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-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Emergency Care Im-
provement Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) To expand provider capacity to respond to 
the COVID–19 pandemic, in April of 2020 the Cen-
ters for Medicare & Medicaid Services issued a waiv-
er allowing freestanding emergency centers (FECs) 
to enroll as Medicare-certified hospitals and receive 
Medicare reimbursement for the duration of the 
COVID–19 public health emergency. 
(2) FECs are fully licensed emergency depart-
ments that are staffed by both Emergency Medicine 
trained physicians and registered nurses who are on- 
site 24 hours a day, seven days a week, and possess 
licensed pharmacies, clinical laboratories, and ad-
vanced imaging services. FECs are State-licensed, 
and adhere to the same standards and provide the 
same level of care as Hospital Based Emergency 
Rooms, including State EMTALA regulations on 
treating all patients. 
(3) Over 110 FECs, mostly located in Texas, 
have enrolled and provided high-quality emergency 
services for all kinds of emergency conditions at sig-
nificant savings to the Medicare program and to 
thousands of Medicare beneficiaries. 
(4) An actuarial study of Medicare claims data 
found that FECs did not increase overall utilization 
of emergency care services and saved the Medicare 
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program 21.8 percent in lower emergency care pay-
ments for patients of similar acuity. 
SEC. 3. COVERAGE OF FREESTANDING EMERGENCY CEN-
TERS UNDER MEDICARE AND MEDICAID. 
(a) COVERAGE UNDER MEDICARE PART B.—Section 
1832(a)(2) of the Social Security Act (42 U.S.C. 
1395k(a)) is amended— 
(1) in subparagraph (I), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (J), by striking the period 
at the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(K) emergency services (as defined in sec-
tion 2799A–1(a)(3)(C) of the Public Health 
Service Act) provided by a freestanding emer-
gency 
center 
(as 
defined 
in 
section 
1861(nnn)).’’. 
(b) FREESTANDING
EMERGENCY
CENTER
DE-
FINED.—Section 1861 of the Social Security Act (42 
U.S.C. 1395x) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(nnn) FREESTANDING EMERGENCY CENTER.—The 
term ‘freestanding emergency center’ means a health care 
facility that— 
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‘‘(1) is an independent freestanding emergency 
department (as defined in section 2799A–1(a)(3)(D) 
of the Public Health Service Act); 
‘‘(2) is operational 24 hours a day, 7 days a 
week, and 365 days a year with a physician (as de-
fined in subsection (r)) onsite and available at all 
times; 
‘‘(3) has in place mechanisms to allow for ap-
propriate transfers and referrals; 
‘‘(4) develops, implements, and maintains an 
ongoing, data-driven quality assessment and per-
formance improvement (QAPI) program; 
‘‘(5) is located— 
‘‘(A) in a metropolitan statistical area; or 
‘‘(B)(i) in the case of a facility established 
prior to 2020, in a rural county; or 
‘‘(ii) in the case of a facility established on 
or after January 1, 2020, in a rural county 
that does not have a Medicare-certified hospital 
or a rural emergency hospital (as defined in 
subsection (kkk)(2)); 
‘‘(6) has established a governing body to deter-
mine, implement, and monitor policies governing the 
total operation of the facility, and has oversight and 
accountability for the QAPI program, ensuring that 
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facility policies and such QAPI program are admin-
istered so as to provide quality health care in a safe 
environment; and 
‘‘(7) meets all State requirements applicable to 
facilities which furnish emergency medical services 
to individuals but do not typically provide for stays 
in excess of 24 hours, and meets such other require-
ments as the Secretary may prescribe not in excess 
of the conditions of participation under this title 
that are specifically applicable to off campus dedi-
cated emergency departments of hospitals (as de-
scribed in section 482.55 of title 42, Code of Federal 
Regulations (or any successor regulation)), and not 
the conditions of participation under this title that 
are applicable to hospitals (as defined in subsection 
(e)), including rural emergency hospitals (as defined 
in subsection (kkk)(2)), other than with respect to 
compliance with the requirements described in sec-
tion 1867;’’. 
(c) 
PAYMENT
UNDER
MEDICARE.—Section 
1833(t)(21) of the Social Security Act (42 U.S.C. 
1395l(t)(21)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) 
TREATMENT
OF
FREESTANDING 
EMERGENCY
CENTERS.—The facility payment 
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rate for services of a freestanding emergency 
center (as defined in section 1861(nnn)) for 
higher acuity evaluation or management level 
services (as represented by HCPCS codes 
99283–99285, or any successor codes) shall be 
in an amount equal to the payment that would 
otherwise apply to a hospital outpatient depart-
ment under this subsection, including the appli-
cation of the geographic adjustment under 
paragraph (2)(D) and the OPD fee schedule in-
crease factor under paragraph (3)(C)(iv).’’. 
(d) 
COVERAGE
UNDER
MEDICAID.—Section 
1905(a)(2)(A) of the Social Security Act (42 U.S.C. 
1396d(a)(2)(A)) is amended by inserting ‘‘, including the 
services of freestanding emergency centers (as defined in 
section 1861(nnn))’’ after ‘‘outpatient hospital services’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this Act shall apply with respect to items and services fur-
nished on or after May 11, 2023. 
Æ 
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