[House Report 117-514]
[From the U.S. Government Publishing Office]
117th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 117-514
======================================================================
IMPROVING TRAUMA SYSTEMS AND EMERGENCY CARE ACT
_______
September 28, 2022.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Pallone, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 8163]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 8163) to amend the Public Health Service Act
with respect to trauma care, having considered the same,
reports favorably thereon with an amendment and recommends that
the bill as amended do pass.
CONTENTS
Page
I. Purpose and Summary..............................................4
II. Background and Need for the Legislation..........................4
III.Committee Hearings...............................................5
IV. Committee Consideration..........................................5
V. Committee Votes..................................................6
VI. Oversight Findings...............................................8
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures8
VIII.Federal Mandates Statement.......................................8
IX. Statement of General Performance Goals and Objectives............8
X. Duplication of Federal Programs..................................8
XI. Committee Cost Estimate..........................................8
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......8
XIII.Advisory Committee Statement.....................................9
XIV. Applicability to Legislative Branch..............................9
XV. Section-by-Section Analysis of the Legislation...................9
XVI. Changes in Existing Law Made by the Bill, as Reported............9
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Improving Trauma Systems and Emergency
Care Act''.
SEC. 2. TRAUMA CARE REAUTHORIZATION.
(a) In General.--Section 1201 of the Public Health Service Act (42
U.S.C. 300d) is amended--
(1) in subsection (a)--
(A) in paragraph (3)--
(i) by inserting ``analyze,'' after
``compile,''; and
(ii) by inserting ``and medically underserved
areas'' before the semicolon;
(B) in paragraph (4), by adding ``and'' after the
semicolon;
(C) by striking paragraph (5); and
(D) by redesignating paragraph (6) as paragraph (5);
(2) by redesignating subsection (b) as subsection (c); and
(3) by inserting after subsection (a) the following:
``(b) Trauma Care Readiness and Coordination.--The Secretary, acting
through the Assistant Secretary for Preparedness and Response, shall
support the efforts of States and consortia of States to coordinate and
improve emergency medical services and trauma care during a public
health emergency declared by the Secretary pursuant to section 319 or a
major disaster or emergency declared by the President under section 401
or 501, respectively, of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act. Such support may include--
``(1) developing, issuing, and updating guidance, as
appropriate, to support the coordinated medical triage and
evacuation to appropriate medical institutions based on patient
medical need, taking into account regionalized systems of care;
``(2) disseminating, as appropriate, information on evidence-
based or evidence-informed trauma care practices, taking into
consideration emergency medical services and trauma care
systems, including such practices identified through activities
conducted under subsection (a) and which may include the
identification and dissemination of performance metrics, as
applicable and appropriate; and
``(3) other activities, as appropriate, to optimize a
coordinated and flexible approach to the emergency response and
medical surge capacity of hospitals, other health care
facilities, critical care, and emergency medical systems.''.
(b) Grants To Improve Trauma Care in Rural Areas.--Section 1202 of
the Public Health Service Act (42 U.S.C. 300d-3) is amended--
(1) by amending the section heading to read as follows:
``grants to improve trauma care in rural areas'';
(2) by amending subsections (a) and (b) to read as follows:
``(a) In General.--The Secretary shall award grants to eligible
entities for the purpose of carrying out research and demonstration
projects to support the improvement of emergency medical services and
trauma care in rural areas through the development of innovative uses
of technology, training and education, transportation of seriously
injured patients for the purposes of receiving such emergency medical
services, access to prehospital care, evaluation of protocols for the
purposes of improvement of outcomes and dissemination of any related
best practices, activities to facilitate clinical research, as
applicable and appropriate, and increasing communication and
coordination with applicable State or Tribal trauma systems.
``(b) Eligible Entities.--
``(1) In general.--To be eligible to receive a grant under
this section, an entity shall be a public or private entity
that provides trauma care in a rural area.
``(2) Priority.--In awarding grants under this section, the
Secretary shall give priority to eligible entities that will
provide services under the grant in any rural area identified
by a State under section 1214(d)(1).''; and
(3) by adding at the end the following:
``(d) Reports.--An entity that receives a grant under this section
shall submit to the Secretary such reports as the Secretary may require
to inform administration of the program under this section.''.
(c) Pilot Grants for Trauma Centers.--Section 1204 of the Public
Health Service Act (42 U.S.C. 300d-6) is amended--
(1) by amending the section heading to read as follows:
``pilot grants for trauma centers'';
(2) in subsection (a)--
(A) by striking ``not fewer than 4'' and inserting
``10'';
(B) by striking ``that design, implement, and
evaluate'' and inserting ``to design, implement, and
evaluate new or existing'';
(C) by striking ``emergency care'' and inserting
``emergency medical''; and
(D) by inserting ``, and improve access to trauma
care within such systems'' before the period;
(3) in subsection (b)(1), by striking subparagraphs (A) and
(B) and inserting the following:
``(A) a State or consortia of States;
``(B) an Indian Tribe or Tribal organization (as
defined in section 4 of the Indian Self-Determination
and Education Assistance Act);
``(C) a consortium of level I, II, or III trauma
centers designated by applicable State or local
agencies within an applicable State or region, and, as
applicable, other emergency services providers; or
``(D) a consortium or partnership of nonprofit Indian
Health Service, Indian Tribal, and urban Indian trauma
centers.'';
(4) in subsection (c)--
(A) in the matter preceding paragraph (1)--
(i) by striking ``that proposes a pilot
project''; and
(ii) by striking ``an emergency medical and
trauma system that--'' and inserting ``a new or
existing emergency medical and trauma system.
Such eligible entity shall use amounts awarded
under this subsection to carry out 2 or more of
the following activities:'';
(B) in paragraph (1)--
(i) by striking ``coordinates'' and inserting
``Strengthening coordination and
communication''; and
(ii) by striking ``an approach to emergency
medical and trauma system access throughout the
region, including 9-1-1 Public Safety Answering
Points and emergency medical dispatch;'' and
inserting ``approaches to improve situational
awareness and emergency medical and trauma
system access.'';
(C) in paragraph (2)--
(i) by striking ``includes'' and inserting
``Providing'';
(ii) by inserting ``support patient movement
to'' after ``region to''; and
(iii) by striking the semicolon and inserting
a period;
(D) in paragraph (3)--
(i) by striking ``allows for'' and inserting
``Improving''; and
(ii) by striking ``; and'' and inserting a
period;
(E) in paragraph (4), by striking ``includes a
consistent'' and inserting ``Supporting a consistent'';
and
(F) by adding at the end the following:
``(5) Establishing, implementing, and disseminating, or
utilizing existing, as applicable, evidence-based or evidence-
informed practices across facilities within such emergency
medical and trauma system to improve health outcomes, including
such practices related to management of injuries, and the
ability of such facilities to surge.
``(6) Conducting activities to facilitate clinical research,
as applicable and appropriate.'';
(5) in subsection (d)(2)--
(A) in subparagraph (A)--
(i) in the matter preceding clause (i), by
striking ``the proposed'' and inserting ``the
applicable emergency medical and trauma
system'';
(ii) in clause (i), by inserting ``or Tribal
entity'' after ``equivalent State office''; and
(iii) in clause (vi), by striking ``; and''
and inserting a semicolon;
(B) by redesignating subparagraph (B) as subparagraph
(C); and
(C) by inserting after subparagraph (A) the
following:
``(B) for eligible entities described in subparagraph
(C) or (D) of subsection (b)(1), a description of, and
evidence of, coordination with the applicable State
Office of Emergency Medical Services (or equivalent
State Office) or applicable such office for a Tribe or
Tribal organization; and'';
(6) in subsection (f), by striking ``population in a
medically underserved area'' and inserting ``medically
underserved population'';
(7) in subsection (g)--
(A) in the matter preceding paragraph (1), by
striking ``described in'';
(B) in paragraph (2), by striking ``the system
characteristics that contribute to'' and inserting
``opportunities for improvement, including
recommendations for how to improve'';
(C) by striking paragraph (4);
(D) by redesignating paragraphs (5) and (6) as
paragraphs (4) and (5), respectively;
(E) in paragraph (4), as so redesignated, by striking
``; and'' and inserting a semicolon;
(F) in paragraph (5), as so redesignated, by striking
the period and inserting ``; and''; and
(G) by adding at the end the following:
``(6) any evidence-based or evidence-informed strategies
developed or utilized pursuant to subsection (c)(5).''; and
(8) by amending subsection (h) to read as follows:
``(h) Dissemination of Findings.--Not later than 1 year after the
completion of the final project under subsection (a), the Secretary
shall submit to the Committee on Health, Education, Labor, and Pensions
of the Senate and the Committee on Energy and Commerce of the House of
Representatives a report describing the information contained in each
report submitted pursuant to subsection (g) and any additional actions
planned by the Secretary related to regionalized emergency care and
trauma systems.''.
(d) Program Funding.--Section 1232(a) of the Public Health Service
Act (42 U.S.C. 300d-32(a)) is amended by striking ``2010 through 2014''
and inserting ``2023 through 2027''.
I. Purpose and Summary
H.R. 8163, the ``Improving Trauma Systems and Emergency
Care Act of 2022,'' reauthorizes grants to improve trauma care
readiness and coordination and to support trauma care and
emergency medical services. The bill directs the Secretary of
the Department of Health and Human Services (HHS), acting
through the Assistant Secretary for Preparedness and Response
(ASPR), to support the efforts of States and consortia of
states to coordinate and improve emergency medical services and
trauma care during declared emergencies. The bill also expands
eligibility and revises grants for improving emergency medical
services and trauma in rural areas and competitive grants for
improving regional emergency medical and trauma systems.
II. Background and Need for Legislation
Managing care for traumatic injuries requires enhanced
coordination and support among health care providers and
support personnel in order to save lives and reduce mortality.
Unintentional injury is the leading cause of death for people
under age 44 and the fourth leading cause of death of all age
groups in the United States.\1\ It is estimated that the annual
burden of trauma care is approximately $670 billion in the
United States when accounting for total medical expenditures
and lost productivity from trauma-related injuries.\2\
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\1\Centers for Disease Control and Prevention, WISQRS 10 Leading
Causes of Death (https://wisqars.cdc.gov/data/lcd/home) (accessed Sept.
22, 2022).
\2\Jeff Choi et al, The Impact of Trauma Systems on Patient
Outcomes, Current Problems in Surgery (Jan. 2021).
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As noted by the National Academies for Sciences,
Engineering, and Medicine in a 2016 report, ``recognizing the
best strategy to reduce the considerable burden associated with
trauma is to prevent injuries from occurring in the first
place, the delivery of optimal trauma care when injuries do
occur is a critical means to preventing unnecessary death and
disability.''\3\ The National Academies estimated that ``of the
147,790 U.S. trauma deaths in 2014, as many as 20 percent--or
about 30,000--may have been preventable after injury with
optimal trauma care.''\4\
---------------------------------------------------------------------------
\3\National Academies of Sciences, Engineering, and Medicine, New
Report: Up to 20 Percent of U.S. Trauma Death Could Be Prevented with
Better Care (June 17, 2016) (press release).
\4\Id.
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Approximately 46.7 million Americans do not live within 60
minutes of a Level I or Level II trauma center--often referred
to as the ``golden hour'' following traumatic injury during
which there is the highest likelihood that prompt medical
treatment can prevent death.\5\ Residents without access to
trauma centers often live in rural areas that lack inclusive
systems of care.\6\
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\5\Charles Branas et al, Access to Trauma Centers in the United
States, JAMA (June 1, 2005).
\6\Id.
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For these reasons, the provisions included in H.R. 8163 are
intended to enhance access to trauma care, improve coordination
among trauma systems, and provide resources for rural access to
trauma services. As noted by Dr. Kevin Croston, the Chief
Executive Officer of North Memorial Health, who testified in
support of H.R. 8163 before the Subcommittee on Health on June
29, 2022, the grants authorized by this bill ``represent and
support a core function of an ideal trauma system:
coordination.''\7\ The grants included in the bill are intended
to help trauma systems develop best practices, not only for
their own patients, but also to facilitate the dissemination of
those best practices to similar trauma systems throughout the
country to improve care overall.
---------------------------------------------------------------------------
\7\House Committee on Energy and Commerce, Testimony of Kevin
Croston, M.D., Chief Executive Officer, North Memorial Health, Hearing
on Investing in Public Health: Legislation to Support Patients,
Workers, and Research, 117th Cong. (June 29, 2022).
---------------------------------------------------------------------------
The 2016 National Academies report on a national trauma
care system provided a series of recommendations on how to
improve trauma care and reduce trauma-related mortality. These
recommendations included creating a vision for a national
trauma care system with national-level leadership that would
help better coordinate care and establish processes and tools
for disseminating trauma knowledge. H.R. 8163 helps further
these goals to integrate and improve the United States' trauma
care system to save lives following traumatic injury.
III. Committee Hearings
For the purposes of section 3(c) of rule XIII of the Rules
of the House of Representatives, the following hearing was used
to develop or consider H.R. 8163:
The Subcommittee on Health held a hearing on June 29, 2022,
entitled ``Investing in Public Health: Legislation to Support
Patients, Workers, and Research.'' The Subcommittee received
testimony from the following witnesses:
Kirsten Bibbins-Domingo, Ph.D., M.D.,
M.A.S., Professor of Epidemiology and Biostatistics and
the Lee Goldman, M.D. Professor of Medicine, University
of California, San Francisco;
Kevin Croston, M.D., CEO, North Memorial
Health;
Tanika Gray Valbrun, Founder and President,
The White Dress Project;
Michael D. Shannon, Executive/President of
Government Solutions, IPTalons, Inc.
Desiree Sweeney, CEO, NEW Health; and
Leslie R. Walker-Harding, M.D., F.A.A.P.,
F.S.A.H.M., Ford/Morgan Endowed Professor Chair
Department of Pediatrics/Associate Dean, University of
Washington; Chief Academic Officer/Senior Vice
President, Seattle Children's Hospital.
IV. Committee Consideration
H.R. 8163, the ``Improving Trauma Systems and Emergency
Care Act of 2022,'' was introduced on June 21, 2022, by
Representative Tom O'Halleran (D-AZ) and was referred to the
Committee on Energy and Commerce. Subsequently, on June 22,
2022, the bill was referred to the Subcommittee on Health.
On September 14, 2022, the Subcommittee on Health met in
open markup session, pursuant to notice, to consider H.R. 8163
and four other bills. During consideration of the bill, an
amendment in the nature of a substitute (AINS), offered by
Representative Eshoo (D-CA), was agreed to by a voice vote.
Upon conclusion of consideration of the bill, the Subcommittee
on Health agreed to report the bill favorably to the full
Committee, amended, by a voice vote.
On September 21, 2022, the full Committee met in open
markup session, pursuant to notice, to consider H.R. 8163 and
23 other bills. An AINS, offered by Representative O'Halleran,
was agreed to by a voice vote. Upon conclusion of consideration
of the bill, the full Committee agreed to a motion on final
passage offered by Representative Pallone, Chairman of the
Committee, to order H.R. 5585 reported favorably to the House,
amended, by a roll call vote of 55 yeas to 1 nays.
V. Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list each record vote
on the motion to report legislation and amendments thereto. The
Committee advises that there was one record vote taken on H.R.
8163, including a motion by Mr. Pallone ordering H.R. 8163
favorably reported to the House, amended. The motion on final
passage of the bill was approved by a record vote of 55 yeas to
1 nays. The following are the record votes taken during
Committee consideration, including the names of those members
voting for and against:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
VI. Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1)
of rule X of the Rules of the House of Representatives, the
oversight findings and recommendations of the Committee are
reflected in the descriptive portion of the report.
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to 3(c)(2) of rule XIII of the Rules of the House
of Representatives, the Committee adopts as its own the
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues contained in the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
The Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether this bill contains any new budget authority, spending
authority, credit authority, or an increase or decrease in
revenues or tax expenditures.
VIII. Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
IX. Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to enhance
access to trauma care, improve coordination among trauma
systems, and provide resources for rural access to trauma
services.
X. Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 8163 is known to be duplicative of another Federal
program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the
most recent Catalog of Federal Domestic Assistance.
XI. Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, the Committee
adopts as its own the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 8163 contains no earmarks, limited
tax benefits, or limited tariff benefits.
XIII. Advisory Committee Statement
No advisory committee within the meaning of section 5(b) of
the Federal Advisory Committee Act was created by this
legislation.
XIV. Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
XV. Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 designates that the short title may be cited as
the ``Improving Trauma Systems and Emergency Care Act.''
Sec. 2. Trauma care reauthorization
Section 2 amends section 1201 of the Public Health Service
Act to direct the Assistant Secretary for Preparedness and
Response to support the efforts of states and consortia of
states to coordinate and improve emergency medical services and
trauma care during a public health emergency. This support may
include developing, issuing, and updating guidance, as
appropriate, to support the coordinated medical triage and
evacuation to appropriate medical institutions based on patient
medical need; identification and dissemination of performance
metrics; and other activities as appropriate to optimize a
coordinated and flexible approach to the emergency response and
medical surge capacity of hospitals, other health care
facilities, critical care, and emergency medical systems.
Section 2 also amends section 1202 of the Public Health
Service Act to award grants to eligible entities for the
purpose of carrying out research and demonstration projects to
support the improvement of emergency medical services and
trauma care in rural areas.
Section 2 also amends section 1204 of the Public Health
Service Act to award pilot grants to trauma centers, such as a
consortium of level I, II, or III trauma centers designated by
applicable State or local agencies, in order to improve
situational awareness and emergency medical and trauma system
access and for other purposes.
Section 2 also amends section 1232(a) of the Public Health
Service Act to reauthorize this provision from 2023 to 2027.
XVI. Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE XII--TRAUMA CARE
Part A--General Authority and Duties of Secretary
SEC. 1201. ESTABLISHMENT.
(a) In General.--The Secretary shall, with respect to trauma
care--
(1) conduct and support research, training,
evaluations, and demonstration projects;
(2) foster the development of appropriate, modern
systems of such care through the sharing of information
among agencies and individuals involved in the study
and provision of such care;
(3) collect, compile, analyze, and disseminate
information on the achievements of, and problems
experienced by, State and local agencies and private
entities in providing trauma care and emergency medical
services and, in so doing, give special consideration
to the unique needs of rural areas and medically
underserved areas;
(4) provide to State and local agencies technical
assistance to enhance each State's capability to
develop, implement, and sustain the trauma care
component of each State's plan for the provision of
emergency medical services; and
[(5) sponsor workshops and conferences; and]
[(6)] (5) promote the collection and categorization
of trauma data in a consistent and standardized manner.
(b) Trauma Care Readiness and Coordination.--The Secretary,
acting through the Assistant Secretary for Preparedness and
Response, shall support the efforts of States and consortia of
States to coordinate and improve emergency medical services and
trauma care during a public health emergency declared by the
Secretary pursuant to section 319 or a major disaster or
emergency declared by the President under section 401 or 501,
respectively, of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act. Such support may include--
(1) developing, issuing, and updating guidance, as
appropriate, to support the coordinated medical triage
and evacuation to appropriate medical institutions
based on patient medical need, taking into account
regionalized systems of care;
(2) disseminating, as appropriate, information on
evidence-based or evidence-informed trauma care
practices, taking into consideration emergency medical
services and trauma care systems, including such
practices identified through activities conducted under
subsection (a) and which may include the identification
and dissemination of performance metrics, as applicable
and appropriate; and
(3) other activities, as appropriate, to optimize a
coordinated and flexible approach to the emergency
response and medical surge capacity of hospitals, other
health care facilities, critical care, and emergency
medical systems.
[(b)] (c) Grants, Cooperative Agreements, and Contracts.--The
Secretary may make grants, and enter into cooperative
agreements and contracts, for the purpose of carrying out
subsection (a).
SEC. 1202. [ESTABLISHMENT OF PROGRAMS FOR IMPROVING TRAUMA CARE IN
RURAL AREAS.] GRANTS TO IMPROVE TRAUMA CARE IN
RURAL AREAS.
[(a) In General.--The Secretary may make grants to public and
nonprofit private entities for the purpose of carrying out
research and demonstration projects with respect to improving
the availability and quality of emergency medical services in
rural areas--
[(1) by developing innovative uses of communications
technologies and the use of new communications
technology;
[(2) by developing model curricula, such as advanced
trauma life support, for training emergency medical
services personnel, including first responders,
emergency medical technicians, emergency nurses and
physicians, and paramedics--
[(A) in the assessment, stabilization,
treatment, preparation for transport, and
resuscitation of seriously injured patients,
with special attention to problems that arise
during long transports and to methods of
minimizing delays in transport to the
appropriate facility; and
[(B) in the management of the operation of
the emergency medical services system;
[(3) by making training for original certification,
and continuing education, in the provision and
management of emergency medical services more
accessible to emergency medical personnel in rural
areas through telecommunications, home studies,
providing teachers and training at locations accessible
to such personnel, and other methods;
[(4) by developing innovative protocols and
agreements to increase access to prehospital care and
equipment necessary for the transportation of seriously
injured patients to the appropriate facilities;
[(5) by evaluating the effectiveness of protocols
with respect to emergency medical services and systems;
and
[(6) by increasing communication and coordination
with State trauma systems.
[(b) Special Consideration for Certain Rural Areas.--In
making grants under subsection (a), the Secretary shall give
special consideration to any applicant for the grant that will
provide services under the grant in any rural area identified
by a State under section 1214(d)(1).]
(a) In General.--The Secretary shall award grants to eligible
entities for the purpose of carrying out research and
demonstration projects to support the improvement of emergency
medical services and trauma care in rural areas through the
development of innovative uses of technology, training and
education, transportation of seriously injured patients for the
purposes of receiving such emergency medical services, access
to prehospital care, evaluation of protocols for the purposes
of improvement of outcomes and dissemination of any related
best practices, activities to facilitate clinical research, as
applicable and appropriate, and increasing communication and
coordination with applicable State or Tribal trauma systems.
(b) Eligible Entities.--
(1) In general.--To be eligible to receive a grant
under this section, an entity shall be a public or
private entity that provides trauma care in a rural
area.
(2) Priority.--In awarding grants under this section,
the Secretary shall give priority to eligible entities
that will provide services under the grant in any rural
area identified by a State under section 1214(d)(1).
(c) Requirement of Application.--The Secretary may not make a
grant under subsection (a) unless an application for the grant
is submitted to the Secretary and the application is in such
form, is made in such manner, and contains such agreements,
assurances, and information as the Secretary determines to be
necessary to carry out this section.
(d) Reports.--An entity that receives a grant under this
section shall submit to the Secretary such reports as the
Secretary may require to inform administration of the program
under this section.
* * * * * * *
SEC. 1204. [COMPETITIVE GRANTS FOR REGIONALIZED SYSTEMS FOR EMERGENCY
CARE RESPONSE.] PILOT GRANTS FOR TRAUMA CENTERS.
(a) In General.--The Secretary, acting through the Assistant
Secretary for Preparedness and Response, shall award [not fewer
than 4] 10 multiyear contracts or competitive grants to
eligible entities to support pilot projects [that design,
implement, and evaluate] to design, implement, and evaluate new
or existing innovative models of regionalized, comprehensive,
and accountable [emergency care] emergency medical and trauma
systems, and improve access to trauma care within such systems.
(b) Eligible Entity; Region.--In this section:
(1) Eligible entity.--The term ``eligible entity''
means--
[(A) a State or a partnership of 1 or more
States and 1 or more local governments; or
[(B) an Indian tribe (as defined in section 4
of the Indian Health Care Improvement Act) or a
partnership of 1 or more Indian tribes.]
(A) a State or consortia of States;
(B) an Indian Tribe or Tribal organization
(as defined in section 4 of the Indian Self-
Determination and Education Assistance Act);
(C) a consortium of level I, II, or III
trauma centers designated by applicable State
or local agencies within an applicable State or
region, and, as applicable, other emergency
services providers; or
(D) a consortium or partnership of nonprofit
Indian Health Service, Indian Tribal, and urban
Indian trauma centers.
(2) Region.--The term ``region'' means an area within
a State, an area that lies within multiple States, or a
similar area (such as a multicounty area), as
determined by the Secretary.
(3) Emergency services.--The term ``emergency
services'' includes acute, prehospital, and trauma
care.
(c) Pilot Projects.--The Secretary shall award a contract or
grant under subsection (a) to an eligible entity [that proposes
a pilot project] to design, implement, and evaluate [an
emergency medical and trauma system that--] a new or existing
emergency medical and trauma system. Such eligible entity shall
use amounts awarded under this subsection to carry out 2 or
more of the following activities:
(1) [coordinates] Strengthening coordination and
communication with public health and safety services,
emergency medical services, medical facilities, trauma
centers, and other entities in a region to develop [an
approach to emergency medical and trauma system access
throughout the region, including 9-1-1 Public Safety
Answering Points and emergency medical dispatch;]
approaches to improve situational awareness and
emergency medical and trauma system access.
(2) [includes] Providing a mechanism, such as a
regional medical direction or transport communications
system, that operates throughout the region to support
patient movement to ensure that the patient is taken to
the medically appropriate facility (whether an initial
facility or a higher-level facility) in a timely
fashion[;].
(3) [allows for] Improving the tracking of
prehospital and hospital resources, including inpatient
bed capacity, emergency department capacity, trauma
center capacity, on-call specialist coverage, ambulance
diversion status, and the coordination of such tracking
with regional communications and hospital destination
decisions[; and].
(4) [includes a consistent] Supporting a consistent
region-wide prehospital, hospital, and interfacility
data management system that--
(A) submits data to the National EMS
Information System, the National Trauma Data
Bank, and others;
(B) reports data to appropriate Federal and
State databanks and registries; and
(C) contains information sufficient to
evaluate key elements of prehospital care,
hospital destination decisions, including
initial hospital and interfacility decisions,
and relevant health outcomes of hospital care.
(5) Establishing, implementing, and disseminating, or
utilizing existing, as applicable, evidence-based or
evidence-informed practices across facilities within
such emergency medical and trauma system to improve
health outcomes, including such practices related to
management of injuries, and the ability of such
facilities to surge.
(6) Conducting activities to facilitate clinical
research, as applicable and appropriate.
(d) Application.--
(1) In general.--An eligible entity that seeks a
contract or grant described in subsection (a) shall
submit to the Secretary an application at such time and
in such manner as the Secretary may require.
(2) Application information.--Each application shall
include--
(A) an assurance from the eligible entity
that [the proposed] the applicable emergency
medical and trauma system system--
(i) has been coordinated with the
applicable State Office of Emergency
Medical Services (or equivalent State
office or Tribal entity);
(ii) includes consistent indirect and
direct medical oversight of
prehospital, hospital, and
interfacility transport throughout the
region;
(iii) coordinates prehospital
treatment and triage, hospital
destination, and interfacility
transport throughout the region;
(iv) includes a categorization or
designation system for special medical
facilities throughout the region that
is integrated with transport and
destination protocols;
(v) includes a regional medical
direction, patient tracking, and
resource allocation system that
supports day-to-day emergency care and
surge capacity and is integrated with
other components of the national and
State emergency preparedness system;
and
(vi) addresses pediatric concerns
related to integration, planning,
preparedness, and coordination of
emergency medical services for infants,
children and adolescents[; and];
(B) for eligible entities described in
subparagraph (C) or (D) of subsection (b)(1), a
description of, and evidence of, coordination
with the applicable State Office of Emergency
Medical Services (or equivalent State Office)
or applicable such office for a Tribe or Tribal
organization; and
[(B)] (C) such other information as the
Secretary may require.
(e) Requirement of Matching Funds.--
(1) In general.--The Secretary may not make a grant
under this section unless the State (or consortia of
States) involved agrees, with respect to the costs to
be incurred by the State (or consortia) in carrying out
the purpose for which such grant was made, to make
available non-Federal contributions (in cash or in kind
under paragraph (2)) toward such costs in an amount
equal to not less than $1 for each $3 of Federal funds
provided in the grant. Such contributions may be made
directly or through donations from public or private
entities.
(2) Non-federal contributions.--Non-Federal
contributions required in paragraph (1) may be in cash
or in kind, fairly evaluated, including equipment or
services (and excluding indirect or overhead costs).
Amounts provided by the Federal Government, or services
assisted or subsidized to any significant extent by the
Federal Government, may not be included in determining
the amount of such non-Federal contributions.
(f) Priority.--The Secretary shall give priority for the
award of the contracts or grants described in subsection (a) to
any eligible entity that serves a [population in a medically
underserved area] medically underserved population (as defined
in section 330(b)(3)).
(g) Report.--Not later than 90 days after the completion of a
pilot project under subsection (a), the recipient of such
contract or grant [described in] shall submit to the Secretary
a report containing the results of an evaluation of the
program, including an identification of--
(1) the impact of the regional, accountable emergency
care and trauma system on patient health outcomes for
various critical care categories, such as trauma,
stroke, cardiac emergencies, neurological emergencies,
and pediatric emergencies;
(2) [the system characteristics that contribute to]
opportunities for improvement, including
recommendations for how to improve the effectiveness
and efficiency of the program (or lack thereof);
(3) methods of assuring the long-term financial
sustainability of the emergency care and trauma system;
[(4) the State and local legislation necessary to
implement and to maintain the system;]
[(5)] (4) the barriers to developing regionalized,
accountable emergency care and trauma systems, as well
as the methods to overcome such barriers[; and];
[(6)] (5) recommendations on the utilization of
available funding for future regionalization
efforts[.]; and
(6) any evidence-based or evidence-informed
strategies developed or utilized pursuant to subsection
(c)(5).
[(h) Dissemination of Findings.--The Secretary shall, as
appropriate, disseminate to the public and to the appropriate
Committees of the Congress, the information contained in a
report made under subsection (g).]
(h) Dissemination of Findings.--Not later than 1 year after
the completion of the final project under subsection (a), the
Secretary shall submit to the Committee on Health, Education,
Labor, and Pensions of the Senate and the Committee on Energy
and Commerce of the House of Representatives a report
describing the information contained in each report submitted
pursuant to subsection (g) and any additional actions planned
by the Secretary related to regionalized emergency care and
trauma systems.
* * * * * * *
Part C--General Provisions Regarding Parts A and B
* * * * * * *
SEC. 1232. FUNDING.
(a) Authorization of Appropriations.--For the purpose of
carrying out parts A and B, subject to subsections (b) and (c),
there are authorized to be appropriated $24,000,000 for each of
fiscal years [2010 through 2014] 2023 through 2027.
(b) Reservation of Funds.--If the amount appropriated under
subsection (a) for a fiscal year is equal to or less than
$1,000,000, such appropriation is available only for the
purpose of carrying out part A. If the amount so appropriated
is greater than $1,000,000, 50 percent of such appropriation
shall be made available for the purpose of carrying out part A
and 50 percent shall be made available for the purpose of
carrying out part B.
(c) Allocation of Part A Funds.--Of the amounts appropriated
under subsection (a) for a fiscal year to carry out part A--
(1) 10 percent of such amounts for such year shall be
allocated for administrative purposes; and
(2) 10 percent of such amounts for such year shall be
allocated for the purpose of carrying out section 1202.
(d) Authority.--For the purpose of carrying out parts A
through C, beginning on the date of enactment of the Patient
Protection and Affordable Care Act, the Secretary shall
transfer authority in administering grants and related
authorities under such parts from the Administrator of the
Health Resources and Services Administration to the Assistant
Secretary for Preparedness and Response.
* * * * * * *
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