[Congressional Record (Bound Edition), Volume 147 (2001), Part 5]
[Extensions of Remarks]
[Page 6884]
[From the U.S. Government Publishing Office, www.gpo.gov]



  THE INTRODUCTION OF THE ACCESS TO EMERGENCY MEDICAL SERVICES ACT OF 
                                  2001

                                 ______
                                 

                        HON. BENJAMIN L. CARDIN

                              of maryland

                    in the house of representatives

                         Wednesday, May 2, 2001

  Mr. CARDIN. Mr. Speaker, I rise today to introduce legislation 
guaranteeing one of the most fundamental of patients' rights--the right 
of access to needed emergency medical care.
  In the 104th, 105th, and 106th Congresses, I introduced the Access to 
Emergency Medical Services Act. This bill would establish the ``prudent 
layperson'' definition of emergency as the standard for insurance 
coverage for emergency services under group health plans, health 
insurers, and the Medicare and Medicaid programs. Health plans would be 
required to cover and pay for emergency care based upon the patient's 
symptoms rather than the final diagnosis. This coverage is tied to the 
federal law called EMTALA, which requires hospitals to provide 
screening and any stabilization services that are necessary. In 
addition, the legislation would prohibit health plans from requiring 
that patients obtain prior authorization before seeking emergency care. 
The bill would also help promote quality, cost-effective care by 
requiring that health plans and emergency physicians work together to 
coordinate any necessary follow-up care.
  The prudent layperson definition requires a health plan to pay for 
treatment rendered when a patient experiences:


       A medical condition manifesting itself by acute symptoms of 
     sufficient severity (including severe pain) such that a 
     prudent layperson, who possesses an average knowledge of 
     health and medicine could reasonably expect the absence of 
     immediate medical attention to result in placing the health 
     of the individual in serious jeopardy, serious impairment to 
     bodily functions, or serious dysfunction of any bodily organ 
     or part.


  In the Balanced Budget Act of 1997, Congress did indeed guarantee 
this right to Medicare and Medicaid patients enrolled in managed care 
plans. Then in February 1998, the President's Executive Order extended 
this right to all persons in federal health programs, including FEHBP, 
veterans and military enrollees. So as subscribers in FEHBP plans, all 
Members of Congress have been guaranteed this important patient 
protection. Thirty-two states and the District of Columbia have also 
passed laws establishing this standard. But to protect residents of the 
eighteen states that have not passed a prudent layperson standard, and 
for the approximately 50 million persons who are enrolled in ERISA 
self-insured plans, Congress must act.
  But I want to caution my colleagues--simply inserting the words 
``prudent layperson'' into a bill does not ensure access to appropriate 
emergency care. During the House debate on The Patient Protection Act 
(H.R. 4250) in the 105th Congress, some Members insisted that it 
contained the same emergency care standard that was provided for in the 
Balanced Budget Act. In October 1998, thirty Members who had voted for 
H.R. 4250 recognized that the language was not the language was not the 
same and wrote the Speaker asking that the true prudent layperson 
standard--reflecting the BBA provisions and consistent with EMTALA--be 
included in any patients' rights legislation that moved forward.
  Regrettably, the 105th Congress adjourned without additional action 
on HMO reform. Millions of Americans enrolled in managed care plans 
were frustrated by our inability to send a bill to the President's 
desk, but remained hopeful that Congress would produce effective 
patients rights legislation when it convened this year.
  In the 106th Congress, this body passed by an overwhelming margin 
comprehensive managed care reform legislation that got the emergency 
services language right. But the other body's bill did not. And in the 
conference that failed to produce a compromise bill, some conferees 
fought against the language approved by the House, language that is 
consistent with Medicare and Medicaid law, language that is strongly 
supported by doctors, hospitals, consumer groups, and one of the oldest 
and largest health maintenance organizations in the United States, 
Kaiser Health Plans.
  And so, joined by my colleague from New Jersey, Mrs. Roukema, today I 
am reintroducing the Access to Emergency Medical Services Act in the 
107th Congress. I encourage all members of Congress to study this issue 
carefully, listen to their constituents, and support passage of this 
fundamental legislation. The American consumers deserve to be protected 
by an authentic prudent layperson standard that ensures them access to 
the full range of services their acute emergency conditions require, 
and Congress should give them this right without further delay.

                          ____________________