I 
110TH CONGRESS 
2D SESSION 
H. R. 6569 
To amend the Public Health Service Act to ensure that victims of public 
health emergencies have meaningful and immediate access to medically 
necessary healthcare services. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 22, 2008 
Mrs. CAPPS (for herself, Ms. MATSUI, and Mr. BUTTERFIELD) 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 healthcare 
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; TABLE OF CONTENTS. 
This section may be cited as the ‘‘Public Health 
Emergency Response Act of 2008’’. 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress finds the following: 
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(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 sixteen 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 
healthcare assistance programs for individuals with 
chronic conditions, exacerbating the costs and risks 
to their health. 
(6) The uninsured could place great financial 
strain on healthcare 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 45 mil-
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lion additional outpatient visits, with 865,000 to 
9,900,000 individuals requiring hospitalization, de-
pending upon the severity of the pandemic. 
(8) Hospitals in the United States could lose as 
much as $3.9 billion 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 healthcare 
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 healthcare 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 
(4) to minimize delays in the provision of emer-
gency healthcare coverage by clarifying eligibility re-
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quirements and the scope of such coverage and iden-
tifying the funding mechanisms for emergency 
healthcare services. 
SEC. 3. EMERGENCY HEALTHCARE COVERAGE. 
(a) IN GENERAL.—Title III of the Public Health 
Service Act is amended by inserting after section 319K 
the following new section: 
‘‘SEC. 319K–1. EMERGENCY HEALTHCARE COVERAGE. 
‘‘(a) ACTIVATION
AND TERMINATION
OF EMER-
GENCY HEALTHCARE COVERAGE.— 
‘‘(1) BASED
ON
PUBLIC
HEALTH
EMER-
GENCY.— 
‘‘(A) IN
GENERAL.—The Secretary may 
activate the coverage of emergency healthcare 
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. 
‘‘(2) CONSIDERATIONS.—In making a deter-
mination under paragraph (1), the Secretary shall 
consider a range of factors including the following: 
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‘‘(A) The degree to which the emergency is 
likely to overwhelm healthcare 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 healthcare providers in the ab-
sence of activation of this section. 
‘‘(F) The need for healthcare services is of 
sufficient severity and magnitude to warrant 
major assistance under this section above and 
beyond the emergency services otherwise avail-
able from the Federal Government. 
‘‘(G) Such other factors as the Secretary 
may deem appropriate. 
‘‘(3) TERMINATION AND EXTENSION.— 
‘‘(A) IN
GENERAL.—Coverage of emer-
gency healthcare services under this section 
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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 healthcare 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, regarding requesting Congress to pro-
vide a further extension of the public health 
emergency period beyond the second 90-day pe-
riod. 
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‘‘(B) REPORT CONTENTS.—A report under 
subparagraph (A) shall include a discussion of 
the healthcare needs of emergency victims and 
affected individuals including the likely need for 
follow-up care over a two-year period. 
‘‘(5) COORDINATION.—The Secretary shall en-
sure that the activation, implementation, and termi-
nation of emergency healthcare 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 healthcare 
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 healthcare needs 
of the affected population related to the public 
health emergency. Such reports shall include rec-
ommendations on how to ensure that emergency vic-
tims and affected individuals have access to needed 
healthcare services. 
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‘‘(b) ELIGIBILITY FOR COVERAGE OF EMERGENCY 
HEALTHCARE SERVICES.— 
‘‘(1) LIMITED ELIGIBILITY.— 
‘‘(A) IN
GENERAL.—Eligibility for cov-
erage of emergency healthcare 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 healthcare in-
surance coverage is not at least actuarially- 
equivalent to benchmark coverage. In es-
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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 healthcare 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 resides in an 
assistance area designated for the 
emergency (or whose residence was 
displaced by the emergency) or, in the 
case of such an emergency consti-
tuting a pandemic flu or other infec-
tious disease outbreak, who resides in 
the area affected by the outbreak (or 
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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 healthcare 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, healthcare insurance information, or 
other documentation; and 
‘‘(B) the primary method for determining 
eligibility for such services shall be an attesta-
tion provided to the healthcare 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 
unattended minors and adults without the ca-
pacity to sign such an attestation form. 
‘‘(3) SERVICE DELIVERY.—Providers may com-
mence provision of emergency healthcare services for 
an individual in the absence of any centralized en-
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rollment process, if the provider has collected basic 
information, specified by the Secretary, including the 
individual’s name, address, social security number, 
and existing health insurance coverage (if any), that 
establishes a prima facie basis for eligibility, except 
that such information shall not be required in cases 
where the individual is unable to provide the infor-
mation due to disability or incapacitation. 
‘‘(c) EMERGENCY HEALTHCARE SERVICES.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, the term ‘emergency healthcare 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 
drug plans under part D of the Medicare pro-
gram with the largest enrollment; 
‘‘(C) may include drugs, devices, biologics, 
and other healthcare products, if such products 
are authorized for use by the Food and Drug 
Administration pursuant to an alternate au-
thority, including the emergency use authority 
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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 three 
months prior to the declaration of the public 
health emergency. 
‘‘(2) NOT MEDICARE, MEDICAID, OR SCHIP BEN-
EFITS.—The emergency healthcare services provided 
under this section are not benefits under Medicare, 
Medicaid or SCHIP. Nothing in this section shall be 
interpreted as altering or otherwise conflicting with 
titles XVIII, XIX, or XXI of the Social Security 
Act. 
‘‘(3) COMPLETION OF TREATMENT FOR EMER-
GENCY
VICTIMS.—Notwithstanding termination of 
the coverage of emergency healthcare services pursu-
ant to subsection (a)(4), the Secretary may identify 
a subgroup of emergency victims on a case-by-case 
basis or otherwise to continue receiving coverage of 
emergency healthcare services for up to an addi-
tional 60 days. Such emergency healthcare services 
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provided after the termination date shall be limited 
to services and items that are medically necessary to 
treat an injury or disease resulting directly from the 
public health emergency involved. 
‘‘(d) COVERED PROVIDERS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
healthcare services are not covered under this sec-
tion unless they are furnished by a healthcare 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 healthcare program (as defined in 
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 healthcare pro-
viders (such as nurses and other healthcare pro-
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viders 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 
healthcare 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-
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 
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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. 
‘‘(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 
healthcare services shall be equal to 100 percent of 
the payment rate for the corresponding service 
under part A or B of the Medicare program, or, in 
the case of prescription drugs and other items and 
services not covered under either such part, such 
amount as the Secretary may specify by rule. Such 
a provider shall not be permitted to impose any cost- 
sharing or to balance bill for services furnished 
under this section. 
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‘‘(2) USE OF MEDICARE CONTRACTORS.—The 
Secretary shall enter into arrangements with Medi-
care administrative contractors under which they 
process claims for emergency healthcare services 
under this section using the claim forms, codes, and 
nomenclature in effect under the Medicare program. 
‘‘(3) APPLICATION
OF
SECONDARY
PAYER 
RULES.—In the case of payment under this section 
for emergency healthcare services for otherwise 
qualified individuals who have some health insurance 
coverage with respect to such services, the adminis-
trative contractors under paragraph (2) shall submit 
a claim to the entity offering such coverage to re-
coup all or some of such payment, reflecting what-
ever amount the entity would normally reimburse for 
each covered service. The provisions of section 
1862(b) of the Social Security Act (42 U.S.C. 
1395y(b)) shall apply to benefits provided under this 
section in the same manner as they apply to benefits 
provided under the Medicare program. 
‘‘(4) PAYMENTS FOR EMERGENCY HEALTHCARE 
SERVICES AND RELATED COSTS.—Payments to pro-
vide, and costs to administer, emergency healthcare 
services under this section shall be made from the 
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