Emergency Care Improvement Act
Bill: H.R.8597 | Sponsor: Rep. Arrington, Jodey C. (R-TX)
Policy area: Health

Summary:
Emergency Care Improvement Act
This bill permanently allows for coverage under Medicare and Medicaid of services that are provided by freestanding emergency centers. The bill takes effect January 1, 2023, or the first day after the end of the COVID-19 public health emergency, whichever is first.

To amend titles XVIII and XIX of the Social Security Act to provide for 
 coverage of services furnished by freestanding emergency centers, and 
                          for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Emergency Care Improvement Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) To expand provider capacity to respond to the COVID-19 
        pandemic, in April of 2020 the Centers for Medicare & Medicaid 
        Services issued a waiver 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 departments 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 advanced 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 significant savings to the Medicare 
        program 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 program 21.8 percent in lower 
        emergency care payments for patients of similar acuity.

SEC. 3. COVERAGE OF FREESTANDING EMERGENCY CENTERS 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 subparagraph:
                    ``(K) emergency services (as defined in section 
                2799A-1(a)(3)(C) of the Public Health Service Act) 
                provided by a freestanding emergency center (as defined 
                in section 1861(lll)).''.
    (b) Freestanding Emergency Center Defined.--Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection:
    ``(lll) Freestanding Emergency Center.--The term `freestanding 
emergency center' means a health care facility that--
            ``(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 defined in subsection (r)) 
        onsite at all times;
            ``(3) has in place mechanisms to allow for appropriate 
        transfers and referrals;
            ``(4) develops, implements, and maintains an ongoing, data-
        driven quality assessment and performance 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 determine, 
        implement, and monitor policies governing the total operation 
        of the facility, and has oversight and accountability for the 
        QAPI program, ensuring that facility policies and such QAPI 
        program are administered 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 requirements as the Secretary may prescribe 
        not in excess of the conditions of participation under this 
        title that are specifically applicable to off campus dedicated 
        emergency departments of hospitals (as described 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 section 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 following new subparagraph:
                    ``(F) Treatment of freestanding emergency 
                centers.--The facility payment rate for services of a 
                freestanding emergency center (as defined in section 
                1861(lll)) 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 department under this subsection, 
                including the application of the geographic adjustment 
                under paragraph (2)(D) and the OPD fee schedule 
                increase 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 ``, 
which shall include the services of freestanding emergency centers, as 
defined in section 1861(lll)'' after ``outpatient hospital services''.
    (e) Effective Date.--The amendments made by this Act shall apply to 
items and services furnished on or after January 1, 2023, or the first 
day following the termination of the emergency period (as defined in 
section 1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
5(g)(1)(B))), whichever comes first.
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