[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 882 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 882

 To amend title XVIII of the Social Security Act to improve access to 
    emergency medical services and the quality of care furnished in 
  emergency departments of hospitals and critical access hospitals by 
establishing a bipartisan commission to examine factors that affect the 
   effective delivery of such services, by providing for additional 
  payments for certain physician services furnished in such emergency 
 departments, and by requiring reports on certain emergency department 
 information as a condition of participation in the Medicare program, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            February 7, 2007

  Mr. Gordon of Tennessee (for himself, Mr. Sessions, Mr. Allen, Ms. 
   Jackson-Lee of Texas, Mr. Hayes, Mr. English of Pennsylvania, Mr. 
    McNulty, Mr. Cohen, Mrs. McCarthy of New York, Mrs. Capps, Mr. 
 Chandler, Mr. Sensenbrenner, Mr. Larsen of Washington, Mr. Holt, Mr. 
 Price of Georgia, Mr. McCaul of Texas, Mr. Dent, Mr. Souder, and Ms. 
Roybal-Allard) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, 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

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to improve access to 
    emergency medical services and the quality of care furnished in 
  emergency departments of hospitals and critical access hospitals by 
establishing a bipartisan commission to examine factors that affect the 
   effective delivery of such services, by providing for additional 
  payments for certain physician services furnished in such emergency 
 departments, and by requiring reports on certain emergency department 
 information as a condition of participation in the Medicare program, 
                        and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) In General.--This Act may be cited as the ``Access to Emergency 
Medical Services Act of 2007''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
 TITLE I--BIPARTISAN COMMISSION ON ACCESS TO EMERGENCY MEDICAL SERVICES

Sec. 101. Establishment.
Sec. 102. Duties.
Sec. 103. Membership.
Sec. 104. Staff and consultants.
Sec. 105. Powers.
Sec. 106. Report on ways to promote the effective delivery of emergency 
                            medical services.
Sec. 107. Termination.
Sec. 108. Authorization of appropriations.
     TITLE II--ADDITIONAL PAYMENTS FOR CERTAIN PHYSICIANS' SERVICES

Sec. 201. Additional payments for certain physicians' services.
TITLE III--HOSPITAL AND CRITICAL ACCESS REPORTING ON CERTAIN EMERGENCY 
                         DEPARTMENT INFORMATION

Sec. 301. Requirement to report information on certain emergency 
                            department information as condition of 
                            Medicare participation.

 TITLE I--BIPARTISAN COMMISSION ON ACCESS TO EMERGENCY MEDICAL SERVICES

SEC. 101. ESTABLISHMENT.

    There is established the United States Bipartisan Commission on 
Access to Emergency Medical Services (in this title referred to as the 
``Commission'').

SEC. 102. DUTIES.

    (a) In General.--The Commission shall perform the following duties:
            (1) Identify and examine factors (including factors 
        described in subsection (b)) in the health care delivery, 
        financing, and legal systems that affect the effective delivery 
        of screening and stabilization services furnished in hospitals 
        that have emergency departments pursuant to EMTALA.
            (2) Make specific recommendations to Congress, taking into 
        account the considerations specified in subsection (c), with 
        respect to Federal programs, policies, and financing needed to 
        assure the availability of such screening and stabilization 
        services and the coordination of State, local, and Federal 
        programs for responding to disasters and emergencies.
    (b) Factors Considered.--For purposes of subsection (a)(1), the 
Commission shall examine at least the following factors, with respect 
to emergency departments of hospitals:
            (1) Crowded conditions in such emergency departments and 
        the practice of boarding patients who require admission, or 
        have already been admitted, to a hospital for extended periods 
        in such departments and in the areas adjacent to such 
        departments.
            (2) With respect to individuals who present at such 
        emergency departments for the treatment of emergency medical 
        conditions, any barriers that impede access within a reasonable 
        period of time to screening, stabilization services, and other 
        appropriate consultations of physicians listed by the hospital 
        on its list of on-call physicians.
            (3) The potential legal and financial liability of health 
        care professionals and providers with respect to services 
        required to be furnished to patients under EMTALA, relating to 
        the requirement of emergency departments to screen and 
        appropriately treat or transfer individuals presenting 
        themselves at the departments with emergency medical conditions 
        and women in labor.
    (c) Considerations in Recommendations.--In making recommendations 
under subsection (a)(2), the Commission shall consider the following:
            (1) Any changes in Federal law that would be necessary to 
        promote the effective delivery of emergency medical services.
            (2) The amount and sources of Federal funds to finance such 
        changes.
            (3) The advantages and disadvantages of alternative 
        approaches to protecting health care professionals and 
        providers from legal and financial liability with respect to 
        services required to be furnished to individuals under EMTALA, 
        such as establishing Federal limits on such liability--
                    (A) that would supersede any conflicting State law 
                related to such liability; and
                    (B) which may be the same as appropriate limits on 
                liability that are established for public health 
                professionals.
            (4) The most efficient and effective manner of coordinating 
        State, local, and Federal programs for responding to disasters 
        and emergencies, with respect to the delivery of emergency 
        medical services.
    (d) Definitions.--For purposes of this title:
            (1) Hospital.--The term ``hospital'' has the meaning given 
        such term in section 1867(e)(5) of the Social Security Act (42 
        U.S.C. 1395dd)).
            (2) EMTALA.--The term ``EMTALA'' means section 1867 of the 
        Social Security Act (42 U.S.C. 1395dd).

SEC. 103. MEMBERSHIP.

    (a) Appointment.--
            (1) The Commission shall be composed of 18 members, who 
        shall be appointed not later than the date that is 60 days 
        after the date of the enactment of this Act and in accordance 
        with paragraph (2), as follows:
                    (A) The President shall appoint six members of the 
                Commission.
                    (B) The Speaker of the House of Representatives, 
                after consultation with the minority leader of the 
                House of Representatives, shall appoint six members of 
                the Commission.
                    (C) The majority leader of the Senate, after 
                consultation with the minority leader of the Senate, 
                shall appoint six members of the Commission.
            (2) Of the members appointed under paragraph (1), the 
        President, the Speaker of the House of Representatives, and the 
        majority leader of the Senate shall each appoint as members of 
        the commission--
                    (A) two individuals who represent physicians and 
                other health care professionals who provide emergency 
                medical services;
                    (B) two individuals who are elected or appointed 
                Federal, State, or local officials and who are involved 
                in issues and programs related to the provision of 
                emergency medical services; and
                    (C) two health care consumer advocates.
    (b) Chairman and Vice Chairmen.--The Commission shall elect a 
chairman and four vice chairmen from among its members.
    (c) Terms.--Each member shall be appointed for the life of the 
Commission.
    (d) Vacancies.--Any member appointed to fill a vacancy occurring 
before the expiration of the term for which the member's predecessor 
was appointed shall be appointed only for the remainder of that term. A 
member may serve after the expiration of that member's term until a 
successor has taken office. Any vacancy in the membership of the 
Commission shall be filled in the manner in which the original 
appointment was made and shall not affect the power of the remaining 
members to execute the duties of the Commission.
    (e) Compensation.--
            (1) In general.--Members of the Commission shall serve 
        without pay.
            (2) Travel expenses.--All members of the Commission shall 
        be reimbursed for travel and per diem in lieu of subsistence 
        expenses during the performance of duties of the Commission 
        while away from their homes or regular places of business, in 
        accordance with subchapter I of chapter 57 of title 5, United 
        States Code.
    (f) Quorum.--A quorum shall consist of nine members of the 
Commission, except that six or more members may conduct a hearing under 
section 105(a).
    (g) Meetings.--The Commission shall meet at the call of its 
chairman or a majority of its members.

SEC. 104. STAFF AND CONSULTANTS.

    (a) Staff.--The Commission may appoint and determine the 
compensation of such staff as may be necessary to carry out the duties 
of the Commission. Such appointments and compensation may be made 
without regard to the provisions of title 5, United States Code, that 
govern appointments in the competitive services, and the provisions of 
chapter 51 and subchapter III of chapter 53 of such title that relate 
to classifications and the General Schedule pay rates.
    (b) Consultants.--The Commission may procure such temporary and 
intermittent services of experts and consultants as the Commission 
determines to be necessary to carry out the duties of the Commission, 
in accordance with section 3109(b) of title 5, United States Code, but 
at rates for individuals not to exceed the daily equivalent of the 
maximum annual rate of basic pay payable for grade GS-15 of the General 
Schedule under section 5332 of such title.
    (c) Detail of Federal Employees.--Upon the request of the 
Commission, the head of any Federal agency is authorized to detail, 
without reimbursement to the agency, any of the personnel of such 
agency to the Commission to assist the Commission in carrying out its 
duties. Any such detail shall not interrupt or otherwise affect the 
civil service status or privileges of such personnel.

SEC. 105. POWERS.

    (a) Hearings and Other Activities.--The Commission may, for the 
purpose of carrying out this Act, hold hearings, sit and act at times 
and places, take testimony, and receive evidence as the Commission 
determines necessary to carry out its duties. The Commission may 
administer oaths or affirmations to witnesses appearing before it.
    (b) Studies by Government Accountability Office.--Upon the request 
of the Commission, the Comptroller General shall conduct such studies 
or investigations as the Commission determines to be necessary to carry 
out its duties.
    (c) Cost Estimates by Congressional Budget Office.--
            (1) Duty to provide requested estimates.--Upon the request 
        of the Commission, the Director of the Congressional Budget 
        Office shall provide to the Commission such cost estimates as 
        the Commission determines to be necessary to carry out its 
        duties.
            (2) Reimbursement for development of cost estimates.--The 
        Commission shall reimburse the Director of the Congressional 
        Budget Office for expenses relating to the employment in the 
        office of the Director of such additional staff as may be 
        necessary for the Director to comply with requests by the 
        Commission under paragraph (1).
    (d) Technical Assistance.--Upon the request of the Commission, the 
head of a Federal agency shall provide such technical assistance to the 
Commission as the Commission determines to be necessary to carry out 
its duties.
    (e) Use of Mails.--The Commission may use the United States mails 
in the same manner and under the same conditions as Federal agencies, 
and shall, for purposes of the frank, be considered a commission of 
Congress as described in section 3215 of title 39, United States Code.
    (f) Obtaining Information.--The Commission may secure directly from 
any Federal agency information necessary to enable it to carry out its 
duties, if the information may be disclosed under section 552 of title 
5, United States Code. Upon request of the Chairman of the Commission, 
the head of such agency shall furnish such information to the 
Commission.
    (g) Administrative Support Services.--Upon the request of the 
Commission, the Administrator of General Services shall provide to the 
Commission on a reimbursable basis such administrative support services 
as the Commission may request.
    (h) Acceptance of Donations.--The Commission may accept, use, and 
dispose of gifts and donations of services or property.
    (i) Printing.--For purposes of costs relating to printing and 
binding, including the costs of personnel detailed from the Government 
Printing Office, the Commission shall be deemed to be a committee of 
the Congress.

SEC. 106. REPORT ON WAYS TO PROMOTE THE EFFECTIVE DELIVERY OF EMERGENCY 
              MEDICAL SERVICES.

    Not later than the date that is 18 months after the date of the 
enactment of this Act, the Commission shall submit to Congress a report 
containing its findings and recommendations described in section 
102(a), including recommendations to remove any identified barriers to 
the effective delivery of emergency medical services in the United 
States and detailed recommendations for appropriate legislative 
initiatives to remove such barriers.

SEC. 107. TERMINATION.

    The Commission shall terminate 30 days after the date of submission 
of the report required in section 106.

SEC. 108. AUTHORIZATION OF APPROPRIATIONS.

    There are authorized to be appropriated such sums as may be 
necessary to carry out this title.

     TITLE II--ADDITIONAL PAYMENTS FOR CERTAIN PHYSICIANS' SERVICES

SEC. 201. ADDITIONAL PAYMENTS FOR CERTAIN PHYSICIANS' SERVICES.

    (a) In General.--Section 1833 of the Social Security Act (42 U.S.C. 
1395l) is amended by adding at the end the following new subsection:
    ``(v) Additional Payment for Physicians' Services Furnished 
Pursuant to EMTALA.--In the case of physicians' services furnished on 
or after January 1, 2008, in the emergency department of a hospital (as 
defined in subsection (e)(5) of section 1867) pursuant to such section 
to an individual covered under the insurance program established under 
this part, in addition to the amount of payment that will otherwise be 
made for such services under this part, there shall also be paid to the 
physician or other person involved (or in the cases described in 
subparagraph (A) of section 1842(b)(6), to an employer or other entity 
involved) from the Federal Supplementary Trust Fund an amount equal to 
10 percent of the payment amount for the services under this part 
(determined without regard to any additional amounts paid under 
subsection (m) or (u)).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to services furnished on or after January 1, 2008.

TITLE III--HOSPITAL AND CRITICAL ACCESS REPORTING ON CERTAIN EMERGENCY 
                         DEPARTMENT INFORMATION

SEC. 301. REQUIREMENT TO REPORT INFORMATION ON CERTAIN EMERGENCY 
              DEPARTMENT INFORMATION AS CONDITION OF MEDICARE 
              PARTICIPATION.

    (a) Requirement.--Section 1866(a)(1) of the Social Security Act (42 
U.S.C. 1395cc(a)(1)) is amended-
            (1) by striking ``and'' at the end of subparagraph (U);
            (2) by striking the period at the end of subparagraph (V) 
        and inserting ``, and''; and
            (3) by inserting after subparagraph (V) the following new 
        subparagraph:
                    ``(W) in the case of a hospital (as defined in 
                section 1867(e)(5)) that has an emergency department, 
                to report to the Secretary information in accordance 
                with subsection (k)(1).''.
    (b) Reporting by Hospitals and Critical Access Hospitals of 
Emergency Department Information and Public Disclosure of Such 
Information.--Section 1866 of such Act (42 U.S.C. 1395cc) is further 
amended by adding at the end the following new subsection:
    ``(k) Reporting by Hospitals of Emergency Department Information 
and Public Disclosure of Such Information.--
            ``(1) Annual reporting requirement.--
                    ``(A) In general.--For purposes of subsection 
                (a)(1)(W), a hospital (as defined in section 
                1867(e)(5)) that has an emergency department shall 
                annually submit to the Secretary a report (beginning 
                for 2008) on the average admission period described in 
                subparagraph (B) at such hospital for such year.
                    ``(B) Admission period described.--The admission 
                period described in this subparagraph, with respect to 
                a hospital (as so defined) that has an emergency 
                department, is the period beginning at the time of 
                admission to the hospital of a patient who presents to 
                such department and ending at the time at which such 
                patient arrives at the patient's definitive inpatient 
                destination in the hospital, which may not be an area 
                immediately outside of the emergency department used to 
                temporarily hold such patient until such patient 
                arrives at the definitive inpatient destination.
                    ``(C) Administration.--Each report submitted under 
                subparagraph (A) shall be in such form and manner and 
                at such time as the Secretary specifies.
            ``(2) Public disclosure of information.--The Secretary 
        shall promptly post, on the official public Internet site of 
        the Department of Health and Human Services, the information 
        reported under paragraph (1)(A). Such information shall be set 
        forth in a manner that promotes comparison of such information 
        among hospitals.''.
    (c) Designation of Emergency Department Quality Measure.--
            (1) In general.--Not later than January 1, 2010, based on 
        information reported under section 1866(k)(1)(A) of the Social 
        Security Act for 2008 and after consultation with experts in 
        emergency care, inpatient critical care, hospital operations 
        management, nursing, and other relevant disciplines, the 
        Secretary of Health and Human Services shall--
                    (A) determine whether or not a quality measure 
                described in paragraph (2) should be developed for 
                purposes of inclusion as a performance measure required 
                to be reported by hospitals under section 
                1886(b)(3)(B)(viii) of the Social Security Act (42 
                U.S.C. 1395ww(b)(3)(B)(viii)) or section 1833(t)(17) of 
                such Act (42 U.S.C. 1395l(t)(17)), as added by section 
                109(a)(1)(B) of the Medicare Improvements and Extension 
                Act of 2006 (division B of Public Law 109-432), as 
                appropriate, to improve the quality of health care 
                delivery; and
                    (B) in the case that the Secretary determines under 
                subparagraph (A) that such a quality measure should be 
                developed for such inclusion, develop such a quality 
                measure and specify the date on which such quality 
                measure will be so included for purposes of such 
                sections.
            (2) Quality measure described.--The quality measure 
        described in this paragraph, with respect to a hospital for a 
        year, is a measure with respect to the average admission period 
        described in section 1866(k)(1)(B) of the Social Security Act, 
        as added by subsection (b) at such hospital for such year.
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