[Congressional Record Volume 143, Number 10 (Thursday, January 30, 1997)]
[Senate]
[Pages S871-S874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRAMS (for himself and Mr. Graham):
  S. 238. A bill to amend title XVIII of the Social Security Act to 
ensure Medicare reimbursement for certain ambulance services, and to 
improve the efficiency of the emergency medical system, and for other 
purposes; to the Committee on Finance.


             THE EMERGENCY MEDICAL SERVICES EFFICIENCY ACT

  Mr. GRAMS. Mr. President, I have come to the floor today, with the 
support of my colleague from Florida, Senator Graham, to introduce an 
important health care proposal that is designed to improve our 
emergency medical system and to ultimately benefit our constituents who 
depend on these services. The area is one I believe has not received 
the attention that it deserves.
  In a nation where some 268,000 Americans turn to the 911 emergency 
response system for help every single day, our population relies on the 
readiness, efficiency and the quick response of our emergency medical 
system. It is something on which the American people have come to 
depend, a service we nearly take for granted. We don't know when we 
need it, but we want it to work well when we do. The men and women who 
risk their lives in delivering emergency care are true heroes, yet 
their desire to improve the services they provide is rarely recognized 
by Congress.
  The nightly news is filled with the stories of local emergency 
response problems. You may recall the tragedy in Philadelphia in 1994 
when a young boy died on the steps of his church after being beaten. It 
took police 40 minutes to respond after the first 911 call was 
received.
  Here in the District of Columbia, some residents have waited for more 
than 25 minutes before an ambulance responded to their 911 medical 
emergency. Far too often, Congress fails to respond until there is a 
national crisis, but we can't afford to wait for a crisis to occur 
before we respond to the needs of our emergency medical system. 
Patients' lives are at risk if Congress doesn't begin to help the 
system become more efficient.
  Currently, emergency medical service providers are not consulted when 
Washington is formulating national policy which affects their ability 
to respond in a timely and in an efficient manner, and there is no 
coordinated Government focus on EMS, no collection of national data and 
statistics which I believe would help Congress and the administration 
develop more effective policies to help improve EMS.
  Furthermore, there is no lead EMS agency to provide guidance and 
direction to Congress and the States when implementing Federal policies 
concerning Medicare reimbursement issues, emergency management 
planning, or the effect of Federal regulations on EMS providers. This 
lack of coordination often negatively impacts providers of EMS and our 
constituents who rely upon them.
  Later this year, Congress will be reauthorizing the Intermodal 
Surface Transportation Efficiency Act, for which its supporters will be 
asking for $26 billion in transportation spending, and yet the 
emergency medical services communities will likely not have a voice in 
improving our transportation system. That is the very system they 
depend upon to ensure that when they are dispatched to a patient in 
need of emergency medical services, the highway design or newest 
technologies will allow them to respond quickly and efficiently. EMS 
providers need a seat at the table.

  I find it ironic that we expect so much from our EMS system and yet, 
when they seek assistance, we continue to ignore their 911 call for 
help.
  That is why I am today introducing the Emergency Medical Services 
Efficiency Act of 1997. My legislation sets out a blueprint for 
responding to the needs of our emergency medical system and begins to 
address just a few of their concerns Washington has long ignored.
  First, the Grams-Graham bill will require Medicare to reimburse for 
ambulance services provided for emergency medical care based on the 
original diagnosis by a prudent layperson, instead of the ultimate 
diagnosis determined by health professionals in the emergency room.
  Mr. President, the division of emergency medical services for the 
city of St. Paul, MN, prepared a list for me of just some of their 1996 
emergency ambulance transports that began as a 911 call for help, but 
were eventually denied payment by Medicare.
  Among the cases where payment was denied include a 79-year-old 
female, on several prescription medications, who had fallen in the 
night and was suffering from vertigo; a 72-year-old male, on numerous 
prescription medications, who had fallen on the sidewalk, had 
lacerations on his arm, a cut over his right eye, and was confused; and 
also a 95-year-old female who awoke confused and weak, possibly 
suffering from a stroke.
  In each of these incidents, emergency services personnel responded to 
what they believed to be medical emergencies. Even though the cases 
were ultimately ruled nonemergencies, the EMS providers should have 
been reimbursed by Medicare for the emergency transport service that 
they provided.
  As Joseph A. Grafft, EMS Manager for the FIRE/EMS Center at 
Metropolitan State University in St. Paul noted in a letter to me, 
``Ambulance providers are not physicians and do not diagnose patients. 
They deal with presenting symptoms and give care based on these 
symptoms. The physicians diagnose and make the final determination. 
Ambulance providers should not be penalized for doing their job.''
  Our bill ensures that Medicare reimbursements are based on the 
original diagnoses of the 911 callers. At the same time, we do not seek 
reimbursements for medical conditions that are clearly not life-
threatening.
  Second, our bill establishes two separate advisory councils comprised 
of emergency service providers and others. The first will advise the 
Health Care Financing Administration on issues pertaining to Medicare 
reimbursement. The second advisory council will make recommendations to 
the administration and Congress in regard to improving the efficiency 
and coordination of our emergency medical system.
  Third, our bill will designate a lead-EMS agency, to be established 
at the direction of the Secretary of Transportation in consultation 
with the Secretary of Health and Human Services. The Secretary will 
make recommendations to Congress as to which functions should be 
transferred to the Transportation Department in order to streamline and 
coordinate the EMS system.
  Finally, our bill directs the Secretary of Transportation to 
establish a national database for the collection of statistics relating 
to the delivery of emergency medical services within our national 
transportation system and national emergency response system.
  The Secretary will set forth the appropriate criteria for national 
data collection in consultation with State EMS agencies to ensure the 
least burdensome data collection reporting procedures. We would hope 
this database could be tied to an existing data collection system.
  I believe these four provisions will begin to address a few of the 
needs that the EMS community has brought to my attention. This bill 
will allow Congress, the President, as well as State and local 
officials to have the resources and also the facts they need to make 
necessary improvements in emergency medical care to patients.
  Dr. Daniel Hankins, president of the Minnesota Chapter of the 
American College of Emergency Physicians, made that point eloquently in 
a recent letter to me. He said, ``For too long EMS has been forgotten 
when health care legislation has been proposed.''
  He went on to say, ``EMS is a small, but crucial part of the overall 
health care system. It is in most rural areas the only lifeline for 
access into emergency care. It is a fragile safety net . . . that is 
only held together by the dedication of the many volunteers that 
comprise the EMS system.''
  Mr. President, I am pleased that I am joined today by the senior 
Senator

[[Page S872]]

from the State of Florida in the introduction of this legislation. We 
are proud to have a large number of organizations--organizations 
dedicated to improving emergency medical care--supporting our 
legislation.
  I ask unanimous consent that a complete list of these organizations 
be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

    List of Organizations Supporting the Emergency Medical Services 
                             Efficiency Act

       (1) Minnesota Ambulance Association.
       (2) Minnesota Air Medical Council.
       (3) Healthspan Transportation.
       (4) Lifelink III.
       (5) Minnesota Emergency Medical Services Association.
       (6) South Central Minnesota Emergency Medical Services 
     Program.
       (7) Minnesota Chapter, College of Emergency Physicians.
       (8) Gold Cross Ambulance Service.
       (9) North Memorial Health Care.
       (10) Minnesota Hospital and Healthcare Partnership.
       (11) West Central Minnesota Emergency Medical Services 
     Program.
  Mr. GRAMS. Thank you, Mr. President. The Emergency Medical Services 
Efficiency Act is not the answer to all of the problems. But it is the 
first step in addressing the concerns of a very important segment of 
both our health care and transportation systems. This bill is a 
blueprint for further improvements in emergency medical services to 
help all Americans.
  By introducing today's legislation early in the session, it is my 
hope that we will call attention to the needs of EMS providers and move 
forward to a more comprehensive bill, one that addresses additional 
concerns that are equally important to the EMS community as those we 
have addressed here today.
  Over the next few weeks, I will be working with EMS providers in 
Minnesota and throughout the country to look at improving four key 
areas: regulatory oversight, technology improvements in medicine and 
transportation, insurance reimbursement issues, and the EMS functions 
which should be transferred and streamlined under the Department of 
Transportation.
  Senator Graham has worked tirelessly to ensure that the definition of 
``prudent layperson'' apply not only to ambulance service but also to 
care provided at emergency departments. In our second bill, it is our 
intent to include Senator Graham's new language to ensure that patients 
are not denied reimbursement for emergency care because they failed to 
obtain proper certification or authorization from their insurance 
provider. I look forward to working with the American Association of 
Health Plans, which today announced new policies to clarify how health 
plans should cover emergency care, in developing an appropriate 
legislative solution.
  The legislation we introduce today and our subsequent work will be 
part of an ongoing effort we hope to include in the newly drafted Rural 
Health Improvement Act. This important overall effort, in which I have 
also been involved, will help ensure that rural areas are not 
overlooked in our desire to improve health care delivery.
  So finally, Mr. President, I look forward to working with Senator 
Graham, Senator Thomas, and others in the months and weeks ahead to 
improve emergency medical services for patients and providers and 
ensure the most efficient use of scarce tax dollars. The American 
people expect--and of course deserve--nothing less.
  Thank you very much, Mr. President.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 238

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Emergency Medical Services 
     Efficiency Act of 1997''.
        TITLE I--MEDICARE COVERAGE OF CERTAIN AMBULANCE SERVICES

     SEC. 101. MEDICARE COVERAGE OF CERTAIN AMBULANCE SERVICES.

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

     SEC. 201. ESTABLISHMENT OF ADVISORY GROUP.

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

     SEC. 202. DUTIES OF THE ADVISORY GROUP.

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

     SEC. 203. POWERS OF THE ADVISORY GROUP.

       (a) Hearings.--The Advisory Group may hold such hearings, 
     sit and act at such times and places, take such testimony, 
     and receive such evidence as the Advisory Group considers 
     necessary to carry out the purposes of this title.

[[Page S873]]

       (b) Information From Federal Agencies.--The Advisory Group 
     may secure directly from any Federal department or agency 
     such information as the Advisory Group considers necessary to 
     carry out the provisions of this title. Upon request of the 
     Chairperson of the Advisory Group, the head of such 
     department or agency shall furnish such information to the 
     Advisory Group.
       (c) Postal Services.--The Advisory Group may use the United 
     States mails in the same manner and under the same conditions 
     as other departments and agencies of the Federal Government.
       (d) Gifts.--The Advisory Group may accept, use, and dispose 
     of gifts or donations of services or property.

     SEC. 204. ADVISORY GROUP PERSONNEL MATTERS.

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

     SEC. 205. FUNDING.

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

     SEC. 206. APPLICABILITY OF FEDERAL ADVISORY COMMITTEE ACT.

       Section 14 of the Federal Advisory Committee Act (5 U.S.C. 
     App.) shall not apply to the Advisory Group.
  TITLE III--FEDERAL ADVISORY COUNCIL FOR EMERGENCY AMBULANCE SERVICES

     SEC. 301. DEFINITION.

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

     SEC. 302. ESTABLISHMENT OF ADVISORY COUNCIL.

       (a) Establishment.--There is established an advisory 
     council to be known as the Federal Advisory Council for 
     Emergency Ambulance Services (in this title referred to as 
     the ``Advisory Council'').
       (b) Membership.--
       (1) Composition.--The Advisory Council shall be composed of 
     23 members, of whom--
       (A) 1 shall be a member of the International Fire Chief's 
     Association, appointed by the President from nominations 
     submitted by the Executive Director of the International Fire 
     Chief's Association;
       (B) 1 shall be a member of the International Association of 
     Firefighters, appointed by the President from nominations 
     submitted by the general president of the International 
     Association of Firefighters;
       (C) 1 shall be a member of the American Ambulance 
     Association, appointed by the President from nominations 
     submitted by the executive vice president of the American 
     Ambulance Association;
       (D) 1 shall be a member of the National Association of 
     Emergency Medical Services Physicians, appointed by the 
     President from nominations submitted by the executive 
     director of the National Association of Emergency Medical 
     Services Physicians;
       (E) 4 shall be appointed by the President, of whom--
       (i) 1 shall be a representative of a volunteer ambulance 
     service;
       (ii) 1 shall be a representative of a hospital-based 
     ambulance service;
       (iii) 1 shall be a representative of a private ambulance 
     service; and
       (iv) 1 shall be a representative of an air ambulance 
     service;
       (F) 1 shall be an individual who is appointed by the 
     Majority Leader of the Senate;
       (G) 1 shall be an individual who is appointed by the 
     Minority Leader of the Senate;
       (H) 1 shall be an individual who is appointed by the 
     Speaker of the House of Representatives;
       (I) 1 shall be an individual who is appointed by the 
     Minority Leader of the House of Representatives;
       (J) 2 shall be employees of the Occupational Safety and 
     Health Administration, appointed by the Secretary of Labor;
       (K) 1 shall be an employee of the United States Coast 
     Guard, appointed by the Secretary of Transportation;
       (L) 2 shall be employees of the National Transportation 
     Safety Board, appointed by the chairman of the National 
     Transportation Safety Board;
       (M) 2 shall be employees of the National Highway Traffic 
     Safety Administration of the Department of Transportation, 
     appointed by the Secretary of Transportation;
       (N) 2 shall be employees of the Federal Emergency 
     Management Agency, appointed by the Director of the Federal 
     Emergency Management Agency; and
       (O) 2 shall each be a member of a governing body of an 
     Indian tribe (as that term is defined in section 4(e) of the 
     Indian Self-Determination and Education Assistance Act (25 
     U.S.C. 450b(e)).
       (2) Additional requirements.--
       (A) Geographical representation and urban and rural 
     representation.--In making appointments of members under 
     paragraph (1), the appointing officials described in such 
     paragraph shall, through consultation and collaboration with 
     each other, select--
       (i) members who are geographically representative of the 
     United States; and
       (ii) members who are representative of rural areas and 
     urban areas.
       (B) Special rule.--The appointing officials described in 
     subparagraph (A) shall ensure that, of the members 
     appointed--
       (i) 11 shall be representative of rural areas;
       (ii) 11 shall be representative of urban areas; and
       (iii) 1 shall be representative of a rural area or an urban 
     area, as provided for in subparagraph (C).
       (C) Alternate representation.--The appointing officials 
     described in subparagraph (A) shall appoint members under 
     subparagraph (B)(iii) by alternating between a member 
     representing a rural area and a member representing an urban 
     area.
       (3) Date.--The appointments of the members of the Advisory 
     Council shall be made not later than January 1, 1998.
       (c) Period of Appointment; Vacancies.--
       (1) Period of appointment.--Members shall be appointed for 
     a term of 4 years.
       (2) Vacancy.--
       (A) In general.--Any vacancy in the Advisory Council shall 
     not affect the powers of the Advisory Council, but shall be 
     filled in the same manner as the original appointment.
       (B) Filling unexpired terms.--An individual chosen to fill 
     a vacancy under this paragraph shall be appointed for the 
     unexpired term of the member replaced.
       (d) Initial Meeting.--Not later than 30 days after the date 
     on which all members of the Advisory Council have been 
     appointed, the Advisory Council shall hold its first meeting.
       (e) Meetings.--The Advisory Council shall meet at the call 
     of the Chairperson.
       (f) Quorum.--A majority of the members of the Advisory 
     Council shall constitute a quorum, but a lesser number of 
     members may hold hearings.
       (g) Chairperson and Vice Chairperson.--The Advisory Council 
     shall select a Chairperson and Vice Chairperson from among 
     the members of the Advisory Council.

     SEC. 303. DUTIES OF THE ADVISORY COUNCIL.

       (a) Study.--
       (1) In general.--The Advisory Council shall conduct a study 
     of--
       (A) the workplace conditions and safety requirements with 
     regard to employees who provide emergency ambulance services, 
     including a review of the emergency ambulance services 
     regulations and standards promulgated by the Secretary of 
     Labor through the Occupational Safety and Health 
     Administration;
       (B) the emergency management planning functions of the 
     Federal Emergency Management Agency; and
       (C) the transportation-related functions of the Department 
     of Transportation related to the provision of emergency 
     ambulance services, including--
       (i) the functions carried out under the Intelligent 
     Vehicle-Highway Systems Act of 1991 (part B of title VI of 
     the Intermodal Surface Transportation Efficiency Act of 1991, 
     Public Law 102-240); and
       (ii) any other issue related to the provision of emergency 
     ambulance services that the Secretary of Transportation 
     recommends for study by the Advisory Council.
       (2) Interpretation of data.--As part of the study conducted 
     under this subsection, the Advisory Council shall use and 
     interpret the data collected by the Office of Emergency 
     Medical Services Data Collection of

[[Page S874]]

     the Department of Transportation established under section 
     402.
       (b) Recommendations.--The Advisory Council shall develop 
     recommendations with regard to--
       (1) the improvement of workplace conditions of employees 
     who provide emergency ambulance services;
       (2) the appropriate application by the Occupational Safety 
     and Health Administration of occupational safety and health 
     standards and regulations to employees who are employed to 
     provide emergency ambulance services; and
       (3) addressing the issues, and improving the functions, 
     referred to in subparagraphs (B) and (C) of subsection 
     (a)(1).
       (c) Report.
       (1) Submission of report to agency officials.--Not later 
     than 2 years after the date of enactment of this Act and 
     annually thereafter, the Advisory Council shall prepare and 
     submit to the Secretary of Labor, the Secretary of Commerce, 
     and the Director of the Federal Emergency Management 
     Administration a report that includes--
       (A) a detailed statement of the results of the matters 
     studied by the Advisory Council under subsection (a); and
       (B) the recommendations of the Advisory Council developed 
     under subsection (b).
       (2) Submission of report to congress.--Not later than 2 
     years after the date of enactment of this Act and annually 
     thereafter, the Advisory Council shall prepare and submit to 
     the appropriate committees of Congress the report described 
     in paragraph (2).

     SEC. 304. POWERS OF THE ADVISORY COUNCIL.

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

     SEC. 305. ADVISORY COUNCIL PERSONNEL MATTERS.

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

     SEC. 306. FUNDING.

       The Secretary of Labor, the Secretary of Commerce, and the 
     Director of the Federal Emergency Management Agency shall 
     provide to the Advisory Council, out of funds otherwise 
     available to such agency heads, such sums as are necessary to 
     carry out the purposes of the Advisory Council under this 
     title.

     SEC. 307. APPLICABILITY OF FEDERAL ADVISORY COMMITTEE ACT.

       Section 14 of the Federal Advisory Committee Act (5 U.S.C. 
     App.) shall not apply to the Advisory Council.
 TITLE IV--DATA COLLECTION AND ADMINISTRATION BY DEPARTMENT OF COMMERCE

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

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

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

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