Title: Emergency Care Improvement Act
Policy area: Health

Summary:
Emergency Care Improvement Act
This bill provides for Medicare and Medicaid coverage of services that are furnished at freestanding emergency centers (i.e., facilities that are open 24-7, are not owned by hospitals, and meet other specified criteria).

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3531 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3531

  To amend titles XVIII and XIX of the Social Security Act to provide 
     coverage under Medicare and Medicaid of services furnished by 
                    freestanding emergency centers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 28, 2018

  Mr. Cassidy introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend titles XVIII and XIX of the Social Security Act to provide 
     coverage under Medicare and Medicaid of services furnished by 
                    freestanding emergency centers.

    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. COVERAGE UNDER MEDICARE AND MEDICAID OF SERVICES FURNISHED BY 
              FREESTANDING EMERGENCY CENTERS.

    (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) services of a freestanding emergency center, 
                as defined in section 1861(jjj).''.
    (b) Definition of Freestanding Emergency Center.--Section 1861 of 
the Social Security Act (42 U.S.C. 1395x) is amended by adding at the 
end the following new subsection:

                    ``Freestanding Emergency Center

    ``(jjj) The term `freestanding emergency center' means a facility 
not owned by a hospital which--
            ``(1) meets all State requirements applicable to facilities 
        which furnish emergency medical services to individuals but 
        does not generally 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 regulations), and not the conditions of participation 
        under this title that are applicable to hospitals generally 
        other than with respect to compliance with section 1867 
        (commonly known as `EMTALA');
            ``(2) is operational 24 hours a day, 7 days a week, and 365 
        days a year with onsite access to physicians 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) establishes a governing body that assumes full legal 
        responsibility for determining, implementing, and monitoring 
        policies governing the total operation of the facility and has 
        oversight and accountability for the quality assessment and 
        performance improvement program, ensuring that facility 
        policies and the program are administered so as to provide 
        quality health care in a safe environment; and
            ``(6) has a written agreement with the Secretary to provide 
        emergency medical services to beneficiaries.''.
    (c) Medicare Payment and Certain Reporting.--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 subparagraphs:
                    ``(F) Treatment of freestanding emergency 
                centers.--The facility payment rate for services of a 
                freestanding emergency center (as defined in section 
                1861(jjj)) for higher acuity evaluation or management 
                level services (represented by HCPCS codes 99283-99285) 
                shall be an amount equal to--
                            ``(i) in the case of services furnished by 
                        such a center in an urban area, 75 percent of 
                        the amount of payment that would otherwise 
                        apply under this subsection, including 
                        application of the geographic adjustment under 
                        paragraph (2)(D) and the OPD fee schedule 
                        increase factor under paragraph (3)(C)(iv); and
                            ``(ii) in the case of services furnished by 
                        such a center located in a rural area, 95 
                        percent of the amount of payment that would 
                        otherwise apply under this subsection, 
                        including application of the geographic 
                        adjustment under paragraph (2)(D) and the OPD 
                        fee schedule increase factor under paragraph 
                        (3)(C)(iv).
                    ``(G) Use of claims modifier.--A hospital-owned 
                off-campus emergency department shall be required to 
                add a claims modifier to claims for payment under this 
                part in order to enable tracking of items and services 
                furnished by those departments under this part.''.
    (d) Medicaid Coverage.--Section 1905(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1396d(a)(2)(A)) is amended by inserting the 
following after ``outpatient hospital services'': ``, which shall 
include the services of freestanding emergency centers, as defined in 
section 1861(jjj), and provided that hospital-owned off-campus 
emergency departments shall be required to add a claims modifier to 
enable tracking of off campus emergency services furnished by these 
departments''.
    (e) Rule of Construction.--Nothing in the provisions of, or 
amendments made by, this Act shall be construed as reducing or 
otherwise affecting the amount of payment for any physicians' 
professional services under the physician fee schedule under section 
1848 of the Social Security Act (42 U.S.C. 1395w-4).
    (f) Effective Date.--The amendments made by this Act shall apply to 
items and services furnished on or after January 1, 2019.
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