[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2045 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 2045

To amend title I of the Employee Retirement Income Security Act of 1974 
  to provide to participants and beneficiaries of group health plans 
                   access to emergency medical care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              June 8, 1999

  Mr. Toomey introduced the following bill; which was referred to the 
                Committee on Education and the Workforce

_______________________________________________________________________

                                 A BILL


 
To amend title I of the Employee Retirement Income Security Act of 1974 
  to provide to participants and beneficiaries of group health plans 
                   access to emergency medical care.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient Right to Emergency Medical 
Care Act of 1999''.

SEC. 2. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of 
the Employee Retirement Income Security Act of 1974 is amended by 
adding at the end the following new section:

``SEC. 714. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.

    ``(a) In General.--To the extent that a group health plan (or a 
health insurance issuer offering health insurance coverage in 
connection with the plan) provides for any benefits consisting of 
emergency medical care, except for items or services specifically 
excluded--
            ``(1) the plan or issuer shall provide benefits, without 
        requiring preauthorization and without regard to otherwise 
        applicable network limitations, for appropriate emergency 
        medical screening examinations (within the capability of the 
        emergency facility, including ancillary services routinely 
        available to the emergency facility) to the extent that a 
        prudent layperson, who possesses an average knowledge of health 
        and medicine, would determine such examinations to be necessary 
        in order to determine whether emergency medical care is 
        required; and
            ``(2) the plan or issuer shall provide benefits for 
        additional emergency medical services following an emergency 
        medical screening examination (if determined necessary under 
        paragraph (1)) to the extent that a prudent emergency medical 
        professional would determine such additional emergency services 
        to be necessary to avoid the consequences described in 
        subsection (c).
    ``(b) Uniform Cost-Sharing Required.--Nothing in this section shall 
be construed as preventing a group health plan or issuer from imposing 
any form of cost-sharing applicable to any participant or beneficiary 
(including coinsurance, copayments, deductibles, and any other charges) 
in relation to benefits described in subsection (a), if such form of 
cost-sharing is uniformly applied under such plan, with respect to 
similarly situated participants and beneficiaries, to all benefits 
consisting of emergency medical care provided to such similarly 
situated participants and beneficiaries under the plan.
    ``(c) Emergency Medical Care.--For purposes of this section, the 
term `emergency medical care' means medical care in any case in which 
an appropriate physician has certified in writing (or as otherwise 
provided in regulations of the Secretary)--
            ``(1) that failure to immediately provide the care to the 
        participant or beneficiary could reasonably be expected to 
        result in--
                    ``(A) placing the health of such participant or 
                beneficiary (or, with respect to such a participant or 
                beneficiary who is a pregnant woman, the health of the 
                woman or her unborn child) in serious jeopardy;
                    ``(B) serious impairment to bodily functions; or
                    ``(C) serious dysfunction of any bodily organ or 
                part; or
            ``(2) that immediate provision of the care is necessary 
        because the participant or beneficiary has made or is at 
        serious risk of making an attempt to harm himself or herself or 
        another individual.''.
    (b) Conforming Amendment.--The table of contents in section 1 of 
such Act is amended by adding at the end of the items relating to 
subpart B of part 7 of subtitle B of title I of such Act the following 
new item:

``Sec. 714. Patient access to emergency medical care.''.

SEC. 3. EFFECTIVE DATE AND RELATED RULES.

    (a) In General.--The amendments made by this Act shall apply with 
respect to plan years beginning on or after January 1 of the second 
calendar year following the date of the enactment of this Act, except 
that the Secretary of Labor may issue regulations before such date 
under such amendments. The Secretary shall first issue regulations 
necessary to carry out the amendments made by this Act before the 
effective date thereof.
    (b) Limitation on Enforcement Actions.--No enforcement action shall 
be taken, pursuant to the amendments made by this Act, against a group 
health plan or health insurance issuer with respect to a violation of a 
requirement imposed by such amendments before the date of issuance of 
regulations issued in connection with such requirement, if the plan or 
issuer has sought to comply in good faith with such requirement.
    (c) Special Rule for Collective Bargaining Agreements.--In the case 
of a group health plan maintained pursuant to one or more collective 
bargaining agreements between employee representatives and one or more 
employers ratified before the date of the enactment of this Act, the 
amendments made by this Act shall not apply with respect to plan years 
beginning before the later of--
            (1) the date on which the last of the collective bargaining 
        agreements relating to the plan terminates (determined without 
        regard to any extension thereof agreed to after the date of the 
        enactment of this Act); or
            (2) January 1, 2002.
For purposes of this subsection, any plan amendment made pursuant to a 
collective bargaining agreement relating to the plan which amends the 
plan solely to conform to any requirement added by this Act shall not 
be treated as a termination of such collective bargaining agreement.
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