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[House Report 111-608]
[From the U.S. Government Publishing Office]


111th Congress                                                   Report
  2d Session             HOUSE OF REPRESENTATIVES               111-608
=======================================================================
 
                            EMT ACT OF 2010 

                                _______
                                

 September 16, 2010.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Waxman, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3199]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3199) to amend the Public Health Service Act to 
provide grants to State emergency medical service departments 
to provide for the expedited training and licensing of veterans 
with prior medical training, and for other purposes, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     3
Committee Consideration..........................................     3
Committee Votes..................................................     4
Committee Oversight Findings and Recommendations.................     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Statement of General Performance Goals and Objectives............     4
Constitutional Authority Statement...............................     4
Earmarks and Tax and Tariff Benefits.............................     4
Federal Advisory Committee Statement.............................     4
Applicability of Law to Legislative Branch.......................     5
Federal Mandates Statement.......................................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Cost Estimate........................     5
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     7

                               Amendment

    The amendment is as follows:
    Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Emergency Medic Transition Act of 
2010'' or the ``EMT Act of 2010''.

SEC. 2. 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 of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by inserting after section 314 the 
following:

``SEC. 315. 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 to such veterans required course work and 
        training that take into account, and are not duplicative of, 
        medical course work and training received when such veterans 
        were active members of the Armed Forces of the United States, 
        to enable such veterans to satisfy emergency medical services 
        personnel certification requirements in the civilian sector, as 
        determined by the appropriate State regulatory entity.
          ``(2) Providing reimbursement for costs associated with--
                  ``(A) such course work and training; or
                  ``(B) applying for licensure or certification.
          ``(3) Expediting the licensing or certification process.
          ``(4) Entering into an agreement with any institution of 
        higher education, or other educational institution certified to 
        provide course work and training to emergency medical 
        personnel, for purposes of providing course work and training 
        under this section if such institution has developed a suitable 
        curriculum that meets the requirements of paragraph (1).
  ``(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 $5,000,000 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 315 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.

                          Purpose and Summary

    H.R. 3199, the ``Emergency Medic Transition (EMT) Act of 
2009'', was introduced by Rep. Jane Harman (D-CA) and referred 
to the Committee on Energy and Commerce on July 14, 2009. The 
goal of H.R. 3199 is to help states with a shortage of 
emergency medical technicians (EMTs) qualify veterans with 
military medical training to become state-certified EMTs.
    H.R. 3199 amends the Public Health Service Act to direct 
the Secretary of Health and Human Services (HHS) to establish a 
program consisting of grants to state entities with 
jurisdiction over emergency medical personnel to help defray 
the costs to veterans with military medical training to become 
a state-qualified or licensed EMT. The legislation authorizes 
such grants to be used to:
         Provide EMT training.
         Provide reimbursement for costs associated 
        with EMT training and the application process for EMT 
        licensure or certification.
         Expedite the EMT licensing or certification 
        process.
    The legislation also authorizes $5 million in each of 
fiscal years 2011 through 2015 to support these activities.
    During consideration of H.R. 3199, the Subcommittee on 
Health adopted a substitute amendment (manager's amendment) 
offered by Rep. Harman that made several changes to the bill. 
The substitute amendment includes the following provisions:
         Clarifies that grant money can be used for 
        training veterans to become EMTs.
         Requires states to demonstrate that they have 
        a shortage of EMTs in the state in order to be eligible 
        for grant funds.
         Requires the Government Accountability Office 
        (GAO) to (1) conduct a study to examine existing 
        barriers that restrict the ability of returning 
        veterans with medical training to become civilian 
        health professionals; and (2) make recommendations on 
        whether the program established under the legislation 
        should be expanded to help returning veterans with 
        medical training become other kinds of state-qualified 
        health professionals.

                  Background and Need for Legislation

    Veterans with military medical training often encounter 
significant certification fees and burdensome requirements to 
study entry-level curricula when they seek to qualify as 
civilian EMTs, making their entry into this field more 
difficult and time-consuming. These barriers come at a time 
when states with EMT shortages are seeking additional personnel 
to help build their emergency response capability. H.R. 3199 is 
designed to address both of these concerns.

                        Committee Consideration

    H.R. 3199, the ``Emergency Medic Transition (EMT) Act of 
2009'', was introduced by Rep. Harman (D-CA) and referred to 
the Committee on Energy and Commerce on July 14, 2009. The bill 
was subsequently referred to the Subcommittee on Health on July 
15, 2009. On July 22, 2010, the Subcommittee on Health met in 
open markup session to consider H.R. 3199. An amendment in the 
nature of a substitute (manager's amendment) by Rep. Harman was 
adopted by a voice vote. Subsequently, H.R. 3199 was favorably 
forwarded to the full Committee, amended, by a voice vote.
    On July 28, 2010, the Committee on Energy and Commerce met 
in open markup session and considered H.R. 3199 as approved by 
the Subcommittee. Subsequently, the Committee ordered H.R. 3199 
favorably reported to the House, as amended by the Subcommittee 
on Health, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. A 
motion by Mr. Waxman ordering H.R. 3199 reported to the House, 
as amended by the Subcommittee on Health on July 22, 2010, was 
approved by a voice vote. There were no record votes taken 
during consideration of this bill.

            Committee Oversight Findings and Recommendations

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the oversight findings and recommendations of 
the Committee are reflected in the descriptive portions of this 
report, including the finding that veterans with military 
medical training often encounter significant obstacles when 
seeking to qualify as civilian EMTs.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Regarding compliance with clause 3(c)(2) of rule XIII of 
the Rules of the House of Representatives, the Committee finds 
that H.R. 3199 would result in no new budget authority, 
entitlement authority, or tax expenditures or revenues.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the performance goals and 
objectives of the Committee are reflected in the descriptive 
portions of this report, including the goal of helping states 
with a shortage of emergency medical technicians qualify 
veterans with military medical training to become state-
certified EMTs.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
constitutional authority for H.R. 3199 is provided under 
Article I, section 8, clauses 3 and 18 of the Constitution of 
the United States.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3199 does not contain any congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9(d), 9(e), or 9(f) of rule XXI of the Rules of the 
House of Representatives.

                  Federal Advisory Committee Statement

    The Committee finds that the legislation does not establish 
or authorize the establishment of an advisory committee within 
the definition of 5 U.S.C. App., section 5(b) of the Federal 
Advisory Committee Act.

             Applicability of Law to the Legislative Branch

    Section 102(b)(3) of Public Law 104-1 requires a 
description of the application of this bill to the legislative 
branch where the bill relates to terms and conditions of 
employment or access to public services and accommodations. 
H.R. 3199 contains no such provisions.

                       Federal Mandates Statement

    Section 423 of the Congressional Budget and Impoundment 
Control Act of 1974 (as amended by section 101(a)(2) of the 
Unfunded Mandates Reform Act, P.L. 104-4) requires a statement 
on whether the provisions of the report include unfunded 
mandates. In compliance with this requirement the Committee 
adopts as its own the estimates of federal mandates prepared by 
the Director of the Congressional Budget Office.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(2) of rule XIII of the Rules of the 
House of Representatives, the Committee adopts as its own the 
cost estimate of H.R. 3199 prepared by the Director of the 
Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    With respect to the requirements of clause (3)(c)(3) of 
rule XIII of the Rules of the House of Representatives and 
section 402 of the Congressional Budget Act of 1974, the 
Committee has received the following cost estimate for H.R. 
3199 from the Director of the Congressional Budget Office:

                                                 September 7, 2010.
Hon. Henry A. Waxman,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 3199, the 
Emergency Medic Transition Act of 2010.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 3199--Emergency Medic Transition Act of 2010

    Summary: H.R. 3199 would authorize a grant program to 
provide funds to states to assist veterans who received and 
completed military emergency medical training while serving in 
the Armed Forces to become licensed or certified emergency 
medical technicians.
    The bill would authorize the appropriation of $5 million 
for fiscal year 2011 and $25 million over the 2011-2015 period. 
Assuming the appropriation of those amounts, CBO estimates that 
implementing the act would cost $3 million in 2011 and $23 
million over the 2011-2015 period. Enacting H.R. 3199 would not 
affect direct spending or revenues; therefore, pay-as-you-go 
procedures do not apply.
    H.R. 3199 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 3199 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                              --------------------------------------------------
                                                                2011    2012    2013    2014    2015   2011-2015
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATIONAuthorization Level..........................................       5       5       5       5       5        25
Estimated Outlays............................................       3       5       5       5       5        23
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: The bill would direct the Secretary of 
Health and Human Services to award grants to states to assist 
veterans to become licensed or certified to work in states as a 
certified emergency medical technician (EMT). The bill would 
authorize $5 million in fiscal year 2011 and for each fiscal 
year through 2015. For this estimate, CBO assumes that H.R. 
3199 will be enacted near the beginning of fiscal year 2011 and 
that the full amounts authorized will be appropriated. The 
outlays are estimated based on the projected number of military 
personnel discharged or released from active duty service who 
would be eligible to receive grant assistance, the average 
costs to train and license an EMT, and the assumption that the 
authorized amounts would be appropriated near the beginning of 
each fiscal year.
    Grant funds would be available to support the costs of 
classes, other training, and licensing fees. H.R. 3199 also 
would require the Government Accountability Office to conduct a 
study on the barriers experienced by veterans who receive 
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 a civilian health professional.
    Intergovernmental and private-sector impact: H.R. 3199 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Funds authorized in the bill would benefit 
states that provide training and education assistance to 
veterans.
    Estimate prepared by: Federal Costs and Impact on State, 
Local, and Tribal Governments: Lisa Ramirez-Branum, Impact on 
the Private Sector: Sarah Axeen.
    Estimate approved by: Peter H. Fontaine, Assistant Director 
for Budget Analysis.

             Section-by-Section Analysis of the Legislation


Section 1. Short title; Table of contents

    Section 1 designates that the short title may be cited as 
the ``Emergency Medic Transition Act of 2010'' or ``EMT Act of 
2010''.

Section 2. Assisting veterans with military emergency medical training 
        to become State-licensed or certified emergency medical 
        technicians (EMTs)

    Section 2(a) establishes a program at HHS to award grants 
to states to assist veterans with military emergency medical 
training to become state-licensed or certified EMTs. It sets 
forth grant eligibility criteria and specifies the requirements 
for use of grant funds. It also requires that the HHS Secretary 
submit an annual report to Congress on the program.
    Section 2(b) requires the Government Accountability Office 
to conduct a study on the barriers experienced by veterans with 
military medical training to become civilian EMTs. It also 
requires GAO to make recommendations as to whether the program 
established under the legislation should be expanded to assist 
veterans seeking to become licensed or certified in a State as 
a health provider other than an EMT.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *


TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


PART B--FEDERAL-STATE COOPERATION

           *       *       *       *       *       *       *


SEC. 315. 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 to such veterans required course work 
        and training that take into account, and are not 
        duplicative of, medical course work and training 
        received when such veterans were active members of the 
        Armed Forces of the United States, to enable such 
        veterans to satisfy emergency medical services 
        personnel certification requirements in the civilian 
        sector, as determined by the appropriate State 
        regulatory entity.
          (2) Providing reimbursement for costs associated 
        with--
                  (A) such course work and training; or
                  (B) applying for licensure or certification.
          (3) Expediting the licensing or certification 
        process.
          (4) Entering into an agreement with any institution 
        of higher education, or other educational institution 
        certified to provide course work and training to 
        emergency medical personnel, for purposes of providing 
        course work and training under this section if such 
        institution has developed a suitable curriculum that 
        meets the requirements of paragraph (1).
  (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 $5,000,000 for 
each of fiscal years 2011 through 2015.

           *       *       *       *       *       *       *