I 

111TH CONGRESS 

1ST SESSION H. R. 2231 

To amend the Public Health Service Act to ensure that victims of public 

health emergencies have meaningful and immediate access to medically 

necessary health care services. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 4, 2009 

Mrs. CAPPS (for herself, Ms. DEGETTE, and Mr. GRIJALVA) introduced the 

following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to ensure that 

victims of public health emergencies have meaningful 

and immediate access to medically necessary health care 

services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Public Health Emer5 gency Response Act of 2009’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress finds the following: 


rfrederick on PROD1PC67 with BILLS
2 

•HR 2231 IH

1 (1) Since 2000, the Secretary of Health and 

2 Human Services has declared that a public health 

3 emergency existed nationwide in response to the at4 tacks of September 11th and in response to Hurri5 canes Katrina and Rita. 

6 (2) In the event of a public health emergency, 

7 compliance with recommendations to seek immediate 

8 care may be critical to containing the spread of an 

9 infectious disease outbreak or responding to a bio10 terror attack. 

11 (3) Nearly 16 percent of Americans lack health 

12 insurance coverage. 

13 (4) Fears of out-of-pocket expenses may cause 

14 individuals to delay seeking medical attention during 

15 a public health emergency. 

16 (5) A public health emergency may disrupt 

17 health care assistance programs for individuals with 

18 chronic conditions, exacerbating the costs and risks 

19 to their health. 

20 (6) The uninsured could place great financial 

21 strain on health care providers during a public 

22 health emergency. 

23 (7) The Department of Health and Human 

24 Services Pandemic Influenza Plan projects that a 

25 pandemic influenza outbreak could result in 


rfrederick on PROD1PC67 with BILLS
3 

•HR 2231 IH

1 45,000,000 additional outpatient visits, with 

2 865,000 to 9,900,000 individuals requiring hos3 pitalization, depending upon the severity of the pan4 demic. 

5 (8) Hospitals in the United States could lose as 

6 much as $3,900,000,000 in uncompensated care and 

7 cash flow losses in the event of a severe pandemic. 

8 (9) Under current statute, no dedicated mecha9 nism exists to reimburse providers for uncompen10 sated care during a public health emergency. 

11 (b) PURPOSES.—The purposes of this Act are— 

12 (1) to provide temporary emergency health care 

13 coverage for uninsured and certain otherwise quali14 fied individuals in the event of a public health emer15 gency declared by the Secretary of Health and 

16 Human Services; 

17 (2) to ensure that health care providers remain 

18 fiscally solvent and are not overburdened by the cost 

19 of uncompensated care during a public health emer20 gency; 

21 (3) to eliminate a primary disincentive for unin22 sured and certain otherwise qualified individuals to 

23 promptly seek medical care during a public health 

24 emergency; and 


rfrederick on PROD1PC67 with BILLS
4 

•HR 2231 IH

1 (4) to minimize delays in the provision of emer2 gency health care coverage by clarifying eligibility 

3 requirements and the scope of such coverage and 

4 identifying the funding mechanisms for emergency 

5 health care services. 

6 SEC. 3. EMERGENCY HEALTH CARE COVERAGE. 

7 (a) IN GENERAL.—Title III of the Public Health 

8 Service Act (42 U.S.C. 241 et seq.) is amended by insert9 ing after section 319K the following new section: 

10 ‘‘SEC. 319K–1. EMERGENCY HEALTH CARE COVERAGE. 

11 ‘‘(a) ACTIVATION AND TERMINATION OF EMER12 GENCY HEALTH CARE COVERAGE.— 

13 ‘‘(1) BASED ON PUBLIC HEALTH EMER14 GENCY.— 

15 ‘‘(A) IN GENERAL.—The Secretary may 

16 activate the coverage of emergency health care 

17 services under this section only if the Secretary 

18 determines that there is a public health emer19 gency. 

20 ‘‘(B) DETERMINATION OF PUBLIC HEALTH

21 EMERGENCY.—For purposes of this section, 

22 there is a ‘public health emergency’ only if a 

23 public health emergency exists under section 

24 319. 


rfrederick on PROD1PC67 with BILLS
5 

•HR 2231 IH

1 ‘‘(2) CONSIDERATIONS.—In making a deter2 mination under paragraph (1), the Secretary shall 

3 consider a range of factors including the following: 

4 ‘‘(A) The degree to which the emergency is 

5 likely to overwhelm health care providers in the 

6 region. 

7 ‘‘(B) The opportunity to minimize mor8 bidity and mortality through intervention under 

9 this section. 

10 ‘‘(C) The estimated number of direct cas11 ualties of the emergency. 

12 ‘‘(D) The potential number of casualties in 

13 the absence of intervention under this section 

14 (such as in the case of infectious disease). 

15 ‘‘(E) The potential adverse financial im16 pacts on local health care providers in the ab17 sence of activation of this section. 

18 ‘‘(F) Whether the need for health care 

19 services is of sufficient severity and magnitude 

20 to warrant major assistance under this section 

21 above and beyond the emergency services other22 wise available from the Federal Government. 

23 ‘‘(G) Such other factors as the Secretary 

24 may deem appropriate. 

25 ‘‘(3) TERMINATION AND EXTENSION.— 


rfrederick on PROD1PC67 with BILLS
6 

•HR 2231 IH

1 ‘‘(A) IN GENERAL.—Coverage of emer2 gency health care services under this section 

3 shall terminate, subject to subsection (c)(2), 

4 upon the earlier of the following: 

5 ‘‘(i) The Secretary’s determination 

6 that a public health emergency no longer 

7 exists. 

8 ‘‘(ii) Subject to subparagraph (B), 90 

9 days after the initiation of coverage of 

10 emergency health care services. 

11 ‘‘(B) EXTENSION AUTHORITY.—The Sec12 retary may extend a public health emergency 

13 for a second 90-day period, but only if a report 

14 to Congress is made under paragraph (4) in 

15 conjunction with making such extension. 

16 ‘‘(4) REPORT.— 

17 ‘‘(A) IN GENERAL.—Prior to making an 

18 extension under paragraph (3)(B), the Sec19 retary shall transmit a report to Congress that 

20 includes information on the nature of the public 

21 health emergency and the expected duration of 

22 the emergency. The Secretary shall include in 

23 such report recommendations, if deemed appro24 priate, that Congress provide a further extenVerDate Nov 24 2008 03:38 May 05, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2231.IH H2231

rfrederick on PROD1PC67 with BILLS
7 

•HR 2231 IH

1 sion of the public health emergency period be2 yond the second 90-day period. 

3 ‘‘(B) REPORT CONTENTS.—A report under 

4 subparagraph (A) shall include a discussion of 

5 the health care needs of emergency victims and 

6 affected individuals including the likely need for 

7 follow-up care over a 2-year period. 

8 ‘‘(5) COORDINATION.—The Secretary shall en9 sure that the activation, implementation, and termi10 nation of emergency health care services under this 

11 section in response to a public health emergency is 

12 coordinated with all functions, personnel, and assets 

13 of the Federal, State, local, and tribal responses to 

14 the emergency. 

15 ‘‘(6) MEDICAL MONITORING PROGRAM.—The 

16 Secretary shall establish a medical monitoring pro17 gram for monitoring and reporting on health care 

18 needs of the affected population over time. At least 

19 annually during the 5-year period following the date 

20 of a public health emergency, the Secretary shall re21 port to Congress on any continuing health care 

22 needs of the affected population related to the public 

23 health emergency. Such reports shall include rec24 ommendations on how to ensure that emergency vicVerDate Nov 24 2008 03:38 May 05, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2231.IH H2231

rfrederick on PROD1PC67 with BILLS
8 

•HR 2231 IH

1 tims and affected individuals have access to needed 

2 health care services. 

3 ‘‘(b) ELIGIBILITY FOR COVERAGE OF EMERGENCY

4 HEALTH CARE SERVICES.— 

5 ‘‘(1) LIMITED ELIGIBILITY.— 

6 ‘‘(A) IN GENERAL.—Eligibility for cov7 erage of emergency health care services under 

8 this section for a public health emergency is 

9 limited to individuals who— 

10 ‘‘(i) are emergency victims who are 

11 uninsured or otherwise qualified; or 

12 ‘‘(ii) are affected individuals who are 

13 uninsured. 

14 ‘‘(B) DEFINITIONS.—For purposes of this 

15 section with respect to a public health emer16 gency: 

17 ‘‘(i) INSURED.—An individual is ‘in18 sured’ if the individual has group or indi19 vidual health insurance coverage or pub20 licly financed health insurance (as defined 

21 by the Secretary). 

22 ‘‘(ii) OTHERWISE QUALIFIED.—An in23 dividual is ‘‘otherwise qualified’’ if the in24 dividual is insured but the Secretary deter25 mines that the individual’s health care inVerDate Nov 24 2008 03:38 May 05, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2231.IH H2231

rfrederick on PROD1PC67 with BILLS
9 

•HR 2231 IH

1 surance coverage is not at least actuarially2 equivalent to benchmark coverage. In es3 tablishing such benchmark coverage, the 

4 Secretary shall consider the standard Blue 

5 Cross/Blue Shield preferred provider op6 tion service benefit plan described in and 

7 offered under section 8903(1) of title 5, 

8 United States Code. 

9 ‘‘(iii) UNINSURED.—An individual is 

10 ‘uninsured’ if the individual is not insured. 

11 ‘‘(iv) EMERGENCY VICTIM.—An indi12 vidual is an ‘emergency victim’ with re13 spect to a public health emergency if the 

14 individual needs health care services due to 

15 injuries or disease resulting from the pub16 lic health emergency. 

17 ‘‘(v) AFFECTED INDIVIDUAL.—An in18 dividual is an ‘affected individual’ with re19 spect to a public health emergency if— 

20 ‘‘(I) the individual— 

21 ‘‘(aa) resides in an assist22 ance area designated for the 

23 emergency (or whose residence 

24 was displaced by the emergency); 

25 or 


rfrederick on PROD1PC67 with BILLS
10 

•HR 2231 IH

1 ‘‘(bb) in the case of such an 

2 emergency constituting a pan3 demic flu or other infectious dis4 ease outbreak, resides in the area 

5 affected by the outbreak (or 

6 whose residence was displaced by 

7 the emergency); and 

8 ‘‘(II) the individual’s ability to 

9 access care or medicine is disrupted 

10 as a result of the emergency. 

11 ‘‘(2) PROCESS.—The Secretary shall establish a 

12 streamlined process for determining eligibility for 

13 emergency health care services under this section. In 

14 establishing such process— 

15 ‘‘(A) the Secretary shall recognize that in 

16 the context of a public health emergency, indi17 viduals may be unable to provide identification 

18 cards, health care insurance information, or 

19 other documentation; and 

20 ‘‘(B) the primary method for determining 

21 eligibility for such services shall be an attesta22 tion provided to the health care provider by the 

23 recipient of the services that the recipient meets 

24 the eligibility criteria established under para25 graph (1)(A), with a standard alternative for 


rfrederick on PROD1PC67 with BILLS
11 

•HR 2231 IH

1 unattended minors and adults without the ca2 pacity to sign such an attestation form. 

3 ‘‘(3) SERVICE DELIVERY.—Providers may com4 mence provision of emergency health care services 

5 for an individual in the absence of any centralized 

6 enrollment process, if the provider has collected 

7 basic information, specified by the Secretary, includ8 ing the individual’s name, address, social security 

9 number, and existing health insurance coverage (if 

10 any), that establishes a prima facie basis for eligi11 bility, except that such information shall not be re12 quired in cases where the individual is unable to pro13 vide the information due to disability or incapacita14 tion. 

15 ‘‘(c) EMERGENCY HEALTH CARE SERVICES.— 

16 ‘‘(1) IN GENERAL.—For purposes of this sec17 tion, the term ‘emergency health care services’— 

18 ‘‘(A) means items and services for which 

19 payment may be made under parts A and B of 

20 the Medicare program; 

21 ‘‘(B) includes prescription drugs (not cov22 ered under such part B) specified by the Sec23 retary under subsection (g), based on the 

24 formularies of the two or more prescription 


rfrederick on PROD1PC67 with BILLS
12 

•HR 2231 IH

1 drug plans under part D of the Medicare pro2 gram with the largest enrollment; 

3 ‘‘(C) may include drugs, devices, biological 

4 products, and other health care products, if 

5 such products are authorized for use by the 

6 Food and Drug Administration pursuant to an 

7 alternate authority, including the emergency 

8 use authority under section 564 of the Federal 

9 Food, Drug, and Cosmetic Act (21 U.S.C. 

10 360bbb–3); and 

11 ‘‘(D) for an affected individual, is limited 

12 to those items and services described under sub13 paragraphs (A), (B), or (C) that a third-party 

14 payor, such as a government program or chari15 table organization, reimbursed or otherwise pro16 vided to an affected individual during the 90 

17 days prior to the declaration of the public 

18 health emergency. 

19 ‘‘(2) NOT MEDICARE, MEDICAID, OR SCHIP BEN20 EFITS.—The emergency health care services pro21 vided under this section are not benefits under Medi22 care, Medicaid or SCHIP. Nothing in this section 

23 shall be interpreted as altering or otherwise con24 flicting with titles XVIII, XIX, or XXI of the Social 

25 Security Act. 


rfrederick on PROD1PC67 with BILLS
13 

•HR 2231 IH

1 ‘‘(3) COMPLETION OF TREATMENT FOR EMER2 GENCY VICTIMS.—Notwithstanding termination of 

3 the coverage of emergency health care services pur4 suant to subsection (a)(3), the Secretary may iden5 tify a subgroup of emergency victims on a case-by6 case basis or otherwise to continue receiving cov7 erage of emergency health care services for up to an 

8 additional 60 days. Such emergency health care 

9 services provided after the termination date shall be 

10 limited to services and items that are medically nec11 essary to treat an injury or disease resulting directly 

12 from the public health emergency involved. 

13 ‘‘(d) COVERED PROVIDERS.— 

14 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

15 health care services are not covered under this sec16 tion unless they are furnished by a health care pro17 vider that— 

18 ‘‘(A) has a valid provider number under 

19 the Medicare program, the Medicaid program, 

20 or SCHIP; 

21 ‘‘(B) is in good standing with such pro22 gram; and 

23 ‘‘(C) is not excluded from participation in 

24 a Federal health care program (as defined in 


rfrederick on PROD1PC67 with BILLS
14 

•HR 2231 IH

1 section 1128B(f) of the Social Security Act (42 

2 U.S.C. 1320a–7b(f))). 

3 ‘‘(2) WAIVER AUTHORITY.— 

4 ‘‘(A) IN GENERAL.—The Secretary may by 

5 regulation waive certain requirements for pro6 vider enrollment that otherwise apply under the 

7 Medicare or Medicaid program or under SCHIP 

8 to ensure an adequate supply of health care 

9 providers (such as nurses and other health care 

10 providers who do not typically participate in the 

11 Medicare or Medicaid program or SCHIP) and 

12 services in the case of a public health emer13 gency. Such requirements may include the re14 quirement that a licensed physician or other 

15 health care professional holds a license in the 

16 State in which the professional provides services 

17 or is otherwise authorized under State law to 

18 provide the services involved. 

19 ‘‘(B) REPORT ON EMERGENCY SYSTEM

20 FOR ADVANCE REGISTRATION OF VOLUNTEER

21 HEALTH PROFESSIONALS (ESAR–VHP).—Not 

22 later than 180 days after the date of the enact23 ment of this section, the Secretary shall submit 

24 to Congress a report on the number of volun25 teers, by profession and credential level, enVerDate Nov 24 2008 03:38 May 05, 2009 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H2231.IH H2231

rfrederick on PROD1PC67 with BILLS
15 

•HR 2231 IH

1 rolled in the Emergency System for Advance 

2 Registration of Volunteer Health Professionals 

3 (ESAR–VHP) that will be available to each 

4 State in the event of a public health emergency. 

5 The Secretary shall determine if the number of 

6 such volunteers is adequate for interstate de7 ployment in response to regional requests for 

8 volunteers and, if not, shall include in the re9 port recommendations for actions to ensure an 

10 adequate surge capacity for public health emer11 gencies in defined geographic areas. 

12 ‘‘(3) MEDICARE AND MEDICAID PROGRAMS AND

13 SCHIP DEFINED.—For purposes of this section: 

14 ‘‘(A) The term ‘Medicare program’ means 

15 the program under parts A, B, and D of title 

16 XVIII of the Social Security Act. 

17 ‘‘(B) The term ‘Medicaid program’ means 

18 the program of medical assistance under title 

19 XIX of such Act. 

20 ‘‘(C) The term ‘SCHIP’ means the State 

21 children’s health insurance program under title 

22 XXI of such Act. 

23 ‘‘(e) PAYMENTS AND CLAIMS ADMINISTRATION.— 

24 ‘‘(1) PAYMENT AMOUNT.—The amount of pay25 ment under this section to a provider for emergency 


rfrederick on PROD1PC67 with BILLS
16 

•HR 2231 IH

1 health care services shall be equal to 100 percent of 

2 the payment rate for the corresponding service 

3 under part A or B of the Medicare program, or, in 

4 the case of prescription drugs and other items and 

5 services not covered under either such part, such 

6 amount as the Secretary may specify by rule. Such 

7 a provider shall not be permitted to impose any cost8 sharing or to balance bill for services furnished 

9 under this section. 

10 ‘‘(2) USE OF MEDICARE CONTRACTORS.—The 

11 Secretary shall enter into arrangements with Medi12 care administrative contractors under which such 

13 contractors process claims for emergency health care 

14 services under this section using the claim forms, 

15 codes, and nomenclature in effect under the Medi16 care program. 

17 ‘‘(3) APPLICATION OF SECONDARY PAYER

18 RULES.—In the case of payment under this section 

19 for emergency health care services for otherwise 

20 qualified individuals who have some health insurance 

21 coverage with respect to such services, the adminis22 trative contractors under paragraph (2) shall submit 

23 a claim to the entity offering such coverage to re24 coup all or some of such payment, reflecting what25 ever amount the entity would normally reimburse for 


rfrederick on PROD1PC67 with BILLS
17 

•HR 2231 IH

1 each covered service. The provisions of section 

2 1862(b) of the Social Security Act (42 U.S.C. 

3 1395y(b)) shall apply to benefits provided under this 

4 section in the same manner as they apply to benefits 

5 provided under the Medicare program. 

6 ‘‘(4) PAYMENTS FOR EMERGENCY HEALTH

7 CARE SERVICES AND RELATED COSTS.—Payments to 

8 provide, and costs to administer, emergency health 

9 care services under this section shall be made from 

10 the Public Health Emergency Fund, as provided 

11 under subsection (f)(1). 

12 ‘‘(5) ATTESTATION REQUIREMENT.—No pay13 ment shall be made under this section to a provider 

14 for emergency health care services unless the pro15 vider has executed an attestation that— 

16 ‘‘(A) the provider has notified the adminis17 trative contractor of any third-party payment 

18 received or claims pending for such services; 

19 ‘‘(B) the recipient of the services has exe20 cuted an attestation or otherwise satisfies the 

21 eligibility criteria established under subsection 

22 (b); and 

23 ‘‘(C) the services were medically necessary. 

24 ‘‘(f) PUBLIC HEALTH EMERGENCY FUND; FRAUD

25 AND ABUSE PROVISIONS.— 


rfrederick on PROD1PC67 with BILLS
18 

•HR 2231 IH

1 ‘‘(1) THE PUBLIC HEALTH EMERGENCY

2 FUND.—There is authorized to be appropriated to 

3 the Public Health Emergency Fund (established 

4 under section 319(b)) such sums as may be nec5 essary under this section for payments to provide 

6 emergency health care services and costs to admin7 ister the services during a public health emergency. 

8 ‘‘(2) NO USE OF MEDICARE FUNDS.—No funds 

9 under the Medicare program shall be made available 

10 or used to make payments under this section. 

11 ‘‘(3) FRAUD AND ABUSE PROVISIONS.—Pro12 viders and recipients of emergency health care serv13 ices under this section shall be subject to the Fed14 eral fraud and abuse protections that apply to Fed15 eral health care programs as defined in section 

16 1128B(f) of the Social Security Act (42 U.S.C. 

17 1320a–7b(f)). 

18 ‘‘(g) RULEMAKING.—The Secretary may issue regu19 lations to carry out this section and shall use a negotiated 

20 rulemaking process to advise the Secretary on key issues 

21 regarding the implementation of this section. 

22 ‘‘(h) PUBLIC HEALTH EMERGENCY PLANNING AND

23 THE EDUCATION OF HEALTH CARE PROVIDERS AND THE

24 GENERAL POPULATION.— 


rfrederick on PROD1PC67 with BILLS
19 

•HR 2231 IH

1 ‘‘(1) PLANNING FOR COVERAGE OF EMERGENCY

2 HEALTH CARE SERVICES IN PUBLIC HEALTH EMER3 GENCIES.—The Secretary shall, not later than 90 

4 days after the date of the enactment of this section, 

5 initiate planning to carry out this section, including 

6 planning relating to implementation of the payments 

7 and claims administration under subsection (e), in 

8 the event of activation of emergency health care cov9 erage. 

10 ‘‘(2) OUTREACH AND PUBLIC EDUCATION CAM11 PAIGN.—The Secretary shall conduct an outreach 

12 and public education campaign to inform health care 

13 providers and the general public about the avail14 ability of emergency health care coverage under this 

15 section during the period of the emergency. Such 

16 campaign shall include— 

17 ‘‘(A) an explanation of the emergency 

18 health care coverage program under this sec19 tion; 

20 ‘‘(B) claim forms and instructions for 

21 health care providers to use when providing cov22 ered services during the emergency period; and 

23 ‘‘(C) special outreach initiatives to vulner24 able and hard-to-reach populations. 


rfrederick on PROD1PC67 with BILLS
20 

•HR 2231 IH

1 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

2 There are authorized to be appropriated for each fis3 cal year (beginning with fiscal year 2009) 

4 $7,000,000 to carry out paragraphs (1) and (2) dur5 ing the fiscal year. 

6 ‘‘(i) APPLICATION OF POLICIES UNDER OTHER FED7 ERAL HEALTH CARE PROGRAMS.—As specified in sub8 sections (c) through (e), the Secretary may adopt in whole 

9 or in part the coverage, reimbursement, provider enroll10 ment, and other policies used under the Medicare program 

11 and other Federal health care programs in administering 

12 emergency health care services under this section to the 

13 extent consistent with this section.’’. 

14 (b) APPLICATION OF PUBLIC HEALTH EMERGENCY

15 FUND.—Section 319(b)(1) of such Act (42 U.S.C. 

16 247d(b)(1)) is amended— 

17 (1) by inserting ‘‘and section 319K–1’’ after 

18 ‘‘subsection (a)’’; and 

19 (2) by striking ‘‘such subsection’’ and inserting 

20 ‘‘subsection (a)’’. 

Æ 


rfrederick on PROD1PC67 with BILLS