[House Report 118-532]
[From the U.S. Government Publishing Office]


118th Congress }                                             { Report
                        HOUSE OF REPRESENTATIVES
 2d Session    }                                             { 118-532

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



 
                SUPPORTING AND IMPROVING RURAL EMS NEEDS  
                          REAUTHORIZATION ACT   

                                _______
                                

  May 31, 2024.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

     Mrs. Rodgers of Washington, from the Committee on Energy and 
                  Commerce, submitted the following

                              R E P O R T

                        [To accompany H.R. 4646]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4646) to reauthorize the rural emergency medical 
service training and equipment assistance program, and for 
other purposes, having considered the same, reports favorably 
thereon with an amendment and recommends that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Committee Action.................................................     3
Committee Votes..................................................     3
Oversight Findings and Recommendations...........................     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Statement of General Performance Goals and Objectives............     5
Duplication of Federal Programs..................................     5
Related Committee and Subcommittee Hearings......................     5
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

    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 ``Supporting and Improving Rural EMS 
Needs Reauthorization Act'' or the ``SIREN Reauthorization Act''.

SEC. 2. RURAL EMERGENCY MEDICAL SERVICE TRAINING AND EQUIPMENT 
           ASSISTANCE PROGRAM.

  Section 330J of the Public Health Service Act (42 U.S.C. 254c-15) is 
amended--
          (1) in subsection (a), by striking ``the Administrator of the 
        Health Resources and Services Administration (referred to in 
        this section as the `Secretary')'' and inserting ``the 
        Assistant Secretary,'';
          (2) in subsection (c)--
                  (A) in paragraph (1)--
                          (i) in subparagraph (C), by striking ``; 
                        and'' and inserting a semicolon; and
                          (ii) by adding at the end the following:
                  ``(E) ensure emergency medical services personnel are 
                trained on mental health and substance use disorders 
                and care for individuals with such disorders in 
                emergency situations; and''; and
                  (B) in paragraph (2)--
                          (i) in subparagraph (B), by striking ``; or'' 
                        and inserting a semicolon;
                          (ii) in subparagraph (C), by striking the 
                        period and inserting ``; or''; and
                          (iii) by adding at the end the following:
                  ``(D) acquire drugs or devices approved, cleared, or 
                otherwise legally marketed under the Federal Food, 
                Drug, and Cosmetic Act for emergency treatment of known 
                or suspected overdose.'';
          (3) by striking subsection (f);
          (4) by redesignating subsection (g) as subsection (f);
          (5) in subsection (f)(1), as so redesignated, by striking 
        ``2019 through 2023'' and inserting ``2025 through 2029'';
          (6) by redesignating such section 330J as section 553 of the 
        Public Health Service Act; and
          (7) by transferring such section 553, as so redesignated, to 
        appear at the end of part D of title V of the Public Health 
        Service Act (42 U.S.C. 290dd et seq.).

                          Purpose and Summary

    H.R. 4646 reauthorizes and modifies the rural emergency 
medical services (EMS) training and equipment assistance 
program through 2029.

                  Background and Need for Legislation

    H.R. 4646 reauthorizes the SIREN program, which supports 
and improves emergency medical services (EMS) in rural areas. 
Eligible applicants are rural local, tribal, and non-profit EMS 
agencies. Rural EMS and fire agencies experience unique 
challenges while serving patients--they are often the only 
health care provider in certain areas and may face difficulty 
in recruiting and retaining workers. The Rural Emergency 
Medical Services Training program was originally authorized 
through the Agriculture Improvement Act of 2018 and provides 
support to recruit and train EMS personnel in rural areas with 
a focus on addressing substance use disorders (SUD) and co-
occurring disorders.1}2 H.R. 4646 grants provide 
direct assistance to EMS programs to purchase the personal 
protective equipment (PPE) needed to protect EMS practitioners 
and firefighters as well as medical supplies. The program also 
supports volunteer recruitment, retention, and training 
efforts. In fiscal year 2023, the Substance Abuse and Mental 
Health Services Administration (SAMHSA) awarded approximately 
36 EMS agencies in multiple states with grants for recruitment 
and training purposes.\3\
---------------------------------------------------------------------------
    \1\Public Law 115-334: Agriculture Improvement Act of 2018, https:/
/www.govinfo.gov/app/details/PLAW-115publ334.
    \2\Department of Health and Human Services, Substance Abuse and 
Mental Health Services Administration, ``FY2024 Rural Emergency Medical 
Services Training'', 2024. https://www.samhsa.gov/sites/default/files/
grants/pdf/fy-2024-ems-training-nofo.pdf.
    \3\Substance Abuse and Mental Health Services Administration, 
``Grants Dashboard''. https://www.samhsa.gov/grants/grants-
dashboard?f%5B0%5D=by_award_fy%3A2023&f%5B1%5D=by_n ofo_number%3ATI-23-
011&page=0%2C1.
---------------------------------------------------------------------------

                            Committee Action

    On February 14, 2024, the Subcommittee on Health held a 
hearing on H.R. 4646. The title of the hearing was 
``Legislative Proposals to Support Patients and Caregivers.'' 
The Subcommittee received testimony from:
           Andy Shih, PhD, Chief Science Officer, 
        Autism Speaks;
           Corey Feist, JD, MBA, Co-Founder and CEO, 
        Dr. Lorna Breen Heroes' Foundation;
           Joanne Pike, DrPH, President and CEO, 
        Alzheimer's Association;
           Gordon Tomaselli, MD, Former President, 
        American Heart Association; Marilyn and Stanley M. Katz 
        Dean, Emeritus and Professor of Medicine, Albert 
        Einstein College of Medicine; Adjunct Professor of 
        Medicine, Johns Hopkins University School of Medicine;
           Michelle Whitten, President, CEO, and Co-
        Founder, Global Down Syndrome Foundation;
           Randy Strozyk, President, American Ambulance 
        Association; and
           Christina Annunziata, MD, PhD, Senior Vice 
        President of Extramural Discovery Science, American 
        Cancer Society.
    On March 12, 2024, the Subcommittee on Health met in open 
markup session and forwarded H.R. 4646, as amended, to the full 
Committee by a record vote of 24 yeas and 0 nays.
    On March 20, 2024, the full Committee on Energy and 
Commerce met in open markup session and ordered H.R. 4646, as 
amended, favorably reported to the House by a record vote of 46 
yeas and 0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:

 [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT] 

                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

     New Budget Authority, Entitlement Authority, and Tax   
                          Expenditures 

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 4646 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       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.

         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 support 
and help improve emergency medical services (EMS) in rural 
areas.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4646 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.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 4646:
           On February 14, 2024, the Subcommittee on 
        Health held a hearing on H.R. 4646. The title of the 
        hearing was ``Legislative Proposals to Support Patients 
        and Caregivers.'' The Subcommittee received testimony 
        from:
                   Andy Shih, PhD, Chief Science 
                Officer, Autism Speaks;
                   Corey Feist, JD, MBA, Co-Founder 
                and CEO, Dr. Lorna Breen Heroes' Foundation;
                   Joanne Pike, DrPH, President and 
                CEO, Alzheimer's Association;
                   Gordon Tomaselli, MD, Former 
                President, American Heart Association; Marilyn 
                and Stanley M. Katz Dean, Emeritus and 
                Professor of Medicine, Albert Einstein College 
                of Medicine; Adjunct Professor of Medicine, 
                Johns Hopkins University School of Medicine;
                   Michelle Whitten, President, 
                CEO, and Co-Founder, Global Down Syndrome 
                Foundation;
                   Randy Strozyk, President, 
                American Ambulance Association; and
                   Christina Annunziata, MD, PhD, 
                Senior Vice President of Extramural Discovery 
                Science, American Cancer Society.

                        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. At the time this report was 
filed, the estimate was not available.

       Earmark, 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. 4646 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 provides that the Act may be cited as the 
``Supporting and Improving Rural EMS Needs Reauthorization 
Act'' or the ``SIREN Reauthorization Act''.

Section 2. Rural Emergency Medical Service Training and equipment 
        assistance program

    Section 2 amends Section 330J of the Public Health Service 
Act to include training on mental health and substance use 
disorder for EMS personnel, grant matching requirements, and 
the ability to acquire overdose reversal medication. This 
section also reauthorizes this program for five fiscal years, 
from fiscal year 2025 through 2029.

         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 V--SUBSTANCE ABUSE AND MENTAL HEALTH  
                        SERVICES ADMINISTRATION 

           *       *       *       *       *       *       *



         Part D--Miscellaneous Provisions Relating to Substance  
                       Abuse and Mental Health  

           *       *       *       *       *       *       *



SEC. [330J]  553. RURAL EMERGENCY MEDICAL SERVICE TRAINING  
            AND EQUIPMENT ASSISTANCE PROGRAM. 

  (a) Grants.--The Secretary, acting through [the Administrator 
of the Health Resources and Services Administration (referred 
to in this section as the ``Secretary'')] the Assistant 
Secretary, shall award grants to eligible entities to enable 
such entities to provide for improved emergency medical 
services in rural areas or to residents of rural areas.
  (b) Eligibility; Application.--To be eligible to receive 
grant under this section, an entity shall--
          (1) be--
                  (A) an emergency medical services agency 
                operated by a local or tribal government 
                (including fire-based and non-fire based); or
                  (B) an emergency medical services agency that 
                is described in section 501(c) of the Internal 
                Revenue Code of 1986 and exempt from tax under 
                section 501(a) of such Code; and
          (2) submit an application to the Secretary at such 
        time, in such manner, and containing such information 
        as the Secretary may require.
  (c) Use of Funds.--An entity--
          (1) shall use amounts received through a grant under 
        subsection (a) to--
                  (A) train emergency medical services 
                personnel as appropriate to obtain and maintain 
                licenses and certifications relevant to service 
                in an emergency medical services agency 
                described in subsection (b)(1);
                  (B) conduct courses that qualify graduates to 
                serve in an emergency medical services agency 
                described in subsection (b)(1) in accordance 
                with State and local requirements;
                  (C) fund specific training to meet Federal or 
                State licensing or certification requirements[; 
                and];
                  (D) acquire emergency medical services 
                equipment; and
                  (E) ensure emergency medical services 
                personnel are trained on mental health and 
                substance use disorders and care for 
                individuals with such disorders in emergency 
                situations; and
          (2) may use amounts received through a grant under 
        subsection (a) to--
                  (A) recruit and retain emergency medical 
                services personnel, which may include volunteer 
                personnel;
                  (B) develop new ways to educate emergency 
                health care providers through the use of 
                technology-enhanced educational methods[; or];
                  (C) acquire personal protective equipment for 
                emergency medical services personnel as 
                required by the Occupational Safety and Health 
                Administration[.]; or
                  (D) acquire drugs or devices approved, 
                cleared, or otherwise legally marketed under 
                the Federal Food, Drug, and Cosmetic Act for 
                emergency treatment of known or suspected 
                overdose.
  (d) Grant Amounts.--Each grant awarded under this section 
shall be in an amount not to exceed $200,000.
  (e) Definitions.--In this section:
          (1) The term ``emergency medical services''--
                  (A) means resources used by a public or 
                private nonprofit licensed entity to deliver 
                medical care outside of a medical facility 
                under emergency conditions that occur as a 
                result of the condition of the patient; and
                  (B) includes services delivered (either on a 
                compensated or volunteer basis) by an emergency 
                medical services provider or other provider 
                that is licensed or certified by the State 
                involved as an emergency medical technician, a 
                paramedic, or an equivalent professional (as 
                determined by the State).
          (2) The term ``rural area'' means--
                  (A) a nonmetropolitan statistical area;
                  (B) an area designated as a rural area by any 
                law or regulation of a State; or
                  (C) a rural census tract of a metropolitan 
                statistical area (as determined under the most 
                recent rural urban commuting area code as set 
                forth by the Office of Management and Budget).
  [(f) Matching Requirement.--The Secretary may not award a 
grant under this section to an entity unless the entity agrees 
that the entity will make available (directly or through 
contributions from other public or private entities) non-
Federal contributions toward the activities to be carried out 
under the grant in an amount equal to 10 percent of the amount 
received under the grant.]
  [(g)] (f) Authorization of Appropriations.--
          (1) In general.--There are authorized to be 
        appropriated to carry out this section such sums as may 
        be necessary for each of fiscal years [2019 through 
        2023] 2025 through 2029.
          (2) Administrative costs.--The Secretary may use not 
        more than 10 percent of the amount appropriated under 
        paragraph (1) for a fiscal year for the administrative 
        expenses of carrying out this section.

           *       *       *       *       *       *       *


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