Section 1 Short title
This Act may be cited as the “Emergency Care Improvement Act”.
Emergency Care Improvement Act
A BILL
To amend titles XVIII and XIX of the Social Security Act to provide for coverage of certain services furnished by freestanding emergency centers.
Sec. 2 Findings
Congress finds the following:
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.
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.
Over 118 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.
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
Coverage under Medicare part B— Section 1832(a)(2) of the Social Security Act (42 U.S.C. 1395k(a)) is amended—
in subparagraph (I), by striking “and” at the end;
in subparagraph (J), by striking the period at the end and inserting “; and”; and
by adding at the end the following new subparagraph:
“(K) specified emergency services furnished by a freestanding emergency center (as such terms are defined in section 1861(nnn)).”
Definitions— 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; specified emergency services
“(1) Freestanding emergency center—The term freestanding emergency center means a health care facility that—
“(A) is an independent freestanding emergency department (as defined in section 2799A–1(a)(3)(D) of the Public Health Service Act);
“(B) is staffed 24 hours a day, 7 days a week, with a physician (as defined in subsection (r)(1)) available to furnish emergency services (as defined in section 2799A–1(a)(3)(C)(i) of the Public Health Service Act) in such facility 24 hours a day;
“(C) has arrangements with one or more hospitals, having agreements in effect under section 1866, for the referral and admission of patients requiring inpatient services or such diagnostic or other specialized services as are not available at such facility;
“(D) has established a governing body to determine, implement, and monitor policies governing the total operation of the facility;
“(E) develops, implements, and maintains an ongoing, data-driven quality assessment and performance improvement program, and has oversight and accountability for such program, ensuring that facility policies and such program are administered so as to provide quality health care in a safe environment;
“(F) is located—
“(i) in a metropolitan statistical area; or
“(ii)
“(I) in the case of a facility established prior to 2022, in a rural county; or
“(II) in the case of a facility established on or after January 1, 2022, in a rural county that does not have a Medicare-certified hospital or a rural emergency hospital (as defined in subsection (kkk)(2)); and
“(G) meets all State requirements applicable to facilities that 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 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)).
“(2) Specified emergency services—The term specified emergency services means emergency services (as defined in section 2799A–1(a)(3)(C)(i) of the Public Health Service Act) other than a service identified, as of the date of the enactment of the Emergency Care Improvement Act, by any of HCPCS evaluation and service management service codes 99281 through 99282.”
in paragraph (2), by—
inserting “other than a freestanding emergency center (as defined in section 1861(nnn))” after “a hospital”; and
inserting “or a freestanding emergency center (as so defined) participating under this title” before the period at the end; and
in paragraph (5), by inserting at the end the following new sentence: “Beginning on the date of the enactment of the Emergency Care Improvement Act, such term also includes a freestanding emergency center (as defined in section 1861(nnn)), and any reference to a hospital that has a hospital emergency department includes such a freestanding emergency center.”.
Payment under Medicare— Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended—
in subparagraph (G)(ii), by striking “and” at the end;
in subparagraph (H), by striking the comma at the end and inserting “; and”; and
by inserting after subparagraph (H) the following new subparagraph:
“(I) with respect to specified emergency services furnished by a freestanding emergency center (as such terms are defined in section 1861(nnn)), the amount that would have been determined under subsection (t) if such services had been covered OPD services,”
Coverage under Medicaid— Section 1905(a)(2) of the Social Security Act (42 U.S.C. 1396d(a)(2)) is amended—
in subparagraph (B), by striking “and” at the end; and
by inserting before the semicolon at the end the following: “, and (D) specified emergency services furnished by freestanding emergency centers (as such terms are defined in section 1861(nnn))”.
Exclusion from prohibition on physician self-Referral— Section 1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)) is amended by adding at the end the following new paragraph:
“(6) Freestanding emergency centers—In the case of laboratory services and imaging services furnished by a freestanding emergency center in connection with specified emergency services (as such terms are defined in section 1861(nnn)).”
Effective date— The amendments made by this Act shall apply with respect to items and services furnished on or after the date of the enactment of this Act.