Congress quietly expands emergency care outside hospitals—with fewer rules

What it does

This bill makes freestanding emergency centers (FECs)—independent, 24/7 emergency departments that are not part of hospitals—permanently eligible for Medicare and Medicaid reimbursement. Currently, FECs can only bill Medicare under a temporary COVID-era waiver. The bill also exempts FECs from certain physician self-referral rules, allowing them to refer patients to their own lab and imaging services. According to the bill, over 118 FECs (mostly in Texas) have saved Medicare 21.8% on emergency care costs while maintaining quality standards.

Why we flagged it

The bill's core function is to convert a temporary COVID-era waiver into permanent Medicare/Medicaid coverage for a specific class of emergency provider (FECs), while carving out regulatory and self-referral exceptions. This is fundamentally a reimbursement and regulatory carve-out, not a broad emergency care reform.

What the text implies

• The self-referral exemption (Section 1877 amendment) allows FECs to refer patients to their own lab and imaging services without triggering Stark Law restrictions, creating financial incentives for ancillary service utilization that may not exist in hospital settings.
• FECs established after 2022 are limited to rural counties without a Medicare-certified hospital, but the bill does not restrict FECs established before 2022 from operating in urban areas, potentially creating a two-tier system with different geographic rules.
• The bill excludes HCPCS codes 99281–99282 (lowest-acuity evaluation/management services) from FEC coverage, suggesting FECs are designed to capture mid-to-high acuity emergency cases, which may cannibalize hospital emergency department revenue.
• FECs are subject to EMTALA (Emergency Medical Treatment and Labor Act) but are not required to maintain inpatient beds or admit patients, creating potential gaps in continuity of care for patients requiring hospitalization.
• The actuarial study cited (21.8% savings) is from the bill's own findings and has not been independently peer-reviewed; the savings claim may reflect selection bias (healthier patients choosing FECs) rather than true efficiency gains.

Who it affects

Medicare beneficiaries may benefit from lower emergency care costs and expanded provider capacity in underserved areas, particularly rural counties. However, the bill creates a new category of emergency provider with weaker regulatory oversight than hospital emergency departments, and the self-referral exemption may incentivize unnecessary lab and imaging services, potentially increasing costs and fragmentation of care.

Who stands to gain

• Freestanding emergency center operators and owners
• Emergency medicine physician groups
• Clinical laboratory and imaging service providers affiliated with FECs
• Private equity firms investing in FEC networks

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Freestanding Emergency Centers (FECs), Medicare Part B, Medicaid, Social Security Act (Sections 1832, 1861, 1867, 1877, 1905, 1833), EMTALA (Emergency Medical Treatment and Labor Act), Stark Law (Physician Self-Referral), HCPCS codes 99281–99282, Rural Emergency Hospitals, Hospital-Based Emergency Departments, RMD (Resmed Inc.)

Where it stands

15 cosponsors: 13 Republicans, 2 Democrats.

• May 1, 2025 — Introduced · Congress.gov: “Introduced in House”
• May 1, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

2 lobbying clients named this bill on 2 disclosure filings across 2 quarters, Mar 2026 to Jun 2026. Those filings disclosed $528,727 in lobbying spend. A filing names 25 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 41% of bills with at least one filing.

Jodey Arrington, the sponsor, reported $573,000 in PAC receipts in the 2026 cycle.

• American College of Emergency Physicians — $468,727 on 1 filing
• National Association of Freestanding Emergency Centers (nafec) — $60,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.