MEDICARE HOSPITAL PATIENT PROTECTION AMENDMENTS.

SEC. 6211. MEDICARE HOSPITAL PATIENT PROTECTION AMENDMENTS. (a) Scope of Hospital Responsibility for Screening.—Subsection (a) of section 1867 of the Social Security Act (42 U.S.C. 1395dd) is amended by striking “department” the third place it appears and inserting the following: “department, including ancillary services routinely available to the emergency department,”. (b) Informed Refusals of Treatment or Transfers.—Subsection (b) of such section is amended— (1) in paragraph (2)— (A) by inserting “and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of such examination and treatment,” after “in that paragraph”, (B) by striking “or treatment” and inserting “and treatment”, and (C) by adding at the end the following new sentence: “The hospital shall take all reasonable steps to secure the individual’s (or person’s) written informed consent to refuse such examination and treatment.”; and (2) in paragraph (3)— (A) by inserting “and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of such transfer,” after “with subsection (c)”, and 103 STAT. 2246 (B) by adding at the end the following new sentence: “The hospital shall take all reasonable steps to secure the individual’s (or person’s) written informed consent to refuse such transfer.”. (c) Authorization for Transfers.— (1) Informed consent for transfers at individual request.—Subsection (c)(1)(A)(i) of such section is amended by striking “requests that the transfer be effected” and inserting “after being informed of the hospital’s obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility”. (2) Clarifying physician authorization for transfers.— Subsection (c)(1)(A) of such section is amended— (A) by striking “or” at the end of clause (i); (B) in clause (ii)—ii (i) by striking “, or other qualified medical personnel when a physician is not readily available in the emergency department,”, and (ii) by inserting “of transfer” after “information available at the time”: (C) by striking and” at the end of clause (ii) and inserting “, or”, and (D) by adding at the end the following new clause: “(iii) if a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as defined by the Secretary in regulations) has signed a certification described in clause (ii) after a physician (as defined in section 1861(r)(1)), in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and”. (3) Standard for authorizing transfer.— Subsection (c)(1)(A)(ii) of such section is amended— (A) by striking “, based upon the reasonable risks and benefits to the patient, and”, and (B) by striking “individual’s medical condition” and inserting “individual and, in the case of labor, to the unborn child”. (4) Inclusion of summary of risks and benefits in certificate of transfer.—Subsection (c)(1) of such section is amended by adding at the end the following: “A certification described in clause (ii) or (iii) of subparagraph (A) shall include a summary of the risks and benefits upon which the certification is based.”. (5) Provision of services pending transfer.— Subsection (c)(2) of such section is amended— (A) by redesignating subparagraphs (A) through (D) as subparagraphs (B) through (E), respectively, and (B) by inserting before subparagraph (B), as so redesignated, the following new subparagraph: “(A) in which the transferring hospital provides the medical treatment within its capacity which minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child;”. (d) Requiring Maintenance of Records of Transfers.—Subsection (c)(2)(C) of such section, as redesignated by subsection (c)(5)(A) of this section, is amended— (1) by striking “provides” and inserting “sends to”, and 103 STAT. 2247 (2) by striking “with appropriate medical records” and all that follows through “transferring hospital” and inserting “all medical records (or copies thereof), related to the emergency condition for which the individual has presented, available at the time of the transfer, including records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) provided under paragraph (1)(A), and the name and address of any on-call physician (described in subsection (d)(2)(C)) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment”. (e) Physician Liability.—Subsection (d)(2) of such subsection is amended— (1) by amending subparagraph (B) to read as follows: “(B) Subject to subparagraph (C), any physician who is responsible for the examination, treatment, or transfer of an individual in a participating hospital, including a physician on-call for the care of such an individual, and who knowingly violates a requirement of this section, including a physician who— “(i) signs a certification under subsection (c)(1)(A) that the medical benefits reasonably to be expected from a transfer to another facility outweigh the risks associated with the transfer, if the physician knew or should have known that the benefits did not outweigh the risks, or “(ii) misrepresents an individual’s condition or other information, including a hospital’s obligations under this section, is subject to a civil money penalty of not more than $50,000 for each such violation and, if the violation is knowing and willful or negligent, to exclusion from participation in this title and State health care programs. The provisions of section 1128A (other than the first and second sentences of subsection (a) and subsection (b)) shall apply to a civil money penalty and exclusion under this subparagraph in the same manner as such provisions apply with respect to a penalty, exclusion, or proceeding under section 1128A(a).”; and (2) by striking subparagraph (C) and inserting the following: “(C) If, after an initial examination, a physician determines that the individual requires the services of a physician listed by the hospital on its list of on-call physicians (required to be maintained under section 1866(a)(1)(I)) and notifies the on-call physician and the on-call physician fails or refuses to appear within a reasonable period of time, and the physician orders the transfer of the individual because the physician determines that without the services of the on-call physician the benefits of transfer outweigh the risks of transfer, the physician authorizing the transfer shall not be subject to a penalty under subparagraph (B). However, the previous sentence shall not apply to the hospital or to the on-call physician who failed or refused to appear.”. (f) Additional Obligations.—Such section is amended by adding at the end the following new subsections: “(g) Nondiscrimination.—A participating hospital that has specialized capabilities or facilities (such as burn units, shock-103 STAT. 2248trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual. “(h) No Delay in Examination or Treatment.—A participating hospital may not delay provision of an appropriate medical screening examination required under subsection (a) or further medical examination and treatment required under subsection (b) in order to inquire about the individual’s method of payment or insurance status. “(i) Whistleblower Protections.—A participating hospital may not penalize or take adverse action against a physician because the physician refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized.”. (g) Change in “Patient” Terminology.— (1) Subsection (c) of such section is amended— (A) by striking “Patient” and inserting “Individual”, and (B) by striking “a patient” “the patient”, “patient’s”, and “patients” each place each appears and inserting “an individual”, “the individual”, “individual’s”, and “individuals”, respectively. (2) Subsection (e)(5) of such section is amended by striking “a patient” each place it appears and inserting “an individual”. (h) Clarification of “Emergency Medical Condition” Definition.— (1) In general.— Subsection (e) of such section (as amended by section 6003(g)(3)(D)(xiv)) is amended— (A) in paragraph (1), by striking “means” and all that follows and inserting the following: “means— “(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in— “(i) placing the health of the individual (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; or “(B) with respect to a pregnant women who is having contractions— “(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or “(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.”; (B) by striking paragraph (2); (C) in paragraph (4)(A)— (i) by inserting “described in paragraph (1)(A)” after “emergency medical condition”, (ii) by inserting “or occur during” after “likely to result from”, (iii) by inserting before the period at the end the following: “, or, with respect to an emergency medical 103 STAT. 2249condition described in paragraph (1)(B), to deliver (including the placenta)”; (D) in paragraph (4)(B)— (i) by inserting “described in paragraph (1)(A)” after “emergency medical condition”, (ii) by inserting “or occur during” after “to result from”, and (iii) by inserting before the period at the end the following: “, or, with respect to an emergency medical condition described in paragraph (1)(B), that the woman has delivered (including the placenta)”; and (E) by redesignating paragraphs (3) through (6) as paragraphs (2) through (5), respectively. (2) Conforming amendments.— Such section is further amended— (A) in the heading, by striking “active”; (B) in subsection (a), by striking “or to determine if the individual is in active labor (within the meaning of section (e)(2))”; (C) in the heading of subsection (b), by striking “Active”; (D) in subsection (b)(1)— (i) by striking “or is in active labor”, and (ii) in subparagraph (A), by striking “or to provide for treatment of the labor”; and (E) in subsection (c)(1), by striking “(e)(4)(B)) or is in active labor” and inserting “(e)(3)(B))”. (i) Effective Date.—The amendments made by this section shall take effect on the first day of the first month that begins more than 180 days after the date of the enactment of this Act, without regard to whether regulations to carry out such amendments have been promulgated by such date.