42 U.S.C. § 1395dd — Examination and treatment for emer-

Page 3663 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd 1 So in original. Probably should be followed by a comma. § 1395dd. Examination and treatment for emer- gency medical conditions and women in labor (a) Medical screening requirement In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this subchapter) comes to the emergency department and a request is made on the individual’s behalf for examination or treatment for a medical con- dition, the hospital must provide for an appro- priate medical screening examination within the capability of the hospital’s emergency depart- ment, including ancillary services routinely available to the emergency department, to de- termine whether or not an emergency medical condition (within the meaning of subsection (e)(1)) exists. (b) Necessary stabilizing treatment for emer- gency medical conditions and labor (1) In general If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines that the individual has an emergency medical condi- tion, the hospital must provide either— (A) within the staff and facilities available at the hospital, for such further medical ex- amination and such treatment as may be re- quired to stabilize the medical condition, or (B) for transfer of the individual to an- other medical facility in accordance with subsection (c). (2) Refusal to consent to treatment A hospital is deemed to meet the require- ment of paragraph (1)(A) with respect to an in- dividual if the hospital offers the individual the further medical examination and treat- ment described in that paragraph and informs the individual (or a person acting on the indi- vidual’s behalf) of the risks and benefits to the individual of such examination and treatment, but the individual (or a person acting on the individual’s behalf) refuses to consent to the examination and treatment. The hospital shall take all reasonable steps to secure the individ- ual’s (or person’s) written informed consent to refuse such examination and treatment. (3) Refusal to consent to transfer A hospital is deemed to meet the require- ment of paragraph (1) with respect to an indi- vidual if the hospital offers to transfer the in- dividual to another medical facility in accord- ance with subsection (c) and informs the indi- vidual (or a person acting on the individual’s behalf) of the risks and benefits to the indi- vidual of such transfer, but the individual (or a person acting on the individual’s behalf) re- fuses to consent to the transfer. The hospital shall take all reasonable steps to secure the individual’s (or person’s) written informed consent to refuse such transfer. (c) Restricting transfers until individual sta- bilized (1) Rule If an individual at a hospital has an emer- gency medical condition which has not been stabilized (within the meaning of subsection (e)(3)(B)), the hospital may not transfer the in- dividual unless— (A)(i) the individual (or a legally respon- sible person acting on the individual’s be- half) 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, (ii) a physician (within the meaning of sec- tion 1395x(r)(1) of this title) has signed a cer- tification that 1 based upon the information available at the time of transfer, the med- ical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the in- creased risks to the individual and, in the case of labor, to the unborn child from ef- fecting the transfer, or (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 regu- lations) has signed a certification described in clause (ii) after a physician (as defined in section 1395x(r)(1) of this title), in consulta- tion with the person, has made the deter- mination described in such clause, and sub- sequently countersigns the certification; and (B) the transfer is an appropriate transfer (within the meaning of paragraph (2)) to that facility. A certification described in clause (ii) or (iii) of subparagraph (A) shall include a summary of the risks and benefits upon which the cer- tification is based. (2) Appropriate transfer An appropriate transfer to a medical facility is a transfer— (A) in which the transferring hospital pro- vides the medical treatment within its ca- pacity which minimizes the risks to the in- dividual’s health and, in the case of a woman in labor, the health of the unborn child; (B) in which the receiving facility— (i) has available space and qualified per- sonnel for the treatment of the individual, and (ii) has agreed to accept transfer of the individual and to provide appropriate med- ical treatment; (C) in which the transferring hospital sends to the receiving facility all medical records (or copies thereof), related to the emergency condition for which the indi- vidual has presented, available at the time of the transfer, including records related to the individual’s emergency medical condi- tion, observations of signs or symptoms, pre- liminary diagnosis, treatment provided, re- sults 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)(1)(C)) who has refused or failed to appear within a reason- able time to provide necessary stabilizing treatment; Page 3664 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd (D) in which the transfer is effected through qualified personnel and transpor- tation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer; and (E) which meets such other requirements as the Secretary may find necessary in the interest of the health and safety of individ- uals transferred. (d) Enforcement (1) Civil money penalties (A) A participating hospital that negligently violates a requirement of this section is sub- ject to a civil money penalty of not more than $50,000 (or not more than $25,000 in the case of a hospital with less than 100 beds) for each such violation. The provisions of section 1320a–7a of this title (other than subsections (a) and (b)) shall apply to a civil money pen- alty under this subparagraph in the same man- ner as such provisions apply with respect to a penalty or proceeding under section 1320a–7a(a) of this title. (B) Subject to subparagraph (C), any physi- cian 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 negligently violates a requirement of this section, including a physician who— (i) signs a certification under subsection (c)(1)(A) that the medical benefits reason- ably to be expected from a transfer to an- other 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 gross and flagrant or is repeated, to exclusion from participation in this sub- chapter and State health care programs. The provisions of section 1320a–7a of this title (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, ex- clusion, or proceeding under section 1320a–7a(a) of this title. (C) If, after an initial examination, a physi- cian determines that the individual requires the services of a physician listed by the hos- pital on its list of on-call physicians (required to be maintained under section 1395cc(a)(1)(I) of this title) and notifies the on-call physician and the on-call physician fails or refuses to ap- pear within a reasonable period of time, and the physician orders the transfer of the indi- vidual 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 trans- fer shall not be subject to a penalty under sub- paragraph (B). However, the previous sentence shall not apply to the hospital or to the on- call physician who failed or refused to appear. (2) Civil enforcement (A) Personal harm Any individual who suffers personal harm as a direct result of a participating hos- pital’s violation of a requirement of this sec- tion may, in a civil action against the par- ticipating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as is appropriate. (B) Financial loss to other medical facility Any medical facility that suffers a finan- cial loss as a direct result of a participating hospital’s violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for financial loss, under the law of the State in which the hospital is located, and such equitable relief as is appropriate. (C) Limitations on actions No action may be brought under this para- graph more than two years after the date of the violation with respect to which the ac- tion is brought. (3) Consultation with quality improvement or- ganizations In considering allegations of violations of the requirements of this section in imposing sanctions under paragraph (1) or in termi- nating a hospital’s participation under this subchapter, the Secretary shall request the appropriate quality improvement organization (with a contract under part B of subchapter XI) to assess whether the individual involved had an emergency medical condition which had not been stabilized, and provide a report on its findings. Except in the case in which a delay would jeopardize the health or safety of individuals, the Secretary shall request such a review before effecting a sanction under para- graph (1) and shall provide a period of at least 60 days for such review. Except in the case in which a delay would jeopardize the health or safety of individuals, the Secretary shall also request such a review before making a compli- ance determination as part of the process of terminating a hospital’s participation under this subchapter for violations related to the appropriateness of a medical screening exam- ination, stabilizing treatment, or an appro- priate transfer as required by this section, and shall provide a period of 5 days for such re- view. The Secretary shall provide a copy of the organization’s report to the hospital or physician consistent with confidentiality re- quirements imposed on the organization under such part B. (4) Notice upon closing an investigation The Secretary shall establish a procedure to notify hospitals and physicians when an inves- tigation under this section is closed. (e) Definitions In this section: (1) The term ‘‘emergency medical condition’’ means— (A) a medical condition manifesting itself by acute symptoms of sufficient severity (in- Page 3665 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd cluding severe pain) such that the absence of immediate medical attention could reason- ably 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 func- tions, or (iii) serious dysfunction of any bodily organ or part; or (B) with respect to a pregnant woman 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. (2) The term ‘‘participating hospital’’ means a hospital that has entered into a provider agreement under section 1395cc of this title. (3)(A) The term ‘‘to stabilize’’ means, with respect to an emergency medical condition de- scribed in paragraph (1)(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 fa- cility, or, with respect to an emergency med- ical condition described in paragraph (1)(B), to deliver (including the placenta). (B) The term ‘‘stabilized’’ means, with re- spect to an emergency medical condition de- scribed in paragraph (1)(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 emer- gency medical condition described in para- graph (1)(B), that the woman has delivered (in- cluding the placenta). (4) The term ‘‘transfer’’ means the move- ment (including the discharge) of an indi- vidual outside a hospital’s facilities at the di- rection of any person employed by (or affili- ated or associated, directly or indirectly, with) the hospital, but does not include such a movement of an individual who (A) has been declared dead, or (B) leaves the facility with- out the permission of any such person. (5) The term ‘‘hospital’’ includes a critical access hospital (as defined in section 1395x(mm)(1) of this title) and a rural emer- gency hospital (as defined in section 1395x(kkk)(2) of this title). (f) Preemption The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly con- flicts with a requirement of this section. (g) Nondiscrimination A participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma 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 appro- priate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the indi- vidual. (h) No delay in examination or treatment A participating hospital may not delay provi- sion of an appropriate medical screening exam- ination 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 qualified medical person described in subsection (c)(1)(A)(iii) or a physician because the person or physician re- fuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized or against any hospital em- ployee because the employee reports a violation of a requirement of this section. (Aug. 14, 1935, ch. 531, title XVIII, § 1867, as added Pub. L. 99–272, title IX, § 9121(b), Apr. 7, 1986, 100 Stat. 164; amended Pub. L. 99–509, title IX, § 9307(c)(4), Oct. 21, 1986, 100 Stat. 1996; Pub. L. 99–514, title XVIII, § 1895(b)(4), Oct. 22, 1986, 100 Stat. 2933; Pub. L. 100–203, title IV, § 4009(a)(1), formerly § 4009(a)(1), (2), Dec. 22, 1987, 101 Stat. 1330–56, 1330–57; Pub. L. 100–360, title IV, § 411(b)(8)(A)(i), July 1, 1988, 102 Stat. 772; Pub. L. 100–485, title VI, § 608(d)(18)(E), Oct. 13, 1988, 102 Stat. 2419; Pub. L. 101–239, title VI, §§ 6003(g)(3)(D)(xiv), 6211(a)–(h), Dec. 19, 1989, 103 Stat. 2154, 2245–2248; Pub. L. 101–508, title IV, §§ 4008(b)(1)–(3)(A), 4207(a)(1)(A), (2), (3), (k)(3), formerly 4027(a)(1)(A), (2), (3), (k)(3), Nov. 5, 1990, 104 Stat. 1388–44, 1388–117, 1388–124, renumbered and amended Pub. L. 103–432, title I, § 160(d)(4), (5)(A), Oct. 31, 1994, 108 Stat. 4444; Pub. L. 105–33, title IV, § 4201(c)(1), Aug. 5, 1997, 111 Stat. 373; Pub. L. 108–173, title VII, § 736(a)(14), title IX, § 944(b), (c)(1), Dec. 8, 2003, 117 Stat. 2355, 2423; Pub. L. 112–40, title II, § 261(a)(3)(A), (E), Oct. 21, 2011, 125 Stat. 423; Pub. L. 116–260, div. CC, title I, § 125(b)(2)(B), Dec. 27, 2020, 134 Stat. 2966.) Editorial Notes PRIOR PROVISIONS A prior section 1395dd, act Aug. 14, 1935, ch. 531, title XVIII, § 1867, as added July 30, 1965, Pub. L. 89–97, title I, § 102(a), 79 Stat. 329; amended Jan. 2, 1968, Pub. L. 90–248, title I, § 164(a), 81 Stat. 873; Oct. 30, 1972, Pub. L. 92–603, title II, § 288, 86 Stat. 1457, related to creation, composition, meetings, and functions of the Health In- surance Benefits Advisory Council and the appointment of a Chairman and members thereto, and qualifica- tions, terms of office, compensation, and reimburse- ment of travel expenses of members, prior to repeal by Pub. L. 98–369, div. B, title III, § 2349(a), July 18, 1984, 98 Stat. 1097, eff. July 18, 1984. AMENDMENTS 2020—Subsec. (e)(5). Pub. L. 116–260 inserted ‘‘and a rural emergency hospital (as defined in section 1395x(kkk)(2) of this title)’’ before period at end. 2011—Subsec. (d)(3). Pub. L. 112–40 substituted ‘‘qual- ity improvement’’ for ‘‘peer review’’ in heading and for ‘‘utilization and quality control peer review’’ in text. 2003—Subsec. (d)(1)(B). Pub. L. 108–173, § 736(a)(14)(A), substituted ‘‘if the violation is’’ for ‘‘if the violation is is’’ in concluding provisions. Page 3666 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd Subsec. (d)(3). Pub. L. 108–173, § 944(c)(1), inserted ‘‘or in terminating a hospital’s participation under this subchapter’’ after ‘‘in imposing sanctions under para- graph (1)’’ and inserted at end ‘‘Except in the case in which a delay would jeopardize the health or safety of individuals, the Secretary shall also request such a re- view before making a compliance determination as part of the process of terminating a hospital’s participation under this subchapter for violations related to the ap- propriateness of a medical screening examination, sta- bilizing treatment, or an appropriate transfer as re- quired by this section, and shall provide a period of 5 days for such review. The Secretary shall provide a copy of the organization’s report to the hospital or physician consistent with confidentiality requirements imposed on the organization under such part B.’’ Subsec. (d)(4). Pub. L. 108–173, § 944(b), added par. (4). Subsec. (e)(1)(B). Pub. L. 108–173, § 736(a)(14)(B), sub- stituted ‘‘a pregnant woman’’ for ‘‘a pregnant women’’. Subsec. (e)(2). Pub. L. 108–173, § 736(a)(14)(C), sub- stituted ‘‘means a hospital’’ for ‘‘means hospital’’. 1997—Subsec. (e)(5). Pub. L. 105–33 substituted ‘‘crit- ical access’’ for ‘‘rural primary care’’. 1994—Subsec. (d)(3). Pub. L. 103–432, § 160(d)(5)(A), made technical amendment to Pub. L. 101–508, § 4207(a)(1)(A). See 1990 Amendment note below. 1990—Subsec. (c)(2)(C). Pub. L. 101–508, § 4008(b)(3)(A)(iii), substituted ‘‘subsection (d)(1)(C)’’ for ‘‘subsection (d)(2)(C)’’. Subsec. (d)(1). Pub. L. 101–508, § 4008(b)(3)(A)(i), (ii), re- designated par. (2) as (1) and struck out former par. (1) which read as follows: ‘‘If a hospital knowingly and willfully, or negligently, fails to meet the requirements of this section, such hospital is subject to— ‘‘(A) termination of its provider agreement under this subchapter in accordance with section 1395cc(b) of this title, or ‘‘(B) at the option of the Secretary, suspension of such agreement for such period of time as the Sec- retary determines to be appropriate, upon reasonable notice to the hospital and to the public.’’ Subsec. (d)(1)(B). Pub. L. 101–508, § 4207(a)(2), (3), for- merly § 4027(a)(2), (3), as renumbered by Pub. L. 103–432, § 160(d)(4), which directed amendment of par. (2)(B) by substituting ‘‘negligently’’ for ‘‘knowingly’’ and ‘‘is gross and flagrant or is repeated’’ for ‘‘knowing and willful or negligent’’, was executed by making the sub- stitutions in par. (1)(B) to reflect the probable intent of Congress and the intervening redesignation of par. (2) as (1) by Pub. L. 101–508, § 4008(b)(3)(A)(ii). See above. Subsec. (d)(2). Pub. L. 101–508, § 4008(b)(3)(A)(ii), redes- ignated par. (3) as (2). Former par. (2) redesignated (1). Subsec. (d)(2)(A). Pub. L. 101–508, § 4008(b)(1), (2), sub- stituted ‘‘negligently’’ for ‘‘knowingly’’ and inserted ‘‘(or not more than $25,000 in the case of a hospital with less than 100 beds)’’ after ‘‘$50,000’’. Subsec. (d)(3). Pub. L. 101–508, § 4207(a)(1)(A), formerly § 4027(a)(1)(A), as renumbered and amended by Pub. L. 103–432, § 160(d)(4), (5)(A), added par. (3). Former par. (3) redesignated (2). Subsec. (i). Pub. L. 101–508, § 4207(k)(3), formerly § 4027(k)(3), as renumbered by Pub. L. 103–432, § 160(d)(4), amended subsec. (i) generally. Prior to amendment, subsec. (i) read as follows: ‘‘A participating hospital may not penalize or take adverse action against a phy- sician because the physician refuses to authorize the transfer of an individual with an emergency medical condition that has not been stabilized.’’ 1989—Pub. L. 101–239, § 6211(h)(2)(A), struck out ‘‘ac- tive’’ before ‘‘labor’’ in section catchline. Subsec. (a). Pub. L. 101–239, § 6211(h)(2)(B), which di- rected the amendment of subsec. (a) by striking out ‘‘or to determine if the individual is in active labor (within the meaning of section (e)(2))’’ was executed by strik- ing out ‘‘or to determine if the individual is in active labor (within the meaning of subsection (e)(2))’’ after ‘‘exists’’. Pub. L. 101–239, § 6211(a), substituted ‘‘hospital’s emer- gency department, including ancillary services rou- tinely available to the emergency department,’’ for ‘‘hospital’s emergency department’’. Subsec. (b). Pub. L. 101–239, § 6211(h)(2)(C), struck out ‘‘active’’ before ‘‘labor’’ in heading. Subsec. (b)(1). Pub. L. 101–239, § 6211(h)(2)(D)(i), struck out ‘‘or is in active labor’’ after ‘‘emergency medical condition’’ in introductory provisions. Subsec. (b)(1)(A). Pub. L. 101–239, § 6211(h)(2)(D)(ii), struck out ‘‘or to provide for treatment of the labor’’ after ‘‘stabilize the medical condition’’. Subsec. (b)(2). Pub. L. 101–239, § 6211(b)(1), inserted ‘‘and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the in- dividual of such examination and treatment,’’ after ‘‘in that paragraph’’, substituted ‘‘and treatment.’’ for ‘‘or treatment.’’, and inserted at end ‘‘The hospital shall take all reasonable steps to secure the individual’s (or person’s) written informed consent to refuse such ex- amination and treatment.’’ Subsec. (b)(3). Pub. L. 101–239, § 6211(b)(2), inserted ‘‘and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the in- dividual of such transfer,’’ after ‘‘subsection (c)’’ and inserted at end ‘‘The hospital shall take all reasonable steps to secure the individual’s (or person’s) written in- formed consent to refuse such transfer.’’ Subsec. (c). Pub. L. 101–239, § 6211(g)(1)(A), substituted ‘‘individual’’ for ‘‘patient’’ in heading. Subsec. (c)(1). Pub. L. 101–239, § 6211(c)(4), (g)(1)(B), (h)(2)(E), in introductory provisions, substituted ‘‘an individual’’ for ‘‘a patient’’, ‘‘subsection (e)(3)(B))’’ for ‘‘subsection (e)(4)(B)) or is in active labor’’, and ‘‘the individual’’ for ‘‘the patient’’, and inserted at end ‘‘A certification described in clause (ii) or (iii) of subpara- graph (A) shall include a summary of the risks and ben- efits upon which the certification is based.’’ Subsec. (c)(1)(A)(i). Pub. L. 101–239, § 6211(c)(1), (g)(1)(B), substituted ‘‘the individual’’ for ‘‘the pa- tient’’, ‘‘the individual’s behalf’’ for ‘‘the patient’s be- half’’, and ‘‘after being informed of the hospital’s obli- gations under this section and of the risk of transfer, in writing requests transfer to another medical facility’’ for ‘‘requests that the transfer be effected’’. Subsec. (c)(1)(A)(ii). Pub. L. 101–239, § 6211(c)(2)(B), (3), (g)(1)(B), substituted ‘‘has signed a certification that based upon the information available at the time of transfer’’ for ‘‘, or other qualified medical personnel when a physician is not readily available in the emer- gency department, has signed a certification that, based upon the reasonable risks and benefits to the pa- tient, and based upon the information available at the time’’ and ‘‘individual and, in the case of labor, to the unborn child’’ for ‘‘individual’s medical condition’’. Subsec. (c)(1)(A)(iii). Pub. L. 101–239, § 6211(c)(2)(A), (C), (D), added cl. (iii). Subsec. (c)(2)(A). Pub. L. 101–239, § 6211(c)(5), added subpar. (A). Former subpar. (A) redesignated (B). Subsec. (c)(2)(B). Pub. L. 101–239, § 6211(c)(5)(A), (g)(1)(B), redesignated subpar. (A) as (B) and sub- stituted ‘‘the individual’’ for ‘‘the patient’’ in cls. (i) and (ii). Former subpar. (B) redesignated (C). Subsec. (c)(2)(C). Pub. L. 101–239, § 6211(c)(5)(A), (d), re- designated subpar. (B) as (C) and substituted ‘‘sends to’’ for ‘‘provides’’ and ‘‘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 individ- ual’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’’ for ‘‘with appropriate medical records (or copies thereof) of the examination and treatment effected at the trans- ferring hospital’’. Former subpar. (C) redesignated (D). Subsec. (c)(2)(D). Pub. L. 101–239, § 6211(c)(5)(A), redes- ignated subpar. (C) as (D). Former subpar. (D) redesig- nated (E). Subsec. (c)(2)(E). Pub. L. 101–239, § 6211(c)(5)(A), (g)(1)(B), redesignated subpar. (D) as (E) and sub- stituted ‘‘individuals’’ for ‘‘patients’’. Page 3667 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd Subsec. (d)(2)(B). Pub. L. 101–239, § 6211(e)(1), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: ‘‘The responsible physician in a partici- pating hospital with respect to the hospital’s violation of a requirement of this subsection is subject to the sanctions described in section 1395u(j)(2) of this title, except that, for purposes of this subparagraph, the civil money penalty with respect to each violation may not exceed $50,000, rather than $2,000.’’ Subsec. (d)(2)(C). Pub. L. 101–239, § 6211(e)(2), added subpar. (C) and struck out former subpar. (C) which read as follows: ‘‘As used in this paragraph, the term ‘responsible physician’ means, with respect to a hos- pital’s violation of a requirement of this section, a phy- sician who— ‘‘(i) is employed by, or under contract with, the participating hospital, and ‘‘(ii) acting as such an employee or under such a contract, has professional responsibility for the pro- vision of examinations or treatments for the indi- vidual, or transfers of the individual, with respect to which the violation occurred.’’ Subsec. (e)(1). Pub. L. 101–239, § 6211(h)(1)(A), sub- stituted ‘‘means—’’ and subpars. (A) and (B) for ‘‘means a medical condition manifesting itself by acute symp- toms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in— ‘‘(A) placing the patient’s health in serious jeop- ardy, ‘‘(B) serious impairment to bodily functions, or ‘‘(C) serious dysfunction of any bodily organ or part.’’ Subsec. (e)(2). Pub. L. 101–239, § 6211(h)(1)(B), (E), re- designated par. (3) as (2) and struck out former par. (2) which defined ‘‘active labor’’. Subsec. (e)(3). Pub. L. 101–239, § 6211(h)(1)(E), redesig- nated par. (4) as (3). Former par. (3) redesignated (2). Subsec. (e)(4). Pub. L. 101–239, § 6211(h)(1)(E), redesig- nated par. (5) as (4). Former par. (4) redesignated (3). Subsec. (e)(4)(A). Pub. L. 101–239, § 6211(h)(1)(C), sub- stituted ‘‘emergency medical condition described in paragraph (1)(A)’’ for ‘‘emergency medical condition’’, ‘‘likely to result from or occur during’’ for ‘‘likely to result from’’, and ‘‘from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta)’’ for ‘‘from a facility’’. Subsec. (e)(4)(B). Pub. L. 101–239, § 6211(h)(1)(D), in- serted ‘‘described in paragraph (1)(A)’’ after ‘‘emer- gency medical condition’’, ‘‘or occur during’’ after ‘‘to result from’’, and ‘‘, or, with respect to an emergency medical condition described in paragraph (1)(B), that the woman has delivered (including the placenta)’’ after ‘‘from a facility’’. Subsec. (e)(5). Pub. L. 101–239, § 6211(h)(1)(E), redesig- nated par. (6) as (5). Former par. (5) redesignated (4). Pub. L. 101–239, § 6211(g)(2), substituted ‘‘an indi- vidual’’ for ‘‘a patient’’ in two places. Subsec. (e)(6). Pub. L. 101–239, § 6211(h)(1)(E), redesig- nated par. (6) as (5). Pub. L. 101–239, § 6003(g)(3)(D)(xiv), added par. (6). Subsecs. (g) to (i). Pub. L. 101–239, § 6211(f), added sub- secs. (g) to (i). 1988—Subsec. (d)(1). Pub. L. 100–360, § 411(b)(8)(A)(i), amended Pub. L. 100–203, § 4009(a)(2), see 1987 Amend- ment note below. Subsec. (d)(2). Pub. L. 100–360, § 411(b)(8)(A)(i), as amended by Pub. L. 100–485, § 608(d)(18)(E), amended Pub. L. 100–203, § 4009(a)(1), see 1987 Amendment note below. 1987—Subsec. (d)(1). Pub. L. 100–203, § 4009(a)(2), which directed insertion of a provision related to imposing the sanction described in section 1395u(j)(2)(A) of this title, was amended generally by Pub. L. 100–360, § 411(b)(8)(A)(i), so that it does not amend par. (1). Subsec. (d)(2). Pub. L. 100–203, § 4009(a)(1), as amended by Pub. L. 100–360, § 411(b)(8)(A)(i), as amended by Pub. L. 100–485, § 608(d)(18)(E), substituted subpars. (A) and (B) for ‘‘In addition to the other grounds for imposition of a civil money penalty under section 1320a–7a(a) of this title, a participating hospital that knowingly vio- lates a requirement of this section and the responsible physician in the hospital with respect to such a viola- tion are each subject, under that section, to a civil money penalty of not more than $25,000 for each such violation.’’, designated second sentence as subpar. (C), substituted ‘‘this paragraph’’ for ‘‘the previous sen- tence’’, and redesignated former subpars. (A) and (B) as cls. (i) and (ii), respectively, of subpar. (C). 1986—Subsec. (b)(2), (3). Pub. L. 99–509 struck out ‘‘le- gally responsible’’ after ‘‘individual (or a’’. Subsec. (e)(3). Pub. L. 99–514 struck out ‘‘and has, under the agreement, obligated itself to comply with the requirements of this section’’ after ‘‘section 1395cc of this title’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2020 AMENDMENT Amendment by Pub. L. 116–260 applicable to items and services furnished on or after Jan. 1, 2023, see sec- tion 125(g) of Pub. L. 116–260, set out as a note under section 1395l of this title. EFFECTIVE DATE OF 2011 AMENDMENT Amendment by Pub. L. 112–40 applicable to contracts entered into or renewed on or after Jan. 1, 2012, see sec- tion 261(e) of Pub. L. 112–40, set out as a note under sec- tion 1320c of this title. EFFECTIVE DATE OF 2003 AMENDMENT Pub. L. 108–173, title IX, § 944(c)(2), Dec. 8, 2003, 117 Stat. 2423, provided that: ‘‘The amendments made by paragraph (1) [amending this section] shall apply to terminations of participation initiated on or after the date of the enactment of this Act [Dec. 8, 2003].’’ EFFECTIVE DATE OF 1997 AMENDMENT Amendment by Pub. L. 105–33 applicable to services furnished on or after Oct. 1, 1997, see section 4201(d) of Pub. L. 105–33, set out as a note under section 1395f of this title. EFFECTIVE DATE OF 1990 AMENDMENT Amendment by section 4008(b)(1)–(3)(A) of Pub. L. 101–508 applicable to actions occurring on or after the first day of the sixth month beginning after Nov. 5, 1990, see section 4008(b)(4) of Pub. L. 101–508, set out as a note under section 1395cc of this title. Amendment by section 4207(a)(1)(A) of Pub. L. 101–508 effective on the first day of the first month beginning more than 60 days after Nov. 5, 1990, see section 4207(a)(1)(C) of Pub. L. 101–508, as amended, set out as a note under section 1320c–3 of this title. Pub. L. 101–508, title IV, § 4207(a)(4), formerly § 4027(a)(4), Nov. 5, 1990, 104 Stat. 1388–118, as renum- bered and amended by Pub. L. 103–432, title I, § 160(d)(4), (5)(B), Oct. 31, 1994, 108 Stat. 4444, provided that: ‘‘The amendments made by paragraphs (2) and (3) [amending this section] shall apply to actions occurring on or after the first day of the sixth month beginning after the date of the enactment of this Act [Nov. 5, 1990].’’ EFFECTIVE DATE OF 1989 AMENDMENT Pub. L. 101–239, title VI, § 6211(i), Dec. 19, 1989, 103 Stat. 2249, provided that: ‘‘The amendments made by this section [amending 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 [Dec. 19, 1989], without regard to whether regulations to carry out such amendments have been promulgated by such date.’’ EFFECTIVE DATE OF 1988 AMENDMENT Amendment by Pub. L. 100–485 effective as if included in the enactment of the Medicare Catastrophic Cov- erage Act of 1988, Pub. L. 100–360, see section 608(g)(1) of Page 3668 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd Pub. L. 100–485, set out as a note under section 704 of this title. Except as specifically provided in section 411 of Pub. L. 100–360, amendment by Pub. L. 100–360, as it relates to a provision in the Omnibus Budget Reconciliation Act of 1987, Pub. L. 100–203, effective as if included in the enactment of that provision in Pub. L. 100–203, see section 411(a) of Pub. L. 100–360, set out as a Reference to OBRA; Effective Date note under section 106 of Title 1, General Provisions. EFFECTIVE DATE OF 1987 AMENDMENT Pub. L. 100–203, title IV, § 4009(a)(2), formerly § 4009(a)(3), Dec. 22, 1987, 101 Stat. 1330–57, as redesig- nated by Pub. L. 100–360, title IV, § 411(b)(8)(A)(ii), July 1, 1988, 102 Stat. 772, provided that: ‘‘The amendments made by this subsection [amending this section] shall apply to actions occurring on or after the date of the enactment of this Act [Dec. 22, 1987].’’ EFFECTIVE DATE OF 1986 AMENDMENT Amendment by Pub. L. 99–514 effective, except as oth- erwise provided, as if included in enactment of the Con- solidated Omnibus Budget Reconciliation Act of 1985, Pub. L. 99–272, see section 1895(e) of Pub. L. 99–514, set out as a note under section 162 of Title 26, Internal Rev- enue Code. EFFECTIVE DATE Pub. L. 99–272, title IX, § 9121(c), Apr. 7, 1986, 100 Stat. 167, provided that: ‘‘The amendments made by this sec- tion [enacting this section and amending section 1395cc of this title] shall take effect on the first day of the first month that begins at least 90 days after the date of the enactment of this Act [Apr. 7, 1986].’’ SHORT TITLE This section is popularly known as the Emergency Medical Treatment and Labor Act (EMTALA). EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) TECHNICAL ADVISORY GROUP Pub. L. 108–173, title IX, § 945, Dec. 8, 2003, 117 Stat. 2423, provided that: ‘‘(a) ESTABLISHMENT.—The Secretary [of Health and Human Services] shall establish a Technical Advisory Group (in this section referred to as the ‘Advisory Group’) to review issues related to the Emergency Med- ical Treatment and Labor Act (EMTALA) and its im- plementation. In this section, the term ‘EMTALA’ re- fers to the provisions of section 1867 of the Social Secu- rity Act (42 U.S.C. 1395dd). ‘‘(b) MEMBERSHIP.—The Advisory Group shall be com- posed of 19 members, including the Administrator of the Centers for Medicare & Medicaid Services and the Inspector General of the Department of Health and Human Services and of which— ‘‘(1) 4 shall be representatives of hospitals, includ- ing at least one public hospital, that have experience with the application of EMTALA and at least 2 of which have not been cited for EMTALA violations; ‘‘(2) 7 shall be practicing physicians drawn from the fields of emergency medicine, cardiology or cardiothoracic surgery, orthopedic surgery, neuro- surgery, pediatrics or a pediatric subspecialty, ob- stetrics-gynecology, and psychiatry, with not more than one physician from any particular field; ‘‘(3) 2 shall represent patients; ‘‘(4) 2 shall be staff involved in EMTALA investiga- tions from different regional offices of the Centers for Medicare & Medicaid Services; and ‘‘(5) 1 shall be from a State survey office involved in EMTALA investigations and 1 shall be from a peer review organization, both of whom shall be from areas other than the regions represented under para- graph (4). In selecting members described in paragraphs (1) through (3), the Secretary shall consider qualified indi- viduals nominated by organizations representing pro- viders and patients. ‘‘(c) GENERAL RESPONSIBILITIES.—The Advisory Group— ‘‘(1) shall review EMTALA regulations; ‘‘(2) may provide advice and recommendations to the Secretary with respect to those regulations and their application to hospitals and physicians; ‘‘(3) shall solicit comments and recommendations from hospitals, physicians, and the public regarding the implementation of such regulations; and ‘‘(4) may disseminate information on the applica- tion of such regulations to hospitals, physicians, and the public. ‘‘(d) ADMINISTRATIVE MATTERS.— ‘‘(1) CHAIRPERSON.—The members of the Advisory Group shall elect a member to serve as chairperson of the Advisory Group for the life of the Advisory Group. ‘‘(2) MEETINGS.—The Advisory Group shall first meet at the direction of the Secretary. The Advisory Group shall then meet twice per year and at such other times as the Advisory Group may provide. ‘‘(e) TERMINATION.—The Advisory Group shall termi- nate 30 months after the date of its first meeting. ‘‘(f) WAIVER OF ADMINISTRATIVE LIMITATION.—The Secretary shall establish the Advisory Group notwith- standing any limitation that may apply to the number of advisory committees that may be established (with- in the Department of Health and Human Services or otherwise).’’ FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED ALIENS Pub. L. 108–173, title X, § 1011, Dec. 8, 2003, 117 Stat. 2432, provided that: ‘‘(a) TOTAL AMOUNT AVAILABLE FOR ALLOTMENT.— ‘‘(1) IN GENERAL.—Out of any funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary [of Health and Human Services] $250,000,000 for each of fiscal years 2005 through 2008 for the purpose of making allotments under this sec- tion for payments to eligible providers in States de- scribed in paragraph (1) or (2) of subsection (b). ‘‘(2) AVAILABILITY.—Funds appropriated under para- graph (1) shall remain available until expended. ‘‘(b) STATE ALLOTMENTS.— ‘‘(1) BASED ON PERCENTAGE OF UNDOCUMENTED ALIENS.— ‘‘(A) IN GENERAL.—Out of the amount appro- priated under subsection (a) for a fiscal year, the Secretary shall use $167,000,000 of such amount to make allotments for such fiscal year in accordance with subparagraph (B). ‘‘(B) FORMULA.—The amount of the allotment for payments to eligible providers in each State for a fiscal year shall be equal to the product of— ‘‘(i) the total amount available for allotments under this paragraph for the fiscal year; and ‘‘(ii) the percentage of undocumented aliens re- siding in the State as compared to the total num- ber of such aliens residing in all States, as deter- mined by the Statistics Division of the Immigra- tion and Naturalization Service, as of January 2003, based on the 2000 decennial census. ‘‘(2) BASED ON NUMBER OF UNDOCUMENTED ALIEN AP- PREHENSION STATES.— ‘‘(A) IN GENERAL.—Out of the amount appro- priated under subsection (a) for a fiscal year, the Secretary shall use $83,000,000 of such amount to make allotments, in addition to amounts allotted under paragraph (1), for such fiscal year for each of the 6 States with the highest number of undocu- mented alien apprehensions for such fiscal year. ‘‘(B) DETERMINATION OF ALLOTMENTS.—The amount of the allotment for each State described in subparagraph (A) for a fiscal year shall be equal to the product of— ‘‘(i) the total amount available for allotments under this paragraph for the fiscal year; and ‘‘(ii) the percentage of undocumented alien ap- prehensions in the State in that fiscal year as Page 3669 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395dd compared to the total of such apprehensions for all such States for the preceding fiscal year. ‘‘(C) DATA.—For purposes of this paragraph, the highest number of undocumented alien apprehen- sions for a fiscal year shall be based on the appre- hension rates for the 4-consecutive-quarter period ending before the beginning of the fiscal year for which information is available for undocumented aliens in such States, as reported by the Depart- ment of Homeland Security. ‘‘(c) USE OF FUNDS.— ‘‘(1) AUTHORITY TO MAKE PAYMENTS.—From the al- lotments made for a State under subsection (b) for a fiscal year, the Secretary shall pay the amount (sub- ject to the total amount available from such allot- ments) determined under paragraph (2) directly to el- igible providers located in the State for the provision of eligible services to aliens described in paragraph (5) to the extent that the eligible provider was not otherwise reimbursed (through insurance or other- wise) for such services during that fiscal year. ‘‘(2) DETERMINATION OF PAYMENT AMOUNTS.— ‘‘(A) IN GENERAL.—Subject to subparagraph (B), the payment amount determined under this para- graph shall be an amount determined by the Sec- retary that is equal to the lesser of— ‘‘(i) the amount that the provider demonstrates was incurred for the provision of such services; or ‘‘(ii) amounts determined under a methodology established by the Secretary for purposes of this subsection. ‘‘(B) PRO-RATA REDUCTION.—If the amount of funds allotted to a State under subsection (b) for a fiscal year is insufficient to ensure that each eligi- ble provider in that State receives the amount of payment calculated under subparagraph (A), the Secretary shall reduce that amount of payment with respect to each eligible provider to ensure that the entire amount allotted to the State for that fis- cal year is paid to such eligible providers. ‘‘(3) METHODOLOGY.—In establishing a methodology under paragraph (2)(A)(ii), the Secretary— ‘‘(A) may establish different methodologies for types of eligible providers; ‘‘(B) may base payments for hospital services on estimated hospital charges, adjusted to estimated cost, through the application of hospital-specific cost-to-charge ratios; ‘‘(C) shall provide for the election by a hospital to receive either payments to the hospital for— ‘‘(i) hospital and physician services; or ‘‘(ii) hospital services and for a portion of the on-call payments made by the hospital to physi- cians; and ‘‘(D) shall make quarterly payments under this section to eligible providers. If a hospital makes the election under subparagraph (C)(i), the hospital shall pass on payments for serv- ices of a physician to the physician and may not charge any administrative or other fee with respect to such payments. ‘‘(4) LIMITATION ON USE OF FUNDS.—Payments made to eligible providers in a State from allotments made under subsection (b) for a fiscal year may only be used for costs incurred in providing eligible services to aliens described in paragraph (5). ‘‘(5) ALIENS DESCRIBED.—For purposes of paragraphs (1) and (2), aliens described in this paragraph are any of the following: ‘‘(A) Undocumented aliens. ‘‘(B) Aliens who have been paroled into the United States at a United States port of entry for the purpose of receiving eligible services. ‘‘(C) Mexican citizens permitted to enter the United States for not more than 72 hours under the authority of a biometric machine readable border crossing identification card (also referred to as a ‘laser visa’) issued in accordance with the require- ments of regulations prescribed under section 101(a)(6) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(6)). ‘‘(d) APPLICATIONS; ADVANCE PAYMENTS.— ‘‘(1) DEADLINE FOR ESTABLISHMENT OF APPLICATION PROCESS.— ‘‘(A) IN GENERAL.—Not later than September 1, 2004, the Secretary shall establish a process under which eligible providers located in a State may re- quest payments under subsection (c). ‘‘(B) INCLUSION OF MEASURES TO COMBAT FRAUD AND ABUSE.—The Secretary shall include in the process established under subparagraph (A) meas- ures to ensure that inappropriate, excessive, or fraudulent payments are not made from the allot- ments determined under subsection (b), including certification by the eligible provider of the veracity of the payment request. ‘‘(2) ADVANCE PAYMENT; RETROSPECTIVE ADJUST- MENT.—The process established under paragraph (1) may provide for making payments under this section for each quarter of a fiscal year on the basis of ad- vance estimates of expenditures submitted by appli- cants for such payments and such other investigation as the Secretary may find necessary, and for making reductions or increases in the payments as necessary to adjust for any overpayment or underpayment for prior quarters of such fiscal year. ‘‘(e) DEFINITIONS.—In this section: ‘‘(1) ELIGIBLE PROVIDER.—The term ‘eligible pro- vider’ means a hospital, physician, or provider of am- bulance services (including an Indian Health Service facility whether operated by the Indian Health Serv- ice or by an Indian tribe or tribal organization). ‘‘(2) ELIGIBLE SERVICES.—The term ‘eligible serv- ices’ means health care services required by the ap- plication of section 1867 of the Social Security Act (42 U.S.C. 1395dd), and related hospital inpatient and out- patient services and ambulance services (as defined by the Secretary). ‘‘(3) HOSPITAL.—The term ‘hospital’ has the mean- ing given such term in section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e)), except that such term shall include a critical access hospital (as de- fined in section 1861(mm)(1) of such Act (42 U.S.C. 1395x(mm)(1)). ‘‘(4) PHYSICIAN.—The term ‘physician’ has the meaning given that term in section 1861(r) of the So- cial Security Act (42 U.S.C. 1395x(r)). ‘‘(5) INDIAN TRIBE; TRIBAL ORGANIZATION.—The terms ‘Indian tribe’ and ‘tribal organization’ have the meanings given such terms in section 4 of the Indian Health Care Improvement Act (25 U.S.C. 1603). ‘‘(6) STATE.—The term ‘State’ means the 50 States and the District of Columbia.’’ INSPECTOR GENERAL STUDY OF PROHIBITION ON HOSPITAL EMPLOYMENT OF PHYSICIANS Pub. L. 101–508, title IV, § 4008(c), Nov. 5, 1990, 104 Stat. 1388–44, directed Secretary of Health and Human Services (acting through Inspector General of Depart- ment of Health and Human Services) to conduct a study of the effect of State laws prohibiting the em- ployment of physicians by hospitals on the availability and accessibility of trauma and emergency care serv- ices, and include in such study an analysis of the effect of such laws on the ability of hospitals to meet the re- quirements of section 1867 of the Social Security Act (this section) relating to the examination and treat- ment of individuals with an emergency medical condi- tion and women in labor, with Secretary to submit a report to Congress on the study not later than 1 year after Nov. 5, 1990. Executive Documents EX. ORD. NO. 13952. PROTECTING VULNERABLE NEWBORN AND INFANT CHILDREN Ex. Ord. No. 13952, Sept. 25, 2020, 85 F.R. 62187, pro- vided: By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows: Page 3670 TITLE 42—THE PUBLIC HEALTH AND WELFARE § 1395ee SECTION 1. Purpose. Every infant born alive, no mat- ter the circumstances of his or her birth, has the same dignity and the same rights as every other individual and is entitled to the same protections under Federal law. Such laws include the Emergency Medical Treat- ment and Labor Act (EMTALA), 42 U.S.C. 1395dd, which guarantees, in hospitals that have an emergency de- partment, each individual’s right to an appropriate medical screening examination and to either stabi- lizing treatment or an appropriate transfer. They also include section 504 of the Rehabilitation Act [of 1973] (Rehab Act), 29 U.S.C. 794, which prohibits discrimina- tion against individuals with disabilities by programs and activities receiving Federal funding. In addition, the Born-Alive Infants Protection Act [of 2002], 1 U.S.C. 8, makes clear that all infants born alive are individ- uals for purposes of these and other Federal laws and are therefore afforded the same legal protections as any other person. Together, these laws help protect in- fants born alive from discrimination in the provision of medical treatment, including infants who require emer- gency medical treatment, who are premature, or who are born with disabilities. Such infants are entitled to meaningful and non-discriminatory access to medical examination and services, with the consent of a parent or guardian, when they present at hospitals receiving Federal funds. Despite these laws, some hospitals refuse the required medical screening examination and stabilizing treat- ment or otherwise do not provide potentially lifesaving medical treatment to extremely premature or disabled infants, even when parents plead for such treatment. Hospitals might refuse to provide treatment to ex- tremely premature infants—born alive before 24 weeks of gestation—because they believe these infants may not survive, may have to live with long-term disabil- ities, or may have a quality-of-life deemed to be inad- equate. Active treatment of extremely premature in- fants has, however, been shown to improve their sur- vival rates. And the denial of such treatment, or dis- couragement of parents from seeking such treatment for their children, devalues the lives of these children and may violate Federal law. SEC. 2. Policy. It is the policy of the United States to recognize the human dignity and inherent worth of every newborn or other infant child, regardless of pre- maturity or disability, and to ensure for each child due protection under the law. SEC. 3. (a) The Secretary of Health and Human Serv- ices (Secretary) shall ensure that individuals respon- sible for all programs and activities under his jurisdic- tion that receive Federal funding are aware of their ob- ligations toward infants, including premature infants or infants with disabilities, who have an emergency medical condition in need of stabilizing treatment, under EMTALA and section 504 of the Rehab Act, as in- terpreted consistent with the Born-Alive Infants Pro- tection Act. In particular, the Secretary shall ensure that individuals responsible for such programs and ac- tivities are aware that they are not excused from com- plying with these obligations, including the obligation to provide an appropriate medical screening examina- tion and stabilizing treatment or transfer, when ex- tremely premature infants are born alive or infants are born with disabilities. The Secretary shall also ensure that individuals responsible for such programs and ac- tivities are aware that they may not unlawfully dis- courage parents from seeking medical treatment for their infant child solely because of their infant child’s disability. The Secretary shall further ensure that indi- viduals responsible for such programs and activities are aware of their obligations to provide stabilizing treat- ment that will allow the infant patients to be trans- ferred to a more suitable facility if appropriate treat- ment is not possible at the initial location. (b) The Secretary shall, as appropriate and consistent with applicable law, ensure that Federal funding dis- bursed by the Department of Health and Human Serv- ices is expended in full compliance with EMTALA and section 504 of the Rehab Act, as interpreted consistent with the Born-Alive Infants Protection Act, as re- flected in the policy set forth in section 2 of this order. (i) The Secretary shall, as appropriate and to the full- est extent permitted by law, investigate complaints of violations of applicable Federal laws with respect to in- fants born alive, including infants who have an emer- gency medical condition in need of stabilizing treat- ment or infants with disabilities whose parents seek medical treatment for their infants. The Secretary shall also clarify, in an easily understandable format, the process by which parents and hospital staff may submit such complaints for investigation under appli- cable Federal laws. (ii) The Secretary shall take all appropriate enforce- ment action against individuals and organizations found through investigation to have violated applicable Federal laws, up to and including terminating Federal funding for non-compliant programs and activities. (c) The Secretary shall, as appropriate and consistent with applicable law, prioritize the allocation of Depart- ment of Health and Human Services discretionary grant funding and National Institutes of Health re- search dollars for programs and activities conducting research to develop treatments that may improve sur- vival—especially survival without impairment—of in- fants born alive, including premature infants or infants with disabilities, who have an emergency medical con- dition in need of stabilizing treatment. (d) The Secretary shall, as appropriate and consistent with applicable law, prioritize the allocation of Depart- ment of Health and Human Services discretionary grant funding to programs and activities, including hospitals, that provide training to medical personnel regarding the provision of life-saving medical treat- ment to all infants born alive, including premature in- fants or infants with disabilities, who have an emer- gency medical condition in need of stabilizing treat- ment. (e) The Secretary shall, as necessary and consistent with applicable law, issue such regulations or guidance as may be necessary to implement this order. SEC. 4. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect: (i) the authority granted by law to an executive de- partment or agency, or the head thereof; or (ii) the functions of the Director of the Office of Man- agement and Budget relating to budgetary, administra- tive, or legislative proposals. (b) This order shall be implemented consistent with applicable law and subject to the availability of appro- priations. (c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforce- able at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. DONALD J. TRUMP. § 1395ee. Practicing Physicians Advisory Council; Council for Technology and Innovation (a) Repealed. Pub. L. 111–148, title III, § 3134(b)(2), Mar. 23, 2010, 124 Stat. 435 (b) Council for Technology and Innovation (1) Establishment The Secretary shall establish a Council for Technology and Innovation within the Centers for Medicare & Medicaid Services (in this sec- tion referred to as ‘‘CMS’’). (2) Composition The Council shall be composed of senior CMS staff and clinicians and shall be chaired by the Executive Coordinator for Technology and Innovation (appointed or designated under paragraph (4)). (3) Duties The Council shall coordinate the activities of coverage, coding, and payment processes