I 
111TH CONGRESS 
1ST SESSION H. R. 2231 
To amend the Public Health Service Act to ensure that victims of public 
health emergencies have meaningful and immediate access to medically 
necessary health care services. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 4, 2009 
Mrs. CAPPS (for herself, Ms. DEGETTE, and Mr. GRIJALVA) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to ensure that 
victims of public health emergencies have meaningful 
and immediate access to medically necessary health care 
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 ‘‘Public Health Emer-
gency Response Act of 2009’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress finds the following: 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
(1) Since 2000, the Secretary of Health and 
Human Services has declared that a public health 
emergency existed nationwide in response to the at-
tacks of September 11th and in response to Hurri-
canes Katrina and Rita. 
(2) In the event of a public health emergency, 
compliance with recommendations to seek immediate 
care may be critical to containing the spread of an 
infectious disease outbreak or responding to a bio-
terror attack. 
(3) Nearly 16 percent of Americans lack health 
insurance coverage. 
(4) Fears of out-of-pocket expenses may cause 
individuals to delay seeking medical attention during 
a public health emergency. 
(5) A public health emergency may disrupt 
health care assistance programs for individuals with 
chronic conditions, exacerbating the costs and risks 
to their health. 
(6) The uninsured could place great financial 
strain on health care providers during a public 
health emergency. 
(7) The Department of Health and Human 
Services Pandemic Influenza Plan projects that a 
pandemic 
influenza 
outbreak 
could 
result 
in 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
45,000,000 
additional 
outpatient 
visits, 
with 
865,000 to 9,900,000 individuals requiring hos-
pitalization, depending upon the severity of the pan-
demic. 
(8) Hospitals in the United States could lose as 
much as $3,900,000,000 in uncompensated care and 
cash flow losses in the event of a severe pandemic. 
(9) Under current statute, no dedicated mecha-
nism exists to reimburse providers for uncompen-
sated care during a public health emergency. 
(b) PURPOSES.—The purposes of this Act are— 
(1) to provide temporary emergency health care 
coverage for uninsured and certain otherwise quali-
fied individuals in the event of a public health emer-
gency declared by the Secretary of Health and 
Human Services; 
(2) to ensure that health care providers remain 
fiscally solvent and are not overburdened by the cost 
of uncompensated care during a public health emer-
gency; 
(3) to eliminate a primary disincentive for unin-
sured and certain otherwise qualified individuals to 
promptly seek medical care during a public health 
emergency; and 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
(4) to minimize delays in the provision of emer-
gency health care coverage by clarifying eligibility 
requirements and the scope of such coverage and 
identifying the funding mechanisms for emergency 
health care services. 
SEC. 3. EMERGENCY HEALTH CARE COVERAGE. 
(a) IN GENERAL.—Title III of the Public Health 
Service Act (42 U.S.C. 241 et seq.) is amended by insert-
ing after section 319K the following new section: 
‘‘SEC. 319K–1. EMERGENCY HEALTH CARE COVERAGE. 
‘‘(a) ACTIVATION
AND TERMINATION
OF EMER-
GENCY HEALTH CARE COVERAGE.— 
‘‘(1) BASED
ON
PUBLIC
HEALTH
EMER-
GENCY.— 
‘‘(A) IN
GENERAL.—The Secretary may 
activate the coverage of emergency health care 
services under this section only if the Secretary 
determines that there is a public health emer-
gency. 
‘‘(B) DETERMINATION OF PUBLIC HEALTH 
EMERGENCY.—For purposes of this section, 
there is a ‘public health emergency’ only if a 
public health emergency exists under section 
319. 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
‘‘(2) CONSIDERATIONS.—In making a deter-
mination under paragraph (1), the Secretary shall 
consider a range of factors including the following: 
‘‘(A) The degree to which the emergency is 
likely to overwhelm health care providers in the 
region. 
‘‘(B) The opportunity to minimize mor-
bidity and mortality through intervention under 
this section. 
‘‘(C) The estimated number of direct cas-
ualties of the emergency. 
‘‘(D) The potential number of casualties in 
the absence of intervention under this section 
(such as in the case of infectious disease). 
‘‘(E) The potential adverse financial im-
pacts on local health care providers in the ab-
sence of activation of this section. 
‘‘(F) Whether the need for health care 
services is of sufficient severity and magnitude 
to warrant major assistance under this section 
above and beyond the emergency services other-
wise available from the Federal Government. 
‘‘(G) Such other factors as the Secretary 
may deem appropriate. 
‘‘(3) TERMINATION AND EXTENSION.— 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
‘‘(A) IN
GENERAL.—Coverage of emer-
gency health care services under this section 
shall terminate, subject to subsection (c)(2), 
upon the earlier of the following: 
‘‘(i) The Secretary’s determination 
that a public health emergency no longer 
exists. 
‘‘(ii) Subject to subparagraph (B), 90 
days after the initiation of coverage of 
emergency health care services. 
‘‘(B) EXTENSION AUTHORITY.—The Sec-
retary may extend a public health emergency 
for a second 90-day period, but only if a report 
to Congress is made under paragraph (4) in 
conjunction with making such extension. 
‘‘(4) REPORT.— 
‘‘(A) IN GENERAL.—Prior to making an 
extension under paragraph (3)(B), the Sec-
retary shall transmit a report to Congress that 
includes information on the nature of the public 
health emergency and the expected duration of 
the emergency. The Secretary shall include in 
such report recommendations, if deemed appro-
priate, that Congress provide a further exten-
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
sion of the public health emergency period be-
yond the second 90-day period. 
‘‘(B) REPORT CONTENTS.—A report under 
subparagraph (A) shall include a discussion of 
the health care needs of emergency victims and 
affected individuals including the likely need for 
follow-up care over a 2-year period. 
‘‘(5) COORDINATION.—The Secretary shall en-
sure that the activation, implementation, and termi-
nation of emergency health care services under this 
section in response to a public health emergency is 
coordinated with all functions, personnel, and assets 
of the Federal, State, local, and tribal responses to 
the emergency. 
‘‘(6) MEDICAL
MONITORING
PROGRAM.—The 
Secretary shall establish a medical monitoring pro-
gram for monitoring and reporting on health care 
needs of the affected population over time. At least 
annually during the 5-year period following the date 
of a public health emergency, the Secretary shall re-
port to Congress on any continuing health care 
needs of the affected population related to the public 
health emergency. Such reports shall include rec-
ommendations on how to ensure that emergency vic-
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
tims and affected individuals have access to needed 
health care services. 
‘‘(b) ELIGIBILITY FOR COVERAGE OF EMERGENCY 
HEALTH CARE SERVICES.— 
‘‘(1) LIMITED ELIGIBILITY.— 
‘‘(A) IN
GENERAL.—Eligibility for cov-
erage of emergency health care services under 
this section for a public health emergency is 
limited to individuals who— 
‘‘(i) are emergency victims who are 
uninsured or otherwise qualified; or 
‘‘(ii) are affected individuals who are 
uninsured. 
‘‘(B) DEFINITIONS.—For purposes of this 
section with respect to a public health emer-
gency: 
‘‘(i) INSURED.—An individual is ‘in-
sured’ if the individual has group or indi-
vidual health insurance coverage or pub-
licly financed health insurance (as defined 
by the Secretary). 
‘‘(ii) OTHERWISE QUALIFIED.—An in-
dividual is ‘‘otherwise qualified’’ if the in-
dividual is insured but the Secretary deter-
mines that the individual’s health care in-
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
surance coverage is not at least actuarially- 
equivalent to benchmark coverage. In es-
tablishing such benchmark coverage, the 
Secretary shall consider the standard Blue 
Cross/Blue Shield preferred provider op-
tion service benefit plan described in and 
offered under section 8903(1) of title 5, 
United States Code. 
‘‘(iii) UNINSURED.—An individual is 
‘uninsured’ if the individual is not insured. 
‘‘(iv) EMERGENCY VICTIM.—An indi-
vidual is an ‘emergency victim’ with re-
spect to a public health emergency if the 
individual needs health care services due to 
injuries or disease resulting from the pub-
lic health emergency. 
‘‘(v) AFFECTED INDIVIDUAL.—An in-
dividual is an ‘affected individual’ with re-
spect to a public health emergency if— 
‘‘(I) the individual— 
‘‘(aa) resides in an assist-
ance area designated for the 
emergency (or whose residence 
was displaced by the emergency); 
or 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
‘‘(bb) in the case of such an 
emergency constituting a pan-
demic flu or other infectious dis-
ease outbreak, resides in the area 
affected by the outbreak (or 
whose residence was displaced by 
the emergency); and 
‘‘(II) the individual’s ability to 
access care or medicine is disrupted 
as a result of the emergency. 
‘‘(2) PROCESS.—The Secretary shall establish a 
streamlined process for determining eligibility for 
emergency health care services under this section. In 
establishing such process— 
‘‘(A) the Secretary shall recognize that in 
the context of a public health emergency, indi-
viduals may be unable to provide identification 
cards, health care insurance information, or 
other documentation; and 
‘‘(B) the primary method for determining 
eligibility for such services shall be an attesta-
tion provided to the health care provider by the 
recipient of the services that the recipient meets 
the eligibility criteria established under para-
graph (1)(A), with a standard alternative for 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
unattended minors and adults without the ca-
pacity to sign such an attestation form. 
‘‘(3) SERVICE DELIVERY.—Providers may com-
mence provision of emergency health care services 
for an individual in the absence of any centralized 
enrollment process, if the provider has collected 
basic information, specified by the Secretary, includ-
ing the individual’s name, address, social security 
number, and existing health insurance coverage (if 
any), that establishes a prima facie basis for eligi-
bility, except that such information shall not be re-
quired in cases where the individual is unable to pro-
vide the information due to disability or incapacita-
tion. 
‘‘(c) EMERGENCY HEALTH CARE SERVICES.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘emergency health care services’— 
‘‘(A) means items and services for which 
payment may be made under parts A and B of 
the Medicare program; 
‘‘(B) includes prescription drugs (not cov-
ered under such part B) specified by the Sec-
retary under subsection (g), based on the 
formularies of the two or more prescription 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
drug plans under part D of the Medicare pro-
gram with the largest enrollment; 
‘‘(C) may include drugs, devices, biological 
products, and other health care products, if 
such products are authorized for use by the 
Food and Drug Administration pursuant to an 
alternate authority, including the emergency 
use authority under section 564 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 
360bbb–3); and 
‘‘(D) for an affected individual, is limited 
to those items and services described under sub-
paragraphs (A), (B), or (C) that a third-party 
payor, such as a government program or chari-
table organization, reimbursed or otherwise pro-
vided to an affected individual during the 90 
days prior to the declaration of the public 
health emergency. 
‘‘(2) NOT MEDICARE, MEDICAID, OR SCHIP BEN-
EFITS.—The emergency health care services pro-
vided under this section are not benefits under Medi-
care, Medicaid or SCHIP. Nothing in this section 
shall be interpreted as altering or otherwise con-
flicting with titles XVIII, XIX, or XXI of the Social 
Security Act. 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
‘‘(3) COMPLETION OF TREATMENT FOR EMER-
GENCY
VICTIMS.—Notwithstanding termination of 
the coverage of emergency health care services pur-
suant to subsection (a)(3), the Secretary may iden-
tify a subgroup of emergency victims on a case-by- 
case basis or otherwise to continue receiving cov-
erage of emergency health care services for up to an 
additional 60 days. Such emergency health care 
services provided after the termination date shall be 
limited to services and items that are medically nec-
essary to treat an injury or disease resulting directly 
from the public health emergency involved. 
‘‘(d) COVERED PROVIDERS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
health care services are not covered under this sec-
tion unless they are furnished by a health care pro-
vider that— 
‘‘(A) has a valid provider number under 
the Medicare program, the Medicaid program, 
or SCHIP; 
‘‘(B) is in good standing with such pro-
gram; and 
‘‘(C) is not excluded from participation in 
a Federal health care program (as defined in 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
section 1128B(f) of the Social Security Act (42 
U.S.C. 1320a–7b(f))). 
‘‘(2) WAIVER AUTHORITY.— 
‘‘(A) IN GENERAL.—The Secretary may by 
regulation waive certain requirements for pro-
vider enrollment that otherwise apply under the 
Medicare or Medicaid program or under SCHIP 
to ensure an adequate supply of health care 
providers (such as nurses and other health care 
providers who do not typically participate in the 
Medicare or Medicaid program or SCHIP) and 
services in the case of a public health emer-
gency. Such requirements may include the re-
quirement that a licensed physician or other 
health care professional holds a license in the 
State in which the professional provides services 
or is otherwise authorized under State law to 
provide the services involved. 
‘‘(B) REPORT
ON
EMERGENCY
SYSTEM 
FOR ADVANCE REGISTRATION OF VOLUNTEER 
HEALTH
PROFESSIONALS
(ESAR–VHP).—Not 
later than 180 days after the date of the enact-
ment of this section, the Secretary shall submit 
to Congress a report on the number of volun-
teers, by profession and credential level, en-
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS
rolled in the Emergency System for Advance 
Registration of Volunteer Health Professionals 
(ESAR–VHP) that will be available to each 
State in the event of a public health emergency. 
The Secretary shall determine if the number of 
such volunteers is adequate for interstate de-
ployment in response to regional requests for 
volunteers and, if not, shall include in the re-
port recommendations for actions to ensure an 
adequate surge capacity for public health emer-
gencies in defined geographic areas. 
‘‘(3) MEDICARE AND MEDICAID PROGRAMS AND 
SCHIP DEFINED.—For purposes of this section: 
‘‘(A) The term ‘Medicare program’ means 
the program under parts A, B, and D of title 
XVIII of the Social Security Act. 
‘‘(B) The term ‘Medicaid program’ means 
the program of medical assistance under title 
XIX of such Act. 
‘‘(C) The term ‘SCHIP’ means the State 
children’s health insurance program under title 
XXI of such Act. 
‘‘(e) PAYMENTS AND CLAIMS ADMINISTRATION.— 
‘‘(1) PAYMENT AMOUNT.—The amount of pay-
ment under this section to a provider for emergency 
VerDate Nov 24 2008 
03:38 May 05, 2009
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H2231.IH
H2231
rfrederick on PROD1PC67 with BILLS