of
public and private partnerships;
(iii)enhanced access
to high-quality field EMS in under served geographic areas;
(iv)unique needs of
volunteer and rural field EMS agencies;
(v)distribution among
a variety of geographic areas, including urban, suburban, and rural;
(vi)distribution of
funds among types of EMS agencies, including governmental, nongovernmental and
volunteer;
(vii)implementation
of evidence-based interventions that improve quality of care, patient outcomes,
efficiency, or cost effectiveness; and
(viii)such other
factors as the Director considers necessary;
(B)a peer-reviewed
process to recommend grant allocations in accordance with the prioritization
established by the Director except that final award determinations shall be
made by the Director; and
(C)the provision of
grant awards to eligible entities on an annual basis, except that the Director
may reserve not more than 25 percent of the available appropriations for
multiyear grants and no grant award may exceed a 2-year period;
(2)shall consult with
and take into consideration the recommendations of the Assistant Secretary for
Preparedness and Response, FICEMS, NEMSAC and relevant stakeholders;
(3)shall ensure that
funds used for day-to-day preparedness activities are consistent and aligned
with Federal preparedness priorities; and
(4)may contract with
an independent, third-party, nonprofit organization to administer the grant
program if the Director establishes conflict-of-interest requirements as part
of any such contractual relationship.
(e)Eligible grant recipients are field EMS
agencies that—
(1)are licensed by or otherwise authorized in
the State in which they operate; and
(2)have medical
oversight and quality improvement programs as defined by the Director.
(f)The Director 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 Director of the Office of EMS and Trauma (in this
section referred to as the Director
) 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 promote
standardization of national EMS certification of emergency medical technicians
and paramedics.
(b)Grants may be used by eligible entities—
(1)to enhance EMS system readiness and
preparedness for day-to-day emergency medical response;
(2)to improve
cross-border collaboration and planning among States; and
(3)to collect data
with regard to—
(A)NEMSIS;
(B)field EMS
education;
(C)field EMS
workforce;
(D)cardiac events,
including STEMI and sudden cardiac arrest;
(E)stroke;
(F)disasters,
including injuries and illnesses;
(G)ambulance
diversion and patient parking;
(H)trauma (in a
manner that is complementary and not duplicative of other trauma data
collection such as the National Trauma Data Bank);
(I)data determined
necessary by the State office of EMS for oversight and coordination of the
State field EMS system; and
(J)any other such
data that the Director specifies;
(4)to implement and
evaluate system-wide quality improvement initiatives, including medical
direction at the State, local, and regional levels;
(5)to integrate field
EMS with other health care services as part of a coordinated system of care
provided to patients with emergency medical conditions to help ensure the right
patient receives the right care by the right crew in the right vehicle and at
the right medical facility in the right amount of time, including by enhancing
regional emergency medical dispatch;
(6)to incorporate
national EMS certification for all levels of emergency medical technicians and
paramedics;
(7)to improve the
State’s planning for ensuring a consistent, available EMS workforce;
(8)to fund EMS
regional and local oversight and planning organizations or develop regional
systems of emergency medical care within the State to further enhance
coordination and systemic development throughout the State; and
(9)for such other
uses as the Director may establish.
(c)In establishing and administering the SPIA grant
program, the Director shall—
(1)establish State
EMS system performance standards to serve as guidance to States in improving
their EMS systems and in applying for grants under this subsection. In
establishing such standards, the Director shall—
(A)take into the
consideration the recommendations of the Assistant Secretary for Preparedness
and Response, 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 Director, 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 Director in
such form and manner, that contains such agreements, assurances, and
information as the Director 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 Director 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 quality for such medical oversight, the Director of the Office
of EMS and Trauma (in this section referred to as the Director
)
shall—
(A)promote
high-quality and comprehensive medical oversight of—
(i)all medical care
provided by field EMS practitioners; and
(ii)the education and
training of field EMS practitioners;
(B)promote the
development, adoption, and utilization of national guidelines for the roles of
physicians who provide medical oversight for field EMS and other health care
providers who support physicians in this role;
(C)support efforts of
relevant physician stakeholders in developing and disseminating guidelines for
use by EMS medical directors and field EMS practitioners on a national basis;
and
(D)convene a Field
EMS Medical Oversight Advisory Committee, comprised of representatives of
relevant physician stakeholders, to advise the Director on ways and means to
advance and support development and maintenance of quality medical oversight
throughout the Nation's systems for field EMS.
(2)Additional
considerationsIn carrying out subparagraphs (B) and (C) of
paragraph (1) (relating to supporting guidelines), the Director shall take into
consideration—
(A)existing
guidelines developed by national professional physician associations, States,
and other relevant governmental or nongovernmental entities;
(B)the input of other
relevant stakeholders, including health care providers who support physicians
who provide medical oversight for field EMS; and
(C)the unique needs
associated with medical oversight of provision of field EMS in rural areas or
by volunteers.
(3)The guidelines promoted under subparagraphs
(B) and (C) of paragraph (1) shall ensure high-quality training, credentialing,
and direction in connection with medical oversight of field EMS at the State,
regional, and local levels while providing sufficient flexibility to account
for historical and legitimate differences in field EMS among States, regions,
and localities.
(4)Required use of
guidelinesAs a condition on receipt of a grant under section 5
or 6, the Director shall require the grant recipient to adopt and implement (to
the extent applicable) the guidelines promoted under subparagraphs (B) and (C)
of paragraph (1).
(b)
(1)The Comptroller General of the United States shall
complete a study on—
(A)medical and
administrative liability issues that may impede—
(i)medical direction
provided by physicians directly regarding specific patients or medical
oversight provided by physicians in establishing medical protocols, procedures,
and other activities related to the provision of emergency medical care in
field EMS; or
(ii)the
highest quality emergency medical care in field EMS provided by personnel other
than physicians such as emergency medical technicians and paramedics;
(B)reimbursement for
any component of medical oversight; and
(C)such other issues
as the Comptroller General 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)The
Administrator of NHTSA shall carry out this paragraph in consultation with the
Director.
(C)In
carrying out subparagraph (A), the Administrator of NHTSA shall promote the
collection and reporting of data on field EMS in a standardized manner.
(D)The Administrator of NHTSA shall ensure that information in
the National EMS Database (other than individually identifiable information) is
available to Federal and State policymakers, EMS stakeholders, and
researchers.
(E)In carrying out subparagraph (A), the Administrator of
NHTSA may provide technical assistance to State and local agencies, field EMS
agencies, and other entities 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 Secretary of Health and Human Services, acting through the
Director, in consultation with the Administrator of NHTSA, 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, and linkages with existing patient
registries, related to the provision of field EMS and utilization of field EMS
with respect to a variety of illnesses and injuries (in both the everyday
provision of field EMS and catastrophic or disaster response) including—
(I)cardiac events such as chest pain, sudden
cardiac arrest, and STEMI;
(II)stroke;
(III)trauma;
(IV)disaster and
catastrophic incidents, such as incidents related to terrorism or natural or
manmade disasters; and
(V)ambulance
diversion and patient parking; and
(iv)include an analysis of the variety of
services provided by field EMS agencies.
(3)Report on data
integration to promote quality of 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 the Director of the Office
of EMS and Trauma, 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 nonindividually 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 Director of the Office of EMS and Trauma (in this section
referred to as the Director
) may make grants to eligible
entities for the development, availability, and dissemination of field EMS
education programs and courses that improve the quality and capability of field
EMS personnel. In carrying out this section, the Director shall take into
consideration 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 Director may award a grant to an eligible entity under
paragraph (1) only if the entity agrees to use the grant to—
(1)develop and
implement education programs that—
(A)train field EMS trainers and promote the
adoption and implementation of the education standards identified in the
Emergency Medical Services Education Agenda for the Future: A Systems
Approach
including any revisions thereto;
(B)bridge the gap in
knowledge and skills in field EMS and among field EMS and other allied health
professions to develop a larger cadre of educational instructors and build a
stronger and more flexible field EMS practitioner corps; or
(C)provide training
and retraining programs to provide displaced workers the opportunity to enter a
field EMS profession;
(2)develop and
implement educational courses pertaining to—
(A)instructor
courses;
(B)provision of
medical direction of field EMS;
(C)field EMS
practitioners, including physicians, emergency medical technicians, paramedics,
nurses, and other relevant clinicians providing emergency medical care in the
field;
(D)field EMS
educational and clinical research;
(E)bridge programs
among field EMS, nursing, and other allied health professions;
(F)field EMS management;
(G)national,
evidence-based guidelines; and
(H)translation of the
lessons learned in military medicine to field EMS;
(3)evaluate education and training courses and
methodologies to identify optimal educational modalities for field EMS
practitioners;
(4)improve the field
EMS education infrastructure by increasing the number of field EMS instructors
and the quality of their preparation by improving, enhancing, and modernizing
the dissemination of EMS education, including distance learning, and by
establishing quality improvement for EMS education programs;
(5)enhance the
opportunity for medical direction training and for promoting appropriate
medical oversight of field emergency medical care;
(6)improve systems to
design, implement, and evaluate education for prospective and current field EMS
providers; or
(7)carrying out such
other activities as the Director may identify.
(d)The Director, in consultation with NHTSA
and relevant stakeholders, and taking into consideration the recommendations of
FICEMS and NEMSAC, shall establish a system of prioritization in awarding
grants under this section to eligible entities.
(e)Grants under this section shall be for a period of 1 to 3
years.
(f)The Director may not award a grant to an
eligible entity under this section unless the entity submits an application to
the Director in such form, in such manner, and containing such agreements,
assurances, and information as the Director may require. The Director shall
ensure that the requirements for submitting an application under this section
are not unduly burdensome.
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 Director of the Office of EMS and Trauma, in consultation with
the Administrator of the Centers for Medicare & Medicaid Services (in this
section referred to as the Director
), and taking into
consideration the recommendations of NEMSAC and FICEMS, shall complete an
evaluation of—
(A)the provision of
and reimbursement for alternative delivery models for medical care through
field EMS; and
(B)the integration of
field EMS patients with other medical providers and facilities as medically
appropriate.
(2)The evaluation under paragraph (1) shall consider each of
the following:
(A)Alternative
dispositions of patients, including—
(i)transporting
patients by ambulance to destinations other than a hospital such as the office
of the patient’s physician, an urgent care center, or the facilities of another
health care provider;
(ii)when medically
necessary, the evaluation, treatment, or referral of patients to other
medically appropriate health care providers; and
(iii)the funding of
the provision of medical care regardless of the decision to transport such as
reimbursement models based on readiness rather than transport and shared
savings.
(B)Issues related to
medical liability and the requirements of section 1867 of the Social Security
Act (42 U.S.C. 1395dd; commonly referred to as EMTALA
)
associated with transport to destinations other than a hospital emergency
department.
(C)Necessary
protections to ensure that patients receive timely and appropriate care in the
appropriate setting.
(D)Whether there are
any barriers to providing alternate dispositions to patients who are not in
need of care in hospital emergency departments.
(E)Other issues
determined by the Director, including, when 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 Director shall
conduct or support at least 10 demonstration projects to—
(A)evaluate the implementation and
reimbursement of alternative dispositions of field EMS patients,
including—
(i)transporting
patients by ambulance to alternate destinations when medically appropriate and
in the patients’ best interests; and
(ii)when medically
necessary, evaluating, treating, or referring patients to other medically
appropriate providers;
(B)evaluate the
implementation of reimbursement models based on readiness rather than transport
or shared savings; and
(C)determine whether such alternative
dispositions and reimbursement models—
(i)improve the
safety, effectiveness, timeliness, and efficiency of EMS; and
(ii)reduce overall
utilization and expenditures under the Medicare program under title XVIII of
the Social Security Act.
(2)The Director shall
ensure that at least one demonstration project under paragraph (1) evaluates
evidence-based protocols that give guidance on selection of the destination to
which patients are transported.
(3)The
period of a demonstration project under paragraph (1) shall not exceed 36
months.
(4)If
the Director 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 field EMS
patients, the Director 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 Director shall submit to the
Congress a report on the results of activities under this section, including
recommendations on the efficacy of alternative dispositions of 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—
(I)regionalization of
emergency care;
(II)medical transport
to alternate destinations; or
(III)when medically
necessary, the evaluation, treatment, or referral of patients to other
medically appropriate health
providers.
.
(b)Emergency
medical 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 Office of Research and Evaluation
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 safety
and effectiveness research;
(2)other appropriate
clinical or systems research; and
(3)research
addressing—
(A)critical care
transport;
(B)off-shore
operations;
(C)tactical emergency
medical services;
(D)air medical
services; and
(E)the application of
lessons learned in military field medicine in the delivery of emergency medical
care in field EMS.
(c)In this section:
(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
2011.
.
(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.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 carrying out the provisions for which amounts are
authorized to be appropriated under subsections (a) and (b) of section 12 of
the Field EMS Quality, Innovation, and Cost
Effectiveness Improvements Act of
2011.
.
(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, 2011.
12.Authorization of
appropriations
(a)Out of amounts in the Emergency Medical Services Trust
Fund, there are authorized to be appropriated—
(1)$12,000,000 shall be for carrying out
sections 4 (excluding the provisions of law listed in subsection (b)(3) of such
section), 7, 9(a), 9(c), and 11 of this Act for each of fiscal years 2013
through 2016;
(2)$200,000,000 shall
be for carrying out section 5 of this Act for each of fiscal years 2013 through
2016;
(3)$50,000,000 shall
be for carrying out section 6 of this Act for each of fiscal years 2013 through
2016;
(4)$4,000,000 shall
be for carrying out section 7(c)(1) of this Act for each of fiscal years 2013
through 2016;
(5)$15,000,000 shall
be for carrying out section 8 of this Act for each of fiscal years 2013 through
2016; and
(6)$40,000,000 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 2013 through 2016.
(b)If, for any fiscal
year, amounts in the Emergency Medical Services Trust Fund exceed the maximum
amount authorized to be appropriated under subsection (a), such excess amounts
are authorized to be appropriated to carry out section 330J, section 498D, and
parts A, B, C, D, and H of title XII of the Public Health Service Act (42
U.S.C. 254c–15, 289g–4, 300d et seq., 300d–11 et seq., 300d–31 et seq., and
300d–81 et seq.).
(c)
(1)Out of the discretionary funds available to the Secretary
of Health and Human Services for each of fiscal years 2012 through 2013,
$40,000,000 shall be for carrying out the provisions listed in subsection (a)
or (b).
(2)The amount of discretionary funds allocated under
paragraph (1) for the purpose of carrying out the provisions listed in
subsection (a) or (b) shall be in addition to, not in lieu of, the amount of
discretionary funds that would otherwise be available for such purpose.
(d)Of the amounts made available under subsection (a), (b),
or (c) to carry out each of the provisions listed in subsection (a), not more
than 5 percent of each such amount may be used for Federal administrative
expenses.