,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #cddc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #ae1 #bjbe ,mr4  
,hudson 7= himself & ,mrs4 ,d+ell7      
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xi ( ! ,social
 ,security ,act to create a model1 & to 
direct ! ,m$ic>e ,paym5t ,advisory      
,commission to c>ry out a /udy & report 
) respect to ,m$ic>e paym5t = em]g5cy   
m$ical s]vices4  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,:5 ,m9utes ,c\nt =
 ,em]g5cy ,m$ical ,pati5ts ,act4  #b4   
,,cmi em]g5cy s]vices paym5t model      
,section #aaae;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acae;a7 is am5d$-- 
7#a7 9 subsection 7b77#b7-- 7,a7 9      
subp>agraph 7,a71 9 ! ?ird s5t5ce1 by   
ins]t+ 1 & %all include ! model describ$

 9 subp>agraph 7,b77xxviii7 be=e ! p]iod
 at ! end2 &  7,b7 9 subp>agraph 7,b71  
by add+ at ! end ! foll[+ new clause3   
7xxviii7 ,! ,:5 ,m9utes ,c\nt = ,,ems   
,pati5ts ,model describ$ 9 subsection   
7h74  2 &  7#b7 by add+ at ! end !      
foll[+ new subsection3  7h7 ,:5 ,m9utes 
,c\nt = ,,ems ,pati5ts ,model  7#a7 ,9  
g5]al ,= purposes ( subsection          
7b77#b77;,b77xxviii71 ! ,:5 ,m9utes     
,c\nt = ,,ems ,pati5ts ,model describ$ 9
 ?is subsection is a model t provides   
supplem5tal paym5t = gr\nd & air        
ambulance s]vices "u title ,,xviii ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 = specifi$ life-su/a9+   
,,ems m$ications & blood products t     
require imm$iate adm9i/ration by ,,ems  
pr(essionals to individuals ) em]g5cy   
m$ical conditions 7z def9$ 9 section    
#ahfg7;e774  7#b7 ,application &        
selection ( eligible entities  7,a7     
,application  7i7 ,9 g5]al ,to be       
eligible to p>ticipate 9 ! model        
describ$ 9 p>agraph 7#a71 an eligible   

entity %all submit to ! ,secret>y an    
application 9 su* =m1 at su* "t1 &      
conta9+ su* in=mation z ! ,secret>y may 
det]m9e appropriate1 :i* %all include at
 lea/ ! in=mation describ$ 9 clause     
7ii74  7ii7 ,in=mation describ$ ,=      
purposes ( clause 7i71 ! in=mation      
describ$ 9 ?is clause is su* in=mation z
 ! ,secret>y det]m9es necess>y to       
demon/rate t ! eligible entity w be able
 to provide suffici5t data = ! ,secret>y
 to be able to p]=m ! analysis requir$ =
 ! report requir$ "u p>agraph 7#e71     
includ+--  7,i7 data t encompasses      
quality ( c>e & ! outcomes ( individuals
 receiv+ em]g5cy m$ical s]vices 7z def9$
 9 #cjc7k77#ac77;,c7 ( ! ,controll$     
,sub/ances ,act72 &  7,,ii7 discrete    
data elem5ts associat$ ) em]g5cy        
dep>tm5t & inpati5t s]vices1 includ+    
,,icd-#aj & ,national ,em]g5cy ,m$ical  
,s]vices ,in=mation ,sy/em 7,,nemsis7   
dispositions 7,,nemsis #c4e elem5ts3    
e,outcome #j4a1 e,outcome #j4b1         
e,outcome #aj1 & e,outcome #ac74  7,b7  

,selection ,! ,secret>y1 9 approv+      
applications "u ?is subp>agraph-- 7i7   
%all select n less ?an #a eligible      
entity 9 ea* ,,hhs region 7z det]m9$ by 
! ,secret>y72 &  7ii7 to ! ext5t        
feasible1 %all select at lea/ #a ( ea*  
type ( em]g5cy m$ical s]vices ag5cy 7z  
su* t]m is def9$ = purposes ( section   
#cjc7k77#ac77;,d7 ( ! ,controll$        
,sub/ances ,act74  7#c7 ,supplem5tal    
paym5t adju/m5ts ,! ,secret>y %all set  
paym5t rates = s]vices furni%$ "u !     
model describ$ 9 p>agraph 7#a7 & %all   
make su* paym5ts 9 addition to any      
paym5ts t eligible entities p>ticipat+ 9
 ! model receive = su* s]vices "u       
section #ahcd ( ?is title4 ,su* paym5t  
rates %all--  7,a7 be calculat$ bas$ on 
! total co/s (-- 7i7 ma9ta9+ a suffici5t
 supply ( specifi$ ,,ems m$ications to  
m9imize ,,ems m$ical directors hav+ to  
r\t9ely *ange protocols = adm9i/ration (
 su* m$ications due to _! p]si/5t       
%ortages 7:i* %all con/itute at lea/    
d\ble ! am\nt ( av]age actual           

acquisition = su* m$ications 9 ! fir/   
ye> ( ! model1 z det]m9$ necess>y by !  
,secret>y to ensure su* suffici5t       
supply72  7ii7 blood products 7calculat$
 sep>ately = ea* type ( product us$ 9 ! 
provision ( em]g5cy m$ical s]vices1 tak+
 into acc\nt ! co/ ( ! acquisition1     
/orage1 ma9t5ance1 transport by gr\nd & 
air1 & adm9i/ration ( blood products2 & 
adm9i/rative co/s associat$ ) blood &   
blood product usage & /orage1 includ+   
wa/age2  7iii7 ma9ta9+ a suffici5t      
supply to s]ve all pati5ts requir+ !    
adm9i/ration ( specifi$ ,,ems m$ications
 & blood products 9 ! eligible entity's 
prim>y s]vice area 7:i* %all n be bas$  
on ! actual adm9i/ration ( su*          
m$ications & blood products to ,m$ic>e  
b5efici>ies72 &  7iv7 ma9ta9+ s(tw>e &  
data integration necess>y = ! report+   
requirem5ts describ$ 9 p>agraph         
7#b77;,a72 &  7,b7 be paid to           
p>ticipants z a lump sum on a mon?ly or 
qu>t]ly basis4  7#d7 ,scope ( model ,!  
,secret>y %all implem5t ! model 9 a     

mann] t w provide = a suffici5t numb] ( 
p>ticipants 9 all ,,hhs regions 7z      
det]m9$ by ! ,secret>y7 & 9 v>y+ types (
 geographic areas 7includ+ rural1       
fronti]1 suburban & urban7 to assess &  
evaluate ! report+ compon5ts requir$ 9 !
 report "u p>agraph 7#e74  7#e7 ,report 
,n lat] ?an #a ye> aft] ! t]m9ation ( ! 
model "u ?is subsection1 ! ,secret>y    
%all submit to ,congress a report t     
includes an analysis ( ! foll[+3  7,a7  
,:e!r supplem5tal paym5ts = gr\nd & air 
ambulance s]vices "u ! model "u ?is     
subsection increas$ ! utilization (     
blood & blood products & less5$ ! adv]se
 effects ( ! specifi$ m$ications 9      
%ortage4  7,b7 ,! impact ( provid+ su*  
specifi$ m$ications & blood products on 
! quality ( c>e provid$1 & pati5t       
outcomes includ+ ,m$ic>e & ,m$icaid     
pati5t morbidity & mortality4  7,c7     
,:e!r su* increas$ utilization (        
specifi$ m$ications & blood products    
improv$ ! quality ( c>e & sav$ lives =  
traditionally und]s]v$ demographics &   

rural communities4  7#f7 ,duration ,!   
model describ$ 9 p>agraph 7#a7 %all be  
c>ri$ out = a p]iod ( n less ?an #e     
ye>s4  7#g7 ,def9itions ,9 ?is          
subsection3 7,a7 ,specifi$ life-sav+    
,,ems m$ication ,! t]m specifi$         
life-sav+ ,,ems m$ication means ! foll[+
 drugs t h ! mean+ giv5 ! t]m life-sav+ 
9 section #cef7;a77#a7 ( ! ,food1 ,drug 
& ,cosmetic ,act3  7i7 ,ep9ephr9e4  7ii7
 ,lidoca9e4  7iii7 ,calcium4  7iv7 #j4i 
p]c5t sal9e solution4  7v7 ,lactat$     
,r+]s solution4  7vi7 ,albut]ol4  7vii7 
,midazolam4  7viii7 #aj p]c5t dextrose  
solution4  7ix7 ,f5tanyl4  7,b7 ,blood  
product ,! t]m blood product means any  
!rapeutic sub/ance d]iv$ f human blood1 
includ+ :ole blood & o!r blood compon5ts
 = transfusion1 & plasma-d]iv$ m$ic9al  
products4  7,c7 ,eligible entity ,! t]m 
eligible entity means an em]g5cy m$ical 
s]vices ag5cy 7z def9$ 9 section        
#cjc7k77#ac77;,d7 ( ! ,controll$        
,sub/ances ,act74  4  #c4 ,med,p,a,c    
report2 ,,emtala guidance  7a7          

,med,p,a,c report  7#a7 ,9 g5]al ,n lat]
 ?an #b ye>s aft] ! date ( ! enactm5t ( 
?is ,act1 ! ,m$ic>e ,paym5t ,advisory   
,commission 79 ?is section ref]r$ to z  
,med,p,a,c7 %all submit to ,congress a  
report on paym5t = em]g5cy m$ical       
s]vices "u title ,,xviii ( ! ,social    
,security ,act 7#db ,u4,s4,c4 #acie et  
seq474 ,su* report %all include--  7,a7 
) respect to ,,ems m$ical directors1 !  
evaluation describ$ 9 p>agraph 7#b72    
7,b7 ) respect to em]g5cy m$ical s]vices
 pr(essionals1 ! evaluation describ$ 9  
p>agraph 7#c72  7,c7 ) respect to       
quality assurance1 ! recomm5dations     
describ$ 9 p>agraph 7#d72 &  7,d7 )     
respect to em]g5cy m$ical s]vices1 !    
analysis & recomm5dation describ$ 9     
p>agraph 7#e74  7#b7 ,,ems m$ical       
director evaluation  7,a7 ,9 g5]al ,=   
purposes ( p>agraph 7#a77;,a71 !        
evaluation describ$ 9 ?is subsection is1
 ) respect to ,,ems m$ical directors & !
 #a-ye> p]iod prec$+ ! date ( ! enactm5t
 ( ! ,:5 ,m9utes ,c\nt = ,em]g5cy       

,m$ical ,pati5ts ,act1 an evaluation ( !
 key roles & responsibilities (         
physician m$ical directors 9 ensur+ !   
highe/ quality ( em]g5cy m$ical s]vices 
furni%$ to a ,m$ic>e b5efici>y & %all   
include ! foll[+ in=mation3 7i7 ,an     
analysis ( ! ext5t to :i* paym5t "u     
title ,,xviii ( ! ,social ,security ,act
 to em]g5cy m$ical s]vices ag5cies z    
provid]s or suppli]s ( gr\nd & air      
ambulance s]vices dur+ su* p]iod 0      
suffici5t to enable su* ag5cies to      
reimburse ,,ems m$ical directors = !    
roles & responsibilities ( m$ical       
direction & ov]sight s]vices id5tifi$ by
 ! s\rces ( in=mation 9 subp>agraph     
7,b74  7ii7 ,consid] h[ mod]nization (  
,,ems s]vices t all[s an em]g5cy m$ical 
s]vices ag5cy t is an ambulance provid] 
or suppli] "u title ,,xviii ( ! ,social 
,security 7#db ,u4,s4,c4 #acie et seq47 
to treat a pati5t 9 place & n transport 
! pati5t to a hospital1 or to transport 
! pati5t to an appropriate cl9ical sett+
 t is n a hospital1 may increase !      

necessity & int5sity ( physician        
sup]vision to ensure pati5t safety &    
quality ( c>e ( pati5ts ) em]g5cy m$ical
 conditions n be+ transport$ to a       
hospital4  7iii7 ,recomm5dations z to   
pot5tial models ( paym5t "u title       
,,xviii ( ! ,social ,security ,act =    
s]vices furni%$ by ,,ems m$ical         
directors1 includ+--  7,i7 any recomm5d$
 diff]5ce 9 paym5t = onl9e & (fl9e      
m$ical direction2 &  7,,ii7             
recomm5dations z to :e!r sep>ate paym5t 
"u su* title ,,xviii = m$ical direction 
& ov]sight w\ld be ju/ifi$ to ensure    
high quality ( em]g5cy c>e provid$ to   
,m$ic>e b5efici>ies & h[ su* sep>ate    
paym5t c\ld be implem5t$4  7,b7 ,s\rces 
( in=mation ,9 conduct+ ! evaluation "u 
subp>agraph 7,a71 ,med,p,a,c %all       
consid] ! foll[+ s\rces ( in=mation )   
respect to ! role ( ,,ems m$ical        
directors 9 ! provision ( em]g5cy m$ical
 s]vices3 7i7 ,! (ficial position       
/atem5t ) respect to ,,ems m$ical       
director comp5sation ( ! ,national      

,association ( ,,ems ,physicians4  7ii7 
,! ,heal? ,res\rces & ,s]vices          
,adm9i/ration ,guide = ,prep>+ ,m$ical  
,directors4  7iii7 ,! ,national ,highway
 ,traffic ,safety ,adm9i/ration ,guide =
 ,prep>+ ,m$ical ,directors4  7iv7 ,!   
,unit$ ,/ates ,fire ,adm9i/ration       
,h&book = ,m$ical ,directors4  7v7 ,!   
sup]vision requirem5ts "u section       
#cjc7k7 ( ! ,controll$ ,sub/ances ,act4 
7vi7 ,! ,m$ic>e ,gr\nd ,ambulance ,data 
,collection ,sy/em e/abli%$ "u section  
#ahcd7l77#ag7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciem7l77#ag774  7vii7 
,! ,am]ican ,college ( ,em]g5cy         
,physicians policy /atem5t entitl$      
,physician ,m$ical ,direction ( ,em]g5cy
 ,m$ical ,s]vices ,education ,programs4 
7viii7 ,any o!r relevant in=mation4     
7#c7 ,em]g5cy m$ical s]vices pr(essional
 evaluation ,= purposes ( p>agraph      
7#a77;,b71 ! evaluation describ$ 9 ?is  
subsection is1 ) respect to em]g5cy     
m$ical s]vices pr(essionals & ! #a-ye>  
p]iod prec$+ ! date ( ! enactm5t ( ! ,:5

 ,m9utes ,c\nt = ,em]g5cy ,m$ical       
,pati5ts ,act1 an evaluation ( ! key    
roles & responsibilities ( em]g5cy      
m$ical s]vices pr(essionals :o provide  
c>e & treatm5t to ,m$ic>e b5efici>ies1 &
 %all include ! foll[+ in=mation3  7,a7 
,an analysis ( ! %ortage ( ,,ems        
pr(essionals s9ce #bjbj & ! impact ( su*
 %ortage on access by ,m$ic>e           
b5efici>ies to em]g5cy m$ical s]vices1  
includ+ causes & pot5tial solutions4    
7,b7 ,an analysis ( ! ext5t to :i*      
paym5t "u title ,,xviii ( ! ,social     
,security ,act impacts su* %ortage1 &   
:e!r ,,ems ag5cies require additional   
paym5t "u su* title ,,xviii to attract &
 reta9 capable ,,ems pr(essionals4  7,c7
 ,an analysis ( h[ mod]nization ( ,,ems 
s]vices describ$ 9 p>agraph 7#b77;,a7   
may impact ! /aff+ ( pr(essionals to    
provide su* s]vices4  7,d7              
,recomm5dations on any *anges t %\ld be 
made to ensure a suffici5t & capable    
,,ems pr(essional work=ce to provide !  
highe/ quality ( c>e & transport =      

,m$ic>e b5efici>ies ) em]g5cy m$ical    
conditions4  7,e7 ,any o!r relevant     
in=mation on ! curr5t & pot5tial future 
role ( su* pr(essionals 9 ! provision ( 
em]g5cy m$ical s]vices1 community       
p>am$ic9e1 & mobile integrat$ heal? c>e 
s]vices4  7#d7 ,quality assurance       
recomm5dations ,= purposes ( p>agraph   
7#a77;,c71 ! recomm5dations describ$ 9  
?is subsection are recomm5dations )     
respect to me*anisms t may be us$ by    
,congress to ensure ! highe/ quality (  
em]g5cy m$ical s]vices furni%$ to       
,m$ic>e b5efici>ies1 su* z ! use (      
quality measures or conditions (        
p>ticipation "u title ,,xviii ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq474 ,9 =m+ su*              
recomm5dations1 ,med,p,a,c %all take    
into consid]ation--  7,a7 ! uniqu5ess ( 
! em]g5cy m$ical s]vices deliv]y model2 
&  7,b7 diff]5t types ( em]g5cy m$ical  
s]vices ag5cies1 z describ$ 9 section   
#cjc7k77#ac77;,d7 ( ! ,controll$        
,sub/ances ,act 7#ba ,u4,s4,c4          

#hbc7k77#ac77;,d774  7#e7 ,em]g5cy      
m$ical s]vices def9ition analysis &     
recomm5dation ,= purposes ( p>agraph    
7#a77;,d71 ! analysis & recomm5dation   
describ$ 9 ?is subsection are ! foll[+3 
7,a7 ,an analysis ( ! consequ5ces (     
am5d+ section #ahfa ( ! ,social         
,security ,act 7#db ,u4,s4,c4 #aciex7 to
 add a def9ition ( ! t]m em]g5cy m$ical 
s]vices t is consi/5t ) ! def9ition (   
su* t]m 9 section #cjc7k77#ac77;,c7 ( ! 
,controll$ ,sub/ances ,act 7#ba         
,u4,s4,c4 #hbc7k77#ac77;,c774  7,b7 ,a  
recomm5dation z to :e!r ! t]m provid] ( 
s]vices "u section #ahfa7u7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4 #aciex7u77
 %\ld be am5d$ to include an em]g5cy    
m$ical s]vices ag5cy4 ,su* recomm5dation
 %all include-- 7i7 an evaluation ( any 
*anges to paym5t "u title ,,xviii ( su* 
,act t w\ld result f su* an am5dm5t2    
7ii7 an evaluation ( any o!r pot5tial   
b5efits or obligations "u titles ,,xviii
 & ,,xix ( su* ,act t w\ld result f su* 
an am5dm5t2 &  7iii7 any o!r relevant   

in=mation4  7b7 ,,emtala guidance &     
report  7#a7 ,guidance ,n lat] ?an #a   
ye> aft] ! date ( enactm5t ( ?is ,act1 !
 ,secret>y ( ,heal? & ,human ,s]vices   
%all issue guidance to hospitals t h a  
hospital em]g5cy dep>tm5t1 reg>d+ !     
obligation ( su* hospitals to address   
wall "t pursuant to section #ahfg ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie;dd74  7#b7 ,report ,n lat] ?an #a 
ye> aft] ! date on :i* ! guidance is    
issu$ "u p>agraph 7#a71 ! ,secret>y %all
 submit a report to ,congress t includes
 an evaluation ( :e!r su* guidance has  
decreas$ ! incid5ces ( wall "t dur+ !   
su* ye>1 & any recomm5dations =         
legislation t ! ,secret>y believes      
,congress %\ld consid] enact+ to        
elim9ate wall "t4  7c7 ,def9itions ,9   
?is section1 ! foll[+ def9itions apply3 
7#a7 ,em]g5cy m$ical s]vices ,! t]m     
em]g5cy m$ical s]vices--  7,a7 has !    
mean+ giv5 su* t]m 9 section            
#cjc7k77#ac77;,c7 ( ! ,controll$        
,sub/ances ,act 7#ba ,u4,s4,c4          

#hbc7k77#ac77;,c772 &  7,b7 includes    
ambulance s]vices 7:e!r gr\nd or air7   
cov]$ "u section #ahcd7l7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#aciem7l774  7#b7 ,em]g5cy m$ical       
s]vices ag5cy ,! t]m em]g5cy m$ical     
s]vices ag5cy has ! mean+ giv5 su* t]m 9
 section #cjc7k77#ac77;,d7 ( !          
,controll$ ,sub/ances ,act 7#ba         
,u4,s4,c4 #hbc7k77#ac77;,d774  7#c7     
,em]g5cy m$ical s]vices pr(essional ,!  
t]m em]g5cy m$ical s]vices pr(essional  
has ! mean+ giv5 su* t]m 9 section      
#cjc7k77#ac77;,e7 ( ! ,controll$        
,sub/ances ,act 7#ba ,u4,s4,c4          
#hbc7k77#ac77;,e774  7#d7 ,,ems m$ical  
director ,! t]m ,,ems m$ical director   
has ! mean+ giv5 ! t]m m$ical director 9
 section #cjc7k77#ac77;,h7 ( !          
,controll$ ,sub/ances ,act 7#ba         
,u4,s4,c4 #hbc7k77#ac77;,h774  7#e7     
,m$ic>e b5efici>y ,! t]m ,m$ic>e        
b5efici>y means an individual entitl$ to
 b5efits "u "p ,a ( title ,,xviii ( !   
,social ,security ,act 7#db ,u4,s4,c4   

#acie et seq47 or enroll$ "u "p ,b ( su*
 title4  7#f7 ,wall "t ,! t]m wall "t   
means ! am\nt ( "t beyond #cj m9utes (  
pati5t h& (f f ,,ems pr(essionals to    
hospital cl9ical p]sonnel able to       
provide c>e to ! pati5t at a hospital   
em]g5cy dep>tm5t or free/&+ em]g5cy     
dep>tm5t4  7#g7 ,specifi$ drug ,! t]m   
specifi$ drug has ! mean+ giv5 ! t]m    
specifi$ life-sav+ ,,ems m$ication 9    
section #aaae;,a7h77#g7 ( ! ,social     
,security ,act1 z add$ by section #b ( !
 ,:5 ,m9utes ,c\nt = ,em]g5cy ,m$ical   
,pati5ts ,act4