[Congressional Record Volume 147, Number 38 (Wednesday, March 21, 2001)]
[Senate]
[Pages S2668-S2669]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Thomas, Mr. Daschle, Mr. Johnson, 
        and Mr. Roberts):
  S. 587. A bill to amend the Public Health Service Act and title XVIII 
of the Social Security Act to sustain access to vital emergency medical 
services in rural areas; to the Committee on Finance.
  Mr. CONRAD. Mr. President, today I am introducing the Sustaining 
Access to Vital Emergency Medical Services Act of 2001. This bill would 
take important steps to strengthen the emergency medical service system 
in rural communities and across the Nation.
  Across America, emergency medical care reduces human suffering and 
saves lives. According to recent statistics, the average U.S. citizen 
will require the services of an ambulance at least

[[Page S2669]]

twice during his or her life. As my colleagues surely know, delays in 
receiving care can mean the difference between illness and permanent 
injury, between life and death. In rural communities, which often lack 
access to local health care services, the need for reliable EMS is 
particularly critical.
  Over the next few decades, the need for quality emergency medical 
care in rural areas is projected to increase as the elderly population 
in these communities continues to rise. Unfortunately, while the need 
for effective EMS systems may increase, we have seen the number of 
individuals able to provide these services decline. Nationwide, the 
majority of emergency medical personnel are unpaid volunteers. As rural 
economies continue to suffer, and individuals have less and less time 
to devote to volunteering, it has become increasingly difficult for 
rural EMS squads to recruit and retain personnel. In my State of North 
Dakota, this phenomenon has resulted in a sharp reduction in EMS squad 
size. In 1980, on average there were 35 members per EMS squad; today, 
the average squad size has plummeted to 12 individuals per unit. I am 
concerned that continued reductions in EMS squad size could jeopardize 
rural residents' access to needed medical services.
  For this reason, the legislation I am introducing today includes 
measures to help communities recruit, retain, and train EMS providers. 
My bill would establish a Rural Emergency Medical Services Training and 
Equipment Assistance program. This program would authorize $50 million 
in grant funding for fiscal years 2002-2007, which could be used in 
rural EMS squads to meet various personnel needs. For example, this 
funding could help cover the costs of training volunteers in emergency 
response, injury prevention, and safety awareness; volunteers could 
also access this funding to help meet the costs of obtaining State 
emergency medical certification. In addition, EMS squads would be 
offered the flexibility to use grant funding to acquire new equipment, 
such as cardiac defibrillators. This is particularly important for 
rural squads that have difficulty affording state-of-the-art equipment 
that is needed for stabilizing patients during long travel times 
between the rural accident site and the nearest medical facility. This 
grant funding could also be used to provide community education 
training in CPR, first aid or other emergency medical needs.
  In addition, this legislation takes steps to help ensure emergency 
medical providers are fairly reimbursed for ambulance services provided 
to Medicare, Medicare+Choice, and Medicaid managed care beneficiaries. 
As you may know, the Balanced Budget Act required that Medicare+Choice 
and Medicaid managed care plans provide payment for emergency services 
that a ``prudent layperson'' would determine are medically needed. 
However, regulations implementing this requirement did not include 
ambulance services within the definition of ``emergency services.'' 
Because of this oversight, ambulance providers are sometimes left in 
the difficult position of providing services to individuals who, by any 
rational review, appear to need immediate medical attention. However, 
when it is later determined that the patient's symptoms were the result 
of heartburn, for example, rather than a serious heart condition, the 
ambulance provider is denied payment for services. This is simply 
unfair.
  While it is certainly important that EMS providers take care not to 
provide unnecessary services, it is unfair to deny ambulance providers 
payment when they provide immediate emergency services to individuals 
who appear tin serious need of medical care. In my State, EMS providers 
are operating on tight budgets and cannot afford to provide high levels 
of uncompensated care. To ensure EMS services remain available, 
particularly in underserved rural areas, we must ensure that EMS 
providers are appropriately reimbursed for the care they provide to our 
communities. For this reason, my legislation would revise the ``prudent 
layperson'' definition to include ambulance services. This change will 
ensure that ambulance providers who provide care in situations where a 
responsible observer would deem this care medically necessary receive 
reimbursement under traditional Medicare, Medicare+Choice, and Medicaid 
managed care.
  It is my hope that the Sustaining Access to Vital Emergency Medical 
Services Act will help ensure EMS providers can continue providing 
quality medical care to our communities. I am happy to say that this 
legislation is supported by the National Association of State EMS 
Directors, the National Rural Health Association, and the American 
Ambulance Association. I am also pleased that Senators Thomas, Daschle, 
Johnson, and others are joining me in this effort. I urge my colleagues 
to support this important piece of legislation.
  Mr. THOMAS. Mr. President, I am pleased to rise today to introduce 
``The Sustaining Access to Vital Emergency Medical Services Act of 
2001'' with Senators Conrad, Daschle, Roberts and Johnson. As with all 
rural health legislation I have worked on, I am proud of the bipartisan 
effort behind this bill.
  ``The Sustaining Access to Vital Emergency Medical Services Act of 
2001'' will provide assistance to rural providers to maintain access to 
important emergency medical services, EMS. This legislation is 
necessary because rural EMS providers are primarily volunteers who have 
difficulty recruiting, retaining and educating EMS personnel. Rural EMS 
providers also have less capital to buy and upgrade essential, life-
saving equipment.
  The first section of this legislation is the authorization of an 
annual $50 million competitive grant program. Grantees can use these 
funds for recruiting volunteers, training emergency personnel, using 
new technologies to educate providers, acquiring EMS vehicles such as 
ambulances and acquiring emergency medical equipment. I think it is 
important to note that all of the above eligible uses of funds were 
priority concerns of State EMS Directors in a recently conducted Rural 
EMS Survey with recruitment and retention ranking as number one.
  The second part of this legislation applies the prudent layperson 
standard for emergency services currently used in hospital emergency 
rooms to ambulance services. This provision will assist ambulance 
providers in collecting payments for transporting patients to the 
hospital after answering a 911 call regardless of the final diagnosis. 
This is a common sense approach and ensures that all aspects of 
emergency care are operating under the same definition of emergency.
  I believe this legislation is an important part of ensuring rural 
residents have access to emergency services. It is also flexible so 
communities can decide for themselves what is their most imminent EMS 
need. Our bill is supported by the National Association of State EMS 
Directors, the National Rural Health Association and the American 
Ambulance Association. I strongly urge all my colleagues interested in 
rural health to consider cosponsoring ``The Sustaining Access to Vital 
Emergency Medical Services Act of 2001.''
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