Emergency Care Improvement Act

Bill Number: H.R. 3134
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-05-01: 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.
Last Updated: 2026-05-22T08:07:26Z

AI-Generated Summary

Purpose

The Emergency Care Improvement Act (H.R. 3134) aims to permanently expand Medicare and Medicaid coverage to include certain emergency services provided by freestanding emergency centers (FECs). These are independent facilities that operate like hospital emergency rooms but are not attached to a hospital. The bill builds on a temporary COVID-19 waiver that allowed FECs to receive Medicare payments, seeking to make this access ongoing to improve emergency care availability while controlling costs.

Key Provisions

Definitions:
A "freestanding emergency center" is defined as a state-licensed facility that operates 24/7 with emergency-trained doctors and nurses on-site, has pharmacies, labs, and imaging services, and meets standards similar to hospital emergency departments. It must have agreements with hospitals for patient transfers, a governing body for oversight, a quality improvement program, and be located in metropolitan areas or specific rural counties (with restrictions for new facilities post-2022). It also complies with state rules for short-stay emergency care.
"Specified emergency services" refers to emergency medical care (like stabilizing patients in crises) but excludes low-acuity visits (e.g., minor evaluations coded as HCPCS 99281-99282, which are basic check-ins for non-serious issues).
Medicare Coverage: Adds FECs to Medicare Part B (outpatient services), allowing reimbursement for specified emergency services at rates equivalent to hospital outpatient department fees.
Medicaid Coverage: Includes specified emergency services from FECs as a covered benefit under Medicaid.
EMTALA Application: Applies the Emergency Medical Treatment and Labor Act (EMTALA—a federal law requiring hospitals to screen and stabilize all patients, regardless of ability to pay) to FECs, treating them like hospital emergency departments.
Payment Rules: Sets Medicare payments for FEC services to match what would be paid for similar hospital outpatient services.
Exceptions to Self-Referral Bans: Allows FECs to provide lab and imaging services without violating the Stark Law (a rule prohibiting doctors from referring patients to facilities they own or invest in, to prevent conflicts of interest), but only when connected to emergency care.
Effective Date: Applies to services provided on or after the date of enactment.

Significant Changes to Existing Law

Permanent Coverage: Previously, FECs could only enroll as Medicare providers temporarily during the COVID-19 public health emergency (via a 2020 waiver). This bill makes coverage permanent under Titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act, removing the time limit.
EMTALA Expansion: EMTALA previously applied only to hospitals; now it explicitly includes FECs, ensuring they must treat all emergency patients without discrimination.
Payment and Referral Adjustments: Introduces specific payment calculations for FECs (tied to hospital outpatient rates) and carves out exceptions to self-referral prohibitions, which did not previously account for FECs as a distinct provider type.
Location Restrictions: Adds new limits for rural FECs established after 2022, requiring they be in counties without existing Medicare-certified hospitals or rural emergency hospitals.

Potential Impacts

On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) will need to certify and oversee FECs as a new provider category, potentially increasing administrative workload but yielding cost savings—Congressional findings cite a 21.8% reduction in Medicare emergency care payments for similar patient cases without increasing overall service use.
On Citizens: Medicare and Medicaid beneficiaries gain easier access to high-quality emergency care, especially in underserved areas like rural Texas (where most of the 118+ FECs operate), at lower costs to the programs and potentially reduced out-of-pocket expenses.
On International Relations: No direct impacts, as this is a domestic health policy focused on U.S. insurance programs.

Main Stakeholders Affected

Freestanding Emergency Centers and Providers: Over 118 facilities (primarily in Texas) benefit from permanent reimbursement eligibility, enabling expansion and sustainability.
Medicare and Medicaid Beneficiaries: Elderly, low-income, and disabled individuals receive broader access to 24/7 emergency services without needing to travel to full hospitals.
Hospitals: Must form referral agreements with FECs for patient transfers, potentially easing their emergency department burdens but competing for some services.
Physicians, Nurses, and Staff: Emergency medicine professionals in FECs gain formal recognition and payment pathways, supporting job stability.
Taxpayers and Government: Benefit from documented cost savings to Medicare, though initial setup costs for regulation may arise.

Notable Legal, Constitutional, or Political Implications

Legal Implications: Strengthens patient protections by extending EMTALA to FECs, ensuring non-discriminatory emergency care. The self-referral exception balances access with anti-conflict rules but could invite scrutiny if perceived as favoring certain providers; it requires FECs to meet strict quality and transfer standards to mitigate abuse risks.
Constitutional Implications: None directly addressed; the bill aligns with Congress's authority under the Spending Clause to set conditions for federal health funding.
Political Implications: Sponsored by bipartisan representatives (including from Texas), it highlights emergency care gaps exposed by COVID-19 and emphasizes cost efficiency, potentially influencing future health policy debates on provider expansion versus budget control. The focus on state-licensed facilities respects federalism by deferring to state standards where applicable.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Arrington, Jodey C. [R-TX-19]

Cosponsors (15)

Rep. Gonzalez, Vicente [D-TX-34], Rep. Crenshaw, Dan [R-TX-2], Rep. Van Duyne, Beth [R-TX-24], Rep. McCaul, Michael T. [R-TX-10], Rep. McCormick, Richard [R-GA-7], Rep. Tenney, Claudia [R-NY-24], Rep. Babin, Brian [R-TX-36], Rep. Kelly, Mike [R-PA-16], Rep. Weber, Randy K. Sr. [R-TX-14], Rep. Jackson, Ronny [R-TX-13], Rep. Cloud, Michael [R-TX-27], Rep. Pfluger, August [R-TX-11], Rep. Ruiz, Raul [D-CA-25], Rep. Moran, Nathaniel [R-TX-1], Rep. Miller, Carol D. [R-WV-1]

Recent Actions

2025-05-01: 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.
2025-05-01: 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.
2025-05-01: Introduced in House
2025-05-01: Introduced in House

Bill Versions

Emergency Care Improvement Act — issued 2025-05-01 — PDF (8 pages)