,i #aacth ,,congress #ast ,session ,h4 ,r4 #hji ,,in ,,the ,,house ,,of ,,representatives ,february #be1 #bjac ,mr4 ,bucshon introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to provide for improvement of field emergency medical services1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,field ,,ems ,quality1 ,innovation1 and ,cost ,effectiveness ,improvements ,act of #bjac4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,findings4 ,sec4 #c4 ,definitions4 ,sec4 #d4 ,recognition of ,,hhs as primary ,federal agency for emergency medical services and trauma care4 ,sec4 #e4 ,field ,,ems ,excellence1 ,quality1 ,universal ,access1 ,innovation1 and ,preparedness4 ,sec4 #f4 ,field ,,ems ,system ,performance1 ,integration1 and ,accountability4 ,sec4 #g4 ,field ,,ems quality4 ,sec4 #h4 ,field ,,ems education grants4 ,sec4 #i4 ,evaluating innovative models for access and delivery of field ,,ems for patients4 ,sec4 #aj4 ,enhancing research in field ,,ems4 ,sec4 #aa4 ,emergency ,medical ,services ,trust ,fund4 ,sec4 #ab4 ,authorization of appropriations4 #b4 ,findings ,the ,congress finds the following3 7#a7 ,all persons throughout the country should have access to and receive high-quality emergency medical care as part of a coordinated emergency medical services system4 7#b7 ,properly functioning emergency medical services 7,,ems7 systems1 #bd hours per day1 #g days per week1 are essential to ensure access to emergency medical care and transport for all patients with emergency medical conditions4 ,such coordinated ,,ems systems are also necessary for response to catastrophic incidents4 7#c7 ,ensuring high-quality and cost-effective ,,ems systems requires readiness1 preparedness1 medical direction1 oversight1 and innovation throughout the continuum of emergency medical care through ,federal1 ,state1 and local multijurisdictional collaboration and sufficient resources for ,,ems agencies and providers4 7#d7 ,at the ,federal level1 ,,ems responsibilities and resources of several ,federal agencies consistent with their expertise and authority must emphasize the critical importance of ,federal agency collaboration and coordination for all emergency medical services4 7#e7 ,at the ,state and local level1 ,,ems systems and agencies require the coordination and improved capabilities of multiple and diverse stakeholders4 7#f7 ,emergency medical services encompass the provision of care provided to patients with emergency medical conditions throughout the continuum1 including emergency medical care and trauma care provided in the field1 hospital1 and rehabilitation settings4 7#g7 ,field ,,ems comprises essential emergency medical services1 including medical care or medical transport provided to patients prior to or outside medical facilities and other clinical settings4 ,the primary purpose of field emergency medical services is to ensure that emergency medical patients receive the right care at the right place in the right amount of time4 7#h7 ,coordinated and high-quality field ,,ems is essential to the ,nation's security4 ,field ,,ems is an essential public service provided by governmental and nongovernmental agencies and practitioners #bd hours a day1 #g days a week1 and during catastrophic incidents4 ,to ensure disaster and all-hazards preparedness for ,,ems operations as part of the ,nation's comprehensive disaster preparedness1 ,federal funding for preparedness activities1 including catastrophic training and drills1 must be provided to governmental and nongovernmental ,,ems agencies so as to ensure a greater capability within each of these areas4 7#i7 ,numerous recommendations from several significant national reports and documents have demonstrated the need in multiple areas for substantial improvement of emergency medical services provided in the field1 including recommendations in the ,,ems ,agenda for the ,future1 the ,institute of ,medicine report ,the ,future of ,emergency ,care in the ,united ,health ,system1 and the ,national ,,ems ,education ,agenda for the ,future3 ,a ,systems ,approach and recommendations by the ,national ,,ems ,workforce ,injury and ,illness ,surveillance ,program1 the ,department of ,transportation's ,national ,,ems ,advisory ,council 7,,nemsac71 and the ,federal ,interagency ,committee on ,emergency ,medical ,services 7,,ficems74 7#aj7 ,to substantially improve field ,,ems1 advancements must be made in several essential areas including readiness1 innovation1 preparedness1 education and workforce development1 safety1 financing1 quality1 standards1 and research4 7#aa7 ,the recognition of a primary programmatic ,federal agency for emergency medical services within the ,department of ,health and ,human ,services was recommended by the ,institute of ,medicine and is necessary to provide a more streamlined1 cost-efficient1 and comprehensive approach for field ,,ems and a focal point for practitioners and agencies to interface with the ,federal ,government4 7#ab7 ,the essential role of field ,,ems in disaster preparedness and response must be incorporated into the national preparedness and response strategy and implementation as provided and overseen by the ,department of ,homeland ,security and the ,department of ,health and ,human ,services pursuant to their respective jurisdictions4 7#ac7 ,the essential role of ,,nhtsa in the continued development of ,,nemsis and in overseeing transportation issues related to field ,,ems such as ,,ems and ambulance vehicle safety standards should be maintained4 7#ad7 ,,ficems must continue in its essential role in coordinating the ,federal activities related to the full spectrum of ,,ems4 #c4 ,definitions ,in this ,act3 7#a7 ,the term ambulance diversion means the practice by hospitals of denying access to an incoming ambulance by requesting it to proceed to another facility due to a stated lack of capacity at the initial facility1 resulting in delayed access to definitive care4 7#b7 ,the term ,,ems means emergency medical services4 7#c7 ,the term ,,ficems means the ,federal ,interagency ,committee on ,emergency ,medical ,services4 7#d7 ,the term field ,,ems means emergency medical services provided to patients 7including transport by ground1 air1 or otherwise7 prior to or outside a medical facility or other clinical setting4 7#e7 ,the term field ,,ems agency means an organization providing field ,,ems1 regardless of-- 7,a7 whether such organization is governmental1 nongovernmental1 or volunteer2 and 7,b7 whether such organization provides field ,,ems by ground1 air1 or otherwise4 7#f7 ,the term emergency medical services or ,,ems means emergency medical care1 trauma care1 and related services provided to patients at any point in the continuum of health care services1 including emergency medical dispatch and emergency medical care1 trauma care1 and related services provided in the field1 during transport1 or in a medical facility or other clinical setting4 7#g7 ,the term field ,,ems patient care reports means the information that a field ,,ems agency typically creates regarding a patient's medical condition and treatment in the course of providing emergency medical services to that patient4 7#h7 ,the term medical oversight means the supervision by a physician of the medical aspects of an ,,ems system or agency and its providers including prospective1 concurrent1 and respective components of field ,,ems and the education of ,,ems providers4 7#i7 ,the term ,,nemsac means the ,national ,emergency ,medical ,services ,advisory ,council4 7#aj7 ,the term ,,nemsis means the ,national ,,ems ,information ,system4 7#aa7 ,the term ,,nhtsa means the ,national ,highway ,traffic ,safety ,administration4 7#ab7 ,the term patient parking means the practice by hospitals of refusing to accept transfer of a patient's care from an ambulance crew until a regular emergency department bed is available1 requiring the crew to continue to provide patient care on the ambulance stretcher other than a patient bed in the hospital until hospital staff will accept the transfer of care1 resulting in delayed access to definitive care4 7#ac7 ,the term ,state ,,ems ,office means an office designated by the ,state with primary responsibility for oversight of the ,state's ,,ems system1 such as responsibility for oversight of ,,ems coordination1 licensing or certifying ,,ems practitioners1 and ,,ems system improvement4 7#ad7 ,the term ,,stemi means ,,st-,segment ,elevation ,myocardial ,infarction4 #d4 ,recognition of ,,hhs as primary ,federal agency for emergency medical services and trauma care 7a7 ,primary ,federal agency ,the ,department of ,health and ,human ,services shall serve as the primary ,federal agency with responsibility for programs and activities relating to emergency medical services and trauma care4 7b7 ,office of ,,ems and ,trauma 7#a7 ,establishment ,there is established an ,office of ,emergency ,medical ,services and ,trauma1 to be known as the ,office of ,,ems and ,trauma1 within the ,department of ,health and ,human ,services4 ,the ,office of ,,ems and ,trauma shall be headed by a director appointed by the ,secretary of ,health and ,human ,services4 7#b7 ,role of ,office within ,,hhs 7,a7 ,in general ,the ,office of ,,ems and ,trauma shall have-- 7i7 the responsibilities delegated to the ,office of ,,ems and ,trauma pursuant to paragraph 7#c72 7ii7 the responsibilities and authorities vested in the ,office of ,,ems and ,trauma by other provisions of this ,act2 and 7iii7 such responsibilities and authorities as may be delegated or transferred to the ,office of ,,ems and ,trauma pursuant to subparagraph 7,b74 7,b7 ,additional responsibilities and authorities ,in addition to the responsibilities and authorities specified in clauses 7i7 and 7ii7 of subparagraph 7,a71 the ,secretary of ,health and ,human ,services may delegate or transfer to the ,office of ,,ems and ,trauma any other responsibility or authority of the ,department of ,health and ,human ,services relating to emergency medical services and trauma care1 including such services and care relating to-- 7i7 the full continuum of emergency medical services1 including field ,,ems and trauma and hospital emergency medical care2 or 7ii7 improving the quality1 innovation1 or cost effectiveness of emergency medical services4 7,c7 ,location of office in ,,hhs ,the ,secretary shall locate the ,office of ,,ems and ,trauma within the organizational structure of the ,department of ,health and ,human ,services in a manner that achieves each of the following3 7i7 ,recognition of the importance and unique life-saving services associated with field ,,ems1 trauma care1 and hospital emergency care as a significant ,federal priority4 7ii7 ,integration of these essential services with the larger health care system and within the disaster preparedness system1 including through regionalization of such services and by enhancing daily readiness capabilities to ensure adequate disaster readiness capabilities1 consistent with the ,national ,health ,security ,strategy4 7iii7 ,consolidation1 co-location1 and cost efficiencies in administering programs and activities related to field ,,ems1 trauma care1 and hospital emergency medical care4 7iv7 ,establishment of a ,federal focal point for leadership and improved coordination1 support1 and oversight of field ,,ems1 trauma care and hospital emergency medical care4 7v7 ,sufficient level and stature such that-- 7,i7 such ,office is able to fulfill its role1 responsibilities1 and authorities2 and 7,,ii7 the ,director of such ,office reports directly to the ,secretary or an official within the ,department who reports directly to the ,secretary4 7vi7 ,establishment of a visible and identifiable point of contact with which the public2 ,,ems agencies and practitioners2 ,state and local government agencies2 ,,ems educational institutions2 ,,ems1 trauma1 and hospital emergency care professional associations2 and all other parties may interact4 7#c7 ,responsibilities ,the ,secretary of ,health and ,human ,services shall1 at a minimum1 delegate responsibility to the ,office of ,,ems and ,trauma to carry out-- 7,a7 sections #e and #f 7relating to the ,,equip and ,,spia grant programs1 respectively72 7,b7 section #ccj;,j of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#ae2 relating to rural emergency service training and equipment assistance program72 7,c7 part ,a 7#db ,u4,s4,c4 #cjj;d et seq471 part ,b 7#db ,u4,s4,c4 #cjj;d-#aa et seq471 part ,c 7#db ,u4,s4,c4 #cjj;d-#ca et seq471 part ,d 7#db ,u4,s4,c4 #cjj;d-#da et seq471 and part ,h 7#db ,u4,s4,c4 #cjj;d-#ha et seq47 of title ,,xii of the ,public ,health ,service ,act 7relating to trauma care72 7,d7 section #h 7relating to the field ,,ems education grant program72 and 7,e7 section #i 7relating to evaluating innovative models for access and delivery of field ,,ems for patients74 7c7 ,national ,,ems strategy ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,office of ,,ems and ,trauma1 and in consultation with the ,assistant ,secretary for ,preparedness and ,response and the ,administrator of the ,health ,resources and ,services ,administration1 shall develop and implement a cohesive national ,,ems strategy to strengthen the development of the full continuum of ,,ems at the ,federal1 ,state1 and local levels4 ,in establishing such a strategy1 the ,secretary shall-- 7#a7 solicit and consider the recommendations of the ,,nemsac as well as relevant stakeholders2 7#b7 consult and collaborate with ,,ficems to ensure consistency of such national ,,ems strategy within the larger ,federal strategy regarding all of emergency medical services and national preparedness and response2 7#c7 address issues related to ,,ems patient and practitioner safety1 standardization of ,,ems practitioner licensing and credentialing1 field ,,ems quality and medical oversight1 regionalization of field ,,ems and trauma and emergency care services1 availability of field ,,ems and trauma care and emergency medical services throughout the ,nation1 and integration of field ,,ems practitioners into the broader health care system1 including-- 7,a7 promotion of the adoption by ,states of the education standards identified in the ,emergency ,medical ,services ,education ,agenda for the ,future3 ,a ,systems ,approach and any revisions thereto1 including the standardization of licensing and credentialing of field ,,ems practitioners and standards of care1 based on best practices and evidence-based medicine1 including by-- 7i7 the identification of differences in the levels of care1 scope of practice1 and licensure and credentialing requirements among the ,states2 and 7ii7 the adoption by the ,states of national standards for such levels of care1 scope of practice and licensure and credentialing requirements2 7,b7 promotion of a culture of safety1 including-- 7i7 the adoption of an anonymous error reporting system designed to identify systemic problems in field ,,ems patient and practitioner safety and ensure a single means of collecting and reporting relevant error data by field ,,ems agencies and ,states2 7ii7 the establishment of field ,,ems patient and practitioner safety goals and the specific means to improve field ,,ems practitioner and patient safety to achieve such goals2 and 7iii7 the adoption of more uniform national ambulance vehicle safety and manufacturing standards as developed by the ,national ,fire ,protection ,administration or coordinated by ,,nhtsa2 7,c7 the integration and utilization of field ,,ems practitioners as part of the larger health care system including-- 7i7 the potential utilization of field ,,ems practitioners for the provision of care to patients with nonemergent medical conditions2 and 7ii7 strategies to implement the recommendations provided by the ,national ,health ,care ,workforce ,commission1 pursuant to section #eaja7;d77#b7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq7d77#b72 and 7,d7 such other issues as the ,secretary considers appropriate2 7#d7 incorporate into such strategy the preparedness and response objectives identified by the ,secretary of ,homeland ,security and the ,assistant ,secretary for ,preparedness and ,response in order-- 7,a7 to ensure the capability and capacity of the full spectrum of ,,ems to respond to terrorist attacks1 disasters1 catastrophic events1 and mass casualty events2 and 7,b7 to coordinate with the ,secretary of ,homeland ,security accordingly2 7#e7 complete the development of such strategy not later than #ah months after the date of enactment of this ,act2 7#f7 communicate such strategy to the relevant congressional committees of jurisdiction2 7#g7 implement such strategy to the extent practical not later than #c years after the date of enactment of this ,act2 and 7#h7 update such strategy not less than every #c years4 7d7 ,statutory construction ,nothing in this ,act shall be construed to supercede any statutory authority of any ,federal agency that is not within the ,department of ,health and ,human ,services4 #e4 ,field ,,ems ,excellence1 ,quality1 ,universal ,access1 ,innovation1 and ,preparedness 7a7 ,in general ,the ,director of the ,office of ,,ems and ,trauma 7in this section referred to as the ,director71 shall establish the ,,equip grant program-- 7#a7 to promote excellence in all aspects of the provision of field ,,ems by field ,,ems agencies2 7#b7 to enhance the quality of emergency medical care provided to patients by field ,,ems practitioners through evidence-based1 medically directed field emergency care2 7#c7 to promote universal access to and availability of high-quality field ,,ems in all geographic locations of the ,nation2 7#d7 to spur innovation in the delivery of field ,,ems2 and 7#e7 to improve ,,ems agency readiness and preparedness for day-to-day emergency medical response4 7b7 ,application 7#a7 ,in general ,to be eligible to receive a grant under this section1 an eligible entity shall submit an application to the ,director in such form and manner1 that contains such agreements1 assurances1 and information as the ,director determines to be reasonably necessary to carry out this section4 7#b7 ,simple form ,the ,director shall ensure that grant application requirements are not unduly burdensome to smaller and volunteer field ,,ems agencies or other agencies with limited resources4 7#c7 ,consistency with preparation goals ,the ,director shall ensure that grant applications are consistent with national and relevant ,state preparedness plans and goals4 7c7 ,use of funds ,grants may be used by eligible entities to-- 7#a7 sustain field ,,ems practitioners to ensure #bd hours a day1 #g days a week readiness and preparedness at the local level2 7#b7 develop and implement initiatives related to delivery of medical services1 including-- 7,a7 innovative clinical practices to improve the cost effectiveness and quality of care delivered to emergency patients in the field that results in improved patient outcomes and cost savings to the health system1 including for high prevalence emergency medical conditions such as sudden cardiac arrest1 ,,stemi1 stroke1 and trauma2 and 7,b7 delivery systems to improve patient outcomes1 which may include implementing evidence-based protocols1 interventions1 systems1 and technologies to reduce clinically meaningful response times2 7#c7 purchase and implement-- 7,a7 medical equipment and training for using such equipment2 7,b7 communication systems to ensure seamless and interoperable communications with other first responders2 and 7,c7 information systems to comply with ,,nemsis data collection and integrate field emergency care with electronic medical records2 7#d7 participate in federally sponsored field ,,ems research2 7#e7 establish or enhance comprehensive medical oversight and quality assurance programs that include the active participation by medical directors in field ,,ems medical direction and educational programs2 and 7#f7 such other uses as the ,director may establish4 7d7 ,administration of grants ,in establishing and administering the ,,equip grant program1 the ,director-- 7#a7 shall establish a grantmaking process that includes-- 7,a7 prioritization for the awarding of grants to eligible entities and consideration of the factors in reviewing grant applications by eligible entities including-- 7i7 demonstrated financial need for funding2 7ii7 utilization of public and private partnerships2 7iii7 enhanced access to high-quality field ,,ems in under served geographic areas2 7iv7 unique needs of volunteer and rural field ,,ems agencies2 7v7 distribution among a variety of geographic areas1 including urban1 suburban1 and rural2 7vi7 distribution of funds among types of ,,ems agencies1 including governmental1 nongovernmental and volunteer2 7vii7 implementation of evidence-based interventions that improve quality of care1 patient outcomes1 efficiency1 or cost effectiveness2 and 7viii7 such other factors as the ,director considers necessary2 7,b7 a peer-reviewed process to recommend grant allocations in accordance with the prioritization established by the ,director except that final award determinations shall be made by the ,director2 and 7,c7 the provision of grant awards to eligible entities on an annual basis1 except that the ,director may reserve not more than #be percent of the available appropriations for multiyear grants and no grant award may exceed a #b-year period2 7#b7 shall consult with and take into consideration the recommendations of the ,assistant ,secretary for ,preparedness and ,response1 ,,ficems1 ,,nemsac and relevant stakeholders2 7#c7 shall ensure that funds used for day-to-day preparedness activities are consistent and aligned with ,federal preparedness priorities2 and 7#d7 may contract with an independent1 third-party1 nonprofit organization to administer the grant program if the ,director establishes conflict-of-interest requirements as part of any such contractual relationship4 7e7 ,eligibility ,eligible grant recipients are field ,,ems agencies that-- 7#a7 are licensed by or otherwise authorized in the ,state in which they operate2 and 7#b7 have medical oversight and quality improvement programs as defined by the ,director4 7f7 ,annual report ,the ,director shall submit an annual report on the ,,equip grant program under this section to the ,congress4 #f4 ,field ,,ems ,system ,performance1 ,integration1 and ,accountability 7a7 ,in general ,the ,director of the ,office of ,,ems and ,trauma 7in this section referred to as the ,director7 shall establish the ,,spia grant program-- 7#a7 to improve field ,,ems system performance1 integration and accountability2 7#b7 to ensure preparedness for field ,,ems at the ,state and local levels2 7#c7 to enhance physician medical oversight of field ,,ems systems2 7#d7 to improve coordination between regional field ,,ems systems and integration of such regional field ,,ems systems into the larger health care system2 7#e7 to enhance data collection and analysis to improve1 on a continuing basis1 the field ,,ems system2 and 7#f7 to promote standardization of national ,,ems certification of emergency medical technicians and paramedics4 7b7 ,use of funds ,grants may be used by eligible entities-- 7#a7 to enhance ,,ems system readiness and preparedness for day-to-day emergency medical response2 7#b7 to improve cross-border collaboration and planning among ,states2 and 7#c7 to collect data with regard to-- 7,a7 ,,nemsis2 7,b7 field ,,ems education2 7,c7 field ,,ems workforce2 7,d7 cardiac events1 including ,,stemi and sudden cardiac arrest2 7,e7 stroke2 7,f7 disasters1 including injuries and illnesses2 7,g7 ambulance diversion and patient parking2 7,h7 trauma 7in a manner that is complementary and not duplicative of other trauma data collection such as the ,national ,trauma ,data ,bank72 7,i7 data determined necessary by the ,state office of ,,ems for oversight and coordination of the ,state field ,,ems system2 and 7,j7 any other such data that the ,director specifies2 7#d7 to implement and evaluate system-wide quality improvement initiatives1 including medical direction at the ,state1 local1 and regional levels2 7#e7 to integrate field ,,ems with other health care services as part of a coordinated system of care provided to patients with emergency medical conditions to help ensure the right patient receives the right care by the right crew in the right vehicle and at the right medical facility in the right amount of time1 including by enhancing regional emergency medical dispatch2 7#f7 to incorporate national ,,ems certification for all levels of emergency medical technicians and paramedics2 7#g7 to improve the ,state's planning for ensuring a consistent1 available ,,ems workforce2 7#h7 to fund ,,ems regional and local oversight and planning organizations or develop regional systems of emergency medical care within the ,state to further enhance coordination and systemic development throughout the ,state2 and 7#i7 for such other uses as the ,director may establish4 7c7 ,administration of grants ,in establishing and administering the ,,spia grant program1 the ,director shall-- 7#a7 establish ,state ,,ems system performance standards to serve as guidance to ,states in improving their ,,ems systems and in applying for grants under this subsection4 ,in establishing such standards1 the ,director shall-- 7,a7 take into the consideration the recommendations of the ,assistant ,secretary for ,preparedness and ,response1 ,,ficems1 ,,nemsac1 and relevant stakeholders2 7,b7 include national1 evidence-based guidelines2 and 7,c7 take into account the needs and resource limitations of volunteer1 smaller agencies1 and agencies in rural areas4 7#b7 provide technical assistance to ,state ,,ems offices in conducting comprehensive ,,ems planning with regard to evidence-based workforce and development competencies for field ,,ems management2 7#c7 allocate1 within the available funds1 ,,spia grants to a maximum of one grant per applicant according to a formula based on population and geographic area1 as determined by the ,director1 for a period not to exceed #b years2 and 7#d7 require that ,states allocate a portion of their grant funds to regional and local oversight and planning ,,ems organizations within the ,state for the purpose of field ,,ems system development1 maintenance1 and improvement of coordination among regional organizations4 7d7 ,application ,to be eligible to receive a grant under this section1 an eligible entity shall submit an application to the ,director in such form and manner1 that contains such agreements1 assurances1 and information as the ,director determines to be reasonably necessary to carry out this section4 7e7 ,eligibility ,the eligible entities for a grant under this section are the ,state ,,ems office in each of the several ,states1 tribes1 and territories4 7f7 ,annual report ,the ,director shall submit an annual report on the ,,spia grant program under this section to the ,congress4 #g4 ,field ,,ems quality 7a7 ,medical oversight 7#a7 ,in general ,to improve medical oversight of field ,,ems and ensure continuity and quality for such medical oversight1 the ,director of the ,office of ,,ems and ,trauma 7in this section referred to as the ,director7 shall-- 7,a7 promote high-quality and comprehensive medical oversight of-- 7i7 all medical care provided by field ,,ems practitioners2 and 7ii7 the education and training of field ,,ems practitioners2 7,b7 promote the development1 adoption1 and utilization of national guidelines for the roles of physicians who provide medical oversight for field ,,ems and other health care providers who support physicians in this role2 7,c7 support efforts of relevant physician stakeholders in developing and disseminating guidelines for use by ,,ems medical directors and field ,,ems practitioners on a national basis2 and 7,d7 convene a ,field ,,ems ,medical ,oversight ,advisory ,committee1 comprised of representatives of relevant physician stakeholders1 to advise the ,director on ways and means to advance and support development and maintenance of quality medical oversight throughout the ,nation's systems for field ,,ems4 7#b7 ,additional considerations ,in carrying out subparagraphs 7,b7 and 7,c7 of paragraph 7#a7 7relating to supporting guidelines71 the ,director shall take into consideration-- 7,a7 existing guidelines developed by national professional physician associations1 ,states1 and other relevant governmental or nongovernmental entities2 7,b7 the input of other relevant stakeholders1 including health care providers who support physicians who provide medical oversight for field ,,ems2 and 7,c7 the unique needs associated with medical oversight of provision of field ,,ems in rural areas or by volunteers4 7#c7 ,flexibility ,the guidelines promoted under subparagraphs 7,b7 and 7,c7 of paragraph 7#a7 shall ensure high-quality training1 credentialing1 and direction in connection with medical oversight of field ,,ems at the ,state1 regional1 and local levels while providing sufficient flexibility to account for historical and legitimate differences in field ,,ems among ,states1 regions1 and localities4 7#d7 ,required use of guidelines ,as a condition on receipt of a grant under section #e or #f1 the ,director shall require the grant recipient to adopt and implement 7to the extent applicable7 the guidelines promoted under subparagraphs 7,b7 and 7,c7 of paragraph 7#a74 7b7 ,,gao study and report 7#a7 ,in general ,the ,comptroller ,general of the ,united ,states shall complete a study on-- 7,a7 medical and administrative liability issues that may impede-- 7i7 medical direction provided by physicians directly regarding specific patients or medical oversight provided by physicians in establishing medical protocols1 procedures1 and other activities related to the provision of emergency medical care in field ,,ems2 or 7ii7 the highest quality emergency medical care in field ,,ems provided by personnel other than physicians such as emergency medical technicians and paramedics2 7,b7 reimbursement for any component of medical oversight2 and 7,c7 such other issues as the ,comptroller ,general deems appropriate relating to improving the quality and medical oversight of emergency medical care in field ,,ems4 7#b7 ,report to ,congress ,not later than #ah months after the date of the enactment of this ,act1 the ,comptroller ,general shall complete the study under paragraph 7#a7 and submit a report to the ,congress on the results of such study1 including any recommendations4 7c7 ,data collection and exchange 7#a7 ,national ,,ems information system 7,a7 ,in general ,the ,administrator of ,,nhtsa may maintain1 improve1 and expand the ,national ,,ems ,information ,system1 including the ,national ,,ems ,database4 7,b7 ,consultation ,the ,administrator of ,,nhtsa shall carry out this paragraph in consultation with the ,director4 7,c7 ,standardization ,in carrying out subparagraph 7,a71 the ,administrator of ,,nhtsa shall promote the collection and reporting of data on field ,,ems in a standardized manner4 7,d7 ,availability of data ,the ,administrator of ,,nhtsa shall ensure that information in the ,national ,,ems ,database 7other than individually identifiable information7 is available to ,federal and ,state policymakers1 ,,ems stakeholders1 and researchers4 7,e7 ,technical assistance ,in carrying out subparagraph 7,a71 the ,administrator of ,,nhtsa may provide technical assistance to ,state and local agencies1 field ,,ems agencies1 and other entities deemed appropriate by the ,administrator to assist in the collection1 analysis1 and reporting of data4 7#b7 ,report on data gaps 7,a7 ,in general ,not later than #ab months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the ,director1 in consultation with the ,administrator of ,,nhtsa1 shall submit to the ,congress a report that-- 7i7 identifies gaps in the collection of data related to the provision of field ,,ems2 and 7ii7 includes recommendations for improving the collection1 reporting1 and analysis of such data4 7,b7 ,recommendations ,the recommendations required by subparagraph 7,a77ii7 shall-- 7i7 take into consideration the recommendations of ,,ficems and ,,nemsac and relevant stakeholders2 7ii7 recommend methods for improving data collection and reporting and analysis without unduly burdening reporting entities and without duplicating existing data sources 7such as data collected by the ,national ,trauma ,data ,bank72 7iii7 address the quality and availability of data1 and linkages with existing patient registries1 related to the provision of field ,,ems and utilization of field ,,ems with respect to a variety of illnesses and injuries 7in both the everyday provision of field ,,ems and catastrophic or disaster response7 including-- 7,i7 cardiac events such as chest pain1 sudden cardiac arrest1 and ,,stemi2 7,,ii7 stroke2 7,,iii7 trauma2 7,,iv7 disaster and catastrophic incidents1 such as incidents related to terrorism or natural or manmade disasters2 and 7,v7 ambulance diversion and patient parking2 and 7iv7 include an analysis of the variety of services provided by field ,,ems agencies4 7#c7 ,report on data integration to promote quality of care ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 acting through the head of the ,office of the ,national ,coordinator for ,health ,information ,technology1 in collaboration with the ,director of the ,office of ,,ems and ,trauma1 ,,ficems1 and the ,administrator of ,,nhtsa as appropriate1 and taking into consideration input from relevant stakeholders1 shall submit a report 7including recommendations7 on issues1 impediments1 and potential solutions pertaining to the following objectives3 7,a7 ,incorporation of field ,,ems patient care reports into patient electronic health records1 taking into consideration-- 7i7 the extent to which field ,,ems patient care reports are presently created in electronic format and the potential for elements of such reports to be incorporated into patient electronic health records2 7ii7 the data elements of field ,,ems patient care reports that would promote quality and efficiency of care if incorporated into patient electronic health records2 7iii7 potential modifications to the ,medicare and ,medicaid programs under titles ,,xviii and ,,xix1 respectively1 of the ,social ,security ,act or other ,federal health programs 7including potential modifications to the ,,hitech ,act 7title ,,xiii of division ,a of ,public ,law #aaa-e7 including modifications to the entities included as eligible for incentive payments under section #ahdh7o71 #ahec7l7 7to the extent that such section #ahdh7o7 is applied71 or #aijc7t7 of the ,social ,security ,act1 criteria for certified ,,ehr technology for purposes of such sections1 and objectives and measures for determining meaningful use of such technology for purposes of such sections7 to provide appropriate reimbursement and financial incentives for ,,ems agencies-- 7,i7 to maintain field ,,ems patient care reports in a structured electronic format2 and 7,,ii7 to otherwise adopt and use electronic health records2 and 7iv7 potential modifications to the ,,hitech ,act to provide incentives to eligible hospitals under section #ahhf7n71 #ahec7m7 7to the extent that such section #ahhf7n7 is applied71 or section #ahad7l77#c7 of the ,social ,security ,act to incorporate appropriate data elements of field ,,ems patient care reports into patient electronic health records4 7,b7 ,incorporation of patient health information created subsequent to the receipt of field ,,ems emergency care into ,,nemsis1 taking into consideration-- 7i7 what types of medical information created subsequent to the receipt of field ,,ems emergency care 7such as outcomes information or information regarding subsequent care and treatment7 would1 if included in ,,nemsis1 be potentially useful in evaluating and improving the quality of ,,ems care2 7ii7 how best to integrate such information into ,,nemsis2 7iii7 potential modifications to the ,,hitech ,act to require eligible hospitals1 as defined in section #ahhf7n77#f77;,b7 of the ,social ,security ,act1 for purposes of incentive payments under #ahhf7;b77#c77;,b77ix7 and #ahhf7n7 of such ,act1 to develop or report relevant data to ,,nemsis or other appropriate ,state or private registries2 and 7iv7 potential modifications to the ,medicare and ,medicaid programs under titles ,,xviii and ,,xix1 respectively1 of the ,social ,security ,act or other ,federal health programs to provide appropriate reimbursement and financial incentives for field ,,ems agencies to develop or report relevant data to ,,nemsis or other appropriate ,state or private registries4 7d7 ,clarification of ,,hipaa 7#a7 ,exchange of information related to the treatment of patients 7,a7 ,in general ,nothing in ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a77#b77 shall be construed as prohibiting the exchange of information between field ,,ems practitioners treating an individual and personnel of a hospital to which the individual is transported for the purposes of relating information on the medical history1 treatment1 care1 and outcome of such individual 7including any health care personnel safety issues such as infectious disease74 7,b7 ,guidelines ,the ,secretary of ,health and ,human ,services shall establish guidelines for exchanges of information between field ,,ems practitioners treating an individual and personnel of a hospital to which the individual is transported to protect the privacy of the individual while ensuring the ability of such ,,ems practitioners and hospital personnel to communicate effectively to further the continuity and quality of emergency medical care provided to such individual4 7#b7 ,,nemsis data ,nothing in ,,hipaa privacy and security law 7as defined in section #cjji7;a77#b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;jj-#ai7;a77#b77 shall be construed as prohibiting-- 7,a7 a field ,,ems agency from submitting ,,ems data to the ,state ,,ems ,office for the purpose of quality improvement and data collection by the ,state for submission to ,,nemsis2 or 7,b7 the ,state ,,ems ,office from submitting aggregated nonindividually identifiable ,,ems data to the ,national ,,ems ,database maintained by ,,nhtsa4 #h4 ,field ,,ems education grants 7a7 ,in general ,for the purpose of promoting field ,,ems as a health profession and ensuring the availability1 quality1 and capability of field ,,ems educators1 practitioners1 and medical directors1 the ,director of the ,office of ,,ems and ,trauma 7in this section referred to as the ,director7 may make grants to eligible entities for the development1 availability1 and dissemination of field ,,ems education programs and courses that improve the quality and capability of field ,,ems personnel4 ,in carrying out this section1 the ,director shall take into consideration input from the ,administrator of ,,nhtsa1 ,,ficems1 ,,nemsac1 the ,national ,health ,care ,workforce ,commission established under section #eaja of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #bidq71 and relevant stakeholders4 7b7 ,eligibility ,in this section1 the term eligible entity means an educational organization1 an educational institution1 a professional association1 and any other entity involved with the education of field ,,ems practitioners4 7c7 ,use of funds ,the ,director may award a grant to an eligible entity under paragraph 7#a7 only if the entity agrees to use the grant to-- 7#a7 develop and implement education programs that-- 7,a7 train field ,,ems trainers and promote the adoption and implementation of the education standards identified in the ,emergency ,medical ,services ,education ,agenda for the ,future3 ,a ,systems ,approach including any revisions thereto2 7,b7 bridge the gap in knowledge and skills in field ,,ems and among field ,,ems and other allied health professions to develop a larger cadre of educational instructors and build a stronger and more flexible field ,,ems practitioner corps2 or 7,c7 provide training and retraining programs to provide displaced workers the opportunity to enter a field ,,ems profession2 7#b7 develop and implement educational courses pertaining to-- 7,a7 instructor courses2 7,b7 provision of medical direction of field ,,ems2 7,c7 field ,,ems practitioners1 including physicians1 emergency medical technicians1 paramedics1 nurses1 and other relevant clinicians providing emergency medical care in the field2 7,d7 field ,,ems educational and clinical research2 7,e7 bridge programs among field ,,ems1 nursing1 and other allied health professions2 7,f7 field ,,ems management2 7,g7 national1 evidence-based guidelines2 and 7,h7 translation of the lessons learned in military medicine to field ,,ems2 7#c7 evaluate education and training courses and methodologies to identify optimal educational modalities for field ,,ems practitioners2 7#d7 improve the field ,,ems education infrastructure by increasing the number of field ,,ems instructors and the quality of their preparation by improving1 enhancing1 and modernizing the dissemination of ,,ems education1 including distance learning1 and by establishing quality improvement for ,,ems education programs2 7#e7 enhance the opportunity for medical direction training and for promoting appropriate medical oversight of field emergency medical care2 7#f7 improve systems to design1 implement1 and evaluate education for prospective and current field ,,ems providers2 or 7#g7 carrying out such other activities as the ,director may identify4 7d7 ,priority ,the ,director1 in consultation with ,,nhtsa and relevant stakeholders1 and taking into consideration the recommendations of ,,ficems and ,,nemsac1 shall establish a system of prioritization in awarding grants under this section to eligible entities4 7e7 ,duration of grants ,grants under this section shall be for a period of #a to #c years4 7f7 ,application ,the ,director may not award a grant to an eligible entity under this section unless the entity submits an application to the ,director in such form1 in such manner1 and containing such agreements1 assurances1 and information as the ,director may require4 ,the ,director shall ensure that the requirements for submitting an application under this section are not unduly burdensome4 #i4 ,evaluating innovative models for access and delivery of field ,,ems for patients 7a7 ,evaluation 7#a7 ,in general ,not later than #a year after the date of the enactment of this ,act1 the ,director of the ,office of ,,ems and ,trauma1 in consultation with the ,administrator of the ,centers for ,medicare ,medicaid ,services 7in this section referred to as the ,director71 and taking into consideration the recommendations of ,,nemsac and ,,ficems1 shall complete an evaluation of-- 7,a7 the provision of and reimbursement for alternative delivery models for medical care through field ,,ems2 and 7,b7 the integration of field ,,ems patients with other medical providers and facilities as medically appropriate4 7#b7 ,specific issues ,the evaluation under paragraph 7#a7 shall consider each of the following3 7,a7 ,alternative dispositions of patients1 including-- 7i7 transporting patients by ambulance to destinations other than a hospital such as the office of the patient's physician1 an urgent care center1 or the facilities of another health care provider2 7ii7 when medically necessary1 the evaluation1 treatment1 or referral of patients to other medically appropriate health care providers2 and 7iii7 the funding of the provision of medical care regardless of the decision to transport such as reimbursement models based on readiness rather than transport and shared savings4 7,b7 ,issues related to medical liability and the requirements of section #ahfg of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd2 commonly referred to as ,,emtala7 associated with transport to destinations other than a hospital emergency department4 7,c7 ,necessary protections to ensure that patients receive timely and appropriate care in the appropriate setting4 7,d7 ,whether there are any barriers to providing alternate dispositions to patients who are not in need of care in hospital emergency departments4 7,e7 ,other issues determined by the ,director1 including1 when possible1 issues recommended by ,,ficems or ,,nemsac for evaluation under this subsection4 7b7 ,demonstration projects 7#a7 ,in general ,beginning not later than #a year after the date of the enactment of this ,act1 the ,director shall conduct or support at least #aj demonstration projects to-- 7,a7 evaluate the implementation and reimbursement of alternative dispositions of field ,,ems patients1 including-- 7i7 transporting patients by ambulance to alternate destinations when medically appropriate and in the patients' best interests2 and 7ii7 when medically necessary1 evaluating1 treating1 or referring patients to other medically appropriate providers2 7,b7 evaluate the implementation of reimbursement models based on readiness rather than transport or shared savings2 and 7,c7 determine whether such alternative dispositions and reimbursement models-- 7i7 improve the safety1 effectiveness1 timeliness1 and efficiency of ,,ems2 and 7ii7 reduce overall utilization and expenditures under the ,medicare program under title ,,xviii of the ,social ,security ,act4 7#b7 ,evidence-based protocols ,the ,director shall ensure that at least one demonstration project under paragraph 7#a7 evaluates evidence-based protocols that give guidance on selection of the destination to which patients are transported4 7#c7 ,duration ,the period of a demonstration project under paragraph 7#a7 shall not exceed #cf months4 7#d7 ,research ,if the ,director determines that further research is necessary prior to or in conjunction with the demonstration projects under this subsection in order to evaluation the implementation of alternative dispositions of field ,,ems patients1 the ,director shall conduct or support such research4 7#e7 ,authorization of appropriations ,of the amount made available to carry out section #aaae;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7 for a fiscal year1 there are authorized to be appropriated such sums as may be necessary to carry out this subsection4 7c7 ,report to ,congress ,not later than #a year after the completion of all demonstration projects under subsection 7b71 the ,director shall submit to the ,congress a report on the results of activities under this section1 including recommendations on the efficacy of alternative dispositions of field ,,ems patients4 #aj4 ,enhancing research in field ,,ems 7a7 ,models ,to be tested by ,center for ,medicare and ,medicaid ,innovation ,section #aaae;,a7b77#b77;,b7 of title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b77 is amended by adding at the end the following3 7xxi7 ,enhancing health outcomes for patients receiving field emergency medical services and improving timely and efficient delivery of high-quality field emergency medical services1 such as through-- 7,i7 regionalization of emergency care2 7,,ii7 medical transport to alternate destinations2 or 7,,iii7 when medically necessary1 the evaluation1 treatment1 or referral of patients to other medically appropriate health providers4 4 7b7 ,emergency medical research ,section #dih;,d of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhi;g-#d7 is amended-- 7#a7 by redesignating subsections 7c7 and 7d7 as subsections 7d7 and 7e71 respectively2 and 7#b7 by inserting after subsection 7b7 the following3 7c7 ,field ,,ems emergency medical research ,the ,secretary shall conduct research and evaluation relating to field ,,ems through the ,agency for ,healthcare ,research and ,quality and the ,center for ,medicare and ,medicaid ,innovation4 4 7c7 ,field ,,ems practice center ,subpart ,,ii of part ,d of title ,,ix of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bii;b-#cc et seq47 is amended by adding at the end the following3 #ich4 ,field ,,ems practice center 7a7 ,establishment ,for the purpose described in subsection 7b71 the ,director shall establish within the ,office of ,research and ,evaluation a ,field ,,ems ,evidence-,based ,practice ,center4 7b7 ,purpose ,the purpose of the ,center is to conduct or support research to promote the highest quality of emergency medical care in field ,,ems and the most effective delivery system for the provision of such care4 ,research conducted or supported pursuant to the preceding sentence shall include-- 7#a7 comparative safety and effectiveness research2 7#b7 other appropriate clinical or systems research2 and 7#c7 research addressing-- 7,a7 critical care transport2 7,b7 off-shore operations2 7,c7 tactical emergency medical services2 7,d7 air medical services2 and 7,e7 the application of lessons learned in military field medicine in the delivery of emergency medical care in field ,,ems4 7c7 ,definition ,in this section3 7#a7 ,the term ,center means the ,field ,,ems ,evidence-,based ,practice ,center established under subsection 7a74 7#b7 ,the term field ,,ems has the meaning given to such term in section #c of the ,field ,,ems ,quality1 ,innovation1 and ,cost ,effectiveness ,improvements ,act of #bjac4 4 7d7 ,limitations on certain uses of research ,section #aahb of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;e-#a7 is amended by striking section #aaha each place it appears and inserting section #aaha of this ,act or section #dih;,d7c7 or #ich of the ,public ,health ,service ,act4 7e7 ,regulatory barriers ,for the purposes of research conducted pursuant to this section or any other research funded by the ,department of ,health and ,human ,services related to emergency medical services in the field in which informed consent is required but may not be attainable1 the ,secretary of ,health and ,human ,services shall-- 7#a7 evaluate and consider the patient and research issues involved2 and 7#b7 address regulatory barriers to such research related to the need for informed consent in a manner that ensures adequate patient safety and notification1 and submit recommendations to ,congress for any changes to ,federal statutes necessary to address such barriers4 #aa4 ,emergency ,medical ,services ,trust ,fund 7a7 ,designation of income tax overpayments and additional contributions for emergency medical services ,subchapter ,a of chapter #fa of the ,internal ,revenue ,code of #aihf 7relating to returns and records7 is amended by adding at the end the following new part3 ,,ix ,designation of income tax overpayments and additional contributions for emergency medical services #fjig4 ,designation by individuals 7a7 ,in general ,every individual 7other than a nonresident alien7-- 7#a7 may designate that a specified portion of any overpayment of tax for a taxable year1 and 7#b7 may designate that an amount in addition to any payment of tax for such taxable year and any designation under paragraph 7#a71 shall be used to fund the ,emergency ,medical ,services ,trust ,fund4 ,designations under the preceding sentence shall be in an amount not less than #a and the ,secretary shall provide for elections in amounts of #a1 #e1 #aj1 or such other amount as the taxpayer designates4 7b7 ,adjusted income tax liability ,for purposes of this section1 the term adjusted income tax liability means income tax liability 7as defined in section #fjif7;b77 reduced by any amount designated under section #fjif 7relating to designation of income tax payments to ,presidential ,election ,campaign ,fund74 7c7 ,overpayments ,treated as ,refunded ,for purposes of this title1 any portion of an overpayment of tax designated under subsection 7a7 shall be treated as-- 7#a7 being refunded to the taxpayer as of the last date prescribed for filing the return of tax imposed by chapter #a 7determined without regard to extensions7 or1 if later1 the date the return is filed1 and 7#b7 a contribution made by such taxpayer on such date to the ,united ,states4 7d7 ,manner and time of designation ,a designation under subsection 7a7 may be made with respect to any taxable year-- 7#a7 at the time of filing the return of the tax imposed by chapter #a for such taxable year1 or 7#b7 at any other time 7after the time of filing the return of the tax imposed by chapter #a for such taxable year7 specified in regulations prescribed by the ,secretary4 ,such designation shall be made in such manner as the ,secretary prescribes by regulations except that1 if such designation is made at the time of filing the return of the tax imposed by chapter #a for such taxable year1 such designation shall be made either on the first page of the return or on the page bearing the signature of the taxpayer4 4 7b7 ,emergency ,medical ,services ,trust ,fund ,subchapter ,a of chapter #ih of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ieab4 ,emergency ,medical ,services ,trust ,fund 7a7 ,creation of trust fund ,there is established in the ,treasury of the ,united ,states a trust fund to be known as the ,emergency ,medical ,services ,trust ,fund1 consisting of such amounts as may be credited or paid to such trust fund as provided in section #fjig4 7b7 ,transfers to trust fund ,there are hereby appropriated to the ,emergency ,medical ,services ,trust ,fund amounts equivalent to the amounts of the overpayments of tax to which designations under section #fjig apply4 7c7 ,expenditures from trust fund ,amounts in the ,emergency ,medical ,services ,trust ,fund shall be available1 as provided in appropriation ,acts1 only for carrying out the provisions for which amounts are authorized to be appropriated under subsections 7a7 and 7b7 of section #ab of the ,field ,,ems ,quality1 ,innovation1 and ,cost ,effectiveness ,improvements ,act of #bjac4 4 7c7 ,clerical amendments 7#a7 ,clerical amendment ,the table of parts for subchapter ,a of chapter #fa of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new item3 ,part ,,ix4 ,designation of income tax overpayments and additional contributions for emergency medical services44 7#b7 ,the table of sections for subchapter ,a of chapter #ih of such ,code is amended by adding at the end the following new item3 ,sec4 #ieab4 ,emergency ,medical ,services ,trust ,fund4 4 7d7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjac4 #ab4 ,authorization of appropriations 7a7 ,in general ,out of amounts in the ,emergency ,medical ,services ,trust ,fund1 there are authorized to be appropriated-- 7#a7 #ab1jjj1jjj shall be for carrying out sections #d 7excluding the provisions of law listed in subsection 7b77#c7 of such section71 #g1 #i7;a71 #i7;c71 and #aa of this ,act for each of fiscal years #bjad through #bjag2 7#b7 #bjj1jjj1jjj shall be for carrying out section #e of this ,act for each of fiscal years #bjad through #bjag2 7#c7 #ej1jjj1jjj shall be for carrying out section #f of this ,act for each of fiscal years #bjad through #bjag2 7#d7 #d1jjj1jjj shall be for carrying out section #g7;c77#a7 of this ,act for each of fiscal years #bjad through #bjag2 7#e7 #ae1jjj1jjj shall be for carrying out section #h of this ,act for each of fiscal years #bjad through #bjag2 and 7#f7 #dj1jjj1jjj shall be for carrying out sections #dih;,d7c7 and #ich of the ,public ,health ,service ,act1 as added by subsections 7b7 and 7c7 of section #aj of this ,act1 for each of fiscal years #bjad through #bjag4 7b7 ,excess amounts ,if1 for any fiscal year1 amounts in the ,emergency ,medical ,services ,trust ,fund exceed the maximum amount authorized to be appropriated under subsection 7a71 such excess amounts are authorized to be appropriated to carry out section #ccj;,j1 section #dih;,d1 and parts ,a1 ,b1 ,c1 ,d1 and ,h of title ,,xii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bed;c-#ae1 #bhi;g-#d1 #cjj;d et seq41 #cjj;d-#aa et seq41 #cjj;d-#ca et seq41 and #cjj;d-#ha et seq474 7c7 ,start-,up funding 7#a7 ,in general ,out of the discretionary funds available to the ,secretary of ,health and ,human ,services for each of fiscal years #bjad and #bjae1 #dj1jjj1jjj shall be for carrying out the provisions listed in subsection 7a7 or 7b74 7#b7 ,relation to other funds ,the amount of discretionary funds allocated under paragraph 7#a7 for the purpose of carrying out the provisions listed in subsection 7a7 or 7b7 shall be in addition to1 not in lieu of1 the amount of discretionary funds that would otherwise be available for such purpose4 7d7 ,administrative expenses ,of the amounts made available under subsection 7a71 7b71 or 7c7 to carry out each of the provisions listed in subsection 7a71 not more than #e percent of each such amount may be used for ,federal administrative expenses4