Emergency Care Improvement Act
- Sponsor
- Rep. Arrington, Jodey C. [R-TX-19]
- Committees
- Ways and Means Committee (primary)
- Last action
- May 1, 2025
Bottom line
The bill expands federal healthcare coverage to freestanding emergency centers, aiming to enhance access to emergency care and potentially reduce costs, while also subjecting these centers to critical patient protection laws like EMTALA.
What it actually does
This bill amends the Social Security Act to enable Medicare Part B and Medicaid coverage for specific emergency services provided by freestanding emergency centers (FECs). It establishes detailed definitions for qualifying FECs and the types of emergency services covered, applies the Emergency Medical Treatment and Labor Act (EMTALA) requirements to these centers, and creates an exception for certain physician self-referral prohibitions related to laboratory and imaging services within FECs.
Proponents argue
Proponents argue that freestanding emergency centers provide high-quality emergency care efficiently and at significant savings to Medicare, as evidenced by their performance under a temporary waiver during the COVID-19 pandemic. They contend that FECs expand vital provider capacity, especially in underserved rural areas, and are fully equipped and staffed to meet the same rigorous standards as hospital-based emergency rooms, including EMTALA obligations.
Opponents contend
Opponents might raise concerns that expanding coverage to freestanding emergency centers could lead to increased overall utilization of emergency services, potential for over-treatment, and fragmentation of care. They may also argue that FECs, despite meeting certain standards, may not offer the same comprehensive care or have the same capacity as full-service hospital emergency departments, particularly for complex cases requiring immediate inpatient admission, potentially impacting the financial stability of traditional hospitals.
The bill is concise and its core provisions are clearly articulated, making it accessible for an informed reader to evaluate its key impacts within a short timeframe.
Section 3(a)
Medicare Part B Coverage for FEC Services
This provision amends Section 1832(a)(2) of the Social Security Act to include "specified emergency services furnished by a freestanding emergency center" as covered medical and other health services under Medicare Part B. This means that Medicare will now reimburse freestanding emergency centers for certain emergency care provided to beneficiaries, formalizing their role in the federal healthcare system.
Supporters argue
Supporters argue that this expansion increases access to emergency care, particularly in areas where FECs are prevalent, and leverages a proven model from the COVID-19 pandemic waiver that demonstrated efficiency and quality.
Critics contend
Critics may contend that this could divert patients from traditional hospitals, potentially impacting their financial stability and ability to provide comprehensive services, and could lead to increased overall healthcare spending if not properly managed.
Tradeoffs
The provision balances the goal of expanding access to emergency care and achieving potential cost savings with the potential impact on the financial stability of existing hospital emergency departments and the overall structure of the healthcare system.
Section 3(b)
Defining Freestanding Emergency Center and Specified Emergency Services
This section adds a new subsection (nnn) to Section 1861 of the Social Security Act, establishing precise definitions. A 'freestanding emergency center' (FEC) must be an independent facility, staffed 24/7 by a physician, have hospital referral arrangements, a governing body, a quality improvement program, and meet state requirements. Location restrictions apply, generally favoring metropolitan areas or specific rural counties. 'Specified emergency services' are defined as emergency services, excluding low-acuity evaluation and management codes (99281-99282), to focus on higher-level emergency care.
Section 3(c)
Application of EMTALA to FECs
This provision amends Section 1867(e) of the Social Security Act to explicitly include freestanding emergency centers (FECs) under the Emergency Medical Treatment and Labor Act (EMTALA). This means FECs, like hospital emergency departments, will be legally required to provide medical screening examinations and stabilizing treatment for all patients presenting with emergency medical conditions, regardless of their ability to pay or insurance status.
Section 3(d)
Medicare Payment for FEC Services
This provision amends Section 1833(a)(2) of the Social Security Act to specify that payment for specified emergency services furnished by a freestanding emergency center will be determined "under subsection (t) if such services had been covered OPD services." This means FECs will be reimbursed by Medicare using the Outpatient Prospective Payment System (OPPS), which is the same payment methodology used for hospital outpatient departments.
Section 3(e)
Medicaid Coverage for FEC Services
This provision amends Section 1905(a)(2) of the Social Security Act to include "specified emergency services furnished by freestanding emergency centers" as covered medical assistance under Medicaid. This expands Medicaid coverage to include emergency care provided at these facilities, similar to the expansion under Medicare Part B.
Section 3(f)
Exclusion From Physician Self-Referral Prohibition (Stark Law Exception)
This provision amends Section 1877(b) of the Social Security Act, commonly known as the Stark Law, to create a new exception. This exception allows physicians with a financial relationship with a freestanding emergency center (FEC) to refer patients to that FEC for laboratory services and imaging services when furnished in connection with specified emergency services, without violating federal self-referral prohibitions.
This provision specifies location restrictions for freestanding emergency centers (FECs) in rural areas. An FEC established prior to 2022 can be located in any rural county. However, an FEC established on or after January 1, 2022, must be in a rural county that does not already have a Medicare-certified hospital or a rural emergency hospital.
Section 1861(nnn)(1)(F)(ii) of the Social Security Act, as added by Section 3(b) of the bill.
Why it matters:This is a common legislative technique to grandfather existing facilities while setting stricter, forward-looking rules for new entrants. It aims to prevent market saturation in areas already served by hospitals and direct new facilities to truly underserved regions.
Case for: Supporters would argue this provision protects existing rural hospitals from new competition while allowing established FECs to continue operating. It also strategically encourages new FECs to open in truly underserved rural areas, maximizing the impact on access where it's most needed.
Case against: Critics might argue that this creates an uneven playing field, potentially limiting the entry of new, potentially more efficient FECs into rural markets that could still benefit from additional emergency care options, even if a hospital exists. It could stifle innovation and competition.
Estimated impact: This provision could significantly influence the geographic distribution and growth patterns of new FECs, particularly in rural areas, by directing them to locations with the greatest need for emergency care access and protecting existing rural hospitals.
This provision defines "specified emergency services" as emergency services, but explicitly excludes those identified by HCPCS evaluation and service management service codes 99281 through 99282. These codes typically represent low-acuity emergency department visits.
Section 1861(nnn)(2) of the Social Security Act, as added by Section 3(b) of the bill.
Why it matters:This is standard legislative practice to precisely define the scope of covered services and prevent federal reimbursement for very minor conditions that might be better handled in less costly settings, thereby controlling costs and ensuring appropriate utilization.
Case for: Supporters would argue this prevents FECs from being used for non-emergency conditions, ensuring that Medicare and Medicaid only pay for appropriate emergency-level care. This helps control costs and prevents the over-utilization of higher-cost emergency facilities for minor ailments.
Case against: Critics might argue that even low-acuity visits sometimes require an initial emergency assessment, and excluding these codes could lead to confusion for patients or discourage them from seeking initial evaluation at an FEC, potentially delaying care for conditions that could worsen.
Estimated impact: This provision aims to limit the scope of services for which FECs can be reimbursed, potentially reducing overall Medicare/Medicaid spending on very minor emergency visits and encouraging patients with truly minor issues to seek care elsewhere.