I
106TH CONGRESS
1ST SESSION
H. R. 1777
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to assure
access to covered emergency hospital services and emergency ambulance
services under a prudent layperson test under group health plans and
health insurance coverage.
IN THE HOUSE OF REPRESENTATIVES
MAY 12, 1999
Mr. UPTON (for himself, Mr. TOWNS, and Mrs. EMERSON) introduced the fol-
lowing bill; which was referred to the Committee on Commerce, and in
addition to the Committees on Ways and Means, and Education and the
Workforce, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, and the Internal
Revenue Code of 1986 to assure access to covered emer-
gency hospital services and emergency ambulance services
under a prudent layperson test under group health plans
and health insurance coverage.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Emergency Ambulance
Services Access Assurance Act of 1999’’.
SEC. 2. ASSURING ACCESS TO EMERGENCY SERVICES.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—Subpart 2 of part A of title XXVII of the
Public Health Service Act is amended by adding at
the end the following new section:
‘‘SEC. 2707. STANDARD RELATING TO ACCESS TO EMER-
GENCY SERVICES AND EMERGENCY AMBU-
LANCE SERVICES.
‘‘(a) COVERAGE OF EMERGENCY SERVICES.—
‘‘(1) IN GENERAL.—If a group health plan, or
health insurance coverage offered in connection with
a health insurance issuer, provides any benefits with
respect to emergency services (as defined in para-
graph (2)(B)), the plan or issuer shall cover emer-
gency 
services 
furnished 
under 
the 
plan 
or
coverage—
‘‘(A) without the need for any prior au-
thorization determination;
‘‘(B) whether or not the health care pro-
vider furnishing such services is a participating
provider with respect to such services;
possesses an average knowledge of health and
medicine, could reasonably expect the absence
of immediate medical attention to result in a
condition described in clause (i), (ii), or (iii) of
section 1867(e)(1)(A) of the Social Security
Act.
‘‘(B) EMERGENCY
SERVICES.—The term
‘emergency services’ means—
‘‘(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment to evaluate an emergency medical
condition (as defined in subparagraph
(A)), and
‘‘(ii) within the capabilities of the
staff and facilities available at the hospital,
such further medical examination and
treatment as are required under section
1867 of such Act to stabilize the patient.
‘‘(C) NONPARTICIPATING.—The term ‘non-
participating’ means, with respect to a health
care provider that provides health care items
and services to a participant, beneficiary, or en-
rollee under group health plan or health insur-
ance coverage, a health care provider that is not
a participating health care provider with respect
to such items and services.
‘‘(D) PARTICIPATING.—The term ‘partici-
pating’ means, with respect to a health care
provider that provides health care items and
services to a participant, beneficiary, or enrollee
under group health plan or health insurance
coverage offered by a health insurance issuer, a
health care provider that furnishes such items
and services under a contract or other arrange-
ment with the plan or issuer.
‘‘(b) COVERAGE OF EMERGENCY AMBULANCE SERV-
ICES.—
‘‘(1) IN GENERAL.—If a group health plan, or
health insurance coverage offered in connection with
a group health plan by a health insurance issuer,
provides any benefits with respect to ambulance
services and emergency services, the plan or issuer
shall cover emergency ambulance services (as defined
in paragraph (2))) furnished under the plan or cov-
erage under the same terms and conditions under
subparagraphs (A) through (D) of subsection (a)(1)
under which coverage is provided for emergency
services.
‘‘(2) EMERGENCY AMBULANCE SERVICES.—For
purposes of this subsection, the term ‘emergency
ambulance services’ means ambulance services (as
defined for purposes of section 1861(s)(7) of the So-
cial Security Act) furnished to transport an indi-
vidual who has an emergency medical condition (as
defined in subsection (a)(2)(A)) to a hospital for the
receipt of emergency services (as defined in sub-
section (a)(2)(B)) in a case in which the emergency
services are covered under the plan or coverage pur-
suant to subsection (a)(1) and a prudent layperson,
with an average knowledge of health and medicine,
could reasonably expect that the absence of such
transport would result in placing the health of the
individual in serious jeopardy, serious impairment of
bodily function, or serious dysfunction of any bodily
organ or part.
‘‘(c) NOTICE.—A group health plan under this part
shall comply with the notice requirement under section
714(b) of the Employee Retirement Income Security Act
of 1974 with respect to the requirements of this section
as if such section applied to such plan.’’.
(2) Section 2723(c) of such Act (42 U.S.C.
300gg–23(c)) is amended by striking ‘‘section 2704’’
and inserting ‘‘sections 2704 and 2707’’.
(3) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 714. STANDARD RELATING TO ACCESS TO EMER-
GENCY SERVICES AND EMERGENCY AMBU-
LANCE SERVICES.
‘‘(a) COVERAGE OF EMERGENCY SERVICES.—
‘‘(1) IN GENERAL.—If a group health plan, or
health insurance coverage offered in connection with
a health insurance issuer, provides any benefits with
respect to emergency services (as defined in para-
graph (2)(B)), the plan or issuer shall cover emer-
gency 
services 
furnished 
under 
the 
plan 
or
coverage—
‘‘(A) without the need for any prior au-
thorization determination;
‘‘(B) whether or not the health care pro-
vider furnishing such services is a participating
provider with respect to such services;
‘‘(C) in a manner so that, if such services
are provided to a participant, beneficiary, or en-
rollee by a nonparticipating health care provider
without prior authorization by the plan or
issuer, the participant, beneficiary, or enrollee
is not liable for amounts that exceed the
amounts of liability that would be incurred if
the services were provided by a participating
health care provider with prior authorization by
the plan or issuer; and
‘‘(D) without regard to any other term or
condition of such coverage (other than exclusion
or coordination of benefits, or an affiliation or
waiting period, permitted under section 2701 of
the Public Health Service Act, section 701 of
this Act, or section 9801 of the Internal Rev-
enue Code of 1986, and other than applicable
cost-sharing).
‘‘(2) DEFINITIONS.—In this section:
‘‘(A) EMERGENCY
MEDICAL
CONDITION
BASED ON PRUDENT LAYPERSON STANDARD.—
The term ‘emergency medical condition’ means
a medical condition manifesting itself by acute
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, who
possesses an average knowledge of health and
medicine, could reasonably expect the absence
of immediate medical attention to result in a
condition described in clause (i), (ii), or (iii) of
section 1867(e)(1)(A) of the Social Security
Act.
‘‘(B) EMERGENCY
SERVICES.—The term
‘emergency services’ means—
‘‘(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment to evaluate an emergency medical
condition (as defined in subparagraph
(A)), and
‘‘(ii) within the capabilities of the
staff and facilities available at the hospital,
such further medical examination and
treatment as are required under section
1867 of such Act to stabilize the patient.
‘‘(C) NONPARTICIPATING.—The term ‘non-
participating’ means, with respect to a health
care provider that provides health care items
and services to a participant, beneficiary, or en-
rollee under group health plan or health insur-
ance coverage, a health care provider that is not
a participating health care provider with respect
to such items and services.
‘‘(D) PARTICIPATING.—The term ‘partici-
pating’ means, with respect to a health care
provider that provides health care items and
services to a participant, beneficiary, or enrollee
under group health plan or health insurance
coverage offered by a health insurance issuer, a
health care provider that furnishes such items
and services under a contract or other arrange-
ment with the plan or issuer.
‘‘(b) COVERAGE OF EMERGENCY AMBULANCE SERV-
ICES.—
‘‘(1) IN GENERAL.—If a group health plan, or
health insurance coverage offered in connection with
a group health plan by a health insurance issuer,
provides any benefits with respect to ambulance
services and emergency services, the plan or issuer
shall cover emergency ambulance services (as defined
in paragraph (2))) furnished under the plan or cov-
erage under the same terms and conditions under
subparagraphs (A) through (D) of subsection (a)(1)
under which coverage is provided for emergency
services.
‘‘(2) EMERGENCY AMBULANCE SERVICES.—For
purposes of this subsection, the term ‘emergency
ambulance services’ means ambulance services (as
defined for purposes of section 1861(s)(7) of the So-
cial Security Act) furnished to transport an indi-
vidual who has an emergency medical condition (as
defined in subsection (a)(2)(A)) to a hospital for the
receipt of emergency services (as defined in sub-
section (a)(2)(B)) in a case in which the emergency
services are covered under the plan or coverage pur-
suant to subsection (a)(1) and a prudent layperson,
with an average knowledge of health and medicine,
could reasonably expect that the absence of such
transport would result in placing the health of the
individual in serious jeopardy, serious impairment of
bodily function, or serious dysfunction of any bodily
organ or part.
‘‘(c) NOTICE UNDER GROUP HEALTH PLAN.—The
imposition of the requirement of this section shall be treat-
ed as a material modification in the terms of the plan de-
scribed in section 102(a)(1), for purposes of assuring no-
tice of such requirements under the plan; except that the
summary description required to be provided under the
last sentence of section 104(b)(1) with respect to such
modification shall be provided by not later than 60 days
after the first day of the first plan year in which such
requirement apply.’’.
(B) Section 731(c) of such Act (29 U.S.C.
1191(c)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 713 the following new item:
‘‘Sec. 714. Standard relating to access to emergency services and emergency am-
bulance services.’’.
(4) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986
is amended by inserting after section 9812 the
following new section:
‘‘SEC. 9813. STANDARD RELATING TO ACCESS TO EMER-
GENCY SERVICES AND EMERGENCY AMBU-
LANCE SERVICES.
‘‘(a) COVERAGE OF EMERGENCY SERVICES.—
‘‘(1) IN GENERAL.—If a group health plan pro-
vides any benefits with respect to emergency services
(as defined in paragraph (2)(B)), the plan shall
cover emergency services furnished under the plan—
‘‘(A) without the need for any prior au-
thorization determination;
‘‘(B) whether or not the health care pro-
vider furnishing such services is a participating
provider with respect to such services;
‘‘(C) in a manner so that, if such services
are provided to a participant or beneficiary by
a nonparticipating health care provider without
prior authorization by the plan, the participant
or beneficiary is not liable for amounts that ex-
ceed the amounts of liability that would be in-
curred if the services were provided by a par-
ticipating health care provider with prior au-
thorization by the plan; and
‘‘(D) without regard to any other term or
condition of such coverage (other than exclusion
or coordination of benefits, or an affiliation or
waiting period, permitted under section 2701 of
the Public Health Service Act, section 701 of
the Employee Retirement Income Security Act
of 1974, or section 9801 of this Code, and
other than applicable cost-sharing).
‘‘(2) DEFINITIONS.—In this section:
‘‘(A) EMERGENCY
MEDICAL
CONDITION
BASED ON PRUDENT LAYPERSON STANDARD.—
The term ‘emergency medical condition’ means
a medical condition manifesting itself by acute
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, who
possesses an average knowledge of health and
medicine, could reasonably expect the absence
of immediate medical attention to result in a
condition described in clause (i), (ii), or (iii) of
section 1867(e)(1)(A) of the Social Security
Act.
‘‘(B) EMERGENCY
SERVICES.—The term
‘emergency services’ means—
‘‘(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment to evaluate an emergency medical
condition (as defined in subparagraph
(A)), and
‘‘(ii) within the capabilities of the
staff and facilities available at the hospital,
such further medical examination and
treatment as are required under section
1867 of such Act to stabilize the patient.