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 provisions 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 freestanding emergency centers. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Emergency Care Im5 provement Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


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1 (1) To expand provider capacity to respond to 

2 the COVID–19 pandemic, in April of 2020 the Cen3 ters for Medicare & Medicaid Services issued a waiv4 er allowing freestanding emergency centers (FECs) 

5 to enroll as Medicare-certified hospitals and receive 

6 Medicare reimbursement for the duration of the 

7 COVID–19 public health emergency. 

8 (2) FECs are fully licensed emergency depart9 ments that are staffed by both Emergency Medicine 

10 trained physicians and registered nurses who are on11 site 24 hours a day, seven days a week, and possess 

12 licensed pharmacies, clinical laboratories, and ad13 vanced imaging services. FECs are State-licensed, 

14 and adhere to the same standards and provide the 

15 same level of care as Hospital Based Emergency 

16 Rooms, including State EMTALA regulations on 

17 treating all patients. 

18 (3) Over 110 FECs, mostly located in Texas, 

19 have enrolled and provided high-quality emergency 

20 services for all kinds of emergency conditions at sig21 nificant savings to the Medicare program and to 

22 thousands of Medicare beneficiaries. 

23 (4) An actuarial study of Medicare claims data 

24 found that FECs did not increase overall utilization 

25 of emergency care services and saved the Medicare 


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1 program 21.8 percent in lower emergency care pay2 ments for patients of similar acuity. 

3 SEC. 3. COVERAGE OF FREESTANDING EMERGENCY CEN4 TERS UNDER MEDICARE AND MEDICAID. 

5 (a) COVERAGE UNDER MEDICARE PART B.—Section 

6 1832(a)(2) of the Social Security Act (42 U.S.C. 

7 1395k(a)) is amended— 

8 (1) in subparagraph (I), by striking ‘‘and’’ at 

9 the end; 

10 (2) in subparagraph (J), by striking the period 

11 at the end and inserting ‘‘; and’’; and 

12 (3) by adding at the end the following new sub13 paragraph: 

14 ‘‘(K) emergency services (as defined in sec15 tion 2799A–1(a)(3)(C) of the Public Health 

16 Service Act) provided by a freestanding emer17 gency center (as defined in section 

18 1861(nnn)).’’. 

19 (b) FREESTANDING EMERGENCY CENTER DE20 FINED.—Section 1861 of the Social Security Act (42 

21 U.S.C. 1395x) is amended by adding at the end the fol22 lowing new subsection: 

23 ‘‘(nnn) FREESTANDING EMERGENCY CENTER.—The 

24 term ‘freestanding emergency center’ means a health care 

25 facility that— 


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1 ‘‘(1) is an independent freestanding emergency 

2 department (as defined in section 2799A–1(a)(3)(D) 

3 of the Public Health Service Act); 

4 ‘‘(2) is operational 24 hours a day, 7 days a 

5 week, and 365 days a year with a physician (as de6 fined in subsection (r)) onsite and available at all 

7 times; 

8 ‘‘(3) has in place mechanisms to allow for ap9 propriate transfers and referrals; 

10 ‘‘(4) develops, implements, and maintains an 

11 ongoing, data-driven quality assessment and per12 formance improvement (QAPI) program; 

13 ‘‘(5) is located— 

14 ‘‘(A) in a metropolitan statistical area; or 

15 ‘‘(B)(i) in the case of a facility established 

16 prior to 2020, in a rural county; or 

17 ‘‘(ii) in the case of a facility established on 

18 or after January 1, 2020, in a rural county 

19 that does not have a Medicare-certified hospital 

20 or a rural emergency hospital (as defined in 

21 subsection (kkk)(2)); 

22 ‘‘(6) has established a governing body to deter23 mine, implement, and monitor policies governing the 

24 total operation of the facility, and has oversight and 

25 accountability for the QAPI program, ensuring that 


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1 facility policies and such QAPI program are admin2 istered so as to provide quality health care in a safe 

3 environment; and 

4 ‘‘(7) meets all State requirements applicable to 

5 facilities which furnish emergency medical services 

6 to individuals but do not typically provide for stays 

7 in excess of 24 hours, and meets such other require8 ments as the Secretary may prescribe not in excess 

9 of the conditions of participation under this title 

10 that are specifically applicable to off campus dedi11 cated emergency departments of hospitals (as de12 scribed in section 482.55 of title 42, Code of Federal 

13 Regulations (or any successor regulation)), and not 

14 the conditions of participation under this title that 

15 are applicable to hospitals (as defined in subsection 

16 (e)), including rural emergency hospitals (as defined 

17 in subsection (kkk)(2)), other than with respect to 

18 compliance with the requirements described in sec19 tion 1867;’’. 

20 (c) PAYMENT UNDER MEDICARE.—Section 

21 1833(t)(21) of the Social Security Act (42 U.S.C. 

22 1395l(t)(21)) is amended by adding at the end the fol23 lowing new subparagraph: 

24 ‘‘(F) TREATMENT OF FREESTANDING

25 EMERGENCY CENTERS.—The facility payment 


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1 rate for services of a freestanding emergency 

2 center (as defined in section 1861(nnn)) for 

3 higher acuity evaluation or management level 

4 services (as represented by HCPCS codes 

5 99283–99285, or any successor codes) shall be 

6 in an amount equal to the payment that would 

7 otherwise apply to a hospital outpatient depart8 ment under this subsection, including the appli9 cation of the geographic adjustment under 

10 paragraph (2)(D) and the OPD fee schedule in11 crease factor under paragraph (3)(C)(iv).’’. 

12 (d) COVERAGE UNDER MEDICAID.—Section 

13 1905(a)(2)(A) of the Social Security Act (42 U.S.C. 

14 1396d(a)(2)(A)) is amended by inserting ‘‘, including the 

15 services of freestanding emergency centers (as defined in 

16 section 1861(nnn))’’ after ‘‘outpatient hospital services’’. 

17 (e) EFFECTIVE DATE.—The amendments made by 

18 this Act shall apply with respect to items and services fur19 nished on or after May 11, 2023. 

Æ 


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