II 

110TH CONGRESS 

1ST SESSION S. 1003 

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. 

IN THE SENATE OF THE UNITED STATES 

MARCH 28, 2007 

Ms. STABENOW (for herself and Mr. SPECTER) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

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. 


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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; TABLE OF CONTENTS. 

4 (a) IN GENERAL.—This Act may be cited as the ‘‘Ac5 cess to Emergency Medical Services Act of 2007’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 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. 

8 TITLE I—BIPARTISAN COMMIS9 SION ON ACCESS TO EMER10 GENCY MEDICAL SERVICES 

11 SEC. 101. ESTABLISHMENT. 

12 There is established the United States Bipartisan 

13 Commission on Access to Emergency Medical Services (in 

14 this title referred to as the ‘‘Commission’’). 


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1 SEC. 102. DUTIES. 

2 (a) IN GENERAL.—The Commission shall perform 

3 the following duties: 

4 (1) Identify and examine factors (including fac5 tors described in subsection (b)) in the health care 

6 delivery, financing, and legal systems that affect the 

7 effective delivery of screening and stabilization serv8 ices furnished in hospitals that have emergency de9 partments pursuant to EMTALA. 

10 (2) Make specific recommendations to Con11 gress, taking into account the considerations speci12 fied in subsection (c), with respect to Federal pro13 grams, policies, and financing needed to assure the 

14 availability of such screening and stabilization serv15 ices and the coordination of State, local, and Federal 

16 programs for responding to disasters and emer17 gencies. 

18 (b) FACTORS CONSIDERED.—For purposes of sub19 section (a)(1), the Commission shall examine at least the 

20 following factors, with respect to emergency departments 

21 of hospitals: 

22 (1) Crowded conditions in such emergency de23 partments and the practice of boarding patients who 

24 require admission, or have already been admitted, to 

25 a hospital for extended periods in such departments 

26 and in the areas adjacent to such departments. 


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1 (2) With respect to individuals who present at 

2 such emergency departments for the treatment of 

3 emergency medical conditions, any barriers that im4 pede access within a reasonable period of time to 

5 screening, stabilization services, and other appro6 priate consultations of physicians listed by the hos7 pital on its list of on-call physicians. 

8 (3) The potential legal and financial liability of 

9 health care professionals and providers with respect 

10 to services required to be furnished to patients 

11 under EMTALA, relating to the requirement of 

12 emergency departments to screen and appropriately 

13 treat or transfer individuals presenting themselves at 

14 the departments with emergency medical conditions 

15 and women in labor. 

16 (c) CONSIDERATIONS IN RECOMMENDATIONS.—In 

17 making recommendations under subsection (a)(2), the 

18 Commission shall consider the following: 

19 (1) Any changes in Federal law that would be 

20 necessary to promote the effective delivery of emer21 gency medical services. 

22 (2) The amount and sources of Federal funds 

23 to finance such changes. 

24 (3) The advantages and disadvantages of alter25 native approaches to protecting health care profesVerDate Aug 31 2005 22:47 Mar 30, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1003.IS S1003

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1 sionals and providers from legal and financial liabil2 ity with respect to services required to be furnished 

3 to individuals under EMTALA. 

4 (4) The most efficient and effective manner of 

5 coordinating State, local, and Federal programs for 

6 responding to disasters and emergencies, with re7 spect to the delivery of emergency medical services. 

8 (d) DEFINITIONS.—For purposes of this title: 

9 (1) HOSPITAL.—The term ‘‘hospital’’ means a 

10 hospital (as defined in subsection (e) of section 1861 

11 of the Social Security Act (42 U.S.C. 1395x)) and 

12 a critical access hospital (as defined in subsection 

13 (mm) of such section). 

14 (2) EMTALA.—The term ‘‘EMTALA’’ means 

15 section 1867 of the Social Security Act (42 U.S.C. 

16 1395dd). 

17 SEC. 103. MEMBERSHIP. 

18 (a) APPOINTMENT.— 

19 (1) The Commission shall be composed of 24 

20 members, who shall be appointed not later than the 

21 date that is 60 days after the date of the enactment 

22 of this Act and in accordance with paragraph (2), as 

23 follows: 

24 (A) The President shall appoint 8 mem25 bers of the Commission. 


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1 (B) The Speaker of the House of Rep2 resentatives, after consultation with the minor3 ity leader of the House of Representatives, shall 

4 appoint 8 members of the Commission. 

5 (C) The majority leader of the Senate, 

6 after consultation with the minority leader of 

7 the Senate, shall appoint 8 members of the 

8 Commission. 

9 (2) Of the members appointed under paragraph 

10 (1), the President, the Speaker of the House of Rep11 resentatives, and the majority leader of the Senate 

12 shall each appoint as members of the commission— 

13 (A) two individuals who represent emer14 gency physicians, emergency nurses, and other 

15 health care professionals who provide emer16 gency medical services; 

17 (B) two individuals who are elected or ap18 pointed Federal, State, or local officials and 

19 who are involved in issues and programs related 

20 to the provision of emergency medical services; 

21 (C) two health care consumer advocates; 

22 and 

23 (D) two individuals who represent hos24 pitals and health systems that provide emer25 gency medical services. 


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1 (b) CHAIRPERSON AND VICE CHAIRPERSON.—The 

2 Commission shall elect a chairperson and 4 vice chair3 persons from among its members. 

4 (c) TERMS.—Each member shall be appointed for the 

5 life of the Commission. 

6 (d) VACANCIES.—Any member appointed to fill a va7 cancy occurring before the expiration of the term for which 

8 the member’s predecessor was appointed shall be ap9 pointed only for the remainder of that term. A member 

10 may serve after the expiration of that member’s term until 

11 a successor has taken office. Any vacancy in the member12 ship of the Commission shall be filled in the manner in 

13 which the original appointment was made and shall not 

14 affect the power of the remaining members to execute the 

15 duties of the Commission. 

16 (e) COMPENSATION.— 

17 (1) IN GENERAL.—Members of the Commission 

18 shall serve without pay. 

19 (2) TRAVEL EXPENSES.—All members of the 

20 Commission shall be reimbursed for travel and per 

21 diem in lieu of subsistence expenses during the per22 formance of duties of the Commission while away 

23 from their homes or regular places of business, in 

24 accordance with subchapter I of chapter 57 of title 

25 5, United States Code. 


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1 (f) QUORUM.—A quorum shall consist of 9 members 

2 of the Commission, except that 6 or more members may 

3 conduct a hearing under section 105(a). 

4 (g) MEETINGS.—The Commission shall meet at the 

5 call of its chairperson or a majority of its members. 

6 SEC. 104. STAFF AND CONSULTANTS. 

7 (a) STAFF.—The Commission may appoint and de8 termine the compensation of such staff as may be nec9 essary to carry out the duties of the Commission. Such 

10 appointments and compensation may be made without re11 gard to the provisions of title 5, United States Code, that 

12 govern appointments in the competitive services, and the 

13 provisions of chapter 51 and subchapter III of chapter 53 

14 of such title that relate to classifications and the General 

15 Schedule pay rates. 

16 (b) CONSULTANTS.—The Commission may procure 

17 such temporary and intermittent services of experts and 

18 consultants as the Commission determines to be necessary 

19 to carry out the duties of the Commission, in accordance 

20 with section 3109(b) of title 5, United States Code, but 

21 at rates for individuals not to exceed the daily equivalent 

22 of the maximum annual rate of basic pay payable for 

23 grade GS–15 of the General Schedule under section 5332 

24 of such title. 


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1 (c) DETAIL OF FEDERAL EMPLOYEES.—Upon the 

2 request of the Commission, the head of any Federal agen3 cy is authorized to detail, without reimbursement to the 

4 agency, any of the personnel of such agency to the Com5 mission to assist the Commission in carrying out its du6 ties. Any such detail shall not interrupt or otherwise affect 

7 the civil service status or privileges of such personnel. 

8 SEC. 105. POWERS. 

9 (a) HEARINGS AND OTHER ACTIVITIES.—The Com10 mission may, for the purpose of carrying out this title, 

11 hold hearings, sit and act at times and places, take testi12 mony, and receive evidence as the Commission determines 

13 necessary to carry out its duties. The Commission may 

14 administer oaths or affirmations to witnesses appearing 

15 before it. 

16 (b) STUDIES BY GOVERNMENT ACCOUNTABILITY OF17 FICE.—Upon the request of the Commission, the Comp18 troller General shall conduct such studies or investigations 

19 as the Commission determines to be necessary to carry 

20 out its duties. 

21 (c) COST ESTIMATES BY CONGRESSIONAL BUDGET

22 OFFICE.— 

23 (1) DUTY TO PROVIDE REQUESTED ESTI24 MATES.—Upon the request of the Commission, the 

25 Director of the Congressional Budget Office shall 


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1 provide to the Commission such cost estimates as 

2 the Commission determines to be necessary to carry 

3 out its duties. 

4 (2) REIMBURSEMENT FOR DEVELOPMENT OF

5 COST ESTIMATES.—The Commission shall reimburse 

6 the Director of the Congressional Budget Office for 

7 expenses relating to the employment in the office of 

8 the Director of such additional staff as may be nec9 essary for the Director to comply with requests by 

10 the Commission under paragraph (1). 

11 (d) TECHNICAL ASSISTANCE.—Upon the request of 

12 the Commission, the head of a Federal agency shall pro13 vide such technical assistance to the Commission as the 

14 Commission determines to be necessary to carry out its 

15 duties. 

16 (e) USE OF MAILS.—The Commission may use the 

17 United States mails in the same manner and under the 

18 same conditions as Federal agencies, and shall, for pur19 poses of the frank, be considered a commission of Con20 gress as described in section 3215 of title 39, United 

21 States Code. 

22 (f) OBTAINING INFORMATION.—The Commission 

23 may secure directly from any Federal agency information 

24 necessary to enable it to carry out its duties, if the infor25 mation may be disclosed under section 552 of title 5, 


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1 United States Code. Upon request of the Chairperson of 

2 the Commission, the head of such agency shall furnish 

3 such information to the Commission. 

4 (g) ADMINISTRATIVE SUPPORT SERVICES.—Upon 

5 the request of the Commission, the Administrator of Gen6 eral Services shall provide to the Commission on a reim7 bursable basis such administrative support services as the 

8 Commission may request. 

9 (h) ACCEPTANCE OF DONATIONS.—The Commission 

10 may accept, use, and dispose of gifts and donations of 

11 services or property. 

12 (i) PRINTING.—For purposes of costs relating to 

13 printing and binding, including the costs of personnel de14 tailed from the Government Printing Office, the Commis15 sion shall be deemed to be a committee of the Congress. 

16 SEC. 106. REPORT ON WAYS TO PROMOTE THE EFFECTIVE 

17 DELIVERY OF EMERGENCY MEDICAL SERV18 ICES. 

19 Not later than the date that is 18 months after the 

20 date of the enactment of this Act, the Commission shall 

21 submit to Congress and the Secretary of Health and 

22 Human Services a report containing its findings and rec23 ommendations described in section 102(a), including rec24 ommendations to remove any identified barriers to the ef25 fective delivery of emergency medical services in the 


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1 United States and detailed recommendations for appro2 priate legislative initiatives to remove such barriers. 

3 SEC. 107. TERMINATION. 

4 The Commission shall terminate 30 days after the 

5 date of submission of the report required in section 106. 

6 SEC. 108. AUTHORIZATION OF APPROPRIATIONS. 

7 There are authorized to be appropriated such sums 

8 as may be necessary to carry out this title. 

9 TITLE II—ADDITIONAL PAY10 MENTS FOR CERTAIN PHYSI11 CIANS’ SERVICES 

12 SEC. 201. ADDITIONAL PAYMENTS FOR CERTAIN PHYSI13 CIANS’ SERVICES. 

14 (a) IN GENERAL.—Section 1833 of the Social Secu15 rity Act (42 U.S.C. 1395l) is amended by adding at the 

16 end the following new subsection: 

17 ‘‘(v) ADDITIONAL PAYMENT FOR PHYSICIANS’ SERV18 ICES FURNISHED PURSUANT TO EMTALA.—In the case 

19 of physicians’ services furnished on or after January 1, 

20 2008, in the emergency department of a hospital (as de21 fined in subsection (e)(5) of section 1867) pursuant to 

22 such section to an individual covered under the insurance 

23 program established under this part, in addition to the 

24 amount of payment that will otherwise be made for such 

25 services under this part, there shall also be paid to the 


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1 physician or other person involved (or in the cases de2 scribed in subparagraph (A) of section 1842(b)(6), to an 

3 employer or other entity involved) from the Federal Sup4 plementary Trust Fund an amount equal to 10 percent 

5 of the payment amount for the services under this part 

6 (determined without regard to any additional amounts 

7 paid under subsection (m) or (u)).’’. 

8 (b) EFFECTIVE DATE.—The amendment made by 

9 subsection (a) shall apply to services furnished on or after 

10 January 1, 2008. 

11 TITLE III—CENTERS FOR MEDI12 CARE & MEDICAID SERVICES 

13 WORKING GROUP TO IM14 PROVE EMERGENCY CARE EF15 FICIENCY 

16 SEC. 301. CENTERS FOR MEDICARE & MEDICAID SERVICES 

17 WORKING GROUP TO IMPROVE EMERGENCY 

18 CARE EFFICIENCY. 

19 (a) WORKING GROUP.— 

20 (1) IN GENERAL.—The Secretary of Health and 

21 Human Services, acting through the Administrator 

22 of the Centers for Medicare & Medicaid Services, 

23 shall convene a working group (in this section re24 ferred to as the ‘‘CMS working group’’) that in25 cludes experts in emergency care, inpatient critical 


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1 care, hospital operations management, nursing, and 

2 other relevant disciplines. The members of the CMS 

3 working group shall be appointed by the Adminis4 trator. 

5 (2) DUTIES.— 

6 (A) DEVELOPMENT OF STANDARDS.—The 

7 CMS working group shall develop— 

8 (i) boarding and diversion standards 

9 for hospitals; and 

10 (ii) guidelines, measures, and incen11 tives for implementation, monitoring, and 

12 enforcement of the standards developed 

13 under clause (i). 

14 (B) IDENTIFICATION OF BARRIERS.—The 

15 CMS working group shall identify barriers con16 tributing to delays in timely processing of pa17 tients requiring admission as an inpatient of a 

18 hospital who initially sought care through the 

19 emergency department of the hospital. 

20 (C) IDENTIFICATION OF BEST PRAC21 TICES.—The CMS working group shall identify 

22 best practices to improve patient flow within 

23 hospitals. 

24 (D) REPORT.—Not later than the date 

25 that is 2 years after the date of the enactment 


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1 of this Act, the CMS Working Group shall sub2 mit to Congress and the Secretary of Health 

3 and Human Services a report containing a de4 tailed description of the standards, guidelines, 

5 measures, and incentives developed under sub6 paragraph (A), the barriers identified under 

7 subparagraph (B), and the best practices iden8 tified under subparagraph (C), together with 

9 recommendations for such legislative and ad10 ministrative actions as the CMS Working group 

11 considers appropriate. 

12 (3) INFORMATION.—In carrying out its duties 

13 under paragraph (2), the CMS Working Group may 

14 request such information from hospitals that the 

15 CMS Working Group considers appropriate. 

16 (4) TERMINATION.—The CMS Working Group 

17 shall terminate 30 days after the date of submission 

18 of the report required in paragraph (2)(D). 

19 (b) DISCLOSURE OF FAILURE TO REPORT.—The 

20 Secretary of Health and Human Services shall establish 

21 a mechanism (such as publication on an Internet website 

22 or in the Federal Register, or both) to disclose to the pub23 lic information regarding any hospital that fails to report 

24 information requested by the CMS working group under 


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1 subsection (a)(3) and the type of information the hospital 

2 failed to report. 

3 (c) HOSPITAL DEFINED.—In this section, the term 

4 ‘‘hospital’’ means a hospital (as defined in subsection (e) 

5 of section 1861 of the Social Security Act (42 U.S.C. 

6 1395x)) and a critical access hospital (as defined in sub7 section (mm) of such section). 

Æ 


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