I
107TH CONGRESS
1ST SESSION
H. R. 1674
To assure access under group health plans and health insurance coverage
to covered emergency medical services.
IN THE HOUSE OF REPRESENTATIVES
MAY 2, 2001
Mr. CARDIN (for himself, Mrs. ROUKEMA, Mr. ABERCROMBIE, Mr. LANGEVIN,
Mr. STARK, Mr. HOEFFEL, Mr. BLUMENAUER, Mrs. THURMAN, Mr.
FARR of California, Mr. MCDERMOTT, Mr. SERRANO, Mr. LEVIN, Mr.
WYNN, Mrs. MINK of Hawaii, Mr. DEFAZIO, Mrs. EMERSON, Mrs.
NAPOLITANO, Ms. SLAUGHTER, Mr. THOMPSON of Mississippi, Mr.
MCHUGH, Ms. BALDWIN, Ms. HOOLEY of Oregon, Mr. DELAHUNT, Mr.
COYNE, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. BENTSEN, Mr.
LEWIS of Georgia, Mr. GEORGE MILLER of California, Ms. RIVERS, Mr.
SPENCE, Mr. BAKER, and Mr. RUSH) introduced the following bill; which
was referred to the Committee on Energy and Commerce, and in addition
to the Committees on Education and the Workforce, and Ways and
Means, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To assure access under group health plans and health
insurance coverage to covered emergency medical services.
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 ‘‘Access to Emergency
Medical Services Act of 2001’’.
SEC. 2. EMERGENCY SERVICES.
(a) COVERAGE OF EMERGENCY SERVICES.—
(1) IN GENERAL.—If a group health plan, or
health insurance coverage offered by a health insur-
ance issuer, provides any benefits with respect to
emergency services (as defined in paragraph (2)(B)),
the plan or issuer shall cover emergency services fur-
nished under the plan or coverage—
(A) without the need for any prior author-
ization 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 pro-
vider, 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 provider; and
(D) without regard to any other term or
condition of such plan or coverage (other than
exclusion or coordination of benefits, or an af-
filiation or waiting period, permitted under sec-
tion 2701 of the Public Health Service Act, sec-
tion 701 of the Employee Retirement Income
Security Act of 1974, or section 9801 of the In-
ternal Revenue 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
(42 U.S.C. 1395dd(e)(1)(A)).
(B) EMERGENCY
SERVICES.—The term
‘‘emergency services’’ means—
(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act, 42 U.S.C. 1395dd)) that
is within the capability of the emergency
department of a hospital, including ancil-
lary services routinely available to the
emergency department to evaluate an
emergency medical condition (as defined in
subparagraph (A)); and
(ii) within the capabilities of the staff
and facilities at the hospital, such further
medical examination and treatment as are
required under section 1867 of such Act to
stabilize the patient.
(C) STABILIZE.—The term ‘‘to stabilize’’,
with respect to an emergency medical condition
(as defined in subparagraph (A)), has the
meaning given in section 1867(e)(3) of the So-
cial Security Act (42 U.S.C. 1395dd(e)(3)).
(b) REIMBURSEMENT FOR MAINTENANCE CARE AND
POST-STABILIZATION CARE.—A group health plan, and
health insurance coverage offered by a health insurance
issuer, must provide reimbursement for maintenance care
and post-stabilization care in accordance with the require-
ments of section 1852(d)(2) of the Social Security Act (42
U.S.C. 1395w–22(d)(2)). Such reimbursement shall be
provided in a manner consistent with subsection (a)(1)(C).
(c) COVERAGE OF EMERGENCY AMBULANCE SERV-
ICES.—
(1) IN GENERAL.—If a group health plan, or
health insurance coverage provided by a health in-
surance 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 coverage under the same terms and condi-
tions under subparagraphs (A) through (D) of sub-
section (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.
(d) 
INFORMATION
FOR
PARTICIPANTS, 
BENE-
FICIARIES, AND ENROLLEES.—
(1) GROUP HEALTH PLANS.—A group health
plan shall—
(A) provide to participants and bene-
ficiaries at the time of initial coverage under
the plan (or the effective date of this Act, in the
case of individuals who are participants and
beneficiaries as of such date), at least annually
thereafter, and at the beginning of any open en-
rollment provided under the plan, the informa-
tion described in paragraph (3) in printed form;
(B) upon request, make available to par-
ticipants and beneficiaries, to the applicable au-
thority, and to prospective participants and
beneficiaries the information described in para-
graph (3) in printed form; and
(C) provide notice to participants and
beneficiaries of information relating to any ma-
terial reduction to the benefits or information
described in paragraph (3) not later than 30
days before the date on which the reduction
takes effect.
(2) HEALTH
INSURANCE
ISSUERS.—A health
insurance issuer, in connection with the provision of
health insurance coverage, shall—
(A) provide to individuals enrolled under
such coverage at the time of enrollment, and at
least annually thereafter, (and to plan adminis-
trators of group health plans in connection with
which such coverage is offered) the information
described in paragraph (3) in printed form;
(B) upon request, make available to the
applicable authority, to individuals who are pro-
spective enrollees, to plan administrators of
group health plans that may obtain such cov-
erage, and to the public the information de-
scribed in paragraph (3) in printed form; and
(C) provide notice to enrollees of informa-
tion relating to any material reduction to the
benefits or information described in paragraph
(3) not later than 30 days before the date on
which the reduction takes effect.
(3) REQUIRED
INFORMATION.—The informa-
tion described in this paragraph with respect to a
group health plan or health insurance coverage of-
fered by a health insurance issuer is information
about 
the 
coverage 
of 
emergency 
services,
including—
(A) the appropriate use of emergency serv-
ices, including use of the 911 telephone system
or its local equivalent in emergency situations
and an explanation of what constitutes an
emergency situation;
(B) the process and procedures of the plan
or issuer for obtaining emergency services;
(C) any cost-sharing applicable to emer-
gency services; and
(D) the locations of—
(i) emergency departments; and
(ii) other settings in which plan physi-
cians and hospitals provide emergency
services and post-stabilization care.
(e) DEFINITIONS.—For purposes of this section—
(1) The term ‘‘applicable authority’’ means—
(A) in the case of a group health plan, the
Secretary of Health and Human Services and
the Secretary of Labor; and
(B) in the case of a health insurance issuer
with respect to a specific provision of this sec-
tion, the applicable State authority or the Sec-
retary of Health and Human Services if such
Secretary is enforcing such provisions under
section 2722(a)(2) or 2761(a)(2) of the Public
Health Service Act (42 U.S.C. 300gg–22(a)(2),
300gg–61(a)(2)).
(2) The terms ‘‘applicable State authority’’,
‘‘beneficiary’’, ‘‘group health plan’’, ‘‘health insur-
ance coverage’’, ‘‘health insurance issuer’’, and ‘‘par-
ticipant’’ shall have the meanings given to such
terms in section 2791 of the Public Health Service
Act (42 U.S.C. 300gg–91).
(3) The term ‘‘nonparticipating’’ means, with
respect to a health care provider that provides health
care items and services to a participant, beneficiary,
or enrollee under a group health plan or health in-
surance coverage, a health care provider that is not
a participating health care provider with respect to
such items and services.
(4) The term ‘‘participating’’ means, with re-
spect to a health care provider that provides health
care items and services to a participant, beneficiary,
or enrollee under a group health plan or health in-
surance coverage offered by a health insurance
issuer, a health care provider that furnishes such
items and services under a contract or other ar-
rangement with the plan or issuer.
‘‘(b) SATISFACTION OF REQUIREMENTS.—For pur-
poses of subsection (a), insofar as a group health plan pro-
vides benefits in the form of health insurance coverage
through a health insurance issuer, the plan shall be treat-
ed as meeting the requirements of the Access to Emer-
gency Medical Services Act of 2001 with respect to such
benefits and not be considered as failing to meet such re-
quirements because of a failure of the issuer to meet such
requirements so long as the plan sponsor or its representa-
tives did not cause such failure by the issuer.’’.
(b) CONFORMING AMENDMENT.—Section 732(a) of
such Act (29 U.S.C. 1191a(a)) is amended by striking
‘‘section 711’’ and inserting ‘‘sections 711 and 714’’.
(c) CLERICAL AMENDMENT.—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. Emergency services.’’.
SEC. 5. STANDARDS UNDER THE INTERNAL REVENUE CODE
OF 1986.
Subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended—
(1) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
‘‘Sec. 9813. Standard relating to emergency services.’’; and
(2) by inserting after section 9812 the fol-
lowing:
‘‘SEC. 9813. STANDARD RELATING TO EMERGENCY SERV-
ICES.
‘‘A group health plan shall comply with the require-
ments of section 2 of the Access to Emergency Medical
Services Act of 2001, and such requirements shall be
deemed to be incorporated into this section.’’.
SEC. 6. EFFECTIVE DATE.
(a) GROUP HEALTH COVERAGE.—
(1) IN GENERAL.—Subject to paragraph (2),
the amendments made by sections 3(a), 4, and 5
(and section 2 insofar as it relates to such sections)
apply to group health plans for plan years beginning
on or after January 1, 2002.
(2) TREATMENT OF COLLECTIVE BARGAINING
AGREEMENTS.—In the case of a group health plan
maintained pursuant to 1 or more collective bar-
gaining agreements between employee representa-
tives and 1 or more employers ratified before the
date of the enactment of this Act, the amendments
made by sections 3(a), 4, and 5 (and section 2 inso-
far as it relates to such sections) shall not apply to
plan years beginning before the later of—
(A) the date on which the last collective
bargaining agreement relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of the
enactment of this Act); or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan that amends the plan
solely to conform to any requirement of this Act
shall not be treated as a termination of such collec-
tive bargaining agreement.
(b) INDIVIDUAL MARKET.—The amendment made by
section 3(b) (and section 2 insofar as it relates to such
section) applies with respect to health insurance coverage
offered, sold, issued, renewed, in effect, or operated in the
individual market on or after January 1, 2002.
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