[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 468 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 468

 To amend title XVIII of the Social Security Act to improve access to 
   emergency medical services and the quality and efficiency 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 establishing a Centers for Medicare & 
        Medicaid Services Working Group, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           February 25, 2009

  Ms. Stabenow (for herself, Mr. Specter, Mr. Levin, and Mr. Inouye) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to improve access to 
   emergency medical services and the quality and efficiency 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 establishing a Centers for Medicare & 
        Medicaid Services Working Group, 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 2009''.
    (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--CENTERS FOR MEDICARE & MEDICAID SERVICES WORKING GROUP TO 
                   IMPROVE EMERGENCY CARE EFFICIENCY

Sec. 301. Centers for Medicare & Medicaid Services Working Group to 
                            improve emergency care efficiency.

 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.
            (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'' means a hospital (as 
        defined in subsection (e) of section 1861 of the Social 
        Security Act (42 U.S.C. 1395x)) and a critical access hospital 
        (as defined in subsection (mm) of such section).
            (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 24 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 8 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 8 members of 
                the Commission.
                    (C) The majority leader of the Senate, after 
                consultation with the minority leader of the Senate, 
                shall appoint 8 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 emergency 
                physicians, emergency nurses, 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;
                    (C) two health care consumer advocates; and
                    (D) two individuals who represent hospitals and 
                health systems that provide emergency medical services.
    (b) Chairperson and Vice Chairperson.--The Commission shall elect a 
chairperson and 4 vice chairpersons 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 9 members of the Commission, 
except that 6 or more members may conduct a hearing under section 
105(a).
    (g) Meetings.--The Commission shall meet at the call of its 
chairperson 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 title, 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 Chairperson 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 and the 
Secretary of Health and Human Services 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:
    ``(x) Additional Payment for Physicians' Services Furnished 
Pursuant to EMTALA.--In the case of physicians' services furnished 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 the date of the enactment of 
this Act.

 TITLE III--CENTERS FOR MEDICARE & MEDICAID SERVICES WORKING GROUP TO 
                   IMPROVE EMERGENCY CARE EFFICIENCY

SEC. 301. CENTERS FOR MEDICARE & MEDICAID SERVICES WORKING GROUP TO 
              IMPROVE EMERGENCY CARE EFFICIENCY.

    (a) Working Group.--
            (1) In general.--The Secretary of Health and Human 
        Services, acting through the Administrator of the Centers for 
        Medicare & Medicaid Services, shall convene a working group (in 
        this section referred to as the ``CMS working group'') that 
        includes experts in emergency care, inpatient critical care, 
        hospital operations management, nursing, and other relevant 
        disciplines. The members of the CMS working group shall be 
        appointed by the Administrator.
            (2) Duties.--
                    (A) Development of standards, guidelines, measures, 
                and incentives.--The CMS working group shall develop 
                boarding and diversion standards, guidelines, measures, 
                and incentives for hospitals, and, with respect to the 
                development of measures, the CMS working group shall 
                consider measures developed or under development by 
                other entities. The CMS working group shall send any 
                measures developed under this subparagraph to the 
                entity with a contract under section 1890(a) of the 
                Social Security Act (42 U.S.C. 1395aaa(a)) for 
                consideration, and shall take into account whether such 
                measures have been recommended or adopted for use by a 
                relevant quality alliance identified by the Secretary 
                (such as the Hospital Quality Alliance).
                    (B) Identification of barriers.--The CMS working 
                group shall identify barriers contributing to delays in 
                timely processing of patients requiring admission as an 
                inpatient of a hospital who initially sought care 
                through the emergency department of the hospital.
                    (C) Identification of best practices.--The CMS 
                working group shall identify best practices to improve 
                patient flow within hospitals. In order to carry out 
                the preceding sentence, the Agency for Healthcare 
                Research and Quality shall examine available evidence 
                of best practices to improve patient flow within 
                hospitals and transmit any findings from that 
                examination to the CMS working group. The CMS working 
                group shall take into account the findings of the 
                Agency in identifying such best practices under this 
                subparagraph.
                    (D) Report.--Not later than the date that is 1 year 
                after the date of the enactment of this Act, the CMS 
                Working Group shall submit to Congress and the 
                Secretary of Health and Human Services a report 
                containing a detailed description of the standards, 
                guidelines, measures, and incentives developed under 
                subparagraph (A), the barriers identified under 
                subparagraph (B), and the best practices identified 
                under subparagraph (C), together with recommendations 
                for such legislative and administrative actions as the 
                CMS Working group considers appropriate.
            (3) Information.--In carrying out its duties under 
        paragraph (2), the CMS Working Group may request such 
        information from hospitals that the CMS Working Group considers 
        appropriate.
            (4) Termination.--The CMS Working Group shall terminate 30 
        days after the date of submission of the report required in 
        paragraph (2)(D).
    (b) Disclosure of Failure To Report.--The Secretary of Health and 
Human Services shall establish a mechanism (such as publication on an 
Internet website or in the Federal Register, or both) to disclose to 
the public information regarding any hospital that fails to report 
information requested by the CMS working group under subsection (a)(3) 
and the type of information the hospital failed to report.
    (c) Hospital Defined.--In this section, the term ``hospital'' means 
a hospital (as defined in subsection (e) of section 1861 of the Social 
Security Act (42 U.S.C. 1395x)) and a critical access hospital (as 
defined in subsection (mm) of such section).
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