[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\
---------------------------------------------------------------------------
    \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).
---------------------------------------------------------------------------
    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.
---------------------------------------------------------------------------
    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\
---------------------------------------------------------------------------
    \5\Charles Branas et al, Access to Trauma Centers in the United 
States, JAMA (June 1, 2005).
    \6\Id.
---------------------------------------------------------------------------
    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.

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Part C--General Provisions Regarding Parts A and B

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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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