I
105TH CONGRESS
1ST SESSION
H. R. 815
To amend the Internal Revenue Code of 1986, the Public Health Service
Act, the Employee Retirement Income Security Act of 1974, and titles
XVIII and XIX of the Social Security Act to assure access to emergency
medical services under group health plans, health insurance coverage,
and the Medicare and Medicaid Programs.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 25, 1997
Mr. CARDIN (for himself, Mrs. ROUKEMA, Mr. DINGELL, Mr. SHAYS, Mr.
STARK, Mr. DAVIS of Virginia, Mr. WAXMAN, Mr. CONDIT, Mr. BROWN
of Ohio, Mr. KENNEDY of Rhode Island, Mr. POMEROY, Mrs. THURMAN,
Mr. GEJDENSON, Mrs. MEEK of Florida, Mr. CLEMENT, Mr. DOYLE, Mr.
NORWOOD, Mr. LEVIN, Mr. EVANS, Mr. MCDERMOTT, Mr. FROST, Mr.
CAMPBELL, Mr. CONYERS, Mr. RAHALL, Mr. MCGOVERN, and Mr.
GANSKE) introduced the following bill; which was referred to the Commit-
tee on Ways and Means, and in addition to the Committees on Com-
merce, and Education and the Workforce, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Internal Revenue Code of 1986, the Public
Health Service Act, the Employee Retirement Income
Security Act of 1974, and titles XVIII and XIX of
the Social Security Act to assure access to emergency
medical services under group health plans, health insur-
ance coverage, and the Medicare and Medicaid Programs.
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.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Access to Emergency Medical Services Act of 1997’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Amendments to the Internal Revenue Code of 1986.
Sec. 3. Amendments to the Employee Retirement Income Security Act of 1974.
Sec. 4. Amendments to the Public Health Service Act relating to the group
market.
Sec. 5. Amendments to the Public Health Service Act relating to the individual
market.
Sec. 6. Application to private coverage for medicare and medicaid beneficiaries.
Sec. 7. Establishment of guidelines.
SEC. 2. AMENDMENTS TO THE INTERNAL REVENUE CODE
OF 1986.
(a) IN GENERAL.—Subtitle K of the Internal Reve-
nue Code of 1986 (as added by section 401(a) of the
Health Insurance Portability and Accountability Act of
1996) is amended—
(1) by striking all that precedes section 9801
and inserting the following:
‘‘Subtitle K—Group Health Plan
Requirements
‘‘CHAPTER 100. Group health plan requirements.
‘‘CHAPTER 100—GROUP HEALTH PLAN
REQUIREMENTS
‘‘Subchapter A. Requirements relating to portability, access, and
renewability.
‘‘Subchapter B. Other requirements.
‘‘Subchapter C. General provisions.
‘‘Subchapter A—Requirements Relating to
Portability, Access, and Renewability
‘‘Sec. 9801. Increased portability through limitation on preexist-
ing condition exclusions.
‘‘Sec. 9802. Prohibiting discrimination against individual partici-
pants and beneficiaries based on health status.
‘‘Sec. 9803. Guaranteed renewability in multiemployer plans and
certain multiple employer welfare arrangements.’’,
(2) by redesignating sections 9804, 9805, and
9806 as sections 9831, 9832, and 9833, respectively,
(3) by inserting before section 9831 (as so re-
designated) the following:
‘‘Subchapter C—General Provisions
‘‘Sec. 9831. General exceptions.
‘‘Sec. 9832. Definitions.
‘‘Sec. 9833. Regulations.’’, and
(4) by inserting after section 9803 the follow-
ing:
‘‘Subchapter B—Other Requirements
‘‘Sec. 9811. Assuring equitable coverage of emergency services,
maintenance care, and post-stabilization care.
‘‘SEC. 9811. ASSURING EQUITABLE COVERAGE OF EMER-
GENCY SERVICES, MAINTENANCE CARE, AND
POST-STABILIZATION CARE.
‘‘(a) PROHIBITION OF CERTAIN RESTRICTIONS ON
COVERAGE OF EMERGENCY SERVICES.—
‘‘(1) IN GENERAL.—If a group health plan pro-
vides any benefits with respect to emergency services
(as defined in paragraph (2)(B)), the plan (and any
health insurance issuer offering health insurance
coverage in connection with such a plan) shall cover
emergency services furnished to a participant or ben-
eficiary of the plan—
‘‘(A) without the need for any prior au-
thorization determination,
‘‘(B) subject to paragraph (3), whether or
not the physician or provider furnishing such
services is a participating physician or provider
with respect to such services, and
‘‘(C) subject to paragraph (3), without re-
gard to any other term or condition of such
plan or coverage (other than an exclusion of
benefits, or an affiliation or waiting period, per-
mitted under section 9801).
‘‘(2) EMERGENCY SERVICES; EMERGENCY MEDI-
CAL CONDITION.—For purposes of this section—
‘‘(A) EMERGENCY
MEDICAL
CONDITION
BASED
ON
PRUDENT
LAYPERSON.—The term
‘emergency medical condition’ means a medical
condition manifesting itself by acute symptoms
of sufficient severity (including severe pain)
such that a prudent layperson, who possesses
an average knowledge of health and medicine,
could reasonably expect the absence of imme-
diate medical attention to result in—
‘‘(i) placing the health of the individ-
ual (or, with respect to a pregnant woman,
the health of the woman or her unborn
child) in serious jeopardy,
‘‘(ii) serious impairment to bodily
functions, or
‘‘(iii) serious dysfunction of any bodily
organ or part.
‘‘(B) EMERGENCY
SERVICES.—The term
‘emergency services’ means—
‘‘(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment, to evaluate an emergency medical
condition (as defined in subparagraph
(A)), and
‘‘(ii) within the capabilities of the
staff and facilities available at the hospital,
such further medical examination and
treatment as are required under section
1867 of the Social Security Act to stabilize
the patient.
‘‘(C) TRAUMA AND BURN CENTERS.—The
provisions of clause (ii) of subparagraph (B)
apply to a trauma or burn center, in a hospital,
that—
‘‘(i) is designated by the State, a re-
gional authority of the State, or by the
designee of the State, or
‘‘(ii) is in a State that has not made
such designations and meets medically rec-
ognized national standards.
‘‘(3) APPLICATION OF NETWORK RESTRICTION
PERMITTED IN CERTAIN CASES.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), if a group health plan (and
an issuer of health insurance coverage in con-
nection with such a plan) denies, limits, or oth-
erwise differentiates in coverage or payment for
benefits other than emergency services on the
basis that the physician or provider of such
services is a nonparticipating physician or pro-
vider, the plan and issuer may deny, limit, or
differentiate in coverage or payment for emer-
gency services on such basis.
‘‘(B) NETWORK RESTRICTIONS NOT PER-
MITTED
IN
CERTAIN
EXCEPTIONAL
CASES.—
The denial or limitation of, or differentiation in,
coverage or payment of benefits for emergency
services under subparagraph (A) shall not apply
in the following cases:
‘‘(i) CIRCUMSTANCES
BEYOND
CON-
TROL OF PARTICIPANT OR BENEFICIARY.—
The participant or beneficiary is unable to
go to a participating hospital for such serv-
ices due to circumstances beyond the con-
trol of the participant or beneficiary (as
determined consistent with guidelines and
subparagraph (C)).
‘‘(ii) LIKELIHOOD
OF
AN
ADVERSE
HEALTH
CONSEQUENCE
BASED
ON
LAYPERSON’S
JUDGMENT.—A 
prudent
layperson possessing an average knowledge
of health and medicine could reasonably
believe that, under the circumstances and
consistent with guidelines, the time re-
quired to go to a participating hospital for
such services could result in any of the ad-
verse health consequences described in a
clause of subsection (a)(2)(A).
‘‘(iii) PHYSICIAN REFERRAL.—A par-
ticipating physician or other person au-
thorized by the plan refers the participant
or beneficiary to an emergency department
of a hospital and does not specify an emer-
gency department of a hospital that is a
participating hospital with respect to such
services.
‘‘(C) APPLICATION OF ‘BEYOND CONTROL’
STANDARDS.—For purposes of applying sub-
paragraph (B)(i), receipt of emergency services
from a nonparticipating hospital shall be treat-
ed under the guidelines as being ‘due to cir-
cumstances beyond the control of the partici-
pant or beneficiary’ if any of the following con-
ditions are met:
‘‘(i) UNCONSCIOUS.—The participant
or beneficiary was unconscious or in an
otherwise altered mental state at the time
of initiation of the services.
‘‘(ii) AMBULANCE
DELIVERY.—The
participant or beneficiary was transported
by an ambulance or other emergency vehi-
cle directed by a person other than the
participant or beneficiary to the non-
participating hospital in which the services
were provided.
‘‘(iii) NATURAL DISASTER.—A natural
disaster or civil disturbance prevented the
participant or beneficiary from presenting
to a participating hospital for the provision
of such services.
‘‘(iv) NO GOOD FAITH EFFORT TO IN-
FORM OF CHANGE IN PARTICIPATION DUR-
ING A CONTRACT YEAR.—The status of the
hospital changed from a participating hos-
pital to a nonparticipating hospital with re-
spect to emergency services during a con-
tract year and the plan or issuer failed to
make a good faith effort to notify the par-
ticipant or beneficiary involved of such
change.
‘‘(v) 
OTHER
CONDITIONS.—There
were other factors (such as those identified
in guidelines) that prevented the partici-
pant or beneficiary from controlling selec-
tion of the hospital in which the services
were provided.
‘‘(b) ASSURING COORDINATED COVERAGE OF MAIN-
TENANCE CARE AND POST-STABILIZATION CARE.—
‘‘(1) IN GENERAL.—In the case of a participant
or beneficiary who is covered under a group health
plan (or under health insurance coverage issued by
a health insurance issuer offered in connection with
such a plan) and who has received emergency serv-
ices pursuant to a screening evaluation conducted
(or supervised) by a treating physician at a hospital
that is a nonparticipating provider with respect to
emergency services, if—
‘‘(A) pursuant to such evaluation, the phy-
sician identifies post-stabilization care (as de-
fined in paragraph (3)(B)) that is required by
the participant or beneficiary,
‘‘(B) the plan or coverage provides benefits
with respect to the care so identified and the
plan requires (but for this subsection) an af-
firmative prior authorization determination as a
condition of coverage of such care, and
‘‘(C) the treating physician (or another in-
dividual acting on behalf of such physician) ini-
tiates, not later than 30 minutes after the time
the treating physician determines that the con-
dition of the participant or beneficiary is sta-
bilized, a good faith effort to contact a physi-
cian or other person authorized by the plan or
issuer (by telephone or other means) to obtain
an affirmative prior authorization determination
with respect to the care,
then, without regard to terms and conditions speci-
fied in paragraph (2) the plan or issuer shall cover
maintenance care (as defined in paragraph (3)(A))
furnished to the participant or beneficiary during
the period specified in paragraph (4) and shall cover
post-stabilization care furnished to the participant or
beneficiary during the period beginning under para-
graph (5) and ending under paragraph (6).
‘‘(2) TERMS
AND
CONDITIONS
WAIVED.—The
terms and conditions (of a plan or coverage) de-
scribed in this paragraph that are waived under
paragraph (1) are as follows:
‘‘(A) The need for any prior authorization
determination.
‘‘(B) Any limitation on coverage based on
whether or not the physician or provider fur-
nishing the care is a participating physician or
provider with respect to such care.
‘‘(C) Any other term or condition of the
plan or coverage (other than an exclusion of
benefits, or an affiliation or waiting period, per-
mitted under section 9801 and other than a re-
quirement relating to medical necessity for cov-
erage of benefits).
‘‘(3) MAINTENANCE
CARE
AND
POST-STA-
BILIZATION CARE DEFINED.—In this subsection:
‘‘(A) MAINTENANCE
CARE.—The term
‘maintenance care’ means, with respect to an
individual who is stabilized after provision of
emergency services, medically necessary items
and services (other than emergency services)
that are required by the individual to ensure
that the individual remains stabilized during
the period described in paragraph (4).
‘‘(B) 
POST-STABILIZATION
CARE.—The
term ‘post-stabilization care’ means, with re-
spect to an individual who is determined to be
stable pursuant to a medical screening examina-
tion or who is stabilized after provision of emer-
gency services, medically necessary items and
services (other than emergency services and
other than maintenance care) that are required
by the individual.
‘‘(4) PERIOD
OF
REQUIRED
COVERAGE
OF
MAINTENANCE CARE.—The period of required cov-
erage of maintenance care of an individual under
this subsection begins at the time of the request (or
the initiation of the good faith effort to make the
request) under paragraph (1)(C) and ends when—
‘‘(A) the individual is discharged from the
hospital;
‘‘(B) a physician (designated by the plan
or issuer involved) and with privileges at the
hospital involved arrives at the emergency de-
partment of the hospital and assumes respon-
sibility with respect to the treatment of the in-
dividual; or
‘‘(C) the treating physician and the plan or
issuer agree to another arrangement with re-
spect to the care of the individual.
‘‘(5) WHEN
POST-STABILIZATION
CARE
RE-
QUIRED TO BE COVERED.—
‘‘(A) WHEN TREATING PHYSICIAN UNABLE
TO
COMMUNICATE
REQUEST.—If the treating
physician or other individual makes the good
faith effort to request authorization under para-
graph (1)(C) but is unable to communicate the
request directly with an authorized person re-
ferred to in such paragraph within 30 minutes
after the time of initiating such effort, then
post-stabilization care is required to be covered
under this subsection beginning at the end of
such 30-minute period.
‘‘(B) WHEN ABLE TO COMMUNICATE RE-
QUEST, AND NO TIMELY RESPONSE.—
‘‘(i) IN
GENERAL.—If the treating
physician or other individual under para-
graph (1)(C) is able to communicate the
request within the 30-minute period de-
scribed in subparagraph (A), the post-sta-
bilization care requested is required to be
covered under this subsection beginning 30
minutes after the time when the plan or is-
suer receives the request unless a person
authorized by the plan or issuer involved
communicates (or makes a good faith ef-
fort to communicate) a denial of the re-
quest for the prior authorization deter-
mination within 30 minutes of the time
when the plan or issuer receives the re-
quest and the treating physician does not
request under clause (ii) to communicate
directly with an authorized physician con-
cerning the denial.
‘‘(ii) REQUEST
FOR
DIRECT
PHYSI-
CIAN-TO-PHYSICIAN COMMUNICATION CON-
CERNING DENIAL.—If a denial of a request
is communicated under clause (i), the
treating physician may request to commu-
nicate respecting the denial directly with a
physician who is authorized by the plan or
issuer to deny or affirm such a denial.
‘‘(C) WHEN NO TIMELY RESPONSE TO RE-
QUEST
FOR
PHYSICIAN-TO-PHYSICIAN
COMMU-
NICATION.—If a request for physician-to-physi-
cian communication is made under subpara-
graph (B)(ii), the post-stabilization care re-
quested is required to be covered under this
subsection beginning 30 minutes after the time
when the plan or issuer receives the request
from a treating physician unless a physician,
who is authorized by the plan or issuer to re-
verse or affirm the initial denial of the care,
communicates (or makes a good faith effort to
communicate) directly with the treating physi-
cian within such 30-minute period.
‘‘(D) DISAGREEMENTS
OVER
POST-STA-
BILIZATION CARE.—If, after a direct physician-
to-physician communication under subpara-
graph (C), the denial of the request for the
post-stabilization care is not reversed and the
treating physician communicates to the plan or
issuer involved a disagreement with such deci-
sion, the post-stabilization care requested is re-
quired to be covered under this subsection be-
ginning as follows:
‘‘(i) DELAY TO ALLOW FOR PROMPT
ARRIVAL
OF
PHYSICIAN
ASSUMING
RE-
SPONSIBILITY.—If the plan or issuer com-
municates that a physician (designated by
the plan or issuer) with privileges at the
hospital involved will arrive promptly (as
determined under guidelines) at the emer-
gency department of the hospital in order
to assume responsibility with respect to the
treatment of the participant or beneficiary
involved, the required coverage of the post-
stabilization care begins after the passage
of such time period as would allow the
prompt arrival of such a physician.
‘‘(ii) OTHER CASES.—If the plan or
issuer does not so communicate, the re-
quired coverage of the post-stabilization
care begins immediately.
‘‘(6) NO REQUIREMENT OF COVERAGE OF POST-
STABILIZATION
CARE
IF
ALTERNATE
PLAN
OF
TREATMENT.—
‘‘(A) IN GENERAL.—Coverage of post-sta-
bilization care is not required under this sub-
section with respect to an individual when—
‘‘(i) subject to subparagraph (B), a
physician (designated by the plan or issuer
involved) and with privileges at the hos-
pital involved arrives at the emergency de-
partment of the hospital and assumes re-
sponsibility with respect to the treatment
of the individual; or
‘‘(ii) the treating physician and the
plan or issuer agree to another arrange-
ment with respect to the post-stabilization
care (such as an appropriate transfer of
the individual involved to another facility
or an appointment for timely followup
treatment for the individual).
‘‘(B) SPECIAL RULE WHERE ONCE CARE
INITIATED.—Required coverage of requested
post-stabilization care shall not end by reason
of subparagraph (A)(i) during an episode of
care (as determined by guidelines) if the treat-
ing physician initiated such care (consistent
with a previous paragraph) before the arrival of
a physician described in such subparagraph.
‘‘(7) CONSTRUCTION.—Nothing in this sub-
section shall be construed as—
‘‘(A) preventing a plan or issuer from au-
thorizing coverage of maintenance care or post-
stabilization care in advance or at any time; or
‘‘(B) preventing a treating physician or
other individual described in paragraph (1)(C)
and a plan or issuer from agreeing to modify
any of the time periods specified in paragraph
(5) as it relates to cases involving such persons.
‘‘(c) LIMITS ON COST-SHARING FOR SERVICES FUR-
NISHED
IN EMERGENCY DEPARTMENTS.—If a group
health plan provides any benefits with respect to emer-
gency services, the plan (or a health insurance issuer offer-
ing health insurance coverage in connection with such a
plan) may impose cost sharing with respect to such serv-
ices only if the following conditions are met:
‘‘(1) LIMITATIONS
ON
COST-SHARING
DIF-
FERENTIAL FOR NONPARTICIPATING PROVIDERS.—
‘‘(A) NO
DIFFERENTIAL
FOR
CERTAIN
SERVICES.—In the case of services furnished
under the circumstances described in clause (i),
(ii), or (iii) of subsection (a)(3)(B) (relating to
circumstances beyond the control of the bene-
ficiary, the likelihood of an adverse health con-
sequence based on layperson’s judgment, and
physician referral), the cost-sharing for such
services provided by a nonparticipating provider
or physician does not exceed the cost-sharing
for such services provided by a participating
provider or physician.
‘‘(B) ONLY
REASONABLE
DIFFERENTIAL
FOR OTHER SERVICES.—In the case of other
emergency services, any differential by which
the cost-sharing for such services provided by a
nonparticipating provider or physician exceeds
the cost-sharing for such services provided by a
participating provider or physician is reasonable
(as determined under guidelines).
‘‘(2) ONLY
REASONABLE
DIFFERENTIAL
BE-
TWEEN EMERGENCY SERVICES AND OTHER SERV-
ICES.—Any differential by which the cost-sharing for
services furnished in an emergency department ex-
ceeds the cost-sharing for such services furnished in
another setting is reasonable (as determined under
guidelines).
‘‘(3) CONSTRUCTION.—Nothing in paragraph
(1)(B) or (2) shall be construed as authorizing
guidelines other than guidelines that establish maxi-
mum cost-sharing differentials.
‘‘(d) INFORMATION
ON ACCESS
TO EMERGENCY
SERVICES.—A group health plan (or a health insurance
issuer, to the extent a health insurance issuer offers group
health insurance coverage in connection with such a plan)
shall provide education to participants and beneficiaries
of the plan on—
‘‘(1) coverage of emergency services (as defined
in subsection (a)(2)(B)) by the plan in accordance
with the provisions of this section,
‘‘(2) the appropriate use of emergency services,
including use of the 911 telephone system or its
local equivalent,
‘‘(3) any cost sharing applicable to emergency
services,
‘‘(4) the process and procedures of the plan for
obtaining emergency services, and
‘‘(5) the locations of—
‘‘(A) emergency departments, and
‘‘(B) other settings,
in which participating physicians and hospitals pro-
vide emergency services and post-stabilization care.
‘‘(e) GENERAL DEFINITIONS.—For purposes of this
section:
‘‘(1) COST SHARING.—The term ‘cost sharing’
means any deductible, coinsurance amount, copay-
ment or other out-of-pocket payment (other than
premiums or enrollment fees) that a group health
plan (or a health insurance issuer offering group
health insurance issuer in connection with such a
plan) imposes on participants and beneficiaries of
the plan with respect to the coverage of benefits.
‘‘(2) GOOD FAITH EFFORT.—The term ‘good
faith effort’ has the meaning given such term in
guidelines and requires such appropriate documenta-
tion as is specified under such guidelines.
‘‘(3) 
GUIDELINES.—The 
term 
‘guidelines’
means guidelines established in accordance with sec-
tion 7 of the Access to Emergency Medical Services
Act of 1997.
‘‘(4) NONPARTICIPATING
PHYSICIAN
OR
PRO-
VIDER.—The term ‘nonparticipating physician or
provider’ means, with respect to health care items
and services furnished to a participant or beneficiary
of a group health plan, a physician or provider that
is not a participating physician or provider for such
services.
‘‘(5) 
PARTICIPATING
PHYSICIAN
OR
PRO-
VIDER.—The term ‘participating physician or pro-
vider’ means, with respect to health care items and
services furnished to a participant or beneficiary of
a group health plan, a physician or provider that
furnishes such items and services under a contract
or other arrangement with such plan (or with a
health insurance issuer offering group health insur-
ance coverage in connection with such a plan).
‘‘(6) 
PRIOR
AUTHORIZATION
DETERMINA-
TION.—The term ‘prior authorization determination’
means, with respect to items and services for which
coverage may be provided under a group health plan,
a determination (before the provision of the items
and services and as a condition of coverage of the
items and services under the plan) of whether or not
such items and services will be covered under the
plan.
‘‘(7) 
STABILIZE.—The 
term 
‘to 
stabilize’
means, with respect to an emergency medical condi-
tion, to provide (in complying with section 1867 of
the Social Security Act) such medical treatment of
the condition as may be necessary to assure, within
reasonable medical probability, that no material de-
terioration of the condition is likely to result from
or occur during the transfer of the individual from
the facility.
‘‘(8) 
STABILIZED.—The 
term 
‘stabilized’
means, with respect to an emergency medical condi-
tion, that no material deterioration of the condition
is likely, within reasonable medical probability, to re-
sult from or occur before an individual can be trans-
ferred from the facility, in compliance with the re-
quirements of section 1867 of the Social Security
Act.
‘‘(9) TREATING PHYSICIAN.—The term ‘treat-
ing physician’ includes a treating health care profes-
sional who is licensed under State law to provide
emergency services other than under the supervision
of a physician.’’
(b) CONFORMING AMENDMENTS.—
(1) Chapter 100 of such Code (as added by sec-
tion 401 of the Health Insurance Portability and Ac-
countability Act of 1996 and as previously amended
by this section) is further amended—
(A) in the last sentence of section
9801(c)(1), by striking ‘‘section 9805(c)’’ and
inserting ‘‘section 9832(c)’’;
(B) 
in 
section 
9831(b), 
by 
striking
‘‘9805(c)(1)’’ and inserting ‘‘9832(c)(1)’’;
(C) in section 9831(c)(1), by striking
‘‘9805(c)(2)’’ and inserting ‘‘9832(c)(2)’’;
(D) in section 9831(c)(2), by striking
‘‘9805(c)(3)’’ and inserting ‘‘9832(c)(3)’’; and
(E) in section 9831(c)(3), by striking
‘‘9805(c)(4)’’ and inserting ‘‘9832(c)(4)’’.
(2) Section 4980D of such Code (as added by
section 402 of the Health Insurance Portability and
Accountability Act of 1996) is amended—
(A) in subsection (c)(3)(B)(i)(I), by strik-
ing ‘‘9805(d)(3)’’ and inserting ‘‘9832(d)(3)’’;
(B) in subsection (d)(1), by inserting
‘‘(other than a failure attributable to section
9811)’’ after ‘‘on any failure’’;
(C) in subsection (d)(3), by striking
‘‘9805’’ and inserting ‘‘9832’’;
(D) in subsection (f)(1), by striking
‘‘9805(a)’’ and inserting ‘‘9832(a)’’.
(3) The table of subtitles for such Code is
amended by striking the item relating to subtitle K
(as added by section 401(b) of the Health Insurance
Portability and Accountability Act of 1996) and in-
serting the following new item:
‘‘SUBTITLE K. Group health plan requirements.’’
(c) EFFECTIVE DATE.—(1) Subject to paragraph (2),
the amendments made by this section shall apply to group
health plans for plan years beginning on or after 18
months after the date of the enactment of this Act.
(2) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made by this section shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) 18 months after the date of the enactment
of this Act.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by this section shall not be
treated as a termination of such collective bargaining
agreement.
SEC. 3. AMENDMENTS TO THE EMPLOYEE RETIREMENT IN-
COME SECURITY ACT OF 1974.
(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. 713. ASSURING EQUITABLE COVERAGE OF EMER-
GENCY SERVICES, MAINTENANCE CARE, AND
POST-STABILIZATION CARE.
‘‘(a) PROHIBITION OF CERTAIN RESTRICTIONS ON
COVERAGE OF EMERGENCY SERVICES.—
‘‘(1) IN GENERAL.—If a group health plan pro-
vides any benefits with respect to emergency services
(as defined in paragraph (2)(B)), the plan (and any
health insurance issuer offering health insurance
coverage in connection with such a plan) shall cover
emergency services furnished to a participant or ben-
eficiary of the plan—
‘‘(A) without the need for any prior au-
thorization determination,
‘‘(B) subject to paragraph (3), whether or
not the physician or provider furnishing such
services is a participating physician or provider
with respect to such services, and
‘‘(C) subject to paragraph (3), without re-
gard to any other term or condition of such
plan or coverage (other than an exclusion of
benefits, or an affiliation or waiting period, per-
mitted under section 701).
‘‘(2) EMERGENCY SERVICES; EMERGENCY MEDI-
CAL CONDITION.—For purposes of this section—
‘‘(A) EMERGENCY
MEDICAL
CONDITION
BASED
ON
PRUDENT
LAYPERSON.—The term
‘emergency medical condition’ means a medical
condition manifesting itself by acute symptoms
of sufficient severity (including severe pain)
such that a prudent layperson, who possesses
an average knowledge of health and medicine,
could reasonably expect the absence of imme-
diate medical attention to result in—
‘‘(i) placing the health of the individ-
ual (or, with respect to a pregnant woman,
the health of the woman or her unborn
child) in serious jeopardy,
‘‘(ii) serious impairment to bodily
functions, or
‘‘(iii) serious dysfunction of any bodily
organ or part.
‘‘(B) EMERGENCY
SERVICES.—The term
‘emergency services’ means—
‘‘(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment, to evaluate an emergency medical
condition (as defined in subparagraph
(A)), and
‘‘(ii) within the capabilities of the
staff and facilities available at the hospital,
such further medical examination and
treatment as are required under section
1867 of the Social Security Act to stabilize
the patient.
‘‘(C) TRAUMA AND BURN CENTERS.—The
provisions of clause (ii) of subparagraph (B)
apply to a trauma or burn center, in a hospital,
that—
‘‘(i) is designated by the State, a re-
gional authority of the State, or by the
designee of the State, or
‘‘(ii) is in a State that has not made
such designations and meets medically rec-
ognized national standards.
‘‘(3) APPLICATION OF NETWORK RESTRICTION
PERMITTED IN CERTAIN CASES.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), if a group health plan (and
an issuer of health insurance coverage in con-
nection with such a plan) denies, limits, or oth-
erwise differentiates in coverage or payment for
benefits other than emergency services on the
basis that the physician or provider of such
services is a nonparticipating physician or pro-
vider, the plan and issuer may deny, limit, or
differentiate in coverage or payment for emer-
gency services on such basis.
‘‘(B) NETWORK RESTRICTIONS NOT PER-
MITTED
IN
CERTAIN
EXCEPTIONAL
CASES.—
The denial or limitation of, or differentiation in,
coverage or payment of benefits for emergency
services under subparagraph (A) shall not apply
in the following cases:
‘‘(i) CIRCUMSTANCES
BEYOND
CON-
TROL OF PARTICIPANT OR BENEFICIARY.—
The participant or beneficiary is unable to
go to a participating hospital for such serv-
ices due to circumstances beyond the con-
trol of the participant or beneficiary (as
determined consistent with guidelines and
subparagraph (C)).
‘‘(ii) LIKELIHOOD
OF
AN
ADVERSE
HEALTH
CONSEQUENCE
BASED
ON
LAYPERSON’S
JUDGMENT.—A 
prudent
layperson possessing an average knowledge
of health and medicine could reasonably
believe that, under the circumstances and
consistent with guidelines, the time re-
quired to go to a participating hospital for
such services could result in any of the ad-
verse health consequences described in a
clause of subsection (a)(2)(A).
‘‘(iii) PHYSICIAN REFERRAL.—A par-
ticipating physician or other person au-
thorized by the plan refers the participant
or beneficiary to an emergency department
of a hospital and does not specify an emer-
gency department of a hospital that is a
participating hospital with respect to such
services.
‘‘(C) APPLICATION OF ‘BEYOND CONTROL’
STANDARDS.—For purposes of applying sub-
paragraph (B)(i), receipt of emergency services
from a nonparticipating hospital shall be treat-
ed under the guidelines as being ‘due to cir-
cumstances beyond the control of the partici-
pant or beneficiary’ if any of the following con-
ditions are met:
‘‘(i) UNCONSCIOUS.—The participant
or beneficiary was unconscious or in an
otherwise altered mental state at the time
of initiation of the services.
‘‘(ii) AMBULANCE
DELIVERY.—The
participant or beneficiary was transported
by an ambulance or other emergency vehi-
cle directed by a person other than the
participant or beneficiary to the non-
participating hospital in which the services
were provided.
‘‘(iii) NATURAL DISASTER.—A natural
disaster or civil disturbance prevented the
participant or beneficiary from presenting
to a participating hospital for the provision
of such services.
‘‘(iv) NO GOOD FAITH EFFORT TO IN-
FORM OF CHANGE IN PARTICIPATION DUR-
ING A CONTRACT YEAR.—The status of the
hospital changed from a participating hos-
pital to a nonparticipating hospital with re-
spect to emergency services during a con-
tract year and the plan or issuer failed to
make a good faith effort to notify the par-
ticipant or beneficiary involved of such
change.
‘‘(v) 
OTHER
CONDITIONS.—There
were other factors (such as those identified
in guidelines) that prevented the partici-
pant or beneficiary from controlling selec-
tion of the hospital in which the services
were provided.
‘‘(b) ASSURING COORDINATED COVERAGE OF MAIN-
TENANCE CARE AND POST-STABILIZATION CARE.—
‘‘(1) IN GENERAL.—In the case of a participant
or beneficiary who is covered under a group health
plan (or under health insurance coverage issued by
a health insurance issuer offered in connection with
such a plan) and who has received emergency serv-
ices pursuant to a screening evaluation conducted
(or supervised) by a treating physician at a hospital
that is a nonparticipating provider with respect to
emergency services, if—
‘‘(A) pursuant to such evaluation, the phy-
sician identifies post-stabilization care (as de-
fined in paragraph (3)(B)) that is required by
the participant or beneficiary,
‘‘(B) the plan or coverage provides benefits
with respect to the care so identified and the
plan requires (but for this subsection) an af-
firmative prior authorization determination as a
condition of coverage of such care, and
‘‘(C) the treating physician (or another in-
dividual acting on behalf of such physician) ini-
tiates, not later than 30 minutes after the time
the treating physician determines that the con-
dition of the participant or beneficiary is sta-
bilized, a good faith effort to contact a physi-
cian or other person authorized by the plan or
issuer (by telephone or other means) to obtain
an affirmative prior authorization determination
with respect to the care,
then, without regard to terms and conditions speci-
fied in paragraph (2) the plan or issuer shall cover
maintenance care (as defined in paragraph (3)(A))
furnished to the participant or beneficiary during
the period specified in paragraph (4) and shall cover
post-stabilization care furnished to the participant or
beneficiary during the period beginning under para-
graph (5) and ending under paragraph (6).
‘‘(2) TERMS
AND
CONDITIONS
WAIVED.—The
terms and conditions (of a plan or coverage) de-
scribed in this paragraph that are waived under
paragraph (1) are as follows:
‘‘(A) The need for any prior authorization
determination.
‘‘(B) Any limitation on coverage based on
whether or not the physician or provider fur-
nishing the care is a participating physician or
provider with respect to such care.
‘‘(C) Any other term or condition of the
plan or coverage (other than an exclusion of
benefits, or an affiliation or waiting period, per-
mitted under section 701 and other than a re-
quirement relating to medical necessity for cov-
erage of benefits).
‘‘(3) MAINTENANCE
CARE
AND
POST-STA-
BILIZATION CARE DEFINED.—In this subsection:
‘‘(A) MAINTENANCE
CARE.—The term
‘maintenance care’ means, with respect to an
individual who is stabilized after provision of
emergency services, medically necessary items
and services (other than emergency services)
that are required by the individual to ensure
that the individual remains stabilized during
the period described in paragraph (4).
‘‘(B) 
POST-STABILIZATION
CARE.—The
term ‘post-stabilization care’ means, with re-
spect to an individual who is determined to be
stable pursuant to a medical screening examina-
tion or who is stabilized after provision of emer-
gency services, medically necessary items and
services (other than emergency services and
other than maintenance care) that are required
by the individual.
‘‘(4) PERIOD
OF
REQUIRED
COVERAGE
OF
MAINTENANCE CARE.—The period of required cov-
erage of maintenance care of an individual under
this subsection begins at the time of the request (or
the initiation of the good faith effort to make the re-
quest) under paragraph (1)(C) and ends when—
‘‘(A) the individual is discharged from the
hospital;
‘‘(B) a physician (designated by the plan
or issuer involved) and with privileges at the
hospital involved arrives at the emergency de-
partment of the hospital and assumes respon-
sibility with respect to the treatment of the in-
dividual; or
‘‘(C) the treating physician and the plan or
issuer agree to another arrangement with re-
spect to the care of the individual.
‘‘(5) WHEN
POST-STABILIZATION
CARE
RE-
QUIRED TO BE COVERED.—
‘‘(A) WHEN TREATING PHYSICIAN UNABLE
TO
COMMUNICATE
REQUEST.—If the treating
physician or other individual makes the good
faith effort to request authorization under para-
graph (1)(C) but is unable to communicate the
request directly with an authorized person re-
ferred to in such paragraph within 30 minutes
after the time of initiating such effort, then
post-stabilization care is required to be covered
under this subsection beginning at the end of
such 30-minute period.
‘‘(B) WHEN ABLE TO COMMUNICATE RE-
QUEST, AND NO TIMELY RESPONSE.—
‘‘(i) IN
GENERAL.—If the treating
physician or other individual under para-
graph (1)(C) is able to communicate the
request within the 30-minute period de-
scribed in subparagraph (A), the post-sta-
bilization care requested is required to be
covered under this subsection beginning 30
minutes after the time when the plan or is-
suer receives the request unless a person
authorized by the plan or issuer involved
communicates (or makes a good faith ef-
fort to communicate) a denial of the re-
quest for the prior authorization deter-
mination within 30 minutes of the time
when the plan or issuer receives the re-
quest and the treating physician does not
request under clause (ii) to communicate
directly with an authorized physician con-
cerning the denial.
‘‘(ii) REQUEST
FOR
DIRECT
PHYSI-
CIAN-TO-PHYSICIAN COMMUNICATION CON-
CERNING DENIAL.—If a denial of a request
is communicated under clause (i), the
treating physician may request to commu-
nicate respecting the denial directly with a
physician who is authorized by the plan or
issuer to deny or affirm such a denial.
‘‘(C) WHEN NO TIMELY RESPONSE TO RE-
QUEST
FOR
PHYSICIAN-TO-PHYSICIAN
COMMU-
NICATION.—If a request for physician-to-physi-
cian communication is made under subpara-
graph (B)(ii), the post-stabilization care re-
quested is required to be covered under this
subsection beginning 30 minutes after the time
when the plan or issuer receives the request
from a treating physician unless a physician,
who is authorized by the plan or issuer to re-
verse or affirm the initial denial of the care,
communicates (or makes a good faith effort to
communicate) directly with the treating physi-
cian within such 30-minute period.
‘‘(D) DISAGREEMENTS
OVER
POST-STA-
BILIZATION CARE.—If, after a direct physician-
to-physician communication under subpara-
graph (C), the denial of the request for the
post-stabilization care is not reversed and the
treating physician communicates to the plan or
issuer involved a disagreement with such deci-
sion, the post-stabilization care requested is re-
quired to be covered under this subsection be-
ginning as follows:
‘‘(i) DELAY TO ALLOW FOR PROMPT
ARRIVAL
OF
PHYSICIAN
ASSUMING
RE-
SPONSIBILITY.—If the plan or issuer com-
municates that a physician (designated by
the plan or issuer) with privileges at the
hospital involved will arrive promptly (as
determined under guidelines) at the emer-
gency department of the hospital in order
to assume responsibility with respect to the
treatment of the participant or beneficiary
involved, the required coverage of the post-
stabilization care begins after the passage
of such time period as would allow the
prompt arrival of such a physician.
‘‘(ii) OTHER CASES.—If the plan or
issuer does not so communicate, the re-
quired coverage of the post-stabilization
care begins immediately.
‘‘(6) NO REQUIREMENT OF COVERAGE OF POST-
STABILIZATION
CARE
IF
ALTERNATE
PLAN
OF
TREATMENT.—
‘‘(A) IN GENERAL.—Coverage of post-sta-
bilization care is not required under this sub-
section with respect to an individual when—
‘‘(i) subject to subparagraph (B), a
physician (designated by the plan or issuer
involved) and with privileges at the hos-
pital involved arrives at the emergency de-
partment of the hospital and assumes re-
sponsibility with respect to the treatment
of the individual; or
‘‘(ii) the treating physician and the
plan or issuer agree to another arrange-
ment with respect to the post-stabilization
care (such as an appropriate transfer of
the individual involved to another facility
or an appointment for timely followup
treatment for the individual).
‘‘(B) SPECIAL RULE WHERE ONCE CARE
INITIATED.—Required coverage of requested
post-stabilization care shall not end by reason
of subparagraph (A)(i) during an episode of
care (as determined by guidelines) if the treat-
ing physician initiated such care (consistent
with a previous paragraph) before the arrival of
a physician described in such subparagraph.
‘‘(7) CONSTRUCTION.—Nothing in this sub-
section shall be construed as—
‘‘(A) preventing a plan or issuer from au-
thorizing coverage of maintenance care or post-
stabilization care in advance or at any time; or
‘‘(B) preventing a treating physician or
other individual described in paragraph (1)(C)
and a plan or issuer from agreeing to modify
any of the time periods specified in paragraph
(5) as it relates to cases involving such persons.
‘‘(c) LIMITS ON COST-SHARING FOR SERVICES FUR-
NISHED
IN EMERGENCY DEPARTMENTS.—If a group
health plan provides any benefits with respect to emer-
gency services, the plan (or a health insurance issuer offer-
ing health insurance coverage in connection with such a
plan) may impose cost sharing with respect to such serv-
ices only if the following conditions are met:
‘‘(1) LIMITATIONS
ON
COST-SHARING
DIF-
FERENTIAL FOR NONPARTICIPATING PROVIDERS.—
‘‘(A) NO
DIFFERENTIAL
FOR
CERTAIN
SERVICES.—In the case of services furnished
under the circumstances described in clause (i),
(ii), or (iii) of subsection (a)(3)(B) (relating to
circumstances beyond the control of the bene-
ficiary, the likelihood of an adverse health con-
sequence based on layperson’s judgment, and
physician referral), the cost-sharing for such
services provided by a nonparticipating provider
or physician does not exceed the cost-sharing
for such services provided by a participating
provider or physician.
‘‘(B) ONLY
REASONABLE
DIFFERENTIAL
FOR OTHER SERVICES.—In the case of other
emergency services, any differential by which
the cost-sharing for such services provided by a
nonparticipating provider or physician exceeds
the cost-sharing for such services provided by a
participating provider or physician is reasonable
(as determined under guidelines).
‘‘(2) ONLY
REASONABLE
DIFFERENTIAL
BE-
TWEEN EMERGENCY SERVICES AND OTHER SERV-
ICES.—Any differential by which the cost-sharing for
services furnished in an emergency department ex-
ceeds the cost-sharing for such services furnished in
another setting is reasonable (as determined under
guidelines).
‘‘(3) CONSTRUCTION.—Nothing in paragraph
(1)(B) or (2) shall be construed as authorizing
guidelines other than guidelines that establish maxi-
mum cost-sharing differentials.
‘‘(d) INFORMATION
ON ACCESS
TO EMERGENCY
SERVICES.—A group health plan (or a health insurance
issuer, to the extent a health insurance issuer offers group
health insurance coverage in connection with such a plan)
shall provide education to participants and beneficiaries
of the plan on—
‘‘(1) coverage of emergency services (as defined
in subsection (a)(2)(B)) by the plan in accordance
with the provisions of this section,
‘‘(2) the appropriate use of emergency services,
including use of the 911 telephone system or its
local equivalent,
‘‘(3) any cost sharing applicable to emergency
services,
‘‘(4) the process and procedures of the plan for
obtaining emergency services, and
‘‘(5) the locations of—
‘‘(A) emergency departments, and
‘‘(B) other settings,
in which participating physicians and hospitals pro-
vide emergency services and post-stabilization care.
‘‘(e) GENERAL DEFINITIONS.—For purposes of this
section:
‘‘(1) COST SHARING.—The term ‘cost sharing’
means any deductible, coinsurance amount, copay-
ment or other out-of-pocket payment (other than
premiums or enrollment fees) that a group health
plan (or a health insurance issuer offering group
health insurance issuer in connection with such a
plan) imposes on participants and beneficiaries of
the plan with respect to the coverage of benefits.
‘‘(2) GOOD FAITH EFFORT.—The term ‘good
faith effort’ has the meaning given such term in
guidelines and requires such appropriate documenta-
tion as is specified under such guidelines.
‘‘(3) 
GUIDELINES.—The 
term 
‘guidelines’
means guidelines established in accordance with sec-
tion 7 of the Access to Emergency Medical Services
Act of 1997.
‘‘(4) NONPARTICIPATING
PHYSICIAN
OR
PRO-
VIDER.—The term ‘nonparticipating physician or
provider’ means, with respect to health care items
and services furnished to a participant or beneficiary
of a group health plan, a physician or provider that
is not a participating physician or provider for such
services.
‘‘(5) 
PARTICIPATING
PHYSICIAN
OR
PRO-
VIDER.—The term ‘participating physician or pro-
vider’ means, with respect to health care items and
services furnished to a participant or beneficiary of
a group health plan, a physician or provider that
furnishes such items and services under a contract
or other arrangement with such plan (or with a
health insurance issuer offering group health insur-
ance coverage in connection with such a plan).
‘‘(6) 
PRIOR
AUTHORIZATION
DETERMINA-
TION.—The term ‘prior authorization determination’
means, with respect to items and services for which
coverage may be provided under a group health plan,
a determination (before the provision of the items
and services and as a condition of coverage of the
items and services under the plan) of whether or not
such items and services will be covered under the
plan.
‘‘(7) 
STABILIZE.—The 
term 
‘to 
stabilize’
means, with respect to an emergency medical condi-
tion, to provide (in complying with section 1867 of
the Social Security Act) such medical treatment of
the condition as may be necessary to assure, within
reasonable medical probability, that no material de-
terioration of the condition is likely to result from or
occur during the transfer of the individual from the
facility.
‘‘(8) 
STABILIZED.—The 
term 
‘stabilized’
means, with respect to an emergency medical condi-
tion, that no material deterioration of the condition
is likely, within reasonable medical probability, to re-
sult from or occur before an individual can be trans-
ferred from the facility, in compliance with the re-
quirements of section 1867 of the Social Security
Act.
‘‘(9) TREATING PHYSICIAN.—The term ‘treat-
ing physician’ includes a treating health care profes-
sional who is licensed under State law to provide
emergency services other than under the supervision
of a physician.
‘‘(f) CONTINUED APPLICABILITY
OF STATE LAW
WITH RESPECT TO HEALTH INSURANCE ISSUERS.—The
provisions of section 731(a) (relating to State authority
to provide for standards and requirements for health in-
surance issuers to the extent the standards and require-
ments do not prevent the application of a requirement of
this part) apply with respect to the requirements of this
section.’’.
(b) CONFORMING AMENDMENTS.—
(1) Section 731(c) of such Act (29 U.S.C.
1191(c)), as amended by section 603(b)(1) of Public
Law 104–204, is amended by striking ‘‘section 711’’
and inserting ‘‘sections 711 and 713’’.
(2) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(3) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Assuring equitable coverage of emergency services, maintenance care,
and post-stabilization care.’’.
(c) EFFECTIVE DATE.—(1) Subject to paragraph (2),
the amendments made by this section shall apply to group
health plans for plan years beginning on or after the date
that is 18 months after the date of the enactment of this
Act.
(2) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made by this section shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) 18 months after the date of the enactment
of this Act.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by this section shall not be
treated as a termination of such collective bargaining
agreement.
SEC. 4. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE GROUP MARKET.
(a) IN GENERAL.—Subpart 2 of part A of title
XXVII of the Public Health Service Act is amended by
adding at the end the following new section:
‘‘SEC. 2706. ASSURING EQUITABLE COVERAGE OF EMER-
GENCY SERVICES, MAINTENANCE CARE, AND
POST-STABILIZATION CARE.
‘‘(a) PROHIBITION OF CERTAIN RESTRICTIONS ON
COVERAGE OF EMERGENCY SERVICES.—
‘‘(1) IN GENERAL.—If a group health plan pro-
vides any benefits with respect to emergency services
(as defined in paragraph (2)(B)), the plan (and any
health insurance issuer offering health insurance
coverage in connection with such a plan) shall cover
emergency services furnished to a participant or ben-
eficiary of the plan—
‘‘(A) without the need for any prior au-
thorization determination,
‘‘(B) subject to paragraph (3), whether or
not the physician or provider furnishing such
services is a participating physician or provider
with respect to such services, and
‘‘(C) subject to paragraph (3), without re-
gard to any other term or condition of such
plan or coverage (other than an exclusion of
benefits, or an affiliation or waiting period, per-
mitted under section 2701).
‘‘(2) EMERGENCY SERVICES; EMERGENCY MEDI-
CAL CONDITION.—For purposes of this section—
‘‘(A) EMERGENCY
MEDICAL
CONDITION
BASED
ON
PRUDENT
LAYPERSON.—The term
‘emergency medical condition’ means a medical
condition manifesting itself by acute symptoms
of sufficient severity (including severe pain)
such that a prudent layperson, who possesses
an average knowledge of health and medicine,
could reasonably expect the absence of imme-
diate medical attention to result in—
‘‘(i) placing the health of the individ-
ual (or, with respect to a pregnant woman,
the health of the woman or her unborn
child) in serious jeopardy,
‘‘(ii) serious impairment to bodily
functions, or
‘‘(iii) serious dysfunction of any bodily
organ or part.
‘‘(B) EMERGENCY
SERVICES.—The term
‘emergency services’ means—
‘‘(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act) that is within the capa-
bility of the emergency department of a
hospital, including ancillary services rou-
tinely available to the emergency depart-
ment, to evaluate an emergency medical
condition (as defined in subparagraph
(A)), and
‘‘(ii) within the capabilities of the
staff and facilities available at the hospital,
such further medical examination and
treatment as are required under section
1867 of the Social Security Act to stabilize
the patient.
‘‘(C) TRAUMA AND BURN CENTERS.—The
provisions of clause (ii) of subparagraph (B)
apply to a trauma or burn center, in a hospital,
that—
‘‘(i) is designated by the State, a re-
gional authority of the State, or by the
designee of the State, or
‘‘(ii) is in a State that has not made
such designations and meets medically rec-
ognized national standards.
‘‘(3) APPLICATION OF NETWORK RESTRICTION
PERMITTED IN CERTAIN CASES.—
‘‘(A) IN GENERAL.—Except as provided in
subparagraph (B), if a group health plan (and
an issuer of health insurance coverage in con-
nection with such a plan) denies, limits, or oth-
erwise differentiates in coverage or payment for
benefits other than emergency services on the
basis that the physician or provider of such
services is a nonparticipating physician or pro-
vider, the plan and issuer may deny, limit, or
differentiate in coverage or payment for emer-
gency services on such basis.
‘‘(B) NETWORK RESTRICTIONS NOT PER-
MITTED
IN
CERTAIN
EXCEPTIONAL
CASES.—
The denial or limitation of, or differentiation in,
coverage or payment of benefits for emergency
services under subparagraph (A) shall not apply
in the following cases:
‘‘(i) CIRCUMSTANCES
BEYOND
CON-
TROL OF PARTICIPANT OR BENEFICIARY.—
The participant or beneficiary is unable to
go to a participating hospital for such serv-
ices due to circumstances beyond the con-
trol of the participant or beneficiary (as
determined consistent with guidelines and
subparagraph (C)).
‘‘(ii) LIKELIHOOD
OF
AN
ADVERSE
HEALTH
CONSEQUENCE
BASED
ON
LAYPERSON’S
JUDGMENT.—A 
prudent
layperson possessing an average knowledge
of health and medicine could reasonably
believe that, under the circumstances and
consistent with guidelines, the time re-
quired to go to a participating hospital for
such services could result in any of the ad-
verse health consequences described in a
clause of subsection (a)(2)(A).
‘‘(iii) PHYSICIAN REFERRAL.—A par-
ticipating physician or other person au-
thorized by the plan refers the participant
or beneficiary to an emergency department
of a hospital and does not specify an emer-
gency department of a hospital that is a
participating hospital with respect to such
services.
‘‘(C) APPLICATION OF ‘BEYOND CONTROL’
STANDARDS.—For purposes of applying sub-
paragraph (B)(i), receipt of emergency services
from a nonparticipating hospital shall be treat-
ed under the guidelines as being ‘due to cir-
cumstances beyond the control of the partici-
pant or beneficiary’ if any of the following con-
ditions are met:
‘‘(i) UNCONSCIOUS.—The participant
or beneficiary was unconscious or in an
otherwise altered mental state at the time
of initiation of the services.
‘‘(ii) AMBULANCE
DELIVERY.—The
participant or beneficiary was transported
by an ambulance or other emergency vehi-
cle directed by a person other than the
participant or beneficiary to the non-
participating hospital in which the services
were provided.
‘‘(iii) NATURAL DISASTER.—A natural
disaster or civil disturbance prevented the
participant or beneficiary from presenting
to a participating hospital for the provision
of such services.
‘‘(iv) NO GOOD FAITH EFFORT TO IN-
FORM OF CHANGE IN PARTICIPATION DUR-
ING A CONTRACT YEAR.—The status of the
hospital changed from a participating hos-
pital to a nonparticipating hospital with re-
spect to emergency services during a con-
tract year and the plan or issuer failed to
make a good faith effort to notify the par-
ticipant or beneficiary involved of such
change.
‘‘(v) 
OTHER
CONDITIONS.—There
were other factors (such as those identified
in guidelines) that prevented the partici-
pant or beneficiary from controlling selec-
tion of the hospital in which the services
were provided.
‘‘(b) ASSURING COORDINATED COVERAGE OF MAIN-
TENANCE CARE AND POST-STABILIZATION CARE.—
‘‘(1) IN GENERAL.—In the case of a participant
or beneficiary who is covered under a group health
plan (or under health insurance coverage issued by
a health insurance issuer offered in connection with
such a plan) and who has received emergency serv-
ices pursuant to a screening evaluation conducted
(or supervised) by a treating physician at a hospital
that is a nonparticipating provider with respect to
emergency services, if—
‘‘(A) pursuant to such evaluation, the phy-
sician identifies post-stabilization care (as de-
fined in paragraph (3)(B)) that is required by
the participant or beneficiary,
‘‘(B) the plan or coverage provides benefits
with respect to the care so identified and the
plan requires (but for this subsection) an af-
firmative prior authorization determination as a
condition of coverage of such care, and
‘‘(C) the treating physician (or another in-
dividual acting on behalf of such physician) ini-
tiates, not later than 30 minutes after the time
the treating physician determines that the con-
dition of the participant or beneficiary is sta-
bilized, a good faith effort to contact a physi-
cian or other person authorized by the plan or
issuer (by telephone or other means) to obtain
an affirmative prior authorization determination
with respect to the care,
then, without regard to terms and conditions speci-
fied in paragraph (2) the plan or issuer shall cover
maintenance care (as defined in paragraph (3)(A))
furnished to the participant or beneficiary during
the period specified in paragraph (4) and shall cover
post-stabilization care furnished to the participant or
beneficiary during the period beginning under para-
graph (5) and ending under paragraph (6).
‘‘(2) TERMS
AND
CONDITIONS
WAIVED.—The
terms and conditions (of a plan or coverage) de-
scribed in this paragraph that are waived under
paragraph (1) are as follows:
‘‘(A) The need for any prior authorization
determination.
‘‘(B) Any limitation on coverage based on
whether or not the physician or provider fur-
nishing the care is a participating physician or
provider with respect to such care.
‘‘(C) Any other term or condition of the
plan or coverage (other than an exclusion of
benefits, or an affiliation or waiting period, per-
mitted under section 2701 and other than a re-
quirement relating to medical necessity for cov-
erage of benefits).
‘‘(3) MAINTENANCE
CARE
AND
POST-STA-
BILIZATION CARE DEFINED.—In this subsection:
‘‘(A) MAINTENANCE
CARE.—The term
‘maintenance care’ means, with respect to an
individual who is stabilized after provision of
emergency services, medically necessary items
and services (other than emergency services)
that are required by the individual to ensure
that the individual remains stabilized during
the period described in paragraph (4).
‘‘(B) 
POST-STABILIZATION
CARE.—The
term ‘post-stabilization care’ means, with re-
spect to an individual who is determined to be
stable pursuant to a medical screening examina-
tion or who is stabilized after provision of emer-
gency services, medically necessary items and
services (other than emergency services and
other than maintenance care) that are required
by the individual.
‘‘(4) PERIOD
OF
REQUIRED
COVERAGE
OF
MAINTENANCE CARE.—The period of required cov-
erage of maintenance care of an individual under
this subsection begins at the time of the request (or
the initiation of the good faith effort to make the re-
quest) under paragraph (1)(C) and ends when—
‘‘(A) the individual is discharged from the
hospital;
‘‘(B) a physician (designated by the plan
or issuer involved) and with privileges at the
hospital involved arrives at the emergency de-
partment of the hospital and assumes respon-
sibility with respect to the treatment of the in-
dividual; or
‘‘(C) the treating physician and the plan or
issuer agree to another arrangement with re-
spect to the care of the individual.
‘‘(5) WHEN
POST-STABILIZATION
CARE
RE-
QUIRED TO BE COVERED.—
‘‘(A) WHEN TREATING PHYSICIAN UNABLE
TO
COMMUNICATE
REQUEST.—If the treating
physician or other individual makes the good
faith effort to request authorization under para-
graph (1)(C) but is unable to communicate the
request directly with an authorized person re-
ferred to in such paragraph within 30 minutes
after the time of initiating such effort, then
post-stabilization care is required to be covered
under this subsection beginning at the end of
such 30-minute period.
‘‘(B) WHEN ABLE TO COMMUNICATE RE-
QUEST, AND NO TIMELY RESPONSE.—
‘‘(i) IN
GENERAL.—If the treating
physician or other individual under para-
graph (1)(C) is able to communicate the
request within the 30-minute period de-
scribed in subparagraph (A), the post-sta-
bilization care requested is required to be
covered under this subsection beginning 30
minutes after the time when the plan or is-
suer receives the request unless a person
authorized by the plan or issuer involved
communicates (or makes a good faith ef-
fort to communicate) a denial of the re-
quest for the prior authorization deter-
mination within 30 minutes of the time
when the plan or issuer receives the re-
quest and the treating physician does not
request under clause (ii) to communicate
directly with an authorized physician con-
cerning the denial.
‘‘(ii) REQUEST
FOR
DIRECT
PHYSI-
CIAN-TO-PHYSICIAN COMMUNICATION CON-
CERNING DENIAL.—If a denial of a request
is communicated under clause (i), the
treating physician may request to commu-
nicate respecting the denial directly with a
physician who is authorized by the plan or
issuer to deny or affirm such a denial.
‘‘(C) WHEN NO TIMELY RESPONSE TO RE-
QUEST
FOR
PHYSICIAN-TO-PHYSICIAN
COMMU-
NICATION.—If a request for physician-to-physi-
cian communication is made under subpara-
graph (B)(ii), the post-stabilization care re-
quested is required to be covered under this
subsection beginning 30 minutes after the time
when the plan or issuer receives the request
from a treating physician unless a physician,
who is authorized by the plan or issuer to re-
verse or affirm the initial denial of the care,
communicates (or makes a good faith effort to
communicate) directly with the treating physi-
cian within such 30-minute period.
‘‘(D) DISAGREEMENTS
OVER
POST-STA-
BILIZATION CARE.—If, after a direct physician-
to-physician communication under subpara-
graph (C), the denial of the request for the
post-stabilization care is not reversed and the
treating physician communicates to the plan or
issuer involved a disagreement with such deci-
sion, the post-stabilization care requested is re-
quired to be covered under this subsection be-
ginning as follows:
‘‘(i) DELAY TO ALLOW FOR PROMPT
ARRIVAL
OF
PHYSICIAN
ASSUMING
RE-
SPONSIBILITY.—If the plan or issuer com-
municates that a physician (designated by
the plan or issuer) with privileges at the
hospital involved will arrive promptly (as
determined under guidelines) at the emer-
gency department of the hospital in order
to assume responsibility with respect to the
treatment of the participant or beneficiary
involved, the required coverage of the post-
stabilization care begins after the passage
of such time period as would allow the
prompt arrival of such a physician.
‘‘(ii) OTHER CASES.—If the plan or
issuer does not so communicate, the re-
quired coverage of the post-stabilization
care begins immediately.
‘‘(6) NO REQUIREMENT OF COVERAGE OF POST-
STABILIZATION
CARE
IF
ALTERNATE
PLAN
OF
TREATMENT.—
‘‘(A) IN GENERAL.—Coverage of post-sta-
bilization care is not required under this sub-
section with respect to an individual when—
‘‘(i) subject to subparagraph (B), a
physician (designated by the plan or issuer
involved) and with privileges at the hos-
pital involved arrives at the emergency de-
partment of the hospital and assumes re-
sponsibility with respect to the treatment
of the individual; or
‘‘(ii) the treating physician and the
plan or issuer agree to another arrange-
ment with respect to the post-stabilization
care (such as an appropriate transfer of
the individual involved to another facility
or an appointment for timely followup
treatment for the individual).
‘‘(B) SPECIAL RULE WHERE ONCE CARE
INITIATED.—Required coverage of requested
post-stabilization care shall not end by reason
of subparagraph (A)(i) during an episode of
care (as determined by guidelines) if the treat-
ing physician initiated such care (consistent
with a previous paragraph) before the arrival of
a physician described in such subparagraph.
‘‘(7) CONSTRUCTION.—Nothing in this sub-
section shall be construed as—
‘‘(A) preventing a plan or issuer from au-
thorizing coverage of maintenance care or post-
stabilization care in advance or at any time; or
‘‘(B) preventing a treating physician or
other individual described in paragraph (1)(C)
and a plan or issuer from agreeing to modify
any of the time periods specified in paragraph
(5) as it relates to cases involving such persons.
‘‘(c) LIMITS ON COST-SHARING FOR SERVICES FUR-
NISHED
IN EMERGENCY DEPARTMENTS.—If a group
health plan provides any benefits with respect to emer-
gency services, the plan (or a health insurance issuer offer-
ing health insurance coverage in connection with such a
plan) may impose cost sharing with respect to such serv-
ices only if the following conditions are met:
‘‘(1) LIMITATIONS
ON
COST-SHARING
DIF-
FERENTIAL FOR NONPARTICIPATING PROVIDERS.—
‘‘(A) NO
DIFFERENTIAL
FOR
CERTAIN
SERVICES.—In the case of services furnished
under the circumstances described in clause (i),
(ii), or (iii) of subsection (a)(3)(B) (relating to
circumstances beyond the control of the bene-
ficiary, the likelihood of an adverse health con-
sequence based on layperson’s judgment, and
physician referral), the cost-sharing for such
services provided by a nonparticipating provider
or physician does not exceed the cost-sharing
for such services provided by a participating
provider or physician.
‘‘(B) ONLY
REASONABLE
DIFFERENTIAL
FOR OTHER SERVICES.—In the case of other
emergency services, any differential by which
the cost-sharing for such services provided by a
nonparticipating provider or physician exceeds
the cost-sharing for such services provided by a
participating provider or physician is reasonable
(as determined under guidelines).
‘‘(2) ONLY
REASONABLE
DIFFERENTIAL
BE-
TWEEN EMERGENCY SERVICES AND OTHER SERV-
ICES.—Any differential by which the cost-sharing for
services furnished in an emergency department ex-
ceeds the cost-sharing for such services furnished in
another setting is reasonable (as determined under
guidelines).
‘‘(3) CONSTRUCTION.—Nothing in paragraph
(1)(B) or (2) shall be construed as authorizing
guidelines other than guidelines that establish maxi-
mum cost-sharing differentials.
‘‘(d) INFORMATION
ON ACCESS
TO EMERGENCY
SERVICES.—A group health plan (or a health insurance
issuer, to the extent a health insurance issuer offers group
health insurance coverage in connection with such a plan)
shall provide education to participants and beneficiaries
of the plan on—
‘‘(1) coverage of emergency services (as defined
in subsection (a)(2)(B)) by the plan in accordance
with the provisions of this section,
‘‘(2) the appropriate use of emergency services,
including use of the 911 telephone system or its
local equivalent,
‘‘(3) any cost sharing applicable to emergency
services,
‘‘(4) the process and procedures of the plan for
obtaining emergency services, and
‘‘(5) the locations of—
‘‘(A) emergency departments, and
‘‘(B) other settings,
in which participating physicians and hospitals pro-
vide emergency services and post-stabilization care.
‘‘(e) GENERAL DEFINITIONS.—For purposes of this
section:
‘‘(1) COST SHARING.—The term ‘cost sharing’
means any deductible, coinsurance amount, copay-
ment or other out-of-pocket payment (other than
premiums or enrollment fees) that a group health
plan (or a health insurance issuer offering group
health insurance issuer in connection with such a
plan) imposes on participants and beneficiaries of
the plan with respect to the coverage of benefits.
‘‘(2) GOOD FAITH EFFORT.—The term ‘good
faith effort’ has the meaning given such term in
guidelines and requires such appropriate documenta-
tion as is specified under such guidelines.
‘‘(3) 
GUIDELINES.—The 
term 
‘guidelines’
means guidelines established in accordance with sec-
tion 7 of the Access to Emergency Medical Services
Act of 1997.
‘‘(4) NONPARTICIPATING
PHYSICIAN
OR
PRO-
VIDER.—The term ‘nonparticipating physician or
provider’ means, with respect to health care items
and services furnished to a participant or beneficiary
of a group health plan, a physician or provider that
is not a participating physician or provider for such
services.
‘‘(5) 
PARTICIPATING
PHYSICIAN
OR
PRO-
VIDER.—The term ‘participating physician or pro-
vider’ means, with respect to health care items and
services furnished to a participant or beneficiary of
a group health plan, a physician or provider that
furnishes such items and services under a contract
or other arrangement with such plan (or with a
health insurance issuer offering group health insur-
ance coverage in connection with such a plan).
‘‘(6) 
PRIOR
AUTHORIZATION
DETERMINA-
TION.—The term ‘prior authorization determination’
means, with respect to items and services for which
coverage may be provided under a group health plan,
a determination (before the provision of the items
and services and as a condition of coverage of the
items and services under the plan) of whether or not
such items and services will be covered under the
plan.
‘‘(7) 
STABILIZE.—The 
term 
‘to 
stabilize’
means, with respect to an emergency medical condi-
tion, to provide (in complying with section 1867 of
the Social Security Act) such medical treatment of
the condition as may be necessary to assure, within
reasonable medical probability, that no material de-
terioration of the condition is likely to result from or
occur during the transfer of the individual from the
facility.
‘‘(8) 
STABILIZED.—The 
term 
‘stabilized’
means, with respect to an emergency medical condi-
tion, that no material deterioration of the condition
is likely, within reasonable medical probability, to re-
sult from or occur before an individual can be trans-
ferred from the facility, in compliance with the re-
quirements of section 1867 of the Social Security
Act.
‘‘(9) TREATING PHYSICIAN.—The term ‘treat-
ing physician’ includes a treating health care profes-
sional who is licensed under State law to provide
emergency services other than under the supervision
of a physician.
‘‘(f) CONTINUED APPLICABILITY
OF STATE LAW
WITH RESPECT TO HEALTH INSURANCE ISSUERS.—The
provisions of section 2723(a) (relating to State authority
to provide for standards and requirements for health in-
surance issuers to the extent the standards and require-
ments do not prevent the application of a requirement of
this part) apply with respect to the requirements of this
section.’’.
(b) CONFORMING AMENDMENT.—Section 2723(c) of
such Act (42 U.S.C. 300gg–23(c)), as amended by section
604(b)(2) of Public Law 104–204, is amended by striking
‘‘section 2704’’ and inserting ‘‘sections 2704 and 2706’’.
(c) EFFECTIVE DATE.—(1) Subject to paragraph (2),
the amendments made by this section shall apply to group
health plans for plan years beginning on or after the date
that is 18 months after the date of the enactment of this
Act.
(2) In the case of a group health plan maintained
pursuant to 1 or more collective bargaining agreements
between employee representatives and 1 or more employ-
ers ratified before the date of enactment of this Act, the
amendments made by this section shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective bar-
gaining agreements relating to the plan terminates
(determined without regard to any extension thereof
agreed to after the date of enactment of this Act),
or
(B) 18 months after the date of the enactment
of this Act.
For purposes of subparagraph (A), any plan amendment
made pursuant to a collective bargaining agreement relat-
ing to the plan which amends the plan solely to conform
to any requirement added by this section shall not be
treated as a termination of such collective bargaining
agreement.
SEC. 5. AMENDMENTS TO THE PUBLIC HEALTH SERVICE
ACT RELATING TO THE INDIVIDUAL MARKET.
(a) IN GENERAL.—Part B of title XXVII of the Pub-
lic Health Service Act is amended—
(1) by redesignating the subpart 3 relating to
other requirements as subpart 2, and
(2) by adding at the end of such subpart the
following new section:
‘‘SEC. 2752. ASSURING EQUITABLE COVERAGE OF EMER-
GENCY SERVICES, MAINTENANCE CARE, AND
POST-STABILIZATION CARE.
‘‘(a) IN GENERAL.—The provisions of section 2706
shall apply to health insurance coverage offered by a
health insurance issuer in the individual market in the
same manner as it applies to health insurance coverage
offered by a health insurance issuer in connection with a
group plan. In applying the previous sentence, the ref-
erence in section 2706(b)(2)(C) to section 2701 is deemed
a reference to subpart 1 of this part.
‘‘(b) CONTINUED APPLICABILITY
OF STATE LAW
WITH RESPECT TO HEALTH INSURANCE ISSUERS.—The
provisions of section 2762 (relating to State authority to
provide for standards and requirements for health insur-
ance issuers to the extent the standards and requirements
do not prevent the application of a requirement of this
part) apply with respect to the requirements of this sec-
tion.’’.
(b) CONFORMING AMENDMENT.—Section 2763(b)(2)
of such Act (42 U.S.C. 300gg–63(b)(2)), as added by sec-
tion 605(b)(3)(B) of Public Law 104–204, is amended by
striking ‘‘section 2751’’ and inserting ‘‘sections 2751 and
2752’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to health insurance
coverage offered, sold, issued, renewed, in effect, or oper-
ated in the individual market on or after the date that
is 18 months after the date of the enactment of this Act.
SEC. 6. APPLICATION TO PRIVATE COVERAGE FOR MEDI-
CARE AND MEDICAID BENEFICIARIES.
(a) 
MEDICARE.—Subparagraph 
(B) 
of 
section
1876(c)(4) of the Social Security Act (42 U.S.C.
1395mm(c)(4)) is amended to read as follows:
‘‘(B) meets the requirements of section 2706 of
the Public Health Service Act with respect to indi-
viduals enrolled with the organization under this sec-
tion.’’.
(b) MEDICAID.—Title XIX of such Act (42 U.S.C.
1396 et seq.) is amended by inserting after section 1908
the following new section:
‘‘ACCESS TO EMERGENCY SERVICES FOR BENEFICIARIES
ENROLLED IN PRIVATE HEALTH PLANS
‘‘SEC. 1909. (a) IN GENERAL.—A state plan may not
be approved under this title unless the plan requires each
health insurance issuer or other entity with a contract
with such plan to provide coverage or benefits to individ-
uals eligible for medical assistance under the plan to com-
ply with the provisions of section 2706 of the Public
Health Service Act with respect to such coverage or bene-
fits.
‘‘(b) COST SHARING.—Nothing in this section or sec-
tion 2706(c) of the Public Health Service Act shall be con-
strued as authorizing a health insurance issuer or entity
to impose cost sharing with respect to the coverage or ben-
efits described in subsection (a) that is inconsistent with
the cost sharing that is otherwise permitted under this
title.
‘‘(c) WAIVERS PROHIBITED.—The requirement of
subsection (a) may not be waived under section 1115 or
section 1915(b) of the Social Security Act.’’.
(c) 
MEDICARE
SELECT
POLICIES.—Section
1882(t)(1) of such Act (42 U.S.C. 1395ss(t)(1)) is amend-
ed—
(1) in subparagraph (B), by inserting ‘‘subject
to subparagraph (G),’’ after ‘‘(B)’’,
(2) by striking ‘‘and’’ at the end of subpara-
graph (E),
(3) by striking the period at the end of sub-
paragraph (F) and inserting ‘‘; and’’, and
(4) by adding at the end the following new sub-
paragraph:
‘‘(G) the issuer of the policy complies with the
requirements of section 2752 of the Public Health
Service Act with respect to enrollees under this sub-
section.’’.
(d) EFFECTIVE DATES.—
(1) MEDICARE.—The amendment made by sub-
section (a) shall apply to eligible organizations under
section 1876 of the Social Security Act for contract
years beginning on or after the date that is 18
months after the date of the enactment of this Act.
(2) MEDICAID.—The amendment made by sub-
section (b) shall apply to State plans under title
XIX of the Social Security Act for contract years be-
ginning on or after the date that is 18 months after
the date of the enactment of this Act.
(3) MEDICARE
SELECT.—The amendments
made by subsection (c) shall apply to policies for
contract years beginning on or after the date that is
18 months after the date of the enactment of this
Act.
SEC. 7. ESTABLISHMENT OF GUIDELINES.
(a) IN GENERAL.—The Secretary of Labor, the Sec-
retary of Health and Human Services, and the Secretary
of the Treasury (in this section referred to as ‘‘the Sec-
retaries’’) shall, in accordance with the process described
in subsection (b), jointly establish guidelines to carry out
section 9811 of the Internal Revenue Code of 1986, sec-
tion 713 of the Employee Retirement Income Security Act
of 1974, and sections 2706 and 2752 of the Public Health
Service Act, including all such guidelines as may be re-
ferred to in such sections.
(b) PROCESS.—
(1) ADVISORY PANEL.—Not later than 90 days
after the date of the enactment of this Act, the Sec-
retaries shall jointly establish an advisory panel to
assist in the development of the guidelines referred
to in subsection (a). The members of the panel shall
include individuals representing—
(A) emergency medical personnel, includ-
ing emergency physicians, emergency nurses,
and other appropriate emergency health care
professionals;
(B) health insurance issuers, including at
least one health maintenance organization;
(C) hospitals;
(D) employers;
(E) the States; and
(F) consumers.
(2) NOTICE
AND
COMMENT.—Not later than
180 days after the date of the enactment of this Act,
the Secretaries shall jointly cause to have published
in the Federal Register notice of proposed rule-
making on the guidelines referred to in subsection
(a). Not later than 60 days after the close of the pe-
riod for public comment on such guidelines, the Sec-
retaries shall jointly cause to have published in the
Federal Register a final rule establishing such guide-
lines.
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