To improve access to emergency medical services, and for other purposes.

Summary: Health Care Safety Net Enhancement Act of 2009 - Amends the Public Health Service Act to deem a hospital or an emergency department and a physician or physician group of such hospital or emergency department to be an employee of the Public Health Service for purposes of any civil action that may arise due to providing emergency and post-stabilization services on or after January 1, 2010.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Care Safety Net Enhancement 
Act of 2009''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) As noted in the 2006 Institute of Medicine report, 
        ``The Future of Emergency Care'', the availability of on-call 
        specialists is an acute problem in emergency departments and 
        trauma centers requiring attention to identified barriers such 
        as liability reform.
            (2) Also acknowledged in the 2006 IOM report, emergency and 
        trauma care is delivered in an inherently challenging 
        environment, often requiring emergency physicians and trauma 
        surgeons to make life-and-death decisions with little time or 
        information or without a standing relationship with the 
        patient. For these reasons, physicians providing emergency and 
        trauma care face extraordinary exposure to medical liability 
        claims, which are far higher than for those physicians who do 
        not provide such care.
            (3) Younger surgeons, who often take the on-call shifts at 
        trauma centers, are leaving States with the most severe 
        liability problems. For example, according to the Project on 
        Medical Liability in Pennsylvania, funded by the Pew Charitable 
        Trust, resident physicians in high-risk fields such as general 
        surgery and emergency medicine named malpractice costs as the 
        reason for leaving the State three times more often than any 
        other factor.
            (4) Further, an American Hospital Association study found 
        that more than 50 percent of hospitals in medical liability 
        crisis States now have trouble recruiting physicians, and 40 
        percent say the liability situation has resulted in less 
        physician coverage for their emergency departments. The crisis 
        has even forced the closure of trauma centers in Florida, 
        Mississippi, Nevada, Pennsylvania, and West Virginia at various 
        times in recent years.
            (5) Specialties that have experienced particularly high 
        premium increases, including neurosurgery, orthopaedics, and 
        general surgery, are also among those services that emergency 
        patients most frequently require.
            (6) According to a report from the General Accountability 
        Office, soaring medical liability premiums have led specialists 
        to reduce or stop on-call services to hospital emergency 
        departments, seriously inhibiting patient access to emergency 
        surgical services.
            (7) The Department of Health and Human Services' 
        congressionally created EMTALA technical advisory group (TAG) 
        recognized that professional liability insurance is a concern 
        for providers and that having protections would increase 
        coverage in the emergency department. The TAG recommended that 
        the Department of Health and Human Services act to support 
        amending the EMTALA statute to include liability protection for 
        hospitals, physicians, and other licensed independent 
        practitioners who provide services to patients covered by 
        EMTALA.

SEC. 3. CONSTITUTIONAL AUTHORITY.

    The constitutional authority upon which this Act rests is the power 
of the Congress to provide for the general welfare, to regulate 
commerce, and to make all laws which shall be necessary and proper for 
carrying into execution Federal powers, as enumerated in section 8 of 
article I of the Constitution of the United States.

SEC. 4. PROTECTION FOR EMERGENCY AND RELATED SERVICES FURNISHED 
              PURSUANT TO EMTALA.

    Section 224(g) of the Public Health Service Act (42 U.S.C. 233(g)) 
is amended--
            (1) in paragraph (4), by striking ``An entity'' and 
        inserting ``Subject to paragraph (6), an entity''; and
            (2) by adding at the end the following:
            ``(6)(A) For purposes of this section--
                    ``(i) an entity described in subparagraph (B) shall 
                be considered to be an entity described in paragraph 
                (4); and
                    ``(ii) the provisions of this section shall apply 
                to an entity described in subparagraph (B) in the same 
                manner as such provisions apply to an entity described 
                in paragraph (4), except that--
                            ``(I) notwithstanding paragraph (1)(B), the 
                        deeming of any entity described in subparagraph 
                        (B), or of an officer, governing board member, 
                        employee, contractor, or on-call provider of 
                        such an entity, to be an employee of the Public 
                        Health Service for purposes of this section 
                        shall apply only with respect to items and 
                        services that are furnished to an individual 
                        pursuant to section 1867 of the Social Security 
                        Act and to post stabilization services (as 
                        defined in subparagraph (D)) furnished to such 
                        an individual;
                            ``(II) nothing in paragraph (1)(D) shall be 
                        construed as preventing a physician or 
                        physician group described in subparagraph 
                        (B)(ii) from making the application referred to 
                        in such paragraph or as conditioning the 
                        deeming of a physician or physician group that 
                        makes such an application upon receipt by the 
                        Secretary of an application from the hospital 
                        or emergency department that employs or 
                        contracts with the physician or group, or 
                        enlists the physician or physician group as an 
                        on-call provider;
                            ``(III) notwithstanding paragraph (3), this 
                        paragraph shall apply only with respect to 
                        causes of action arising from acts or omissions 
                        that occur on or after January 1, 2010;
                            ``(IV) paragraph (5) shall not apply to a 
                        physician or physician group described in 
                        subparagraph (B)(ii);
                            ``(V) the Attorney General, in consultation 
                        with the Secretary, shall make separate 
                        estimates under subsection (k)(1) with respect 
                        to entities described in subparagraph (B) and 
                        entities described in paragraph (4) (other than 
                        those described in subparagraph (B)), and the 
                        Secretary shall establish separate funds under 
                        subsection (k)(2) with respect to such groups 
                        of entities, and any appropriations under this 
                        subsection for entities described in 
                        subparagraph (B) shall be separate from the 
                        amounts authorized by subsection (k)(2);
                            ``(VI) notwithstanding subsection (k)(2), 
                        the amount of the fund established by the 
                        Secretary under such subsection with respect to 
                        entities described in subparagraph (B) may 
                        exceed a total of $10,000,000 for a fiscal 
                        year; and
                            ``(VII) subsection (m) shall not apply to 
                        entities described in subparagraph (B).
            ``(B) An entity described in this subparagraph is--
                    ``(i) a hospital or an emergency department to 
                which section 1867 of the Social Security Act applies; 
                and
                    ``(ii) a physician or physician group that is 
                employed by, is under contract with, or is an on-call 
                provider of such hospital or emergency department, to 
                furnish items and services to individuals under such 
                section.
            ``(C) For purposes of this paragraph, the term `on-call 
        provider' means a physician or physician group that--
                    ``(i) has full, temporary, or locum tenens staff 
                privileges at a hospital or emergency department to 
                which section 1867 of the Social Security Act applies; 
                and
                    ``(ii) is not employed by or under contract with 
                such hospital or emergency department, but agrees to be 
                ready and available to provide services pursuant to 
                section 1867 of the Social Security Act or post-
                stabilization services to individuals being treated in 
                the hospital or emergency department with or without 
                compensation from the hospital or emergency department.
            ``(D) For purposes of this paragraph, the term `post 
        stabilization services' means, with respect to an individual 
        who has been treated by an entity described in subparagraph (B) 
        for purposes of complying with section 1867 of the Social 
        Security Act, services that are--
                    ``(i) related to the condition that was so treated; 
                and
                    ``(ii) provided after the individual is stabilized 
                in order to maintain the stabilized condition or to 
                improve or resolve the condition of the individual.
            ``(E)(i) Nothing in this paragraph (or in any other 
        provision of this section as such provision applies to entities 
        described in subparagraph (B) by operation of subparagraph (A)) 
        shall be construed as authorizing or requiring the Secretary to 
        make payments to such entities, the budget authority for which 
        is not provided in advance by appropriation Acts.
            ``(ii) The Secretary shall limit the total amount of 
        payments under this paragraph for a fiscal year to the total 
        amount appropriated in advance by appropriation Acts for such 
        purpose for such fiscal year. If the total amount of payments 
        that would otherwise be made under this paragraph for a fiscal 
        year exceeds such total amount appropriated, the Secretary 
        shall take such steps as may be necessary to ensure that the 
        total amount of payments under this paragraph for such fiscal 
        year does not exceed such total amount appropriated.''.