I
111th CONGRESS
1st Session
H. R. 1188
IN THE HOUSE OF REPRESENTATIVES
February 25, 2009
Mr. Gordon of Tennessee (for himself, Mr. Sessions, Mr. McGovern, Mr. Thompson of California, Mr. Graves, Mr. Wilson of Ohio, Mr. Langevin, Mr. Holt, Mr. Ryan of Ohio, Mr. Frelinghuysen, Mr. Hinojosa, Mr. Schiff, Ms. DeLauro, Mr. Farr, Mr. Chandler, Mr. LoBiondo, Mr. McCaul, Mr. Rogers of Michigan, Mrs. Blackburn, Mr. Klein of Florida, Mr. Dent, Mr. Kucinich, Mr. Carson of Indiana, Mr. Kennedy, Mr. Boustany, Mr. Sires, Mr. Larson of Connecticut, Mr. Capuano, Mr. Sensenbrenner, Mr. Marchant, Mr. Gerlach, Mr. Courtney, Mr. Souder, Ms. Zoe Lofgren of California, Mr. Massa, Ms. McCollum, Mr. Hare, Ms. Schwartz, Mr. Bishop of New York, Mr. Hinchey, Mr. Burgess, Mrs. Bachmann, Mr. Lance, Mr. Gene Green of Texas, Mr. Price of North Carolina, Mr. Pascrell, Mr. Castle, Mr. Kildee, Mr. Wilson of South Carolina, Mr. Wu, Mr. Smith of New Jersey, and Mr. Platts) 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 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.
Short title; table of contents
In general
This Act may be cited as the
Access to Emergency Medical Services
Act of 2009
.
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.
Bipartisan Commission on Access to Emergency Medical Services
Establishment
There is established the United States Bipartisan Commission on Access to Emergency Medical Services (in this title referred to as the “Commission”).
Duties
In general
The Commission shall perform the following duties:
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.
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.
Factors considered
For purposes of subsection (a)(1), the Commission shall examine at least the following factors, with respect to emergency departments of hospitals:
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.
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.
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.
Considerations in recommendations
In making recommendations under subsection (a)(2), the Commission shall consider the following:
Any changes in Federal law that would be necessary to promote the effective delivery of emergency medical services.
The amount and sources of Federal funds to finance such changes.
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.
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.
Definitions
For purposes of this title:
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).
EMTALA
The term EMTALA means section 1867 of the Social Security Act (42 U.S.C. 1395dd).
Membership
Appointment
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:
The President shall appoint 8 members of the Commission.
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.
The majority leader of the Senate, after consultation with the minority leader of the Senate, shall appoint 8 members of the Commission.
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—
two individuals who represent emergency physicians, emergency nurses, and other health care professionals who provide emergency medical services;
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;
two health care consumer advocates; and
two individuals who represent hospitals and health systems that provide emergency medical services.
Chairperson and vice chairperson
The Commission shall elect a chairperson and 4 vice chairpersons from among its members.
Terms
Each member shall be appointed for the life of the Commission.
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.
Compensation
In general
Members of the Commission shall serve without pay.
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.
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).
Meetings
The Commission shall meet at the call of its chairperson or a majority of its members.
Staff and consultants
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.
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.
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.
Powers
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.
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.
Cost estimates by Congressional Budget Office
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.
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).
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.
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.
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.
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.
Acceptance of donations
The Commission may accept, use, and dispose of gifts and donations of services or property.
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.
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.
Termination
The Commission shall terminate 30 days after the date of submission of the report required in section 106.
Authorization of appropriations
There are authorized to be appropriated such sums as may be necessary to carry out this title.
Additional payments for certain physicians’ services
Additional payments for certain physicians’ services
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:
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)).
.
Effective date
The amendment made by subsection (a) shall apply to services furnished on or after the date of the enactment of this Act.
Centers for Medicare & Medicaid Services Working Group to improve emergency care efficiency
Centers for Medicare & Medicaid Services Working Group to improve emergency care efficiency
Working group
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.
Duties
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).
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.
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.
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.
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.
Termination
The CMS working group shall terminate 30 days after the date of submission of the report required in paragraph (2)(D).
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.
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).