This bill authorizes the use of certain Public Health Service Act data modernization grants to develop State- or region-wide systems that track hospital bed capacity in near real‑time and publish a public-facing dashboard (with privacy redactions). It also amends the Social Security Act to require the Center for Medicare & Medicaid Innovation (CMMI) to include two new pilot model types focused on improving emergency care for older adults and for people in acute psychiatric crisis.
Why it matters: the measure targets a persistent operational problem—ED boarding and crowding—by directing federal grant dollars toward better situational awareness and by pushing payment-innovation pilots that test staffing, infrastructure, care transitions, and dedicated psychiatric emergency units. The bill also directs the Government Accountability Office to study best practices and measure how such systems affect boarding, wait times, and EMS offload delays, producing a report to Congress within a year.
At a Glance
What It Does
The bill amends 42 U.S.C. 300hh–33(a)(1) to add a new grant authority allowing HHS to award grants or cooperative agreements to build scalable, real‑time (or near real‑time) systems that track hospital bed capacity and associated ED metrics, and to fund a public dashboard of that information (with privacy redaction). It also amends 42 U.S.C. 1315a to add two enumerated CMMI model types focused on geriatric emergency care and emergency psychiatric care, and it mandates a GAO study and one‑year report on best practices and operational effects.
Who It Affects
State and regional public health departments, hospital systems (including EDs, ICUs, inpatient psychiatric units, and skilled nursing facilities), EHR vendors and health information exchanges that would need to connect to capacity trackers, CMMI as the pilot operator, and EMS agencies whose offload times the bill explicitly targets.
Why It Matters
If implemented, the bill shifts federal data modernization funding toward operational capacity visibility—potentially changing how states and hospitals prioritize interoperability and near real‑time reporting. It also signals federal interest in payment-model experiments that tackle ED boarding for older adults and people in psychiatric crisis, which could influence future reimbursement and facility-design standards.
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What This Bill Actually Does
The bill modifies existing public‑health data modernization grant law to allow HHS to fund the development and upkeep of multi‑facility, multi‑jurisdiction systems that report bed availability and ED operational metrics in real time or near real time. Those systems are meant to be accurate and scalable across a State or region and to include not just general inpatient beds but ED capacity, adult and pediatric ICUs, inpatient psychiatric services, skilled nursing beds, and other appropriate facility types.
The statute requires grantees to produce a public‑facing dashboard of the collected information, with information redacted to comply with applicable privacy laws.
On the innovation side, the bill instructs CMMI to explicitly include two kinds of pilot models among its allowable demonstrations: one focused on improving emergency care for older adults (through staffing, training, ED infrastructure changes, geriatric protocols, and better coordination with post‑acute care), and one focused on improving emergency care for people in acute psychiatric crisis (including dedicated ED units and expedited transfers to post‑acute psychiatric settings). The bill ties those model types into the statutory list CMMI already uses so they are treated as authorized approaches for demonstration and payment‑model testing.Finally, the Comptroller General must conduct a structured study on best practices for building and maintaining these hospital‑capacity data systems—covering technical standards, integration with hospital electronic health records, what facility types to include, and how to scale across regions—and must assess measurable effects on ED boarding, wait times, and EMS offload delays.
The GAO is required to complete the study and report the findings to Congress within one year of the law’s enactment. Together, these elements are designed to produce both operational tools (data systems and dashboards) and policy evidence (CMMI tests and a GAO study) that policymakers and health systems can use to address ED crowding.
The Five Things You Need to Know
The bill adds a new subparagraph (C) to 42 U.S.C. 300hh–33(a)(1) authorizing grants or cooperative agreements specifically to develop State‑ or region‑wide systems that track hospital bed capacity and related ED metrics.
Grantees must establish or maintain a public‑facing dashboard of the tracked information, with the bill requiring redaction 'in accordance with applicable privacy laws.', The Social Security Act’s CMMI authority at 42 U.S.C. 1315a(b)(2) is amended to explicitly include two new model categories—clause (xxviii) for geriatric emergency care improvements and clause (xxix) for emergency psychiatric care improvements.
The GAO (Comptroller General) must complete a best‑practices study on such public health capacity systems and assess impacts on ED boarding, wait times, and EMS offload delays, and submit its report to Congress within 1 year of enactment.
The capacity tracking requirement explicitly lists facility types to be considered: emergency departments, adult and pediatric ICUs, inpatient psychiatric services, skilled nursing facilities, and 'other appropriate' facility types, and calls for direct integration with hospital EHR systems where feasible.
Section-by-Section Breakdown
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Short title
Names the statute the 'Addressing Boarding and Crowding in the Emergency Department Act of 2025' (ABC‑ED Act of 2025). This is purely titular but signals the bill’s operational focus—boarding, crowding, and emergency department flow.
Allow PH data modernization grants to fund hospital capacity tracking and public dashboards
This is the operative data‑modernization change: it inserts a new subparagraph permitting HHS to award grants or cooperative agreements to appropriate entities to build and modernize systems for tracking bed capacity and related ED metrics in real time or near real time. The provision requires systems to be State‑ or region‑wide, accurate, and scalable, and it mandates a public‑facing dashboard. From an implementation perspective, this creates a federal funding pathway for interoperability projects that prioritize capacity status and ED flow metrics rather than just lab reporting or case surveillance.
Add CMMI model types for geriatric and psychiatric ED improvements
The bill directs CMMI to treat two model types as authorized demonstration approaches: one focused on evidence‑based interventions to improve emergency care for older adults (staffing, infrastructure, geriatric protocols, and coordination with post‑acute care), and one focused on people in acute psychiatric crisis (dedicated ED units and improved transfer/placement processes). Practically, this compels CMMI to consider proposals in these areas when designing payment and delivery experiments, which can influence what projects receive federal support and how CMS evaluates ED‑focused innovations.
GAO study on best practices and effects of capacity‑tracking systems
The Comptroller General must study best practices for building and maintaining capacity‑tracking systems (including technical architecture, facility types to include, and EHR integration) and assess how such systems influence ED boarding rates, wait times, and EMS offload delays. The statute sets a firm 1‑year completion and reporting deadline, creating a near‑term evidence product for Congress and HHS to use in subsequent rulemaking or funding decisions.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- State and local public health agencies — they gain a funded pathway to build interoperable, region‑wide capacity dashboards that improve situational awareness and coordination across hospitals and post‑acute facilities.
- EMS agencies — better visibility into ED and downstream bed availability can reduce offload times and improve deployment decisions, potentially lowering personnel idle time and patient handoff delays.
- Older adults and individuals in psychiatric crisis — by directing CMMI to test targeted models, the bill creates a route for federal support of specialized staffing, ED design, care protocols, and expedited transfer pathways that directly target these populations’ care needs.
- Hospital system operations and bed management teams — access to standardized, near real‑time capacity data across a region can improve transfer decisions, load balancing, and resource allocation.
Who Bears the Cost
- Hospitals and health systems — they will likely face technical and operational costs to integrate EHRs with new capacity trackers, supply timely bed‑status feeds, and maintain data quality; smaller hospitals may lack resources to comply without pass‑through grant funds.
- EHR vendors and health information exchanges — the bill implicitly demands new interfaces, APIs, and data standards work, creating development obligations and potential contractual renegotiations with provider customers.
- State public health agencies and grant administrators — managing these grants and maintaining public dashboards will require staff time, procurement, and ongoing maintenance costs that may exceed initial federal funding levels.
- Post‑acute care facilities (e.g., skilled nursing) — the systems encourage tracking and faster transfers, which could increase pressure on these facilities to accept discharges more quickly or invest in intake processes.
Key Issues
The Core Tension
The central tension is between rapid transparency and operational feasibility: the bill pushes for open, near real‑time capacity visibility to reduce ED boarding, but doing that at scale requires technical standards, sustained funding, EHR integration, and careful privacy safeguards—each of which creates costs and complexity that can limit coverage or create uneven participation across hospitals and regions.
Several implementation questions could blunt the bill’s intended effects. First, 'real‑time (or near real‑time)' is not defined in the statutory text, leaving open the acceptable latency, update frequency, and data‑quality standards—choices that materially affect usefulness.
Second, the requirement for a public‑facing dashboard raises privacy and competitive concerns: while the bill directs redaction 'in accordance with applicable privacy laws,' it does not specify technical or legal standards for de‑identification, nor how to balance transparency with hospital‑level competitive data that some systems may view as commercially sensitive. Third, the statute requires integration 'with relevant hospital electronic medical records systems' where feasible, but hospitals vary widely in EHR capability and interoperability; absent minimum data standards and funding for connection work, the systems could end up partial or uneven, undermining the goal of region‑wide visibility.
On the innovation side, adding geriatric and psychiatric model categories to CMMI’s list gives CMS discretion to design pilots, but it does not appropriate funds or require specific payment approaches; success will depend on whether CMMI prioritizes these models and whether pilots include clear evaluation metrics tied to ED boarding and throughput. Finally, the GAO study’s tight one‑year timeline produces rapid evidence but may limit the depth of longitudinal analysis; short‑term monitoring can show operational changes (like reduced offload times) but might miss system adaptations or cost shifts that emerge later.
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