I
106TH CONGRESS
1ST SESSION
H. R. 2045
To amend title I of the Employee Retirement Income Security Act of 1974
to provide to participants and beneficiaries of group health plans access
to emergency medical care.
IN THE HOUSE OF REPRESENTATIVES
JUNE 8, 1999
Mr. TOOMEY introduced the following bill; which was referred to the
Committee on Education and the Workforce
A BILL
To amend title I of the Employee Retirement Income Secu-
rity Act of 1974 to provide to participants and bene-
ficiaries of group health plans access to emergency med-
ical care.
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 ‘‘Patient Right to Emer-
gency Medical Care Act of 1999’’.
SEC. 2. PATIENT ACCESS TO EMERGENCY MEDICAL CARE.
(a) IN GENERAL.—Subpart B of part 7 of subtitle
B of title I of the Employee Retirement Income Security
Act of 1974 is amended by adding at the end the following
new section:
‘‘SEC. 714. PATIENT ACCESS TO EMERGENCY MEDICAL
CARE.
‘‘(a) IN GENERAL.—To the extent that a group
health plan (or a health insurance issuer offering health
insurance coverage in connection with the plan) provides
for any benefits consisting of emergency medical care, ex-
cept for items or services specifically excluded—
‘‘(1) the plan or issuer shall provide benefits,
without requiring preauthorization and without re-
gard to otherwise applicable network limitations, for
appropriate emergency medical screening examina-
tions (within the capability of the emergency facility,
including ancillary services routinely available to the
emergency facility) to the extent that a prudent
layperson, who possesses an average knowledge of
health and medicine, would determine such examina-
tions to be necessary in order to determine whether
emergency medical care is required; and
‘‘(2) the plan or issuer shall provide benefits for
additional emergency medical services following an
emergency medical screening examination (if deter-
mined necessary under paragraph (1)) to the extent
that a prudent emergency medical professional
would determine such additional emergency services
to be necessary to avoid the consequences described
in subsection (c).
‘‘(b) UNIFORM COST-SHARING REQUIRED.—Nothing
in this section shall be construed as preventing a group
health plan or issuer from imposing any form of cost-shar-
ing applicable to any participant or beneficiary (including
coinsurance, copayments, deductibles, and any other
charges) in relation to benefits described in subsection (a),
if such form of cost-sharing is uniformly applied under
such plan, with respect to similarly situated participants
and beneficiaries, to all benefits consisting of emergency
medical care provided to such similarly situated partici-
pants and beneficiaries under the plan.
‘‘(c) EMERGENCY MEDICAL CARE.—For purposes of
this section, the term ‘emergency medical care’ means
medical care in any case in which an appropriate physician
has certified in writing (or as otherwise provided in regula-
tions of the Secretary)—
‘‘(1) that failure to immediately provide the
care to the participant or beneficiary could reason-
ably be expected to result in—
‘‘(A) placing the health of such participant
or beneficiary (or, with respect to such a partic-
ipant or beneficiary who is a pregnant woman,
the health of the woman or her unborn child)
in serious jeopardy;
‘‘(B) serious impairment to bodily func-
tions; or
‘‘(C) serious dysfunction of any bodily
organ or part; or
‘‘(2) that immediate provision of the care is
necessary because the participant or beneficiary has
made or is at serious risk of making an attempt to
harm himself or herself or another individual.’’.
(b) CONFORMING AMENDMENT.—The table of con-
tents in section 1 of such Act is amended by adding at
the end of the items relating to subpart B of part 7 of
subtitle B of title I of such Act the following new item:
‘‘Sec. 714. Patient access to emergency medical care.’’.
SEC. 3. EFFECTIVE DATE AND RELATED RULES.
(a) IN GENERAL.—The amendments made by this
Act shall apply with respect to plan years beginning on
or after January 1 of the second calendar year following
the date of the enactment of this Act, except that the Sec-
retary of Labor may issue regulations before such date
under such amendments. The Secretary shall first issue
regulations necessary to carry out the amendments made
by this Act before the effective date thereof.
(b) LIMITATION ON ENFORCEMENT ACTIONS.—No
enforcement action shall be taken, pursuant to the amend-
to any requirement added by this Act shall not be treated
as a termination of such collective bargaining agreement.
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