November 2, 2001

Energy and Commerce Bill Addresses EMTALA Regulations

The full House Energy and Commerce Committee Oct. 31 unanimously passed a Medicare regulatory relief bill, the Medicare Regulatory, Appeals, Contracting, and Education Reform Act of 2001 (H.R. 3046) ("Medicare RACER Act"). The mark - an amendment in the nature of a substitute offered by Rep. Michael Bilirakis (R-Fla.) - includes most provisions contained in the House Ways and Means Committee's Medicare regulatory relief/reform bill, the Medicare Regulatory and Contracting Reform Act of 2001 (H.R. 2768) (MRCRA). The Ways and Means bill passed the full committee in early October [see Washington Highlights, Sept. 28, Oct. 5, 19].

Unique to the Commerce bill is a provision that directs the Department of Health and Human Services (HHS) to establish an Emergency Medical Treatment and Active Labor Act (EMTALA) Task Force that includes hospital administrators and physicians. The Task Force will review EMTALA regulations; solicit comments/recommendations from hospitals, physicians, and the public regarding the implementation of such regulations; and advise the HHS Secretary accordingly. The Task Force would also comprise the Administrator of the Centers for Medicare and Medicaid Services (CMS), the HHS Inspector General, a consumer representative, and an attorney with expertise in EMTALA defense cases.

In addition, the RACER Act requires HHS to notify hospitals and physicians when an EMTALA investigation closes, grant peer review for providers facing Medicare termination, and allow treating physicians to determine whether EMTALA services are reasonable and necessary based on the information available at the time the care was provided.

Reflecting committee concerns that the potential financial obligation implied by advance beneficiary notices discourages Medicare beneficiaries from receiving care, the RACER Act directs HHS to create a "prior determination process" that informs Medicare beneficiaries of coverage eligibility before receiving certain services. The bill also contains provisions to create a process for requesting exceptions to national coverage decisions.

Information: Chris Mitchell, AAMC Office of Governmental Relations, 202-828-0526.