I 118th CONGRESS 1st Session H. R. 1694 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. Short title This Act may be cited as the Emergency Care Improvement Act . 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 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 program 21.8 percent in lower emergency care payments for patients of similar acuity. 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(nnn)). . (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: (nnn) 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 and available 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(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 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 , 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 furnished on or after May 11, 2023.