Emergency Care Bill Permanently Adds Freestanding Centers to Medicare, Extends EMTALA Rules

The new Emergency Care Improvement Act is a big deal for how and where you can get emergency medical help if you’re on Medicare or Medicaid. Essentially, this bill takes the temporary COVID-era rules that allowed independent, state-licensed Freestanding Emergency Centers (FECs) to get paid by Medicare and makes them permanent. Starting immediately upon enactment, these centers—which are basically non-hospital ERs—will be covered under Medicare Part B and Medicaid for most emergency services, provided they meet strict federal requirements.

The New Rules for Emergency Access

Think of an FEC as a fully operational, 24/7 emergency room that isn’t physically attached to a big hospital campus. This bill defines a qualified FEC as a facility that is staffed around the clock with a doctor available at all times, has its own governing body and quality program, and, crucially, has agreements in place with hospitals for patient transfers. This means if you have a heart attack and go to an FEC, they must be able to stabilize you and quickly get you to a hospital if needed. For people in areas where the nearest hospital ER is a long drive, this could be a major win for access and speed of care.

Critically, the bill extends the federal EMTALA rules—the law that requires hospitals to provide emergency screening and stabilizing treatment regardless of a patient’s ability to pay—to these FECs. This is huge: It means these centers now have the same legal obligation as traditional hospital emergency departments to treat everyone who walks in needing emergency care (SEC. 3). The bill also puts specific location limits on new FECs built after 2022, primarily directing them toward rural counties that lack a Medicare-certified hospital, aiming to fill genuine service gaps.

The Cost and Coverage Catch

While this bill aims to increase access, it also contains some complex financial details. Medicare will pay FECs for covered services based on the existing outpatient department payment structure, and Congress notes that past data suggests this structure actually saved Medicare about 21.8% compared to traditional hospital ERs for similar patients (SEC. 2). However, there’s a catch for patients: the bill specifically excludes coverage for the lowest-acuity emergency care codes (HCPCS 99281–99282) (SEC. 3). If you show up at an FEC with a minor sprain or cold that falls into one of those excluded categories, you or your state Medicaid program might end up responsible for the bill, even though you received care there. This could create confusion about what is or isn't covered for minor emergencies.

A Regulatory Carve-Out for Doctors

One of the most interesting and potentially contentious parts of the bill is the creation of a specific exception to the Stark Law (the federal physician self-referral prohibition). Normally, doctors can’t refer patients to facilities for services like lab work or imaging if they have a financial stake in that facility. This bill creates an exception for FECs, allowing them to bill for lab and imaging services provided in connection with the emergency care they deliver (SEC. 3). This is designed to ensure FECs can operate efficiently, but it also gives these specific facilities a business advantage—the ability to keep the revenue from those ancillary services—that other outpatient providers don’t have. For traditional hospitals, which already face competition, this means losing volume to centers that now have a clear path to federal payment and a regulatory leg up on in-house services.