[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1694 Introduced in House (IH)]
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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.
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 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.
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(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.
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