Rubber Meets the Road: Healthcare Reform Bill with EMS funding HAS JUST PASSED THE HOUSE, 220-215 in a late-night vote!!

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Permalink Reply by Thomas Durkee on November 8, 2009 at 12:03pm

HERE IS THE TRAUMA/EMS SECTION OF THE HOUSE BILL - - - - -

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H.R.3962
Affordable Health Care for America Act (Introduced in House)

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PART 3--EMERGENCY CARE-RELATED PROGRAMS

SEC. 2551. TRAUMA CARE CENTERS.

(a) Grants for Trauma Care Centers- Section 1241 (42 U.S.C. 300d-41) is amended to read as follows:

`SEC. 1241. GRANTS FOR CERTAIN TRAUMA CENTERS.

`(a) In General- The Secretary shall establish a trauma center program consisting of awarding grants under section (b).

`(b) Grants- The Secretary shall award grants as follows:

`(1) EXISTING CENTERS- Grants to public, private nonprofit, Indian Health Service, Indian tribal, and urban Indian trauma centers--

`(A) to further the core missions of such centers; or

`(B) to provide emergency relief to ensure the continued and future availability of trauma services by trauma centers--

`(i) at risk of closing or operating in an area where a closing has occurred within their primary service area; or

`(ii) in need of financial assistance following a natural disaster or other catastrophic event, such as a terrorist attack.

`(2) NEW CENTERS- Grants to local governments and public or private nonprofit entities to establish new trauma centers in urban areas with a substantial degree of trauma resulting from violent crimes.

`(c) Minimum Qualifications of Trauma Centers-

`(1) PARTICIPATION IN TRAUMA CARE SYSTEM OPERATING UNDER CERTAIN PROFESSIONAL GUIDELINES-

`(A) LIMITATION- Subject to subparagraph (B), the Secretary may not award a grant to an existing trauma center under this section unless the center is a participant in a trauma care system that substantially complies with section 1213.

`(B) EXEMPTION- Subparagraph (A) shall not apply to trauma centers that are located in States with no existing trauma care system.

`(2) DESIGNATION- The Secretary may not award a grant under this section to an existing trauma center unless the center is--

`(A) verified as a trauma center by the American College of Surgeons; or

`(B) designated as a trauma center by the applicable State health or emergency medical services authority.'.

(b) Considerations in Making Grants- Section 1242 (42 U.S.C. 300d-42) is amended to read as follows:

`SEC. 1242. CONSIDERATIONS IN MAKING GRANTS.

`(a) Core Mission Awards-

`(1) IN GENERAL- In awarding grants under section 1241(b)(1)(A), the Secretary shall--

`(A) reserve a minimum of 25 percent of the amount allocated for such grants for level III and level IV trauma centers in rural or underserved areas;

`(B) reserve a minimum of 25 percent of the amount allocated for such grants for level I and level II trauma centers in urban areas; and

`(C) give preference to any application made by a trauma center--

`(i) in a geographic area where growth in demand for trauma services exceeds capacity;

`(ii) that demonstrates the financial support of the State or political subdivision involved;

`(iii) that has at least 1 graduate medical education fellowship in trauma or trauma-related specialties, including neurological surgery, surgical critical care, vascular surgery, and spinal cord injury, for which demand is exceeding supply; or

`(iv) that demonstrates a substantial commitment to serving vulnerable populations.

`(2) FINANCIAL SUPPORT- For purposes of paragraph (1)(C)(ii), financial support may be demonstrated by State or political subdivision funding for the trauma center's capital or operating expenses (including through State trauma regional advisory coordination activities, Medicaid funding designated for trauma services, or other governmental funding). State funding derived from Federal support shall not constitute State or local financial support for purposes of preferential treatment under this subsection.

`(3) USE OF FUNDS- The recipient of a grant under section 1241(b)(1)(A) shall carry out, consistent with furthering the core missions of the center, one or more of the following activities:

`(A) Providing 24-hour-a-day, 7-day-a-week trauma care availability.

`(B) Reducing overcrowding related to throughput of trauma patients.

`(C) Enhancing trauma surge capacity.

`(D) Ensuring physician and essential personnel availability.

`(E) Trauma education and outreach.

`(F) Coordination with local and regional trauma care systems.

`(G) Such other activities as the Secretary may deem appropriate.

`(b) Emergency Awards; New Centers- In awarding grants under paragraphs (1)(B) and (2) of section 1241(b), the Secretary shall--

`(1) give preference to any application submitted by an applicant that demonstrates the financial support (in accordance with subsection (a)(2)) of the State or political subdivision involved for the activities to be funded through the grant for each fiscal year during which payments are made to the center under the grant; and

`(2) give preference to any application submitted for a trauma center that--

`(A) is providing or will provide trauma care in a geographic area in which the availability of trauma care has either significantly decreased as a result of a trauma center in the area permanently ceasing participation in a system described in section 1241(c)(1) as of a date occurring during the 2-year period preceding the fiscal year for which the trauma center is applying to receive a grant, or in geographic areas where growth in demand for trauma services exceeds capacity;

`(B) will, in providing trauma care during the 1-year period beginning on the date on which the application for the grant is submitted, incur substantial uncompensated care costs in an amount that renders the center unable to continue participation in such system and results in a significant decrease in the availability of trauma care in the geographic area;

`(C) operates or will operate in rural areas where trauma care availability will significantly decrease if the center is forced to close or downgrade service and substantial costs are contributing to a likelihood of such closure or downgradation;

`(D) is in a geographic location substantially affected by a natural disaster or other catastrophic event such as a terrorist attack; or

`(E) will establish a new trauma service in an urban area with a substantial degree of trauma resulting from violent crimes.

`(c) Designations of Levels of Trauma Centers in Certain States- In the case of a State which has not designated 4 levels of trauma centers, any reference in this section to--

`(1) a level I or level II trauma center is deemed to be a reference to a trauma center within the highest 2 levels of trauma centers designated under State guidelines; and

`(2) a level III or IV trauma center is deemed to be a reference to a trauma center not within such highest 2 levels.'.

(c) Certain Agreements- Section 1243 (42 U.S.C. 300d-43) is amended to read as follows:

`SEC. 1243. CERTAIN AGREEMENTS.

`(a) Commitment Regarding Continued Participation in Trauma Care System- The Secretary may not award a grant to an applicant under section 1241(b) unless the applicant agrees that--

`(1) the trauma center involved will continue participation, or in the case of a new center will participate, in the system described in section 1241(c)(1), except as provided in section 1241(c)(1)(B), throughout the grant period beginning on the date that the center first receives payments under the grant; and

`(2) if the agreement made pursuant to paragraph (1) is violated by the center, the center will be liable to the United States for an amount equal to the sum of--

`(A) the amount of assistance provided to the center under section 1241; and

`(B) an amount representing interest on the amount specified in subparagraph (A).

`(b) Maintenance of Financial Support- With respect to activities for which funds awarded through a grant under section 1241 are authorized to be expended, the Secretary may not award such a grant unless the applicant agrees that, during the period in which the trauma center involved is receiving payments under the grant, the center will maintain access to trauma services at levels not less than the levels for the prior year, taking into account--

`(1) reasonable volume fluctuation that is not caused by intentional trauma boundary reduction;

`(2) downgrading of the level of services; and

`(3) whether such center diverts its incoming patients away from such center 5 percent or more of the time during which the center is in operation over the course of the year.

`(c) Trauma Care Registry- The Secretary may not award a grant to a trauma center under section 1241(b)(1) unless the center agrees that--

`(1) not later than 6 months after the date on which the center submits a grant application to the Secretary, the center will establish and operate a registry of trauma cases in accordance with guidelines developed by the American College of Surgeons; and

`(2) in carrying out paragraph (1), the center will maintain information on the number of trauma cases treated by the center and, for each such case, the extent to which the center incurs uncompensated costs in providing trauma care.'.

(d) General Provisions- Section 1244 (42 U.S.C. 300d-44) is amended to read as follows:

`SEC. 1244. GENERAL PROVISIONS.

`(a) Limitation on Duration of Support- The period during which a trauma center receives payments under a grant under section 1241(b)(1) shall be for 3 fiscal years, except that the Secretary may waive such requirement for the center and authorize the center to receive such payments for 1 additional fiscal year.

`(b) Eligibility- The acquisition of, or eligibility for, a grant under section 1241(b) shall not preclude a trauma center's eligibility for another grant described in such section.

`(c) Funding Distribution- Of the total amount appropriated for a fiscal year under section 1245--

`(1) 90 percent shall be used for grants under paragraph (1)(A) of section 1241(b); and

`(2) 10 percent shall be used for grants under paragraphs (1)(B) and (2) of section 1241(b).

`(d) Report- Beginning 2 years after the date of the enactment of the Affordable Health Care for America Act, and every 2 years thereafter, the Secretary shall biennially--

`(1) report to Congress on the status of the grants made pursuant to section 1241;

`(2) evaluate and report to Congress on the overall financial stability of trauma centers in the United States;

`(3) report on the populations using trauma care centers and include aggregate patient data on income, race, ethnicity, and geography; and

`(4) evaluate the effectiveness and efficiency of trauma care center activities using standard public health measures and evaluation methodologies.'.

(e) Authorization of Appropriations- Section 1245 (42 U.S.C. 300d-45) is amended to read as follows:

`SEC. 1245. AUTHORIZATION OF APPROPRIATIONS.

`(a) In General- For the purpose of carrying out this part, there are authorized to be appropriated $100,000,000 for fiscal year 2011, and such sums as may be necessary for each of fiscal years 2012 through 2015. Such authorization of appropriations is in addition to any other authorization of appropriations or amounts that are available for such purpose.

`(b) Reallocation- The Secretary shall reallocate for grants under section 1241(b)(1)(A) any funds appropriated for grants under paragraph (1)(B) or (2) of section 1241(b), but not obligated due to insufficient applications eligible for funding.'.

`(C) promote local, regional, and State emergency medical systems' preparedness for and response to public health events.





SEC. 2552. EMERGENCY CARE COORDINATION.

(a) In General- Subtitle B of title XXVIII (42 U.S.C. 300hh-10 et seq.) is amended by adding at the end the following:

`SEC. 2816. EMERGENCY CARE COORDINATION.

`(a) Emergency Care Coordination Center-

`(1) ESTABLISHMENT- The Secretary shall establish, within the Office of the Assistant Secretary for Preparedness and Response, an Emergency Care Coordination Center (in this section referred to as the `Center'), to be headed by a director.

`(2) DUTIES- The Secretary, acting through the Director of the Center, in coordination with the Federal Interagency Committee on Emergency Medical Services, shall--

`(A) promote and fund research in emergency medicine and trauma health care;

`(B) promote regional partnerships and more effective emergency medical systems in order to enhance appropriate triage, distribution, and care of routine community patients; and

`(C) promote local, regional, and State emergency medical systems' preparedness for and response to public health events.



Thomas Durkee said:

Here is the 11-page summary of the Healthcare Reform bill that just passed the House:

http://www.politico.com/static/PPM41_hcr_complete_summary.html


--Tom

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Permalink Reply by Thomas Durkee on November 8, 2009 at 12:16pm

`(b) Council of Emergency Care-

`(1) ESTABLISHMENT- The Secretary, acting through the Director of the Center, shall establish a Council of Emergency Care to provide advice and recommendations to the Director on carrying out this section.

`(2) COMPOSITION- The Council shall be comprised of employees of the departments and agencies of the Federal Government who are experts in emergency care and management.

`(c) Report-

`(1) SUBMISSION- Not later than 12 months after the date of the enactment of the Affordable Health Care for America Act, the Secretary shall submit to the Congress an annual report on the activities carried out under this section.

`(2) CONSIDERATIONS- In preparing a report under paragraph (1), the Secretary shall consider factors including--

`(A) emergency department crowding and boarding; and

`(B) delays in care following presentation.

`(d) Authorization of Appropriations- To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2011 through 2015.'.

(b) Functions, Personnel, Assets, Liabilities, and Administrative Actions- All functions, personnel, assets, and liabilities of, and administrative actions applicable to, the Emergency Care Coordination Center, as in existence on the day before the date of the enactment of this Act, shall be transferred to the Emergency Care Coordination Center established under section 2816(a) of the Public Health Service Act, as added by subsection (a).

SEC. 2553. PILOT PROGRAMS TO IMPROVE EMERGENCY MEDICAL CARE.

Part B of title III (42 U.S.C. 243 et seq.) is amended by inserting after section 314 the following:

`SEC. 315. REGIONALIZED COMMUNICATION SYSTEMS FOR EMERGENCY CARE RESPONSE.

`(a) In General- The Secretary, acting through the Assistant Secretary for Preparedness and Response, shall award not fewer than 4 multiyear contracts or competitive grants to eligible entities to support demonstration programs that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care systems.

`(b) Eligible Entity; Region-

`(1) ELIGIBLE ENTITY- In this section, the term `eligible entity' means a State or a partnership of 1 or more States and 1 or more local governments.

`(2) REGION- In this section, the term `region' means an area within a State, an area that lies within multiple States, or a similar area (such as a multicounty area), as determined by the Secretary.

`(c) Demonstration Program- The Secretary shall award a contract or grant under subsection (a) to an eligible entity that proposes a demonstration program to design, implement, and evaluate an emergency medical system that--

`(1) coordinates with public safety services, public health services, emergency medical services, medical facilities, and other entities within a region;

`(2) coordinates an approach to emergency medical system access throughout the region, including 9-1-1 public safety answering points and emergency medical dispatch;

`(3) includes a mechanism, such as a regional medical direction or transport communications system, that operates throughout the region to ensure that the correct patient is taken to the medically appropriate facility (whether an initial facility or a higher level facility) in a timely fashion;

`(4) allows for the tracking of prehospital and hospital resources, including inpatient bed capacity, emergency department capacity, on-call specialist coverage, ambulance diversion status, and the coordination of such tracking with regional communications and hospital destination decisions; and

`(5) includes a consistent regionwide prehospital, hospital, and interfacility data management system that--

`(A) complies with the National EMS Information System, the National Trauma Data Bank, and others;

`(B) reports data to appropriate Federal and State databanks and registries; and

`(C) contains information sufficient to evaluate key elements of prehospital care, hospital destination decisions, including initial hospital and interfacility decisions, and relevant outcomes of hospital care.

`(d) Application-

`(1) IN GENERAL- An eligible entity that seeks a contract or grant described in subsection (a) shall submit to the Secretary an application at such time and in such manner as the Secretary may require.

`(2) APPLICATION INFORMATION- Each application shall include--

`(A) an assurance from the eligible entity that the proposed system--

`(i) has been coordinated with the applicable State office of emergency medical services (or equivalent State office);

`(ii) is compatible with the applicable State emergency medical services system;

`(iii) includes consistent indirect and direct medical oversight of prehospital, hospital, and interfacility transport throughout the region;

`(iv) coordinates prehospital treatment and triage, hospital destination, and interfacility transport throughout the region;

`(v) includes a categorization or designation system for special medical facilities throughout the region that is--

`(I) consistent with State laws and regulations; and

`(II) integrated with the protocols for transport and destination throughout the region; and

`(vi) includes a regional medical direction system, a patient tracking system, and a resource allocation system that--

`(I) support day-to-day emergency care system operation;

`(II) can manage surge capacity during a major event or disaster; and

`(III) are integrated with other components of the national and State emergency preparedness system;

`(B) an agreement to make available non-Federal contributions in accordance with subsection (e); and

`(C) such other information as the Secretary may require.

`(e) Matching Funds-

`(1) IN GENERAL- With respect to the costs of the activities to be carried out each year with a contract or grant under subsection (a), a condition for the receipt of the contract or grant is that the eligible entity involved agrees to make available (directly or through donations from public or private entities) non-Federal contributions toward such costs in an amount that is not less than 25 percent of such costs.

`(2) DETERMINATION OF AMOUNT CONTRIBUTED- Non-Federal contributions required in paragraph (1) may be in cash or in kind, fairly evaluated, including plant, equipment, or services. Amounts provided by the Federal Government, or services assisted or subsidized to any significant extent by the Federal Government, may not be included in determining the amount of such non-Federal contributions.

`(f) Priority- The Secretary shall give priority for the award of the contracts or grants described in subsection (a) to any eligible entity that serves a medically underserved population (as defined in section 330(b)(3)).

`(g) Report- Not later than 90 days after the completion of a demonstration program under subsection (a), the recipient of such contract or grant described in such subsection shall submit to the Secretary a report containing the results of an evaluation of the program, including an identification of--

`(1) the impact of the regional, accountable emergency care system on patient outcomes for various critical care categories, such as trauma, stroke, cardiac emergencies, and pediatric emergencies;

`(2) the system characteristics that contribute to the effectiveness and efficiency of the program (or lack thereof);

`(3) methods of assuring the long-term financial sustainability of the emergency care system;

`(4) the State and local legislation necessary to implement and to maintain the system; and

`(5) the barriers to developing regionalized, accountable emergency care systems, as well as the methods to overcome such barriers.

`(h) Evaluation- The Secretary, acting through the Assistant Secretary for Preparedness and Response, shall enter into a contract with an academic institution or other entity to conduct an independent evaluation of the demonstration programs funded under subsection (a), including an evaluation of--

`(1) the performance of the eligible entities receiving the funds; and

`(2) the impact of the demonstration programs.

`(i) Dissemination of Findings- The Secretary shall, as appropriate, disseminate to the public and to the appropriate committees of the Congress, the information contained in a report made under subsection (h).

`(j) Authorization of Appropriations-

`(1) IN GENERAL- There is authorized to be appropriated to carry out this section $12,000,000 for each of fiscal years 2011 through 2015.

`(2) RESERVATION- Of the amount appropriated to carry out this section for a fiscal year, the Secretary shall reserve 3 percent of such amount to carry out subsection (h) (relating to an independent evaluation).'.

SEC. 2554. ASSISTING VETERANS WITH MILITARY EMERGENCY MEDICAL TRAINING TO BECOME STATE-LICENSED OR CERTIFIED EMERGENCY MEDICAL TECHNICIANS (EMTS).

(a) In General- Part B of title III (42 U.S.C. 243 et seq.), as amended, is amended by inserting after section 315 the following:

`SEC. 315A. ASSISTING VETERANS WITH MILITARY EMERGENCY MEDICAL TRAINING TO BECOME STATE-LICENSED OR CERTIFIED EMERGENCY MEDICAL TECHNICIANS (EMTS).

`(a) Program- The Secretary shall establish a program consisting of awarding grants to States to assist veterans who received and completed military emergency medical training while serving in the Armed Forces of the United States to become, upon their discharge or release from active duty service, State-licensed or certified emergency medical technicians.

`(b) Use of Funds- Amounts received as a grant under this section may be used to assist veterans described in subsection (a) to become State-licensed or certified emergency medical technicians as follows:

`(1) Providing training.

`(2) Providing reimbursement for costs associated with--

`(A) training; or

`(B) applying for licensure or certification.

`(3) Expediting the licensing or certification process.

`(c) Eligibility- To be eligible for a grant under this section, a State shall demonstrate to the Secretary's satisfaction that the State has a shortage of emergency medical technicians.

`(d) Report- The Secretary shall submit to the Congress an annual report on the program under this section.

`(e) Authorization of Appropriations- To carry out this section, there are authorized to be appropriated such sums as may be necessary for each of fiscal years 2011 through 2015.'.

(b) GAO Study and Report- The Comptroller General of the United States shall--

(1) conduct a study on the barriers experienced by veterans who received training as medical personnel while serving in the Armed Forces of the United States and, upon their discharge or release from active duty service, seek to become licensed or certified in a State as civilian health professionals; and

(2) not later than 2 years after the date of the enactment of this Act, submit to the Congress a report on the results of such study, including recommendations on whether the program established under section 315A of the Public Health Service Act, as added by subsection (a), should be expanded to assist veterans seeking to become licensed or certified in a State as health providers other than emergency medical technicians.

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Permalink Reply by Ben Waller on November 8, 2009 at 5:42pm

"The House Bill is dead on arrival in the Senate." Sen. Lindsey Graham, R-SC

The moderate Democrats hold the key to passing health care reform.
Apparently, they'd rather be re-elected instead of passing the bill in its current form.

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Permalink Reply by Russell Stine on November 8, 2009 at 6:02pm

I pray to God above that the Senate kills this bill and any like it.

Let's fix what we have before we start creating new bureaucracy.

Ben Waller said:

"The House Bill is dead on arrival in the Senate." Sen. Lindsey Graham, R-SC
The moderate Democrats hold the key to passing health care reform. Apparently, they'd rather be re-elected instead of passing the bill in its current form.

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Permalink Reply by Thomas Durkee on November 8, 2009 at 8:02pm

Last night, after the Bill passed the House, sirens sounded (EMS. Police AND Fire), people cheered, and the bars & lounges here in D.C. were packed (well, it WAS a Saturday night!!).

All of the D.C. EMS and Fire personnel I drank beers with last night were elated that hundreds of millions of dollars may be freed-up for such important programs as EMS for Children, Training for Iraq/Afghanistan veterans so that they may have an EMS career, a Trauma System Registry, Grants for EMS System development, Money to study PATIENT OUTCOMES after EMS treatment, and money to study "the impact of the regional, accountable emergency care system on patient outcomes for various critical care categories, such as trauma, stroke, cardiac emergencies, and pediatric emergencies" (direct quote from the Bill)

Fortunately for EMS, Senator Lindsay Graham has absolutely no political weight in this town anymore.
He is an obstructionist who is bent on keeping money from the EMS field. His disdain for our profession is well-documented; and it is highly doubtful that he has any traction to stop this important bill in the Senate.

Read the bill before you criticize it; otherwise you just might be shooting yourself (and your agency) in the foot.

-Tom

The Capitol Dome is lit up for a rare late Saturday night vote. It lit up the whole Capitol Area including the National Mall.

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Permalink Reply by Thomas Durkee on November 8, 2009 at 8:24pm

Note the flag at half-staff for the Fort Dix soldiers and personnel who were massacred last Friday.

--Tom

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Permalink Reply by Ben Waller on November 8, 2009 at 8:30pm

Amazing...the only local agencies that can directly tap federal dollars without having to justify outcomes, procedures, or how they treat people...cheering for a federal giveaway that someone else will pay for...for now.

The point isn't what more federal giveaways can do for my agency, it's how we - and our children - and our grandchildren - and maybe their children are going to pay for it. It's also about how inflationary the bottomless pit of deficit spending will be, and the end result on the overall economy. After all, health care may be 15% to 20% of the economy, but it's the health of the other 80% to 85% that creates the wealth to pay for it.

We need the best health care we can afford, not questionable health care we can't afford.

As for Sen. Graham, don't be so sure. The 2010 elections are just around the corner, and if the New Jersey and Virginia state elections are any indication, it's going to be a rough year for Democrats. That will put a moderate like Sen. Graham right back atop the heap. Sen. Graham isn't disdainful of EMS, he just wants to be fiscally prudent. A lot of what you perceive as his voting against EMS interests are EMS interests that are buried in bills that have nothing to do with EMS and that have much larger national implications, or are bills that contained poisoned earmarks, or both. That's just the way the game is played in Washington.

Further, if you read the MSNBC story (now THERE is an ultraconservative bastion for you) you'll note that Sen. Graham was merely commenting. The Blue Dog Democrats are the swing votes for the Senate bill, not Sen. Graham, the other Republicans, or Independents like Seb, Joe Lieberman.

And Tom, I did read most of the bill, and it has a lot of pork that has nothing to do with real health care outcomes.

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Permalink Reply by Thomas Durkee on November 8, 2009 at 8:47pm

Good post, Ben. And the battle for health care reform continues.....


One thing I should have mentioned that kinda got lost in the Health Care Reform struggle is:

This week the Senate and House passed the final version of S. 1793, the Ryan White HIV/AIDS Treatment Extension Act of 2009. The legislation is now on its way to President Obama for signature. Due in large part to Advocates for EMS, the first responder notification provision that was dropped in the 2006 law has been reinstated.

Now, that alone probably deserves its own discussion post, but I'd like to mention that the Advocates are out there doing good work and are having some success.

I thought it was worth mentioning....

-Tom

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Permalink Reply by Jasen Adam on November 8, 2009 at 9:04pm

Well put Ben, Well put.

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