,,ii  #aaeth ,,congress  #b;d ,session  
,s4 #ceca  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #bh1
 #bjah ,mr4 ,cassidy introduced the     
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to amend titles ,,xviii and 
,,xix of the ,social ,security ,act to  
provide coverage under ,medicare and    
,medicaid of services furnished by      
freestanding emergency centers4  #a4    
,short title  ,this ,act may be cited as
 the ,emergency ,care ,improvement ,act4
  #b4 ,coverage under ,medicare and     
,medicaid of services furnished by      
freestanding emergency centers  7a7     
,coverage under ,medicare part ,b       
,section #ahcb7;a77#b7 of the ,social   
,security ,act 7#db ,u4,s4,c4 #aciek7a77
 is amended-- 7#a7 in subparagraph 7,i71
 by striking and at the end2  7#b7 in   
subparagraph 7,j71 by striking the      
period at the end and inserting 2 and2  
and  7#c7 by adding at the end the      
following new subparagraph3  7,k7       

services of a freestanding emergency    
center1 as defined in section           
#ahfa7;jjj74  4  7b7 ,definition of     
freestanding emergency center ,section  
#ahfa of the ,social ,security ,act 7#db
 ,u4,s4,c4 #aciex7 is amended by adding 
at the end the following new subsection3
  7jjj7 ,freestanding emergency center  
,the term freestanding emergency center 
means a facility not owned by a hospital
 which-- 7#a7 meets all ,state          
requirements applicable to facilities   
which furnish emergency medical services
 to individuals but does not generally  
provide for stays in excess of #bd      
hours1 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       
#dhb4ee of title #db1 ,code of ,federal 
,regulations 7or any successor          
regulations71 and not the conditions of 

participation under this title that are 
applicable to hospitals generally other 
than with respect to compliance with    
section #ahfg 7commonly known as        
,,emtala72  7#b7 is operational #bd     
hours a day1 #g days a week1 and #cfe   
days a year with onsite access to       
physicians at all times2  7#c7 has in   
place mechanisms to allow for           
appropriate transfers and referrals2    
7#d7 develops1 implements1 and maintains
 an ongoing1 data-driven quality        
assessment and performance improvement  
7,,qapi7 program2  7#e7 establishes a   
governing body that assumes full legal  
responsibility for determining1         
implementing1 and monitoring policies   
governing the total operation of the    
facility and has oversight and          
accountability for the quality          
assessment and performance improvement  
program1 ensuring that facility policies
 and the program are administered so as 
to provide quality health care in a safe
 environment2 and  7#f7 has a written   

agreement with the ,secretary to provide
 emergency medical services to          
beneficiaries4  4  7c7 ,medicare payment
 and certain reporting ,section         
#ahcc7t77#ba7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciel7t77#ba77 is  
amended by adding at the end the        
following new subparagraphs3  7,f7      
,treatment of freestanding emergency    
centers ,the facility payment rate for  
services of a freestanding emergency    
center 7as defined in section           
#ahfa7;jjj77 for higher acuity          
evaluation or management level services 
7represented by ,,hcpcs codes           
#iibhc-iibhe7 shall be an amount equal  
to--  7i7 in the case of services       
furnished by such a center in an urban  
area1 #ge percent of the amount of      
payment that would otherwise apply under
 this subsection1 including application 
of the geographic adjustment under      
paragraph 7#b77;,d7 and the ,,opd fee   
schedule increase factor under paragraph
 7#c77;,c77iv72 and  7ii7 in the case of

 services furnished by such a center    
located in a rural area1 #ie percent of 
the amount of payment that would        
otherwise apply under this subsection1  
including application of the geographic 
adjustment under paragraph 7#b77;,d7 and
 the ,,opd fee schedule increase factor 
under paragraph 7#c77;,c77iv74  7,g7    
,use of claims modifier ,a              
hospital-owned off-campus emergency     
department shall be required to add a   
claims modifier to claims for payment   
under this part in order to enable      
tracking of items and services furnished
 by those departments under this part4  
4  7d7 ,medicaid coverage ,section      
#aije7;a77#b77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acif;d7a77#b77;,a77 is amended by      
inserting the following after outpatient
 hospital services3 1 which shall       
include the services of freestanding    
emergency centers1 as defined in section
 #ahfa7;jjj71 and provided that         
hospital-owned off-campus emergency     

departments shall be required to add a  
claims modifier to enable tracking of   
off campus emergency services furnished 
by these departments4  7e7 ,rule of     
construction ,nothing in the provisions 
of1 or amendments made by1 this ,act    
shall be construed as reducing or       
otherwise affecting the amount of       
payment for any physicians' professional
 services under the physician fee       
schedule under section #ahdh of the     
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#d74  7f7 ,effective date ,the   
amendments made by this ,act shall apply
 to items and services furnished on or  
after ,january #a1 #bjai4