I 

108TH CONGRESS 

2D SESSION H. R. 4992

To amend the Public Health Service Act to protect certain health care 

providers against legal liability for providing emergency and related care 

to uninsured individuals. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 22, 2004

Mr. SHADEGG (for himself, Mr. NORWOOD, and Mr. THORNBERRY) introduced 

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

Commerce 

A BILL

To amend the Public Health Service Act to protect certain 

health care providers against legal liability for providing 

emergency and related care to uninsured individuals.

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 ‘‘Ensuring Access to 

5 Emergency Rooms Act of 2004’’. 

6 SEC. 2. CONSTITUTIONAL AUTHORITY. 

7 The constitutional authority upon which this Act 

8 rests is the power of the Congress to provide for the gen9 eral welfare, to regulate commerce, and to make all laws 
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1 which shall be necessary and proper for carrying into exe2 cution Federal powers, as enumerated in section 8 of arti3 cle I of the Constitution of the United States. 

4 SEC. 3. PROTECTION AGAINST LEGAL LIABILITY FOR 

5 EMERGENCY AND RELATED SERVICES FUR6 NISHED TO UNINSURED INDIVIDUALS. 

7 Section 224(g) of the Public Health Service Act (42 

8 U.S.C. 233(g)) is amended—

9 (1) in paragraph (4), by striking ‘‘An entity’’ 

10 and inserting in lieu thereof ‘‘Subject to paragraph 

11 (6), an entity’’; and 

12 (2) by adding at the end the following: 

13 ‘‘(6)(A) For purposes of this section—

14 ‘‘(i) an entity described in subparagraph 

15 (B) shall be considered to be an entity de16 scribed in paragraph (4); and 

17 ‘‘(ii) the provisions of this section shall 

18 apply to an entity described in subparagraph 

19 (B) in the same manner as such provisions 

20 apply to an entity described in paragraph (4), 

21 except that—

22 ‘‘(I) notwithstanding paragraph 

23 (1)(B), the deeming of any entity described 

24 in subparagraph (B), or of an officer, gov25 erning board member, employee, or con-
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1 tractor of such an entity, to be an em2 ployee of the Public Health Service for 

3 purposes of this section shall apply only 

4 with respect to items and services that are 

5 furnished to an uninsured individual (as 

6 defined in subparagraph (C)) pursuant to 

7 section 1867 of the Social Security Act 

8 and to post-stabilization services (as de9 fined in subparagraph (D)) furnished to 

10 such an individual; 

11 ‘‘(II) nothing in paragraph (1)(D) 

12 shall be construed as preventing a physi13 cian or physician group described in sub14 paragraph (B)(ii) from making the appli15 cation referred to in such paragraph or as 

16 conditioning the deeming of a physician or 

17 physician group that makes such an appli18 cation upon receipt by the Secretary of an 

19 application from the hospital or emergency 

20 department that employs or contracts with 

21 the physician or group; 

22 ‘‘(III) notwithstanding paragraph (3), 

23 this paragraph shall apply only with re24 spect to causes of action arising from acts 
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1 or omissions that occur on or after Janu2 ary 1, 2003; 

3 ‘‘(IV) paragraph (5) shall not apply to 

4 a physician or physician group described in 

5 subparagraph (B)(ii); 

6 ‘‘(V) the Attorney General, in con7 sultation with the Secretary, shall make 

8 separate estimates under subsection (k)(1) 

9 with respect to entities described in sub10 paragraph (B) and entities described in 

11 paragraph (4) (other than those described 

12 in subparagraph (B)), and the Secretary 

13 shall establish separate funds under sub14 section (k)(2) with respect to such groups 

15 of entities, and any appropriations under 

16 this subsection for entities described in 

17 subparagraph (B) shall be separate from 

18 the amounts authorized by subsection 

19 (k)(2); 

20 ‘‘(VI) notwithstanding subsection 

21 (k)(2), the amount of the fund established 

22 by the Secretary under such subsection 

23 with respect to entities described in sub24 paragraph (B) may exceed a total of 

25 $10,000,000 for a fiscal year; and 
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1 ‘‘(VII) subsection (m) shall not apply 

2 to entities described in subparagraph (B). 

3 ‘‘(B) An entity described in this subparagraph 

4 is—

5 ‘‘(i) a hospital or an emergency depart6 ment to which section 1867 of the Social Secu7 rity Act applies; and 

8 ‘‘(ii) a physician or physician group that is 

9 employed by, or under contract with, such hos10 pital or department to furnish items and serv11 ices to individuals under such section. 

12 ‘‘(C) For purposes of this paragraph, the term 

13 ‘uninsured individual’ means an individual who, at 

14 the time treatment is provided by an entity de15 scribed in subparagraph (B) for purposes of com16 plying with section 1867 of the Social Security 

17 Act—

18 ‘‘(i) does not have coverage under—

19 ‘‘(I) a group health plan (as defined 

20 in section 2791(a)(1)); 

21 ‘‘(II) part A or B of title XVIII of the 

22 Social Security Act; or 

23 ‘‘(III) a State plan under title XIX of 

24 such Act; and 
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1 ‘‘(ii) does not have health insurance cov2 erage (as defined in section 2791(b)(1) of the 

3 Public Health Service Act (42 U.S.C. 300gg–

4 91(b)(1)) from any other source. 

5 ‘‘(D) For purposes of this paragraph, the term 

6 ‘post-stabilization services’ means, with respect to an 

7 individual who has been treated by an entity de8 scribed in subparagraph (B) for purposes of com9 plying with section 1867 of the Social Security Act, 

10 services that are—

11 ‘‘(i) related to the condition that was so 

12 treated; and 

13 ‘‘(ii) provided after the individual is sta14 bilized in order to maintain the stabilized condi15 tion or to improve or resolve the individual’s 

16 condition. 

17 ‘‘(E)(i) Nothing in this paragraph (or in any 

18 other provision of this section as such provision ap19 plies to entities described in subparagraph (B) by 

20 operation of subparagraph (A)) shall be construed as 

21 authorizing or requiring the Secretary to make pay22 ments to such entities, the budget authority for 

23 which is not provided in advance by appropriation 

24 Acts. 
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1 ‘‘(ii) The Secretary shall limit the total amount 

2 of payments under this paragraph for a fiscal year 

3 to the total amount appropriated in advance by ap4 propriation Acts for such purpose for such fiscal 

5 year. If the total amount of payments that would 

6 otherwise be made under this paragraph for a fiscal 

7 year exceeds such total amount appropriated, the 

8 Secretary shall take such steps as may be necessary 

9 to ensure that the total amount of payments under 

10 this paragraph for such fiscal year does not exceed 

11 such total amount appropriated.’’.

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