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overhead costs or charges for legal services are not 
deductible disbursements or costs for such purpose. 
(17) STATE.—The term ‘‘State’’ means each of 
the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Virgin Islands, 
Guam, American Samoa, the Northern Mariana Is-
lands, the Trust Territory of the Pacific Islands, and 
any other territory or possession of the United 
States, or any political subdivision thereof. 
SEC. 109. EFFECT ON OTHER LAWS. 
(a) VACCINE INJURY.— 
(1) To the extent that title XXI of the Public 
Health Service Act establishes a Federal rule of law 
applicable to a civil action brought for a vaccine-re-
lated injury or death— 
(A) this title does not affect the application 
of the rule of law to such an action; and 
(B) any rule of law prescribed by this title 
in conflict with a rule of law of such title XXI 
shall not apply to such action. 
(2) If there is an aspect of a civil action 
brought for a vaccine-related injury or death to 
which a Federal rule of law under title XXI of the 
Public Health Service Act does not apply, then this 
title or otherwise applicable law (as determined
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under this title) will apply to such aspect of such ac-
tion. 
(b) OTHER FEDERAL LAW.—Except as provided in 
this section, nothing in this title shall be deemed to affect 
any defense available to a defendant in a health care law-
suit or action under any other provision of Federal law. 
SEC. 
110. 
STATE 
FLEXIBILITY 
AND 
PROTECTION 
OF 
STATES’ RIGHTS. 
(a) HEALTH CARE LAWSUITS.—The provisions gov-
erning health care lawsuits set forth in this title preempt, 
subject to subsections (b) and (c), State law to the extent 
that State law prevents the application of any provisions 
of law established by or under this title. The provisions 
governing health care lawsuits set forth in this title super-
sede chapter 171 of title 28, United States Code, to the 
extent that such chapter— 
(1) provides for a greater amount of damages 
or contingent fees, a longer period in which a health 
care lawsuit may be commenced, or a reduced appli-
cability or scope of periodic payment of future dam-
ages, than provided in this title; or 
(2) prohibits the introduction of evidence re-
garding collateral source benefits, or mandates or 
permits subrogation or a lien on collateral source 
benefits.
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(b) PROTECTION OF STATES’ RIGHTS AND OTHER 
LAWS.—(1) Any issue that is not governed by any provi-
sion of law established by or under this title (including 
State standards of negligence) shall be governed by other-
wise applicable State or Federal law. 
(2) This title shall not preempt or supersede any 
State or Federal law that imposes greater procedural or 
substantive protections for health care providers and 
health care organizations from liability, loss, or damages 
than those provided by this title or create a cause of ac-
tion. 
(c) STATE FLEXIBILITY.—No provision of this title 
shall be construed to preempt— 
(1) any State law (whether effective before, on, 
or after the date of the enactment of this title) that 
specifies a particular monetary amount of compen-
satory or punitive damages (or the total amount of 
damages) that may be awarded in a health care law-
suit, regardless of whether such monetary amount is 
greater or lesser than is provided for under this title, 
notwithstanding section 4(a); or 
(2) any defense available to a party in a health 
care lawsuit under any other provision of State or 
Federal law.
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SEC. 111. APPLICABILITY; EFFECTIVE DATE. 
This title shall apply to any health care lawsuit 
brought in a Federal or State court, or subject to an alter-
native dispute resolution system, that is initiated on or 
after the date of the enactment of this title, except that 
any health care lawsuit arising from an injury occurring 
prior to the date of the enactment of this title shall be 
governed by the applicable statute of limitations provisions 
in effect at the time the injury occurred. 
TITLE 
II—REPEAL 
OF 
INDE-
PENDENT 
PAYMENT 
ADVI-
SORY BOARD 
SEC. 201. SHORT TITLE. 
This title may be cited as the ‘‘Medicare Decisions 
Accountability Act of 2012’’. 
SEC. 202. REPEAL OF THE INDEPENDENT PAYMENT ADVI-
SORY BOARD. 
Effective as of the enactment of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148), sec-
tions 3403 and 10320 of such Act (including the amend-
ments made by such sections, but excluding subsection (d) 
of section 1899A of the Social Security Act, as added and 
amended by such sections) are repealed, and any provision 
of law amended by such sections is hereby restored as if 
such sections had not been enacted into law.
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TITLE III—HEALTH CARE 
SAFETY NET ENHANCEMENT 
SEC. 301. SHORT TITLE. 
This title may be cited as the ‘‘Health Care Safety 
Net Enhancement Act of 2012’’. 
SEC. 302. 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 de-
scribed 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
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in subparagraph (B), or of an officer, gov-
erning board member, employee, con-
tractor, or on-call provider of such an enti-
ty, to be an employee of the Public Health 
Service for purposes of this section shall 
apply only with respect to items and serv-
ices that are furnished to an individual 
pursuant to section 1867 of the Social Se-
curity 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 physi-
cian or physician group described in sub-
paragraph (B)(ii) from making the appli-
cation referred to in such paragraph or as 
conditioning the deeming of a physician or 
physician group that makes such an appli-
cation 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 phy-
sician or physician group as an on-call pro-
vider;
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‘‘(III) notwithstanding paragraph (3), 
this paragraph shall apply only with re-
spect to causes of action arising from acts 
or omissions that occur on or after Janu-
ary 1, 2012; 
‘‘(IV) paragraph (5) shall not apply to 
a physician or physician group described in 
subparagraph (B)(ii); 
‘‘(V) the Attorney General, in con-
sultation with the Secretary, shall make 
separate estimates under subsection (k)(1) 
with respect to entities described in sub-
paragraph (B) and entities described in 
paragraph (4) (other than those described 
in subparagraph (B)), and the Secretary 
shall establish separate funds under sub-
section (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
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with respect to entities described in sub-
paragraph (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 depart-
ment to which section 1867 of the Social Secu-
rity 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 in-
dividuals 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 de-
partment 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
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services pursuant to section 1867 of the Social 
Security Act or post-stabilization services to in-
dividuals being treated in the hospital or emer-
gency 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 de-
scribed in subparagraph (B) for purposes of com-
plying 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 sta-
bilized in order to maintain the stabilized condi-
tion 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 ap-
plies to entities described in subparagraph (B) by 
operation of subparagraph (A)) shall be construed as 
authorizing or requiring the Secretary to make pay-
ments to such entities, the budget authority for 
which is not provided in advance by appropriation 
Acts.
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‘‘(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 ap-
propriation 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.’’. 
SEC. 303. CONSTITUTIONAL AUTHORITY. 
The constitutional authority upon which this title 
rests is the power of the Congress to provide for the gen-
eral welfare, to regulate commerce, and to make all laws 
which shall be necessary and proper for carrying into exe-
cution Federal powers, as enumerated in section 8 of arti-
cle I of the Constitution of the United States. 
TITLE IV—RESTORING THE AP-
PLICATION 
OF 
ANTITRUST 
LAWS TO HEALTH SECTOR IN-
SURERS 
SEC. 401. SHORT TITLE. 
This title may be cited as the ‘‘Health Insurance In-
dustry Fair Competition Act of 2012’’.
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SEC. 402. APPLICATION OF THE ANTITRUST LAWS TO THE 
BUSINESS OF HEALTH INSURANCE. 
(a) AMENDMENT TO MCCARRAN-FERGUSON ACT.— 
Section 3 of the Act of March 9, 1945 (15 U.S.C. 1013), 
commonly known as the McCarran-Ferguson Act, is 
amended by adding at the end the following: 
‘‘(c) Nothing contained in this Act shall modify, im-
pair, or supersede the operation of any of the antitrust 
laws with respect to the business of health insurance. For 
purposes of the preceding sentence, the term ‘antitrust 
laws’ has the meaning given it in subsection (a) of the 
first section of the Clayton Act, except that such term in-
cludes section 5 of the Federal Trade Commission Act to 
the extent that such section 5 applies to unfair methods 
of competition. For the purposes of this subsection, the 
term ‘business of health insurance’ shall— 
‘‘(1) mean ‘health insurance coverage’ offered 
by a ‘health insurance issuer’ as those terms are de-
fined in section 9001 of the Patient Protection and 
Affordable Care Act, which incorporates by reference 
and utilizes the definitions included in section 9832 
of the Internal Revenue Code (26 U.S.C. 9832); and 
‘‘(2) not include— 
‘‘(A) life insurance and annuities; 
‘‘(B) property or casualty insurance, in-
cluding but not limited to, automobile, medical