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‘‘(4) NOTICE
UPON
CLOSING
AN
INVESTIGA-
TION.—The Secretary shall establish a procedure to 
notify hospitals and physicians when an investigation 
under this section is closed.’’. 
(c) PRIOR REVIEW BY PEER REVIEW ORGANIZA-
TIONS IN EMTALA CASES INVOLVING TERMINATION OF 
PARTICIPATION.—
(1) IN
GENERAL.—Section 1867(d)(3) (42 
U.S.C. 1395dd(d)(3)) is amended—
(A) in the first sentence, by inserting ‘‘or 
in terminating a hospital’s participation under 
this title’’ after ‘‘in imposing sanctions under 
paragraph (1)’’; and 
(B) by adding at the end the following new 
sentences: ‘‘Except in the case in which a delay 
would jeopardize the health or safety of individ-
uals, the Secretary shall also request such a re-
view before making a compliance determination 
as part of the process of terminating a hos-
pital’s participation under this title for viola-
tions related to the appropriateness of a med-
ical screening examination, stabilizing treat-
ment, or an appropriate transfer as required by 
this section, and shall provide a period of 5 
days for such review. The Secretary shall pro-
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vide a copy of the organization’s report to the 
hospital or physician consistent with confiden-
tiality requirements imposed on the organiza-
tion under such part B.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to terminations of par-
ticipation initiated on or after the date of the enact-
ment of this Act.
(d) MODIFICATION OF REQUIRMENT FOR MEDICAL 
SCREENING EXAMINATIONS
FOR PATIENTS NOT RE-
QUESTING EMERGENCY DEPARTMENT SERVICES.—
(1) IN GENERAL.—Section 1867(a) (42 U.S.C. 
1395dd(a)) is amended—
(A) by designating all that follows ‘‘(a) 
MEDICAL
SCREENING
REQUIREMENT.—’’ as 
paragraph (1) with the heading ‘‘IN
GEN-
ERAL.—’’; 
(B) by aligning such paragraph with the 
paragraph added by paragraph (3); and 
(C) by adding at the end the following new 
paragraph: 
‘‘(2) EXCEPTION FOR CERTAIN CASES.—The re-
quirement for an appropriate medical screening ex-
amination under paragraph (1) shall not apply in 
the case of an individual who comes to the emer-
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gency department and neither the individual, nor an-
other person on the individual’s behalf, requests ex-
amination or treatment for an emergency medical 
condition (such as a request solely for preventive 
services, such as blood pressure screening or non-
emergency laboratory and diagnostic tests).’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to terminations of par-
ticipation initiated on or after the date of the enact-
ment of this Act. 
SEC. 945. EMERGENCY MEDICAL TREATMENT AND ACTIVE 
LABOR ACT (EMTALA) TECHNICAL ADVISORY 
GROUP. 
(a) ESTABLISHMENT.—The Secretary shall establish 
a Technical Advisory Group (in this section referred to 
as the ‘‘Advisory Group’’) to review issues related to the 
Emergency 
Medical 
Treatment 
and 
Labor 
Act 
(EMTALA) and its implementation. In this section, the 
term ‘‘EMTALA’’ refers to the provisions of section 1867 
of the Social Security Act (42 U.S.C. 1395dd). 
(b) MEMBERSHIP.—The Advisory Group shall be 
composed of 19 members, including the Administrator of 
the Centers for Medicare & Medicaid Services and the In-
spector General of the Department of Health and Human 
Services and of which—
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(1) 4 shall be representatives of hospitals, in-
cluding at least one public hospital, that have experi-
ence with the application of EMTALA and at least 
2 of which have not been cited for EMTALA viola-
tions; 
(2) 7 shall be practicing physicians drawn from 
the fields of emergency medicine, cardiology or 
cardiothoracic surgery, orthopedic surgery, neuro-
surgery, pediatrics or a pediatric subspecialty, ob-
stetrics-gynecology, and psychiatry, with not more 
than one physician from any particular field; 
(3) 2 shall represent patients; 
(4) 2 shall be staff involved in EMTALA inves-
tigations from different regional offices of the Cen-
ters for Medicare & Medicaid Services; and 
(5) 1 shall be from a State survey office in-
volved in EMTALA investigations and 1 shall be 
from a peer review organization, both of whom shall 
be from areas other than the regions represented 
under paragraph (4). 
In selecting members described in paragraphs (1) through 
(3), the Secretary shall consider qualified individuals nom-
inated by organizations representing providers and pa-
tients.
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(c) GENERAL
RESPONSIBILITIES.—The Advisory 
Group—
(1) shall review EMTALA regulations; 
(2) may provide advice and recommendations to 
the Secretary with respect to those regulations and 
their application to hospitals and physicians; 
(3) shall solicit comments and recommendations 
from hospitals, physicians, and the public regarding 
the implementation of such regulations; and 
(4) may disseminate information on the applica-
tion of such regulations to hospitals, physicians, and 
the public. 
(d) ADMINISTRATIVE MATTERS.—
(1) CHAIRPERSON.—The members of the Advi-
sory Group shall elect a member to serve as chair-
person of the Advisory Group for the life of the Ad-
visory Group. 
(2) MEETINGS.—The Advisory Group shall first 
meet at the direction of the Secretary. The Advisory 
Group shall then meet twice per year and at such 
other times as the Advisory Group may provide. 
(e) TERMINATION.—The Advisory Group shall termi-
nate 30 months after the date of its first meeting. 
(f) WAIVER OF ADMINISTRATIVE LIMITATION.—The 
Secretary shall establish the Advisory Group notwith-
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standing any limitation that may apply to the number of 
advisory committees that may be established (within the 
Department of Health and Human Services or otherwise). 
SEC. 946. AUTHORIZING USE OF ARRANGEMENTS TO PRO-
VIDE CORE HOSPICE SERVICES IN CERTAIN 
CIRCUMSTANCES. 
(a) IN GENERAL.—Section 1861(dd)(5) (42 U.S.C. 
1395x(dd)(5)) is amended by adding at the end the fol-
lowing: 
‘‘(D) In extraordinary, exigent, or other non-routine 
circumstances, such as unanticipated periods of high pa-
tient loads, staffing shortages due to illness or other 
events, or temporary travel of a patient outside a hospice 
program’s service area, a hospice program may enter into 
arrangements with another hospice program for the provi-
sion by that other program of services described in para-
graph 
(2)(A)(ii)(I). 
The 
provisions 
of 
paragraph 
(2)(A)(ii)(II) shall apply with respect to the services pro-
vided under such arrangements. 
‘‘(E) A hospice program may provide services de-
scribed in paragraph (1)(A) other than directly by the pro-
gram if the services are highly specialized services of a 
registered professional nurse and are provided non-rou-
tinely and so infrequently so that the provision of such