128
SEC. 503. TREATMENT OF HOSPITALS FOR CERTAIN SERV-
ICES UNDER MEDICARE SECONDARY PAYOR 
(MSP) PROVISIONS. 
(a) IN GENERAL.—The Secretary shall not require 
a hospital (including a critical access hospital) to ask ques-
tions (or obtain information) relating to the application 
of section 1862(b) of the Social Security Act (relating to 
medicare secondary payor provisions) in the case of ref-
erence laboratory services described in subsection (b), if 
the Secretary does not impose such requirement in the 
case of such services furnished by an independent labora-
tory. 
(b) 
REFERENCE
LABORATORY
SERVICES
DE-
SCRIBED.—Reference laboratory services described in this 
subsection are clinical laboratory diagnostic tests (or the 
interpretation of such tests, or both) furnished without a 
face-to-face encounter between the individual entitled to 
benefits under part A or enrolled under part B, or both, 
and the hospital involved and in which the hospital sub-
mits a claim only for such test or interpretation. 
SEC. 504. EMTALA IMPROVEMENTS. 
(a) PAYMENT FOR EMTALA-MANDATED SCREEN-
ING AND STABILIZATION SERVICES.—
(1) IN
GENERAL.—Section 1862 (42 U.S.C. 
1395y) is amended by inserting after subsection (c) 
the following new subsection:
129
‘‘(d) For purposes of subsection (a)(1)(A), in the case 
of any item or service that is required to be provided pur-
suant to section 1867 to an individual who is entitled to 
benefits under this title, determinations as to whether the 
item or service is reasonable and necessary shall be made 
on the basis of the information available to the treating 
physician or practitioner (including the patient’s pre-
senting symptoms or complaint) at the time the item or 
service was ordered or furnished by the physician or prac-
titioner (and not on the patient’s principal diagnosis). 
When making such determinations with respect to such 
an item or service, the Secretary shall not consider the 
frequency with which the item or service was provided to 
the patient before or after the time of the admission or 
visit.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply to items and services 
furnished on or after January 1, 2004. 
(b) NOTIFICATION OF PROVIDERS WHEN EMTALA 
INVESTIGATION CLOSED.—Section 1867(d) (42 U.S.C. 42 
U.S.C. 1395dd(d)) is amended by adding at the end the 
following new paragraph: 
‘‘(4) NOTICE
UPON
CLOSING
AN
INVESTIGA-
TION.—The Secretary shall establish a procedure to
130
notify hospitals and physicians when an investigation 
under this section is closed.’’. 
(c) PRIOR REVIEW BY PEER REVIEW ORGANIZA-
TIONS IN EMTALA CASES INVOLVING TERMINATION OF 
PARTICIPATION.—
(1) IN
GENERAL.—Section 1867(d)(3) (42 
U.S.C. 1395dd(d)(3)) is amended—
(A) in the first sentence, by inserting ‘‘or 
in terminating a hospital’s participation under 
this title’’ after ‘‘in imposing sanctions under 
paragraph (1)’’; and 
(B) by adding at the end the following new 
sentences: ‘‘Except in the case in which a delay 
would jeopardize the health or safety of individ-
uals, the Secretary shall also request such a re-
view before making a compliance determination 
as part of the process of terminating a hos-
pital’s participation under this title for viola-
tions related to the appropriateness of a med-
ical screening examination, stabilizing treat-
ment, or an appropriate transfer as required by 
this section, and shall provide a period of 5 
days for such review. The Secretary shall pro-
vide a copy of the organization’s report to the 
hospital or physician consistent with confiden-
131
tiality requirements imposed on the organiza-
tion under such part B.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to terminations of par-
ticipation initiated on or after the date of the enact-
ment of this Act. 
SEC. 505. EMERGENCY MEDICAL TREATMENT AND ACTIVE 
LABOR ACT (EMTALA) TECHNICAL ADVISORY 
GROUP. 
(a) ESTABLISHMENT.—The Secretary shall establish 
a Technical Advisory Group (in this section referred to 
as the ‘‘Advisory Group’’) to review issues related to the 
Emergency 
Medical 
Treatment 
and 
Labor 
Act 
(EMTALA) and its implementation. In this section, the 
term ‘‘EMTALA’’ refers to the provisions of section 1867 
of the Social Security Act (42 U.S.C. 1395dd). 
(b) MEMBERSHIP.—The Advisory Group shall be 
composed of 19 members, including the Administrator of 
the Centers for Medicare & Medicaid Services and the In-
spector General of the Department of Health and Human 
Services and of which—
(1) 4 shall be representatives of hospitals, in-
cluding at least one public hospital, that have experi-
ence with the application of EMTALA and at least
132
2 of which have not been cited for EMTALA viola-
tions; 
(2) 7 shall be practicing physicians drawn from 
the fields of emergency medicine, cardiology or 
cardiothoracic surgery, orthopedic surgery, neuro-
surgery, pediatrics or a pediatric subspecialty, ob-
stetrics-gynecology, and psychiatry, with not more 
than one physician from any particular field; 
(3) 2 shall represent patients; 
(4) 2 shall be staff involved in EMTALA inves-
tigations from different regional offices of the Cen-
ters for Medicare & Medicaid Services; and 
(5) 1 shall be from a State survey office in-
volved in EMTALA investigations and 1 shall be 
from a peer review organization, both of whom shall 
be from areas other than the regions represented 
under paragraph (4). 
In selecting members described in paragraphs (1) through 
(3), the Secretary shall consider qualified individuals nom-
inated by organizations representing providers and pa-
tients. 
(c) GENERAL
RESPONSIBILITIES.—The Advisory 
Group—
(1) shall review EMTALA regulations;
133
(2) may provide advice and recommendations to 
the Secretary with respect to those regulations and 
their application to hospitals and physicians; 
(3) shall solicit comments and recommendations 
from hospitals, physicians, and the public regarding 
the implementation of such regulations; and 
(4) may disseminate information on the applica-
tion of such regulations to hospitals, physicians, and 
the public. 
(d) ADMINISTRATIVE MATTERS.—
(1) CHAIRPERSON.—The members of the Advi-
sory Group shall elect a member to serve as chair-
person of the Advisory Group for the life of the Ad-
visory Group. 
(2) MEETINGS.—The Advisory Group shall first 
meet at the direction of the Secretary. The Advisory 
Group shall then meet twice per year and at such 
other times as the Advisory Group may provide.
(e) TERMINATION.—The Advisory Group shall termi-
nate 30 months after the date of its first meeting. 
(f) WAIVER OF ADMINISTRATIVE LIMITATION.—The 
Secretary shall establish the Advisory Group notwith-
standing any limitation that may apply to the number of 
advisory committees that may be established (within the 
Department of Health and Human Services or otherwise).
134
SEC. 506. AUTHORIZING USE OF ARRANGEMENTS WITH 
OTHER HOSPICE PROGRAMS TO PROVIDE 
CORE HOSPICE SERVICES IN CERTAIN CIR-
CUMSTANCES. 
(a) IN GENERAL.—Section 1861(dd)(5) (42 U.S.C. 
1395x(dd)(5)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) In extraordinary, exigent, or other non-routine 
circumstances, such as unanticipated periods of high pa-
tient loads, staffing shortages due to illness or other 
events, or temporary travel of a patient outside a hospice 
program’s service area, a hospice program may enter into 
arrangements with another hospice program for the provi-
sion by that other program of services described in para-
graph 
(2)(A)(ii)(I). 
The 
provisions 
of 
paragraph 
(2)(A)(ii)(II) shall apply with respect to the services pro-
vided under such arrangements.’’. 
(b) CONFORMING
PAYMENT
PROVISION.—Section 
1814(i) (42 U.S.C. 1395f(i)) is amended by adding at the 
end the following new paragraph: 
‘‘(4) In the case of hospice care provided by a hospice 
program 
under 
arrangements 
under 
section 
1861(dd)(5)(D) made by another hospice program, the 
hospice program that made the arrangements shall bill 
and be paid for the hospice care.’’.
135
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to hospice care provided on or after 
the date of the enactment of this Act. 
SEC. 507. APPLICATION OF OSHA BLOODBORNE PATHO-
GENS STANDARD TO CERTAIN HOSPITALS. 
(a) IN GENERAL.—Section 1866 (42 U.S.C. 1395cc) 
is amended—
(1) in subsection (a)(1)—
(A) in subparagraph (R), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (S), by striking the 
period at the end and inserting ‘‘, and’’; and 
(C) by inserting after subparagraph (S) 
the following new subparagraph: 
‘‘(T) in the case of hospitals that are not other-
wise subject to the Occupational Safety and Health 
Act of 1970, to comply with the Bloodborne Patho-
gens standard under section 1910.1030 of title 29 of 
the Code of Federal Regulations (or as subsequently 
redesignated).’’; and 
(2) by adding at the end of subsection (b) the 
following new paragraph: 
‘‘(4)(A) A hospital that fails to comply with the re-
quirement of subsection (a)(1)(T) (relating to the 
Bloodborne Pathogens standard) is subject to a civil
136
money penalty in an amount described in subparagraph 
(B), but is not subject to termination of an agreement 
under this section. 
‘‘(B) The amount referred to in subparagraph (A) is 
an amount that is similar to the amount of civil penalties 
that may be imposed under section 17 of the Occupational 
Safety and Health Act of 1970 for a violation of the 
Bloodborne Pathogens standard referred to in subsection 
(a)(1)(T) by a hospital that is subject to the provisions 
of such Act. 
‘‘(C) A civil money penalty under this paragraph shall 
be imposed and collected in the same manner as civil 
money penalties under subsection (a) of section 1128A are 
imposed and collected under that section.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this subsection (a) shall apply to hospitals as of July 1, 
2004. 
SEC. 508. BIPA-RELATED TECHNICAL AMENDMENTS AND 
CORRECTIONS. 
(a) TECHNICAL AMENDMENTS RELATING TO ADVI-
SORY COMMITTEE UNDER BIPA SECTION 522.—(1) Sub-
section (i) of section 1114 (42 U.S.C. 1314)—
(A) is transferred to section 1862 and added at 
the end of such section; and 
(B) is redesignated as subsection (j).
137
(2) Section 1862 (42 U.S.C. 1395y) is amended—
(A) in the last sentence of subsection (a), by 
striking ‘‘established under section 1114(f)’’; and 
(B) in subsection (j), as so transferred and re-
designated—
(i) by striking ‘‘under subsection (f)’’; and 
(ii) by striking ‘‘section 1862(a)(1)’’ and 
inserting ‘‘subsection (a)(1)’’. 
(b) 
TERMINOLOGY
CORRECTIONS.—(1) 
Section 
1869(c)(3)(I)(ii) (42 U.S.C. 1395ff(c)(3)(I)(ii)), as 
amended by section 521 of BIPA, is amended—
(A) in subclause (III), by striking ‘‘policy’’ and 
inserting ‘‘determination’’; and 
(B) in subclause (IV), by striking ‘‘medical re-
view policies’’ and inserting ‘‘coverage determina-
tions’’. 
(2) Section 1852(a)(2)(C) (42 U.S.C. 1395w–
22(a)(2)(C)) is amended by striking ‘‘policy’’ and ‘‘POL-
ICY’’ and inserting ‘‘determination’’ each place it appears 
and ‘‘DETERMINATION’’, respectively. 
(c) REFERENCE CORRECTIONS.—Section 1869(f)(4) 
(42 U.S.C. 1395ff(f)(4)), as added by section 522 of 
BIPA, is amended—
138
(1) in subparagraph (A)(iv), by striking ‘‘sub-
clause (I), (II), or (III)’’ and inserting ‘‘clause (i), 
(ii), or (iii)’’; 
(2) in subparagraph (B), by striking ‘‘clause 
(i)(IV)’’ and ‘‘clause (i)(III)’’ and inserting ‘‘sub-
paragraph (A)(iv)’’ and ‘‘subparagraph (A)(iii)’’, re-
spectively; and 
(3) in subparagraph (C), by striking ‘‘clause 
(i)’’, ‘‘subclause (IV)’’ and ‘‘subparagraph (A)’’ and 
inserting ‘‘subparagraph (A)’’, ‘‘clause (iv)’’ and 
‘‘paragraph (1)(A)’’, respectively each place it ap-
pears. 
(d) OTHER CORRECTIONS.—Effective as if included 
in the enactment of section 521(c) of BIPA, section 
1154(e) (42 U.S.C. 1320c–3(e)) is amended by striking 
paragraph (5).
(e) EFFECTIVE DATE.—Except as otherwise pro-
vided, the amendments made by this section shall be effec-
tive as if included in the enactment of BIPA. 
SEC. 509. CONFORMING AUTHORITY TO WAIVE A PROGRAM 
EXCLUSION. 
The first sentence of section 1128(c)(3)(B) (42 
U.S.C. 1320a–7(c)(3)(B)) is amended to read as follows: 
‘‘Subject to subparagraph (G), in the case of an exclusion 
under subsection (a), the minimum period of exclusion
139
shall be not less than five years, except that, upon the 
request of the administrator of a Federal health care pro-
gram (as defined in section 1128B(f)) who determines 
that the exclusion would impose a hardship on individuals 
entitled to benefits under part A of title XVIII or enrolled 
under part B of such title, or both, the Secretary may 
waive the exclusion under subsection (a)(1), (a)(3), or 
(a)(4) with respect to that program in the case of an indi-
vidual or entity that is the sole community physician or 
sole source of essential specialized services in a commu-
nity.’’. 
SEC. 510. TREATMENT OF CERTAIN DENTAL CLAIMS. 
(a) IN GENERAL.—Section 1862 (42 U.S.C. 1395y) 
is amended by adding after subsection (g) the following 
new subsection: 
‘‘(h)(1) Subject to paragraph (2), a group health plan 
(as defined in subsection (a)(1)(A)(v)) providing supple-
mental or secondary coverage to individuals also entitled 
to services under this title shall not require a medicare 
claims determination under this title for dental benefits 
specifically excluded under subsection (a)(12) as a condi-
tion of making a claims determination for such benefits 
under the group health plan. 
‘‘(2) A group health plan may require a claims deter-
mination under this title in cases involving or appearing
140
to involve inpatient dental hospital services or dental serv-
ices expressly covered under this title pursuant to actions 
taken by the Secretary.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date that is 60 days 
after the date of the enactment of this Act. 
SEC. 511. MISCELLANEOUS REPORTS, STUDIES, AND PUBLI-
CATION REQUIREMENTS. 
(a) GAO REPORTS ON THE PHYSICIAN COMPENSA-
TION.—
(1) SUSTAINABLE GROWTH RATE
AND UP-
DATES.—Not later than 6 months after the date of 
the enactment of this Act, the Comptroller General 
of the United States shall submit to Congress a re-
port on the appropriateness of the updates in the 
conversion factor under subsection (d)(3) of section 
1848 of the Social Security Act (42 U.S.C. 1395w–
4), including the appropriateness of the sustainable 
growth rate formula under subsection (f) of such 
section for 2002 and succeeding years. Such report 
shall examine the stability and predictability of such 
updates and rate and alternatives for the use of such 
rate in the updates. 
(2) PHYSICIAN COMPENSATION GENERALLY.—
Not later than 12 months after the date of the en-
141
actment of this Act, the Comptroller General shall 
submit to Congress a report on all aspects of physi-
cian compensation for services furnished under title 
XVIII of the Social Security Act, and how those as-
pects interact and the effect on appropriate com-
pensation for physician services. Such report shall 
review alternatives for the physician fee schedule 
under section 1848 of such title (42 U.S.C. 1395w–
4). 
(b) PROMPT SUBMISSION OF OVERDUE REPORTS ON 
PAYMENT AND UTILIZATION OF OUTPATIENT THERAPY 
SERVICES.—Not later than January 1, 2004, the Sec-
retary shall submit to Congress the reports required under 
section 4541(d)(2) of the Balanced Budget Act of 1997 
(relating to alternatives to a single annual dollar cap on 
outpatient therapy) and under section 221(d) of the Medi-
care, Medicaid, and SCHIP Balanced Budget Refinement 
Act of 1999 (relating to utilization patterns for outpatient 
therapy). 
(c) ANNUAL PUBLICATION OF LIST OF NATIONAL 
COVERAGE DETERMINATIONS.—The Secretary shall pro-
vide, in an appropriate annual publication available to the 
public, a list of national coverage determinations made 
under title XVIII of the Social Security Act in the pre-
142
vious year and information on how to get more informa-
tion with respect to such determinations.
Æ