I
106TH CONGRESS
1ST SESSION
H. R. 904
To assure access under group health plans and health insurance coverage
to covered emergency medical services.
IN THE HOUSE OF REPRESENTATIVES
MARCH 2, 1999
Mr. CARDIN (for himself, Mrs. ROUKEMA, Mr. SHAYS, Mr. TIERNEY, Mr.
CAMPBELL, Mr. BERRY, Mr. SERRANO, Mr. DELAHUNT, Mr. BENTSEN,
Mr. COOKSEY, Mr. ABERCROMBIE, Mr. UNDERWOOD, Mr. STARK, Mr.
DEFAZIO, Mr. KLECZKA, Mrs. JOHNSON of Connecticut, Mr. WEYGAND,
Mr. GREEN of Texas, Mr. MCNULTY, Mr. BOEHLERT, Mr. GALLEGLY,
Mr. LAFALCE, Mr. ACKERMAN, Ms. SLAUGHTER, Mr. DOYLE, Mrs.
MALONEY of New York, Mrs. THURMAN, Mr. HINCHEY, Mr. INSLEE, Mr.
LEWIS of Georgia, Mr. COYNE, Mr. ROTHMAN, Mr. ENGLISH, Mrs. MINK
of Hawaii, Mr. WALSH, Mr. KLINK, Ms. HOOLEY of Oregon, Mrs. EMER-
SON, Mr. LEVIN, Mr. DAVIS of Florida, Mr. UPTON, Ms. EDDIE BERNICE
JOHNSON of Texas, Mr. GONZALEZ, and Mrs. MYRICK) introduced the
following bill; which was referred to the Committee on Commerce, and
in addition to the Committees on Education and the Workforce, and
Ways and Means, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall within
the jurisdiction of the committee concerned
A BILL
To assure access under group health plans and health
insurance coverage to covered emergency medical 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.
This Act may be cited as the ‘‘Access to Emergency
Medical Services Act of 1999’’.
SEC. 2. EMERGENCY SERVICES.
(a) COVERAGE OF EMERGENCY SERVICES.—
(1) IN GENERAL.—If a group health plan, or
health insurance coverage offered by a health insur-
ance issuer, provides any benefits with respect to
emergency services (as defined in paragraph (2)(B)),
the plan or issuer shall cover emergency services fur-
nished under the plan or coverage—
(A) without the need for any prior author-
ization determination;
(B) whether or not the health care pro-
vider furnishing such services is a participating
provider with respect to such services;
(C) in a manner so that, if such services
are provided to a participant, beneficiary, or en-
rollee by a nonparticipating health care pro-
vider, the participant, beneficiary, or enrollee is
not liable for amounts that exceed the amounts
of liability that would be incurred if the services
were provided by a participating provider; and
(D) without regard to any other term or
condition of such plan or coverage (other than
exclusion or coordination of benefits, or an af-
filiation or waiting period, permitted under sec-
tion 2701 of the Public Health Service Act, sec-
tion 701 of the Employee Retirement Income
Security Act of 1974, or section 9801 of the In-
ternal Revenue Code of 1986, and other than
applicable cost sharing).
(2) DEFINITIONS.—In this section:
(A) EMERGENCY
MEDICAL
CONDITION
BASED ON PRUDENT LAYPERSON STANDARD.—
The term ‘‘emergency medical condition’’ means
a medical condition manifesting itself by acute
symptoms of sufficient severity (including se-
vere pain) such that a prudent layperson, who
possesses an average knowledge of health and
medicine, could reasonably expect the absence
of immediate medical attention to result in a
condition described in clause (i), (ii), or (iii) of
section 1867(e)(1)(A) of the Social Security Act
(42 U.S.C. 1395dd(e)(1)(A)).
(B) EMERGENCY
SERVICES.—The term
‘‘emergency services’’ means—
(i) a medical screening examination
(as required under section 1867 of the So-
cial Security Act, 42 U.S.C. 1395dd)) that
is within the capability of the emergency
(B) upon request, make available to par-
ticipants and beneficiaries, to the applicable au-
thority, and to prospective participants and
beneficiaries the information described in para-
graph (3) in printed form.
(2) HEALTH
INSURANCE
ISSUERS.—A health
insurance issuer, in connection with the provision of
health insurance coverage, shall—
(A) provide to individuals enrolled under
such coverage at the time of enrollment, and at
least annually thereafter, (and to plan adminis-
trators of group health plans in connection with
which such coverage is offered) the information
described in paragraph (3) in printed form; and
(B) upon request, make available to the
applicable authority, to individuals who are pro-
spective enrollees, to plan administrators of
group health plans that may obtain such cov-
erage, and to the public the information de-
scribed in paragraph (3) in printed form.
(3) REQUIRED
INFORMATION.—The informa-
tion described in this paragraph with respect to a
group health plan or health insurance coverage of-
fered by a health insurance issuer is information
about 
the 
coverage 
of 
emergency 
services,
including—
(A) the appropriate use of emergency serv-
ices, including use of the 911 telephone system
or its local equivalent in emergency situations
and an explanation of what constitutes an
emergency situation;
(B) the process and procedures of the plan
or issuer for obtaining emergency services;
(C) any cost-sharing applicable to emer-
gency services; and
(D) the locations of—
(i) emergency departments; and
(ii) other settings in which plan physi-
cians and hospitals provide emergency
services and post-stabilization care.
(d) DEFINITIONS.—For purposes of this section—
(1) The term ‘‘applicable authority’’ means—
(A) in the case of a group health plan, the
Secretary of Health and Human Services and
the Secretary of Labor; and
(B) in the case of a health insurance issuer
with respect to a specific provision of this sec-
tion, the applicable State authority or the Sec-
retary of Health and Human Services if such
Secretary is enforcing such provisions under
section 2722(a)(2) or 2761(a)(2) of the Public
Health Service Act (42 U.S.C. 300gg–22(a)(2),
300gg–61(a)(2)).
(2) The terms ‘‘applicable State authority’’,
‘‘beneficiary’’, ‘‘group health plan’’, ‘‘health insur-
ance coverage’’, ‘‘health insurance issuer’’, and ‘‘par-
ticipant’’ shall have the meanings given to such
terms in section 2791 of the Public Health Service
Act (42 U.S.C. 300gg–91).
(3) The term ‘‘nonparticipating’’ means, with
respect to a health care provider that provides health
care items and services to a participant, beneficiary,
or enrollee under a group health plan or health in-
surance coverage, a health care provider that is not
a participating health care provider with respect to
such items and services.
(4) The term ‘‘participating’’ means, with re-
spect to a health care provider that provides health
care items and services to a participant, beneficiary,
or enrollee under a group health plan or health in-
surance coverage offered by a health insurance
issuer, a health care provider that furnishes such
items and services under a contract or other ar-
rangement with the plan or issuer.
SEC. 3. STANDARDS UNDER THE PUBLIC HEALTH SERVICE
ACT.
(a) GROUP MARKET.—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. 2707. EMERGENCY SERVICES.
‘‘(a) IN GENERAL.—Each group health plan (and
each health insurance issuer offering group health insur-
ance coverage in connection with such a plan) shall comply
with the requirements of the Access to Emergency Medical
Services Act of 1999, and such requirements shall be
deemed to be incorporated into this subsection.
‘‘(b) NOTICE.—A group health plan shall comply with
the notice requirement under section 711(d) of the Em-
ployee Retirement Income Security Act with respect to the
requirements referred to in subsection (a), and a health
insurance issuer shall comply with such notice requirement
as if such section applied to such issuer and such issuer
were a group health plan.’’.
(b) INDIVIDUAL MARKET.—Part B of title XXVII of
the Public Health Service Act is amended by inserting
after section 2752 the following new section:
‘‘SEC. 2753. EMERGENCY SERVICES.
‘‘(a) IN GENERAL.—Each health insurance issuer
shall comply with the requirements of the Access to Emer-
gency Medical Services Act of 1999 with respect to indi-
vidual health insurance coverage it offers, and such re-
quirements shall be deemed to be incorporated into this
subsection.
‘‘(b) NOTICE.—A health insurance issuer under this
part shall comply with the notice requirement under sec-
tion 711(d) of the Employee Retirement Income Security
Act with respect to the requirements referred to in sub-
section (a) as if such section applied to such issuer and
such issuer were a group health plan.’’.
SEC. 4. STANDARDS UNDER THE EMPLOYEE RETIREMENT
INCOME 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. 714. EMERGENCY SERVICES.
‘‘(a) IN GENERAL.—Subject to subsection (b), a
group health plan (and a health insurance issuer offering
group health insurance coverage in connection with such
a plan) shall comply with the requirements of the Access
to Emergency Medical Services Act of 1999, and such re-
quirements shall be deemed to be incorporated into this
subsection.
‘‘(b) SATISFACTION OF REQUIREMENTS.—For pur-
poses of subsection (a), insofar as a group health plan pro-
vides benefits in the form of health insurance coverage
through a health insurance issuer, the plan shall be treat-
ed as meeting the requirements of the Access to Emer-
gency Medical Services Act of 1999 with respect to such
benefits and not be considered as failing to meet such re-
quirements because of a failure of the issuer to meet such
requirements so long as the plan sponsor or its representa-
tives did not cause such failure by the issuer.’’.
(b) CONFORMING AMENDMENT.—Section 732(a) of
such Act (29 U.S.C. 1191a(a)) is amended by striking
‘‘section 711’’ and inserting ‘‘sections 711 and 714’’.
(c) CLERICAL AMENDMENT.—The table of contents
in section 1 of such Act is amended by inserting after the
item relating to section 713 the following new item:
‘‘Sec. 714. Emergency services.’’.
SEC. 5. STANDARDS UNDER THE INTERNAL REVENUE CODE
OF 1986.
Subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended—
(1) in the table of sections, by inserting after
the item relating to section 9812 the following new
item:
‘‘Sec. 9813. Standard relating to emergency services.’’; and
(2) by inserting after section 9812 the follow-
ing:
‘‘SEC. 9813. STANDARD RELATING TO EMERGENCY SERV-
ICES.
‘‘A group health plan shall comply with the require-
ments of the Access to Emergency Medical Services Act
of 1999, and such requirements shall be deemed to be in-
corporated into this section.’’.
SEC. 6. EFFECTIVE DATE.
(a) GROUP HEALTH COVERAGE.—
(1) IN GENERAL.—Subject to paragraph (2),
the amendments made by sections 3(a), 4, and 5
(and section 2 insofar as it relates to such sections)
apply to group health plans for plan years beginning
on or after January 1, 2000.
(2) TREATMENT OF COLLECTIVE BARGAINING
AGREEMENTS.—In the case of a group health plan
maintained pursuant to 1 or more collective bargain-
ing agreements between employee representatives
and 1 or more employers ratified before the date of
the enactment of this Act, the amendments made by
sections 3(a), 4, and 5 (and section 2 insofar as it
relates to such sections) shall not apply to plan
years beginning before the later of—
(A) the date on which the last collective
bargaining agreement relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of the
enactment of this Act); or
(B) January 1, 2000.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan that amends the plan
solely to conform to any requirement of this Act
shall not be treated as a termination of such collec-
tive bargaining agreement.
(b) INDIVIDUAL MARKET.—The amendment made by
section 3(b) (and section 2 insofar as it relates to such
section) applies with respect to health insurance coverage
offered, sold, issued, renewed, in effect, or operated in the
individual market on or after January 1, 2000.
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