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. 104. Staff and consultants.
Sec. 106. Report on ways to promote the effective delivery of emergency
medical services.
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.
(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.
(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.
END
