119th Congress (2025-2026)

HR 3134

Emergency Care Improvement Act

Introduced

Jurisdiction

US Congress

Session

119th Congress (2025-2026)

Official source

Chamber

House

Session

119th Congress (2025-2026)

Jurisdiction

US Congress

Bill overview

The Emergency Care Improvement Act amends the Social Security Act to expand Medicare and Medicaid coverage for freestanding emergency centers (FECs). It defines FECs as independently licensed emergency departments staffed 24/7 with medical professionals and meeting certain quality standards. The bill aims to integrate FECs into the healthcare system, allowing them to receive reimbursement for emergency services and ensuring access to care, particularly in underserved areas. It also addresses EMTALA regulations and physician self-referral rules to accommodate FECs.

Key provisions

Expands Medicare coverage for services provided by freestanding emergency centers.
Defines ‘freestanding emergency center’ based on specific operational and licensing requirements.
Includes FECs in EMTALA regulations, recognizing their role in treating all patients.
Modifies payment rules for Medicare to align with outpatient department (OPD) services for FEC-provided emergency services.
Extends Medicaid coverage to include services from freestanding emergency centers.
Addresses physician self-referral rules regarding laboratory and imaging services from FECs.
Establishes criteria for locating FECs, including rural areas with limited hospital access.
Provides for the application of quality assessment and performance improvement programs for FECs.

Who is affected

Medicare beneficiaries
Medicaid recipients
Freestanding Emergency Centers (FECs)
Hospitals

Positions across the country

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Arguments opposed

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Legislative history

2025-05-01House

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.

2025-05-01House

2025-05-01

Introduced in House

2025-05-01

Introduced in House

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May 1, 2025XMLView source

119th CONGRESS — 1st Session

H. R. 3134

IN THE HOUSE OF REPRESENTATIVES

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.

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 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.

(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 BSection 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)specified emergency services furnished by a freestanding emergency center (as such terms are defined in section 1861(nnn)).

(b)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 centerThe 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.

(c)Application of EMTALA

Section 1867(e) of the Social Security Act (42 U.S.C. 1395dd(e)) is amended—

(1)

in paragraph (2), by—

(A)

inserting other than a freestanding emergency center (as defined in section 1861(nnn)) after a hospital; and

(B)

inserting or a freestanding emergency center (as so defined) participating under this title before the period at the end; and

(2)

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..

(d)Payment under Medicare

Section 1833(a)(2) of the Social Security Act (42 U.S.C. 1395l(a)(2)) is amended—

(1)

in subparagraph (G)(ii), by striking and at the end;

(2)

in subparagraph (H), by striking the comma at the end and inserting ; and; and

(3)

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,

(e)Coverage under MedicaidSection 1905(a)(2) of the Social Security Act (42 U.S.C. 1396d(a)(2)) is amended—

(1)

in subparagraph (B), by striking and at the end; and

(2)

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)).

(f)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 centersIn 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)).

(g)Effective dateThe 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.

HR 3134

Bill overview

Key provisions

Who is affected

Sponsors

Primary sponsor

Cosponsors

Positions across the country

Arguments in favor

Arguments opposed

Bill text

Notable changes

Fiscal impact

Positions across the country