S. 1203 — what changed

added “1784A. Examination and treatment for emergency medical conditions and women in labor

added “(a) In general—In the case of a hospital of the Department that has an emergency department, if any individual comes to the hospital or the campus of the hospital and a request is made on behalf of the individual for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists.

added “(b) Necessary stabilizing treatment for emergency medical conditions and labor

added “(1) If any individual comes to a hospital of the Department that has an emergency department or the campus of such a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either—

added “(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition; or

added “(B) for transfer of the individual to another medical facility in accordance with subsection (c).

added “(2) A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such examination and treatment, but the individual (or a person acting on behalf of the individual) refuses to consent to the examination and treatment. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such examination and treatment.

added “(3) A hospital is deemed to meet the requirement of paragraph (1) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) and informs the individual (or a person acting on behalf of the individual) of the risks and benefits to the individual of such transfer, but the individual (or a person acting on behalf of the individual) refuses to consent to the transfer. The hospital shall take all reasonable steps to secure the written informed consent of the individual (or person) to refuse such transfer.

added “(c) Restricting transfers until individual stabilized

added “(1) If an individual at a hospital of the Department has an emergency medical condition that has not been stabilized, the hospital may not transfer the individual unless—

added “(A)

added “(i) the individual (or a legally responsible person acting on behalf of the individual), after being informed of the obligations of the hospital under this section and of the risk of transfer, requests, in writing, transfer to another medical facility;

added “(ii) a physician of the Department has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual and, in the case of labor, to the unborn child from effecting the transfer; or

added “(iii) if a physician of the Department is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as defined by the Secretary for purposes of this section) has signed a certification described in clause (ii) after a physician of the Department, in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification; and

added “(B) the transfer is an appropriate transfer to that facility.

added “(2) A certification described in clause (ii) or (iii) of paragraph (1)(A) shall include a summary of the risks and benefits upon which the certification is based.

added “(3) For purposes of paragraph (1)(B), an appropriate transfer to a medical facility is a transfer—

added “(A) in which the transferring hospital provides the medical treatment within its capacity that minimizes the risks to the health of the individual and, in the case of a woman in labor, the health of the unborn child;

added “(B) in which the receiving facility—

added “(i) has available space and qualified personnel for the treatment of the individual; and

added “(ii) has agreed to accept transfer of the individual and to provide appropriate medical treatment;

added “(C) in which the transferring hospital sends to the receiving facility all medical records (or copies thereof) available at the time of the transfer relating to the emergency medical condition for which the individual has presented, including—

added “(i) observations of signs or symptoms;

added “(ii) preliminary diagnosis;

added “(iii) treatment provided;

added “(iv) the results of any tests; and

added “(v) the informed written consent or certification (or copy thereof) provided under paragraph (1)(A);

added “(D) in which the transfer is effected through qualified personnel and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer; and

added “(E) that meets such other requirements as the Secretary considers necessary in the interest of the health and safety of individuals transferred.

added “(d) Definitions—In this section:

added “(1) The term campus means, with respect to a hospital of the Department—

added “(A) the physical area immediately adjacent to the main buildings of the hospital;

added “(B) other areas and structures that are not strictly contiguous to the main buildings but are located not less than 250 yards from the main buildings; and

added “(C) any other areas determined by the Secretary to be part of the campus of the hospital.

added “(2) The term emergency medical condition means—

added “(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—

added “(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;

added “(ii) serious impairment to bodily functions; or

added “(iii) serious dysfunction of any bodily organ or part; or

added “(B) with respect to a pregnant woman who is having contractions—

added “(i) that there is inadequate time to effect a safe transfer to another hospital before delivery; or

added “(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

added “(3)

added “(A) The term to stabilize means, with respect to an emergency medical condition described in paragraph (2)(A), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (2)(B), to deliver (including the placenta).

added “(B) The term stabilized means, with respect to an emergency medical condition described in paragraph (2)(A), that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (2)(B), that the woman has delivered (including the placenta).

added “(4) The term transfer means the movement (including the discharge) of an individual outside the facilities of a hospital of the Department at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who—

added “(A) has been declared dead; or

added “(B) leaves the facility without the permission of any such person.”

added Section 7402(b)(11)(A) of title 38, United States Code, is amended by inserting “or doctoral degree” after “master's degree”.

added Not later than 15 months after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the criteria and procedures that the Secretary will use to determine appropriate staffing levels at the regional offices of the Department once the Department has transitioned to using the National Work Queue for the distribution of the claims processing workload.

added Not later than 120 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report that details the plans of the Secretary to reduce the inventory of work items listed in the Monday Morning Workload Report under End Products 130, 137, 173, 290, 400, 600, 607, 690, 930, and 960.

added It is the sense of Congress that the Secretary of Veterans Affairs should include in each Monday Morning Workload Report published by the Secretary the following:

added Section 504 of the Veterans’ Benefits Improvement Act of 1996 (Public Law 104–275; 38 U.S.C. 5101 note) is amended—

added “(c) Licensure of contract physicians

added “(1) In general—Notwithstanding any law regarding the licensure of physicians, a physician described in paragraph (2) may conduct an examination pursuant to a contract entered into under subsection (a) at any location in any State, the District of Columbia, or a Commonwealth, territory, or possession of the United States, so long as the examination is within the scope of the authorized duties under such contract.

added “(2) Physician described—A physician described in this paragraph is a physician who—

added “(A) has a current license to practice the health care profession of the physician; and

added “(B) is performing authorized duties for the Department of Veterans Affairs pursuant to a contract entered into under subsection (a).”

added “(D) indicating the highest level of education attained by each individual who transfers a portion of the individual's entitlement to educational assistance under section 3319 of this title; and”

added “(c) Coordination with State departments of labor and veterans affairs—Each Director for Veterans' Employment and Training for a State shall coordinate the Director's activities under this chapter with the State department of labor and the State department of veterans affairs.”

added “(C) For purposes of subparagraph (A), the term “active duty” does not include full-time training duty, annual training duty, and attendance, while in the active military service, at a school designated as a service school by law or by the Secretary concerned.”

added “(C) The date that—

added “(i) in the case of a surviving spouse of a veteran with a service-connected disability rated as 100 percent disabling or who dies as a result of a service-connected disability, is 10 years after the date of the veteran's death; or

added “(ii) in the case of a surviving spouse of a veteran with a service-connected disability rated as less than 100 percent disabling who does not die as a result of a service-connected disability, is three years after the date of the veteran's death.”

added “(i) Treatment of businesses after death of servicemember-owner

added “(1) If a member of the Armed Forces owns at least 51 percent of a small business concern and such member is killed in line of duty in the active military, naval, or air service, the surviving spouse or dependent child of such member who acquires such ownership rights in such small business concern shall, for the period described in paragraph (2), be treated as if the surviving spouse or dependent child were a veteran with a service-connected disability for purposes of determining the status of the small business concern as a small business concern owned and controlled by veterans for purposes of contracting goals and preferences under this section.

added “(2) The period referred to in paragraph (1) is the period beginning on the date on which the member of the Armed Forces dies and ending on the date as follows:

added “(A) In the case of a surviving spouse, the earliest of the following dates:

added “(i) The date on which the surviving spouse remarries.

added “(ii) The date on which the surviving spouse relinquishes an ownership interest in the small business concern and no longer owns at least 51 percent of such small business concern.

added “(iii) The date that is ten years after the date of the member's death.

added “(B) In the case of a dependent child, the earliest of the following dates:

added “(i) The date on which the surviving dependent child relinquishes an ownership interest in the small business concern and no longer owns at least 51 percent of such small business concern.

added “(ii) The date that is ten years after the date of the member's death.”

added Any person who is entitled under chapter 1223 of title 10, United States Code, to retired pay for nonregular service or, but for age, would be entitled under such chapter to retired pay for nonregular service shall be honored as a veteran but shall not be entitled to any benefit by reason of this honor.