PROPERTYOF NOV20 RECTI HCFALIBRARY 105thcongress S.2091 2dSession ToamendtitleX\^IIoftheSocialSecurityActtoensuremedicarereimburse- ment for certain ambulance services, and to improve the efficiency of theemergencymedicalsystem,andforotherpurposes. IN THE SENATE OF THE UN^TED STATES May19,1998 Mr.Gramsintroducedthefollowingbill;whichwasreadtwiceandreferred totheCommitteeonFinance A BILL To amend title XVHI of the Social Security Act to ensure medicare reimbursement for certain ambulance sendees, and to improve the efficiency ofthe emergency medical system,andforotherpurposes. 1 BeitenactedhytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, 3 SECTION1.SHORTTITLE. 4 This Act may be cited as the "Emergency Medical 5 ServicesEfficiencyActof1998". — TITLE I—MEDICARE COVERAGE 1 OF CERTAIN AMBULANCE 2 SERVICES 3 4 SEC.101.MEDICARECOVERAGEOFCERTAINAMBULANCE 5 SERVICES. 6 (a)Coverage.—Section1861(s)(7)oftheSocialSe- 7 curityAct(42U.S.C. 1395x(s)(7))isamendedbystriking 8 "regulations;" and inserting "regulations, except that 9 suchregulationsshallnotfailtotreatambulanceservices 10 asmedicalandotherhealthsendeessolelybecausetheul- 11 timatediagnosisoftheindividualreceivingtheambulance 12 servicesresultsinthe conclusionthat ambulance services 13 werenotnecessary, aslongastherequestforambulance 14 servicesismadeafterthesuddenonsetofamedicalcondi- 15 tionthatismanifestedbysymptomsofsuchsufficientse- 16 verity, including severe pam, that a prudent layperson, 17 who possesses anaverageknowledge ofhealth and medi- 18 cine, couldreasonablyexpecttoresult,withoutimmediate 19 medicalattention,in 20 (A) placing the indi\ddaars health in serious 21 jeopardy; 22 "(B) serious impairment to the individual's 23 bodilyfunctions;or 24 "(C) seriousdysfunction ofanybodUyorganor 25 partoftheindividual;". >S2091IS 3 — 1 (b) Effective Date. The amendment made by 2 subsection (a) shall applyto items and services provided 3 onorafterthedateofenactmentofthisAct. TITLE II—STATE EMERGENCY 4 MEDICAL SERVICES AGENCY 5 PARTICIPATION IN CERTAIN 6 FEDERAL PROGRAMS 7 8 SEC.201.TELEMEDICINEANDDISTANCELEARNINGSERV- 9 ICESINRURALAREAS. — 10 (a) In General. Section 2333(c)(1) ofchapter 1 11 ofsubtitleDoftitleXXIIIoftheFood,Agriculture,Con- 12 servation, and Trade Act of 1990 (7 U.S.C. 950aaa- 13 2(c)(1)) is amended by adding at the end the following 14 flushsentence: 15 "Forpurposes ofthisparagraph, the term 'entities' 16 shallinclude Stateemergencymedicalservices agen- 17 cies.". — 18 (b) Effective Date. The amendment made by 19 subsection (a) shalltake effectonthe date ofenactment 20 ofthisAct. 21 SEC.202.INFORMATICS,TELEMEDICINE,ANDEDUCATION 22 DEMONSTRATIONPROJECT. — 23 (a) In Gent:ral. Section 4207(c) ofthe Balanced 24 Budget Act of 1997 (42 U.S.C. 1395b-l(c) note.) is >S2091IS — 4 1 amended by adding at the end the following flush sen- 2 tence: 3 "A State emergency medical services agencj^ may 4 participateintheconsortiumunderthissection.". 5 (b) Effective Date.—The amendment made by 6 subsection (a) shall take effect onthe date ofenactment 7 ofthisAct. TITLE III—FEDERAL COMMIS- 8 SIGN FOR EMERGENCYAMBU- 9 LANCE SERVICES 10 11 SEC.301.DEFINITIONOFEMERGENCYAMBULANCESERV- 12 ICES. 13 In this title, the term "emergency ambulance serv- 14 ices"— 15 (1) means resourcesusedbya quahfied pubhc, 16 private, or nonprofit entity to dehver medical care 17 underemergencyconditions 18 (A) that occur as aresult ofthe condition 19 ofapatient;or 20 (B) thatoccurasaresultofanaturaldis- 21 asterorsimilarsituation;and 22 (2) includes services dehveredbyan emergency 23 ambulance employee that is hcensed or certified by 24 a Stateasanemergencymedicaltechnician apara- S2091IS — 1 medic, a registered nurse, a physician assistant, or 2 aphysician. ... 3 SEC.302.ESTABLISHMENTOFCOMMISSION. — 4 (a) Establishment. There is estabUshed a com- 5 missiontobeknownastheFederalCommissionforEmer- 6 gencyAmbulance Services (inthistitlereferredto asthe 7 "Commission"). — 8 (b)Membership. — 9 (1) Composition. The Commission shall be 10 composedof21 members,ofwhom 11 (A) 1 shall be an individual who is ap- 12 pointed by the Majority Leader ofthe Senate; 13 (B) 1 shall be an individual who is ap- 14 pointed by the Minority Leader ofthe Senate; 15 (C) 1 shall be an individual who is ap- 16 pointed by the Speaker ofthe House of Rep- 17 resentatives; 18 (D) 1 shall be an individual who is ap- 19 pointedbytheMinorityLeaderoftheHouseof 20 Representatives; 21 (E) 1 shall be a member ofthe American 22 AcademyofPediatrics, appointedbythe Presi- 23 dent from a Ust of nominations submitted by 24 , theAmericanAcademyofPediatrics; 'S2091IS 6 1 (F) 1 shall be a member oftheAmerican 2 AmbulanceAssociation, appointedbythePresi- 3 dent from a list of nominations submitted by 4 theAmericanAmbulanceAssociation; 5 (G) 1 shall be a member ofthe American 6 College ofEmergencyPhysicians, appointed by 7 the President from a hst of nominations sub- 8 mitted by the American College of Emergency 9 Physicians; 10 (H) 1 shallbeamemberoftheCommittee 11 onTraumawithmtheAmericanCollegeofSur- 12 geons, appointedbythePresidentfromahstof 13 nominations submittedbytheAmericanCollege 14 ofSurgeons; 15 (I) 1 shaU be a member ofthe American 16 Hospital Association, appointed by the Presi- 17 dent from a list of nominations submitted by 18 theAmericanHospitalAssociation; 19 (J) 1 shallbe amemberofthe Committee 20 on EMS-F30 within the American Soc'sty for 21 Testing and Material, appointed by the Presi- 22 dent from a hst of nominations submitted by 23 theAmerican SocietyforTestingandMaterial; 24 (K) 1 shallbe amemberoftheAssociated 25 Pubhc Safety Communications Officials Inter- •S2091IS it 7 1 national, appointedbythePresidentfromalist 2 of nominations submitted by the Associated 3 Public Safety Communications Officials Inter- 4 national; 5 (L) 1 shallbeamemberoftheAssociation 6 ofAirMedicalServices, appointedbythePresi- 7 dent from a list of nominations submitted by 8 theAssociationofAirMedicalServices; 9 (M) 1 shallbeamemberoftheEmergency 10 NursesAssociation, appointedbythePresident 11 from a list of nominations submitted by the 12 EmergencyNursesAssociation; 13 (N) 1 shall be a member of the Inter- 14 national Association of Fire Chiefs, appointed 15 bythePresidentfromahstofnominationssub- 16 mittedbythe InternationalAssociation ofFire 17 Chiefs; 18 (O) 1 shall be a member of the Inter- 19 nationalAssociationofFireFighters, appointed 20 bythePresidentfromalistofnominationssub- 21 mittedbythe InternationalAssociation ofFire 22 Fighters; 23 (P) 1 shalleachbe amemberofagovern- 24 ingbodyofanIndiantribe (asthattermisde- 25 fined in section 4(e) ofthe Indian Self-Deter- •S2091IS 8 mination and Education Assistance Act (25 U.S.C. 450b(e)), appointedbythePresident; (Q) 1 shall be a member ofthe National Association of Emergency Medical Services Physicians, appointed by the President from a list of nominations submitted by the National Association of Emergency Medical Services Physicians; (R) 1 shall be a member ofthe National Association of State Emergency Medical Serv- icesDirectors, appointedbythePresidentfrom ahstofnominations submittedbythe National Association of State Emergency Medical Serv- icesDirectors; (S) 1 shall be a member ofthe National Association ofEmergencyMedical Technicians, appointedbythePresidentfromahst ofnomi- nations submitted by the National Association ofEmergencyMedicalTechnicians; (T) 1 shall be a member ofthe Natirnal Rural Health Association, appointed by the President from a hst ofnominations submitted bythe National Rural HealthAssociation; and (U) 1 shall be a member ofthe National VolunteerFire Council, appointedbythePresi- — — 9 1 dent from a list of nominations submitted by 2 theNationalVolunteerFireCouncil. — 3 (2)Additionalrequirements. 4 (A) Geographicalrepresentationand — 5 URBAN ANT) RURAL REPRESENTATION. In 6 making appointments of members under para- 7 graph (1), the appointing officials described in 8 suchparagraph shall, through consultation and 9 collaborationwitheachother,select 10 (i) members who are geographically 11 representativeoftheUnitedStates; and 12 (ii)memberswhoarerepresentativeof 13 ruralareasandurbanareas. — 14 (B) Special rule. The appointing offi- 15 cials describedparagraph (1) shall ensurethat, 16 ofthemembersappointed 17 (i) 11 shaU be representative ofrural 18 areas;and 19 (ii) 11 shaU be representative of 20 urbanareas. . — 21 (3) Date. The appointments ofthe members 22 oftheCommissionshallbemadenotlaterthanJan- 23 uary1, 1999. — 24 (c)PeriodofAppointment;Vacancies. •S2091IS 10 — 1 (1) Period ofappointment. Members shall 2 beappointedforatermof4years. — 3 (2)Vacancy. — 4 (A) In general. ^Any vacancy in the 5 Commission shall not affect the powers ofthe 6 Commission, but shall be filled in the same 7 mannerastheoriginalappointment. — 8 (B) Filling unexpired terms. ^An in- 9 dividual chosen to fiU a vacancy under this 10 paragraph shall be appointed forthe unexpired 11 termofthememberreplaced. 12 (d)INITLU.Meeting.—Notlaterthan30daysafter 13 the date onwhich all members ofthe Commission have 14 beenappointed, theCommissionshallholditsfirstmeet- 15 ing. 16 (e) Meetings.—The Commission shall meet at the 17 calloftheChairperson. 18 (f) Quorum.—A majority of the members of the 19 Commissionshallconstituteaquorum, butalessernum- 20 berofmembersmayholdhearings. — 21 (g) Chairperson and Vice Chairperson. The 22 Commission shall select a Chairj^erson and Vice Chair- 23 personfromamongthemembersoftheCommission. >S2091IS