110 HR 882 IH: Access to Emergency Medical
U.S. House of Representatives
2007-02-07
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of
contents
(a)This Act may be cited
as the Access to Emergency Medical
Services Act of 2007
.
(b)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.
<enum>I</enum><header>Bipartisan
commission on access to emergency medical services</header>
<section id="HAA2F0EAD2A7F4AAA870091670494119C"><enum>101.</enum><header>Establishment</header><text display-inline="no-display-inline">There is established the United States
Bipartisan Commission on Access to Emergency Medical Services (in this title
referred to as the “Commission”).</text>
</section><section id="HCC33429309484E0ABABB7124F96A2B8"><enum>102.</enum><header>Duties</header>
<subsection id="H6F5073EDCA0244ADA6299F482000FFA2"><enum>(a)</enum><header>In
general</header><text>The Commission shall perform the following duties:</text>
<paragraph id="HD6691EFFE4DE4D5C9148BD1E5063722F"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="HF34EC61119EE4E3CBA20432FFFB00E7"><enum>(2)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><subsection id="H4066B4E1451C45F0998B4D137CC7E98"><enum>(b)</enum><header>Factors
considered</header><text>For purposes of subsection (a)(1), the Commission
shall examine at least the following factors, with respect to emergency
departments of hospitals:</text>
<paragraph id="HFA3D3AC6827549C08FFB9ED2EB3F808D"><enum>(1)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph><paragraph id="H7342D377F1B04A4EA6A79F03C3CF5225"><enum>(2)</enum><text>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.</text>
</paragraph><paragraph id="H6618B72CE37141198B666851AC00B49C"><enum>(3)</enum><text>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.</text>
</paragraph></subsection><subsection id="HE88411E5ACE14D86A146029C00EBA7C8"><enum>(c)</enum><header>Considerations
in recommendations</header><text>In making recommendations under subsection
(a)(2), the Commission shall consider the following:</text>
<paragraph id="H02BF65B1E59D4594911617D462E61C5D"><enum>(1)</enum><text>Any changes in
Federal law that would be necessary to promote the effective delivery of
emergency medical services.</text>
</paragraph><paragraph id="H3D1729A3D64C437A93BA113C5BA782FB"><enum>(2)</enum><text>The amount and
sources of Federal funds to finance such changes.</text>
</paragraph><paragraph commented="no" id="H0EA848F4369842CF9BECE0BD653ECD6F"><enum>(3)</enum><text>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—</text>
<subparagraph id="H683F27BCB89A46EB9B3BD589ABF0D900"><enum>(A)</enum><text>that would
supersede any conflicting State law related to such liability; and</text>
</subparagraph><subparagraph id="HD163C8132C584ECFA6BCE72DB4D64D5B"><enum>(B)</enum><text>which may be the
same as appropriate limits on liability that are established for public health
professionals.</text>
</subparagraph></paragraph><paragraph commented="no" id="H950DE14D971D461C9F503642CF57FA9E"><enum>(4)</enum><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><subsection id="HD366F7220E0A417FA888915072D830E4"><enum>(d)</enum><header>Definitions</header><text>For
purposes of this title:</text>
<paragraph id="H908B0F3C09E2497687734EB671974168"><enum>(1)</enum><header>Hospital</header><text>The
term <term>hospital</term> has the meaning given such term in section
1867(e)(5) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395dd">42 U.S.C. 1395dd</external-xref>)).</text>
</paragraph><paragraph id="HEF3BEC9444B54D2EAD22A04BAD177632"><enum>(2)</enum><header>EMTALA</header><text>The
term <term>EMTALA</term> means section 1867 of the Social Security Act (42
U.S.C. 1395dd).</text>
</paragraph></subsection></section><section id="HA5B92725144349FA953DEAF559750614"><enum>103.</enum><header>Membership</header>
<subsection id="H27D97A043A094BA1AB93F9D06E7517E7"><enum>(a)</enum><header>Appointment</header><text></text>
<paragraph id="H4CDFAF441EBC4CC4BD0230AB495EA6E8"><enum>(1)</enum><text>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:</text>
<subparagraph id="H6380C2227AA44C28849865341801F194"><enum>(A)</enum><text>The President
shall appoint six members of the Commission.</text>
</subparagraph><subparagraph id="H62CCBFA7DFBD4B739F66728F5ED722A0"><enum>(B)</enum><text>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.</text>
</subparagraph><subparagraph id="HABE08D5580B341BAAAD55888D2562B30"><enum>(C)</enum><text>The majority
leader of the Senate, after consultation with the minority leader of the
Senate, shall appoint six members of the Commission.</text>
</subparagraph></paragraph><paragraph id="HE8D787865E5D4846AAFE2D889E1D5901"><enum>(2)</enum><text>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—</text>
<subparagraph id="H0A47C914797B4ECB898F129B4CEAB785"><enum>(A)</enum><text>two individuals
who represent physicians and other health care professionals who provide
emergency medical services;</text>
</subparagraph><subparagraph id="H744101B249DE42EF8BCEC9F06F356F31"><enum>(B)</enum><text>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</text>
</subparagraph><subparagraph id="HED68D53B070D4850AF44BB08CCB09EE9"><enum>(C)</enum><text display-inline="yes-display-inline">two health care consumer advocates.</text>
</subparagraph></paragraph></subsection><subsection id="HF15572A226A94641B0BD89355ED32F76"><enum>(b)</enum><header>Chairman and
vice chairmen</header><text>The Commission shall elect a chairman and four vice
chairmen from among its members.</text>
</subsection><subsection id="HC1CFEAC0DD924B5690C97FE142BB5F27"><enum>(c)</enum><header>Terms</header><text>Each
member shall be appointed for the life of the Commission.</text>
</subsection><subsection id="HAE9FBE58B03B4775BC5B65291229B1EB"><enum>(d)</enum><header>Vacancies</header><text>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.</text>
</subsection><subsection id="H946AA09EBD43493EA75E859B07027910"><enum>(e)</enum><header>Compensation</header>
<paragraph id="H10523B2CA39F4BD1B2E130643BC959F3"><enum>(1)</enum><header>In
general</header><text>Members of the Commission shall serve without pay.</text>
</paragraph><paragraph id="HC66FA45DC3314329893D08A8DD0078C5"><enum>(2)</enum><header>Travel
expenses</header><text display-inline="yes-display-inline">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
<external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/57">chapter 57</external-xref> of title 5, United States Code.</text>
</paragraph></subsection><subsection id="HD3944A32F5554437872E288248BC2678"><enum>(f)</enum><header>Quorum</header><text>A
quorum shall consist of nine members of the Commission, except that six or more
members may conduct a hearing under section 105(a).</text>
</subsection><subsection id="HDFB2E8B38C654BD8A482001F1810595B"><enum>(g)</enum><header>Meetings</header><text>The
Commission shall meet at the call of its chairman or a majority of its
members.</text>
</subsection></section><section id="H7B46CC4A8E0943AE9BA2C7F5C5B4FEB6"><enum>104.</enum><header>Staff and
consultants</header>
<subsection id="HC41DCAC6D10A4A9BA839015EF52F8B9F"><enum>(a)</enum><header>Staff</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H4C3572F4FA4240A6B61E16F900B5A414"><enum>(b)</enum><header>Consultants</header><text display-inline="yes-display-inline">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 <external-xref legal-doc="usc" parsable-cite="usc/5/3109">section 3109(b)</external-xref> 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.</text>
</subsection><subsection display-inline="no-display-inline" id="H48AB2B91F40C4BC7933F83CF4D4780F9"><enum>(c)</enum><header>Detail of
Federal employees</header><text>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.</text>
</subsection></section><section id="H2B6E70D45DAF4EAA83CF28DB0499B00"><enum>105.</enum><header>Powers</header>
<subsection id="H11EEE06E09D34C550004E014E831F6BC"><enum>(a)</enum><header>Hearings and
other activities</header><text>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.</text>
</subsection><subsection id="HC9025AF701364DD49D555FD92070FAC6"><enum>(b)</enum><header>Studies by
government accountability office</header><text>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.</text>
</subsection><subsection id="H67031A6FD18E4780AF1892B985E54427"><enum>(c)</enum><header>Cost estimates
by Congressional Budget Office</header>
<paragraph id="HC9CD9AD120144AE29D665F2F711B023E"><enum>(1)</enum><header>Duty to provide
requested estimates</header><text>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.</text>
</paragraph><paragraph id="H50A8D6CE8267431B99A74D391BFA9B1F"><enum>(2)</enum><header>Reimbursement
for development of cost estimates</header><text>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).</text>
</paragraph></subsection><subsection id="H9A3AF0E92F0B49938C05352D744E12F9"><enum>(d)</enum><header>Technical
assistance</header><text>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.</text>
</subsection><subsection id="H0C6FDBC98F1D4FA4B0B9C54400651B00"><enum>(e)</enum><header>Use of
mails</header><text>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
<external-xref legal-doc="usc" parsable-cite="usc/39/3215">section 3215</external-xref> of title 39, United States Code.</text>
</subsection><subsection id="H9749B441AA934572A59CF48B95D90300"><enum>(f)</enum><header>Obtaining
information</header><text display-inline="yes-display-inline">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.</text>
</subsection><subsection id="H73D3A063AD344023BDE098E18BF44F90"><enum>(g)</enum><header>Administrative
support services</header><text>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.</text>
</subsection><subsection id="HF997B7E9B10A44FFB6604600C2004431"><enum>(h)</enum><header>Acceptance of
donations</header><text>The Commission may accept, use, and dispose of gifts
and donations of services or property.</text>
</subsection><subsection id="HB08BF477F9B1484396DEF87BC14EFC6C"><enum>(i)</enum><header>Printing</header><text>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.</text>
</subsection></section><section id="H3E77B23CF67642F5B8648300A6D9BD43"><enum>106.</enum><header>Report on ways
to promote the effective delivery of emergency medical services</header><text display-inline="no-display-inline">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.</text>
</section><section id="H5C7B6EC7463140C69B4FAE2217CFF207"><enum>107.</enum><header>Termination</header><text display-inline="no-display-inline">The Commission shall terminate 30 days
after the date of submission of the report required in section 106.</text>
</section><section id="H9C0F2A74CF95431DB5C440031451E86E"><enum>108.</enum><header>Authorization
of appropriations</header><text display-inline="no-display-inline">There are
authorized to be appropriated such sums as may be necessary to carry out this
title.</text>
</section><enum>II</enum><header>Additional
payments for certain physicians’ services</header>
<section id="HB29A2C85AC0C4BCD84904E7551FF71D0"><enum>201.</enum><header>Additional
payments for certain physicians’ services</header>
<subsection id="H0823FF52AA0B4BDA87E600CD17B992B4"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 1833 of the
Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395l">42 U.S.C. 1395l</external-xref>) is amended by adding at the end the
following new subsection:</text>
<quoted-block id="HA05B24A5FBE74C2BB95C927B3E1F00CF" style="OLC">
<subsection id="HAC389CDF306D49B39D247DD4CF529B8"><enum>(v)</enum><header>Additional
payment for physicians’ services furnished pursuant to EMTALA</header><text>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)).</text>
</subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HE6D3709F563B477A85230400FF9FA0A5"><enum>(b)</enum><header>Effective
date</header><text>The amendment made by subsection (a) shall apply to services
furnished on or after January 1, 2008.</text>
</subsection></section><enum>III</enum><header>Hospital and
critical access reporting on certain emergency department information</header>
<section id="H85C36D08EE834E7AB0E50026D4EDB1D0"><enum>301.</enum><header>Requirement to
report information on certain emergency department information as condition of
Medicare participation</header>
<subsection id="HB29FB2D744B54562AB8583FB2E76651B"><enum>(a)</enum><header>Requirement</header><text>Section
1866(a)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)(1)</external-xref>) is
amended–</text>
<paragraph id="H5C280A1D9BB04635AAC7E6F134DB7B77"><enum>(1)</enum><text>by striking
<quote>and</quote> at the end of subparagraph (U);</text>
</paragraph><paragraph id="H750D8F67A42D449C80DEC27300D52B89"><enum>(2)</enum><text>by striking the
period at the end of subparagraph (V) and inserting <quote>, and</quote>;
and</text>
</paragraph><paragraph id="H08D63CCC02804E1A84723B44A99351AF"><enum>(3)</enum><text>by inserting after
subparagraph (V) the following new subparagraph:</text>
<quoted-block id="HA34090C07A3E4C638BA9B365EE3FB84D" style="OLC">
<subparagraph id="HD44738BFE85F4F958236687571BDD214"><enum>(W)</enum><text display-inline="yes-display-inline">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).</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H61AB5FC864F94F57A11B9E5911007E5F"><enum>(b)</enum><header>Reporting by
hospitals and critical access hospitals of emergency department information and
public disclosure of such information</header><text display-inline="yes-display-inline">Section 1866 of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc</external-xref>)
is further amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H7ED9C6AFE35E4F2AA1C0B100CF936C05" style="OLC">
<subsection id="H43F92CD115544AF096EF96B319C4A916"><enum>(k)</enum><header>Reporting by
hospitals of emergency department information and public disclosure of such
information</header>
<paragraph id="HC00E1334F00D47C58273E8EDE530337C"><enum>(1)</enum><header>Annual reporting
requirement</header>
<subparagraph id="H2CD30898F57C456A82BC2D3529013736"><enum>(A)</enum><header>In
general</header><text>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.</text>
</subparagraph><subparagraph id="HF508F9566DFA4D348C96EEE65A1788C"><enum>(B)</enum><header>Admission period
described</header><text>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.</text>
</subparagraph><subparagraph id="HEF27804B14EB459A9C1409FB709BE5B7"><enum>(C)</enum><header>Administration</header><text>Each
report submitted under subparagraph (A) shall be in such form and manner and at
such time as the Secretary specifies.</text>
</subparagraph></paragraph><paragraph id="HF2967C3672F44DB5B700E2C212A98572"><enum>(2)</enum><header>Public
disclosure of information</header><text display-inline="yes-display-inline">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.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H0F729022F55B466A9CBA3749C8697B61"><enum>(c)</enum><header>Designation of
emergency department quality measure</header>
<paragraph id="HA7B562A20438438CB832CF3BACD00631"><enum>(1)</enum><header>In
general</header><text>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—</text>
<subparagraph id="H606D9A4F26B24BFE9C36A700E2D8C75"><enum>(A)</enum><text display-inline="yes-display-inline">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 <external-xref legal-doc="public-law" parsable-cite="pl/109/432">Public Law 109–432</external-xref>), as appropriate,
to improve the quality of health care delivery; and</text>
</subparagraph><subparagraph id="HEEF7FC56DA1D4F599100007BC121B97E"><enum>(B)</enum><text>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.</text>
</subparagraph></paragraph><paragraph id="HD94EB2E04AEB41BEB1CC2C71E5C6B573"><enum>(2)</enum><header>Quality measure
described</header><text>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.</text>
</paragraph></subsection></section>