Index for HR3962: Affordable Health Care for America Act

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

(a) Grants for trauma care centers.—Section 1241 (42 U.S.C. 300d–41) is amended to read as follows:

“(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:

“(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:

“(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:

“(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:

“(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.”.

(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:

“(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.

“(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).

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

(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.

(a) National health security strategy.—Section 2802(b)(3) (42 U.S.C. 300hh–1(b)(3)) is amended—

(1) in the matter preceding subparagraph (A), by inserting “dental and” before “mental health facilities”; and

(2) in subparagraph (D), by inserting “and dental” after “medical”.

(b) All-Hazards public health and medical response curricula and training.—Section 319F(a)(5)(B) (42 U.S.C. 247d–6(a)(5)(B)) is amended by striking “public health or medical” and inserting “public health, medical, or dental”.

(a) National response framework.—Paragraph (6) of section 2 of the Homeland Security Act of 2002 (6 U.S.C. 101) is amended by inserting “and dental” after “emergency medical”.

(b) National preparedness system.—Subparagraph (B) of section 653(b)(4) of the Post-Katrina Emergency Management Reform Act of 2006 (6 U.S.C. 753(b)(4)) is amended by striking “public health and medical” and inserting “public health, medical, and dental”.

(c) Chief Medical Officer.—Paragraph (5) of section 516(c) of the Homeland Security Act of 2002 (6 U.S.C. 321e(c)) is amended by striking “medical community” and inserting “medical and dental communities”.