[House Report 115-565]
[From the U.S. Government Publishing Office]


115th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                       {     115-565

======================================================================

 
   TO AUTHORIZE THE SECRETARY OF THE INTERIOR TO ESTABLISH FEES FOR 
MEDICAL SERVICES PROVIDED IN UNITS OF THE NATIONAL PARK SYSTEM, AND FOR 
                             OTHER PURPOSES

                                _______
                                

 February 15, 2018.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

Mr. Bishop of Utah, from the Committee on Natural Resources, submitted 
                             the following

                              R E P O R T

                        [To accompany H.R. 3607]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Natural Resources, to whom was referred 
the bill (H.R. 3607) to authorize the Secretary of the Interior 
to establish fees for medical services provided in units of the 
National Park System, and for other purposes, having considered 
the same, report favorably thereon with an amendment and 
recommend that the bill as amended do pass.
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. FEES FOR MEDICAL SERVICES.

  (a) Fees Authorized.--The Secretary may establish and collect fees 
for medical services provided to persons in units of the National Park 
System or for medical services provided by National Park Service 
personnel outside units of the National Park System.
  (b) National Park Medical Services Fund.--There is hereby established 
in the Treasury a fund to be known as the ``National Park Medical 
Services Fund''. The Fund shall consist of--
          (1) donations to the Fund; and
          (2) fees collected under subsection (a).
  (c) Availability of Amounts.--All amounts deposited into the Fund 
shall be available to the Secretary, to the extent provided in advance 
by Acts of appropriation, for the following in units of the National 
Park System:
          (1) Services listed in subsection (a).
          (2) Preparing needs assessments or other programmatic 
        analyses for medical facilities, equipment, vehicles, and other 
        needs and costs of providing services listed in subsection (a).
          (3) Developing management plans for medical facilities, 
        equipment, vehicles, and other needs and costs of services 
        listed in subsection (a).
          (4) Training related to providing services listed in 
        subsection (a).
          (5) Obtaining or improving medical facilities, equipment, 
        vehicles, and other needs and costs of providing services 
        listed in subsection (a).
  (d) Definitions.--For the purposes of this section:
          (1) Fund.--The term ``Fund'' means the National Park Medical 
        Services Fund established by subsection (b).
          (2) Secretary.--The term ``Secretary'' means the Secretary of 
        the Interior.

                          PURPOSE OF THE BILL

    The purpose of H.R. 3607 is to authorize the Secretary of 
the Interior to establish fees for medical services provided in 
units of the National Park System.

                  BACKGROUND AND NEED FOR LEGISLATION

    The National Park Service (NPS) currently manages eleven 
units that provide medical services, including ambulance 
transport, EMT services, and clinical services. These units are 
remote and visitors and staff have few or no other options for 
receiving timely medical care, especially in emergency 
situations.
    Under current law, NPS has the authority and responsibility 
to provide medical services, but does not have authority to 
retain revenues from insurance payments or other payments, 
which go to the general Treasury. NPS does not collect fees 
directly but instead works with third-party agencies to bill 
insurance companies or individuals. The ability to retain 
revenues to offset the costs of medical services would help NPS 
to provide higher quality patient care with industry-standard 
equipment and technology. H.R. 3607 allows the Secretary of the 
Interior to establish and collect fees for medical services 
provided at national parks.
    The following tables provided by NPS show the amounts that 
were collected for medical services and the amounts allocated 
to run medical services at each of the eleven units in Fiscal 
Year (FY) 2016:


                            COMMITTEE ACTION

    H.R. 3607 was introduced on July 28, 2017, by Congressman 
Tom McClintock (R-CA). The bill was referred to the Committee 
on Natural Resources, and within the Committee to the 
Subcommittee on Federal Lands. On October 11, 2017, the 
Subcommittee held a hearing on the legislation. On November 29, 
2017, the Natural Resources Committee met to consider the bill. 
The Subcommittee was discharged by unanimous consent. 
Congressman Tom McClintock offered an amendment designated #1; 
it was adopted by unanimous consent. No further amendments were 
offered, and the bill, as amended, was ordered favorably 
reported to the House of Representatives by unanimous consent 
on November 30, 2017.

            COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS

    Regarding clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII of the Rules of the House of Representatives, the 
Committee on Natural Resources' oversight findings and 
recommendations are reflected in the body of this report.

      COMPLIANCE WITH HOUSE RULE XIII AND CONGRESSIONAL BUDGET ACT

    1. Cost of Legislation and the Congressional Budget Act. 
With respect to the requirements of clause 3(c)(2) and (3) of 
rule XIII of the Rules of the House of Representatives and 
sections 308(a) and 402 of the Congressional Budget Act of 
1974, the Committee has received the following estimate for the 
bill from the Director of the Congressional Budget Office:
                                     U.S. Congress,
                               Congressional Budget Office,
                                  Washington, DC, February 7, 2018.
Hon. Rob Bishop,
Chairman, Committee on Natural Resources,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3607, a bill to 
authorize the Secretary of the Interior to establish fees for 
medical services provided in units of the National Park System, 
and for other purposes.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Janani 
Shankaran.
            Sincerely,
                                                 Keith Hall
                                                          Director.
    Enclosure.

H.R. 3607--A bill to authorize the Secretary of the Interior to 
        establish fees for medical services provided in units of the 
        National Park System, and for other purposes

    H.R. 3607 would authorize (but not require) the National 
Park Service (NPS) to collect fees for medical services 
provided within the National Park System in addition to any 
payments it already receives for such services. The bill would 
establish a separate fund in the Treasury in which to deposit 
those new collections. Under the bill, the deposited amounts 
would be available to the NPS to the extent provided in advance 
by appropriation acts for medical services within the National 
Park System and to upgrade medical facilities and equipment.
    According to the NPS, the agency typically contracts out 
the operation of its medical clinics, but operates medical 
clinics in 11 system units where third parties choose not to 
compete for contracts to do that work. The NPS pays for medical 
costs at those facilities, which total about $4 million a year, 
using a mix of appropriated funds and direct spending of 
collections from park entrance fees and concession franchise 
fees. CBO expects that under the bill, the NPS would continue 
to operate clinics using funds from the same sources, in 
addition to any amounts that would be collected under this bill 
and thereafter appropriated.
    Under current law, the NPS does not have the authority to 
retain and spend payments it receives for medical services from 
people or insurance providers. Those offsetting receipts (about 
$2 million a year) are treated as reductions in direct spending 
and deposited into the general fund of the Treasury.
    Enacting H.R. 3607 could increase offsetting receipts. How 
or whether the proposed fees would be collected is unclear, 
however CBO estimates that those increases would not be 
significant. Because enacting the bill could affect direct 
spending, pay-as-you-go procedures apply. Enacting the bill 
would not affect revenues.
    CBO expects that the NPS would incur administrative costs 
associated with collecting those fees. Based on the costs for 
similar activities, CBO estimates that those costs would be 
less than $500,000 annually; such spending would be subject to 
the availability of appropriated funds. Any appropriation of 
the newly collected funds also would increase spending by less 
than $500,000, CBO estimates.
    CBO estimates that enacting H.R. 3607 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 3607 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Janani 
Shankaran. The estimate was approved by H. Samuel Papenfuss, 
Deputy Assistant Director for Budget Analysis.
    2. General Performance Goals and Objectives. As required by 
clause 3(c)(4) of rule XIII, the general performance goal or 
objective of this bill is to authorize the Secretary of the 
Interior to establish fees for medical services provided in 
units of the National Park System.

                           EARMARK STATEMENT

    This bill does not contain any Congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined 
under clause 9(e), 9(f), and 9(g) of rule XXI of the Rules of 
the House of Representatives.

                    COMPLIANCE WITH PUBLIC LAW 104-4

    This bill contains no unfunded mandates.

                       COMPLIANCE WITH H. RES. 5

    Directed Rule Making. This bill does not contain any 
directed rule makings.
    Duplication of Existing Programs. This bill does not 
establish or reauthorize a program of the federal government 
known to be duplicative of another program. Such program was 
not included in any report from the Government Accountability 
Office to Congress pursuant to section 21 of Public Law 111-139 
or identified in the most recent Catalog of Federal Domestic 
Assistance published pursuant to the Federal Program 
Information Act (Public Law 95-220, as amended by Public Law 
98-169) as relating to other programs.

                PREEMPTION OF STATE, LOCAL OR TRIBAL LAW

    This bill is not intended to preempt any State, local or 
tribal law.

                        CHANGES IN EXISTING LAW

    If enacted, this bill would make no changes to existing 
law.

                                  [all]