What This Bill Does
This bill amends Medicare and Medicaid to cover emergency services provided by freestanding emergency centers (independent emergency departments that operate separately from hospitals). The bill allows these facilities to receive Medicare reimbursement and Medicaid coverage for emergency care services.
Who It Affects
Medicare beneficiaries, Medicaid beneficiaries, freestanding emergency centers seeking Medicare and Medicaid participation, and state health agencies that license these facilities.
Key Provisions
• Medicare Part B now covers emergency services provided by freestanding emergency centers (Sec. 3(a))
• Freestanding emergency centers must operate 24 hours a day, 7 days a week, 365 days a year with a physician onsite at all times (Sec. 3(b))
• Facilities must have a quality assessment and performance improvement program and a governing body to oversee operations and ensure quality care (Sec. 3(b))
• Payment for higher acuity emergency services at freestanding emergency centers equals the payment rate for hospital outpatient departments, including geographic adjustments (Sec. 3(c))
• Medicaid now covers services provided by freestanding emergency centers as part of outpatient hospital services (Sec. 3(d))
What Changes
If this bill becomes law, freestanding emergency centers can enroll in Medicare and receive reimbursement for emergency services. These facilities also become covered under Medicaid. Previously, these centers only had temporary coverage during the COVID-19 public health emergency.
Important Definitions
Freestanding emergency center: A healthcare facility that is an independent emergency department operating 24/7/365 with an onsite physician, established transfer mechanisms, a quality improvement program, and a governing body. The facility must meet state licensing requirements and be located in a metropolitan area or, if built before 2020, in a rural county (or after 2020, in a rural county without a Medicare-certified hospital or rural emergency hospital).
Effective Date
The amendments apply to services furnished on or after May 11, 2023.
I
118TH CONGRESS
1ST SESSION H. R. 1694
To amend titles XVIII and XIX of the Social Security Act to provide for
coverage of services furnished by freestanding emergency centers.
IN THE HOUSE OF REPRESENTATIVES
MARCH 22, 2023
Mr. ARRINGTON (for himself, Mr. VICENTE GONZALEZ of Texas, Mr. CLOUD,
Mr. BURGESS, and Mr. SESSIONS) introduced the following bill; which
was referred to the Committee on Energy and Commerce, and in addition
to the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To amend titles XVIII and XIX of the Social Security Act
to provide for coverage of services furnished by free-
standing emergency centers.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Emergency Care Im-
4
provement Act’’.
5
SEC. 2. FINDINGS.
6
Congress finds the following:
7
VerDate Sep 11 2014
21:02 Apr 05, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H1694.IH
H1694
pbinns on DSKJLVW7X2PROD with $$_JOB
2
•HR 1694 IH
(1) To expand provider capacity to respond to
1
the COVID–19 pandemic, in April of 2020 the Cen-
2
ters for Medicare & Medicaid Services issued a waiv-
3
er allowing freestanding emergency centers (FECs)
4
to enroll as Medicare-certified hospitals and receive
5
Medicare reimbursement for the duration of the
6
COVID–19 public health emergency.
7
(2) FECs are fully licensed emergency depart-
8
ments that are staffed by both Emergency Medicine
9
trained physicians and registered nurses who are on-
10
site 24 hours a day, seven days a week, and possess
11
licensed pharmacies, clinical laboratories, and ad-
12
vanced imaging services. FECs are State-licensed,
13
and adhere to the same standards and provide the
14
same level of care as Hospital Based Emergency
15
Rooms, including State EMTALA regulations on
16
treating all patients.
17
(3) Over 110 FECs, mostly located in Texas,
18
have enrolled and provided high-quality emergency
19
services for all kinds of emergency conditions at sig-
20
nificant savings to the Medicare program and to
21
thousands of Medicare beneficiaries.
22
(4) An actuarial study of Medicare claims data
23
found that FECs did not increase overall utilization
24
of emergency care services and saved the Medicare
25
VerDate Sep 11 2014
21:02 Apr 05, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H1694.IH
H1694
pbinns on DSKJLVW7X2PROD with $$_JOB
3
•HR 1694 IH
program 21.8 percent in lower emergency care pay-
1
ments for patients of similar acuity.
2
SEC. 3. COVERAGE OF FREESTANDING EMERGENCY CEN-
3
TERS UNDER MEDICARE AND MEDICAID.
4
(a) COVERAGE UNDER MEDICARE PART B.—Section
5
1832(a)(2) of the Social Security Act (42 U.S.C.
6
1395k(a)) is amended—
7
(1) in subparagraph (I), by striking ‘‘and’’ at
8
the end;
9
(2) in subparagraph (J), by striking the period
10
at the end and inserting ‘‘; and’’; and
11
(3) by adding at the end the following new sub-
12
paragraph:
13
‘‘(K) emergency services (as defined in sec-
14
tion 2799A–1(a)(3)(C) of the Public Health
15
Service Act) provided by a freestanding emer-
16
gency
center
(as
defined
in
section
17
1861(nnn)).’’.
18
(b) FREESTANDING
EMERGENCY
CENTER
DE-
19
FINED.—Section 1861 of the Social Security Act (42
20
U.S.C. 1395x) is amended by adding at the end the fol-
21
lowing new subsection:
22
‘‘(nnn) FREESTANDING EMERGENCY CENTER.—The
23
term ‘freestanding emergency center’ means a health care
24
facility that—
25
VerDate Sep 11 2014
21:02 Apr 05, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H1694.IH
H1694
pbinns on DSKJLVW7X2PROD with $$_JOB
4
•HR 1694 IH
‘‘(1) is an independent freestanding emergency
1
department (as defined in section 2799A–1(a)(3)(D)
2
of the Public Health Service Act);
3
‘‘(2) is operational 24 hours a day, 7 days a
4
week, and 365 days a year with a physician (as de-
5
fined in subsection (r)) onsite and available at all
6
times;
7
‘‘(3) has in place mechanisms to allow for ap-
8
propriate transfers and referrals;
9
‘‘(4) develops, implements, and maintains an
10
ongoing, data-driven quality assessment and per-
11
formance improvement (QAPI) program;
12
‘‘(5) is located—
13
‘‘(A) in a metropolitan statistical area; or
14
‘‘(B)(i) in the case of a facility established
15
prior to 2020, in a rural county; or
16
‘‘(ii) in the case of a facility established on
17
or after January 1, 2020, in a rural county
18
that does not have a Medicare-certified hospital
19
or a rural emergency hospital (as defined in
20
subsection (kkk)(2));
21
‘‘(6) has established a governing body to deter-
22
mine, implement, and monitor policies governing the
23
total operation of the facility, and has oversight and
24
accountability for the QAPI program, ensuring that
25
VerDate Sep 11 2014
21:02 Apr 05, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H1694.IH
H1694
pbinns on DSKJLVW7X2PROD with $$_JOB
5
•HR 1694 IH
facility policies and such QAPI program are admin-
1
istered so as to provide quality health care in a safe
2
environment; and
3
‘‘(7) meets all State requirements applicable to
4
facilities which furnish emergency medical services
5
to individuals but do not typically provide for stays
6
in excess of 24 hours, and meets such other require-
7
ments as the Secretary may prescribe not in excess
8
of the conditions of participation under this title
9
that are specifically applicable to off campus dedi-
10
cated emergency departments of hospitals (as de-
11
scribed in section 482.55 of title 42, Code of Federal
12
Regulations (or any successor regulation)), and not
13
the conditions of participation under this title that
14
are applicable to hospitals (as defined in subsection
15
(e)), including rural emergency hospitals (as defined
16
in subsection (kkk)(2)), other than with respect to
17
compliance with the requirements described in sec-
18
tion 1867;’’.
19
(c)
PAYMENT
UNDER
MEDICARE.—Section
20
1833(t)(21) of the Social Security Act (42 U.S.C.
21
1395l(t)(21)) is amended by adding at the end the fol-
22
lowing new subparagraph:
23
‘‘(F)
TREATMENT
OF
FREESTANDING
24
EMERGENCY
CENTERS.—The facility payment
25
VerDate Sep 11 2014
21:02 Apr 05, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H1694.IH
H1694
pbinns on DSKJLVW7X2PROD with $$_JOB
6
•HR 1694 IH
rate for services of a freestanding emergency
1
center (as defined in section 1861(nnn)) for
2
higher acuity evaluation or management level
3
services (as represented by HCPCS codes
4
99283–99285, or any successor codes) shall be
5
in an amount equal to the payment that would
6
otherwise apply to a hospital outpatient depart-
7
ment under this subsection, including the appli-
8
cation of the geographic adjustment under
9
paragraph (2)(D) and the OPD fee schedule in-
10
crease factor under paragraph (3)(C)(iv).’’.
11
(d)
COVERAGE
UNDER
MEDICAID.—Section
12
1905(a)(2)(A) of the Social Security Act (42 U.S.C.
13
1396d(a)(2)(A)) is amended by inserting ‘‘, including the
14
services of freestanding emergency centers (as defined in
15
section 1861(nnn))’’ after ‘‘outpatient hospital services’’.
16
(e) EFFECTIVE DATE.—The amendments made by
17
this Act shall apply with respect to items and services fur-
18
nished on or after May 11, 2023.
19
Æ
VerDate Sep 11 2014
21:02 Apr 05, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6301
E:\BILLS\H1694.IH
H1694
pbinns on DSKJLVW7X2PROD with $$_JOB