Lawmakers Reintroduce Bill Requiring Coverage if ‘Prudent Layperson’ Deems Case an Emergency

For the fourth consecutive Congress, lawmakers have reintroduced a bill that would impose a "prudent layperson" standard for reimbursement of emergency care, CongressDaily reports. The bill, titled the "Access to Emergency Medical Services Act," would require health insurers to pay for care in a hospital emergency room if a "'prudent layperson' believes his or her symptoms warrant such care." The bill was introduced in the Senate by Sens. Bob Graham (D-Fla.) and Lincoln Chafee (R-R.I.), and in the House by Reps. Benjamin Cardin (D-Md.) and Marge Roukema (R-N.J.). Although such coverage for emergency care has been a "consensus portion" of "virtually every" patients' rights bill in both the House and Senate, it has failed to become law due to "continuing disputes over the broader bill." Although 32 states have passed their own prudent layperson laws, Cardin said that a national law is still necessary. "Health plan enrollees in 28 other states and 50 million persons in ERISA self-insured plans across the nation are still not covered by these protections," he said since only the federal government can regulate such plans (CongressDaily, 5/2). Last session, Chafee's father, the late Sen. John Chafee (R-R.I.), was a co-sponsor of the bill (American Health Line, 3/3/99).