The ABC-ED Act of 2025 amends the Public Health Service Act to permit public health data modernization grants to be used to develop State- or region-wide, real-time (or near real-time) systems that track hospital bed capacity and related emergency department (ED) crowding metrics, and to create public-facing dashboards (with privacy redaction). It also adds two categories of Center for Medicare & Medicaid Innovation (CMMI) pilot models focused on improving emergency care for older adults and for people in acute psychiatric crisis.
Separately, the bill directs the Comptroller General to study best practices for such capacity-tracking systems, including integration with hospital electronic medical records (EMRs) and specific facility types to be tracked, and to report to Congress within one year. For health system leaders, state public health officials, and compliance officers, the bill creates new expectations around data collection, interoperability, privacy protections, and possible demonstration projects that could change ED operations and post-acute transfer practices.
At a Glance
What It Does
The bill amends 42 U.S.C. 300hh–33(a)(1) to allow public health data modernization grants to fund development of State- or region-wide, real-time (or near real-time) systems for tracking hospital bed capacity and ED crowding indicators, and requires a public-facing dashboard with legally compliant redaction. It also amends 42 U.S.C. 1315a(b)(2) to add two CMMI model types for geriatric-focused ED improvements and acute psychiatric crisis care, and directs a GAO study on best practices and impacts.
Who It Affects
State and local health departments and Health Information Exchanges that would receive and implement grants; hospitals and health systems that must supply capacity and flow data and integrate with EMRs; EMS agencies that monitor offload times; post-acute care facilities that may be included in transfer-improvement work; and CMMI/CMS as operator of new pilot models.
Why It Matters
If implemented, the bill could standardize capacity metrics and public data visibility, enabling more timely operational responses to ED boarding and EMS offload delays. The CMMI additions open a federal pathway to test workforce, infrastructure, and transfer solutions for older adults and people in psychiatric crisis—changes that could alter payment and operations if pilots scale.
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What This Bill Actually Does
The bill creates a new, authorized use for existing public health data modernization grants: building systems that give states and regions near real-time visibility into where beds are available and how that availability is driving ED crowding and EMS offload delays. Those systems are supposed to be ‘‘accurate and scalable’’ and, importantly, to feed a public-facing dashboard—subject to applicable privacy laws—so that officials, providers, and the public can see system strain.
The statute uses broad language about ‘‘appropriate entities’’ as grant recipients, which in practice will likely include state health departments, statewide health information exchanges (HIEs), or multi-stakeholder consortia that can aggregate hospital inputs.
For hospital systems and vendors, the act signals federal support for linking capacity-tracking to clinical systems: the GAO study mandate explicitly asks for systems that are ‘‘seamlessly and directly integrated’’ with hospital EMRs. That creates a technical expectation (and a potential compliance requirement) to adopt interoperable standards and reporting pipelines that can feed real-time dashboards and analytics.
The bill, however, does not itself appropriate new funds—rather it expands allowable grant uses—so the pace and scope of adoption will depend on grant awards and available appropriations.On care delivery, the bill expands CMMI’s explicit authority to test models targeted at two high-priority populations. One model set focuses on older adults and lists possible interventions—staffing and education, ED physical redesign, geriatric-focused protocols and quality metrics, and better coordination with post-acute care including bidirectional medical information exchange.
The other model set targets people in acute psychiatric crisis, including dedicated ED units and faster transfers or expedited placements to appropriate facilities. Those model descriptions give CMMI a clear statutory imprimatur to pilot workforce, infrastructure, and coordination reforms designed to reduce boarding and improve outcomes.Finally, the Comptroller General must complete a focused study and report within one year identifying best practices for capacity-tracking systems (including which facility types to include—EDs, adult and pediatric ICUs, inpatient psychiatric services, skilled nursing facilities, etc.), how to achieve real-time EMR integration, and how those systems affect ED boarding, wait times, and EMS offload.
That report could set de facto federal expectations for interoperability, metrics, and the kinds of quality measures CMS and accrediting bodies should use when assessing boarding and flow.
The Five Things You Need to Know
Section 2823(a)(1) of the Public Health Service Act is amended to add an explicit grant purpose allowing State- or region-wide, real-time (or near real-time) tracking of hospital bed capacity and related ED crowding metrics.
The statute requires grants to support a public-facing dashboard of the tracked information, but mandates that the dashboard redact data in accordance with applicable privacy laws.
CMMI’s list of demonstration models (Social Security Act §1115A(b)(2)(B)) is expanded by two new model types—numbered (xxviii) and (xxix)—targeting emergency care improvements for older adults and for individuals experiencing acute psychiatric crisis.
The GAO must study best practices for capacity-tracking systems—covering EDs, adult/pediatric ICUs, inpatient psychiatric services, skilled nursing facilities, and EMR integration—and submit a report to Congress within one year of enactment.
The bill ties evaluation to operational metrics: GAO must assess effects on ED boarding rates (using CMS and accreditor quality measures), ED wait times for treatment and discharge, and EMS offload times.
Section-by-Section Breakdown
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Short title
Provides the act’s formal name: the Addressing Boarding and Crowding in the Emergency Department Act of 2025 (ABC-ED Act of 2025). This is purely stylistic but useful when referring to the legislation in regulations, notices, or grant guidance.
Allow PH data modernization grants to fund real-time capacity-tracking and dashboards
This amendment inserts a new grant purpose: to develop State- or region-wide systems that track hospital bed capacity and how that capacity affects ED boarding, ED wait times, and EMS offload delays, and to establish or maintain a public-facing dashboard of that information with privacy-compliant redactions. Practically, grant applicants will need to demonstrate the ability to collect near real-time inputs from hospitals and related facilities, aggregate and normalize those inputs, and present them on a dashboard that balances transparency with HIPAA and other privacy constraints. ‘‘Appropriate entities’’ is broad; implementation guidance or grant solicitations will define eligible recipients, reporting standards, and acceptable de-identification/redaction techniques.
Add CMMI model types for geriatric and psychiatric emergency care
This section requires that CMMI include models described in two new clauses. The geriatric-focused model explicitly permits CMMI to test bundled operational changes—staffing models and education, ED physical redesigns, geriatric-specific protocols and metrics, and strengthened transitions with post-acute care through bidirectional information exchange. The psychiatric-focused model allows pilots that incorporate dedicated ED units and expedited transfers or placements. From a regulatory perspective, CMMI can design demonstrations that fund facility upgrades, workforce training, care coordination agreements, and possibly payment reforms to support those interventions.
GAO study on best practices and impact evaluation
The Comptroller General must study best practices for capacity-tracking systems—ensuring State- or region-wide scale, real-time operation, accuracy, EMR integration, and inclusion of multiple facility types—and assess how such systems affect ED boarding rates, wait times, and EMS offload times. The report is due within one year. Agencies and stakeholders should anticipate that the GAO findings will influence future grant criteria, CMS quality measures, and interoperability expectations.
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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 health departments: Gain federally authorized grant uses to build or expand surveillance systems that give operational visibility into bed availability and ED flow, supporting policy and surge response decisions.
- Emergency medical services providers: Stand to benefit from system-level visibility and targeted interventions that reduce offload times and waiting at EDs, improving ambulance turnaround and availability.
- Older adults and their caregivers: Could see pilots that test geriatric-focused staffing, infrastructure, and protocols in EDs—measures designed to reduce harm from boarding and improve care continuity.
- Individuals experiencing acute psychiatric crisis: May benefit from CMMI-funded pilots creating dedicated ED units and expedited transfer pathways that can reduce boarding and provide more appropriate psychiatric care.
- Researchers and policymakers: Will gain standardized data sources and a GAO-compiled set of best practices to analyze interventions’ effectiveness and guide investment decisions.
Who Bears the Cost
- Hospitals and health systems: Must supply the underlying capacity data, invest in EMR interfaces or APIs, and possibly alter workflows; smaller or rural hospitals may face disproportionate IT and staffing costs.
- State health departments and HIEs: Will take on build-and-maintain responsibilities for regional systems and dashboards, incurring operational and personnel expenses to meet real-time expectations.
- Post-acute care facilities (skilled nursing, psychiatric beds): May face pressure to accept expedited placements or enter data-sharing arrangements, requiring staffing, bed-management, and coordination investments.
- Health IT vendors and HIE operators: Will need to build compliant, scalable integrations and dashboards meeting federal grant criteria and interoperability expectations.
- CMS/CMMI and federal agencies: Will allocate administrative resources to design, run, and evaluate the new models and to incorporate GAO recommendations; absent new appropriations, those costs compete with other priorities.
Key Issues
The Core Tension
The central dilemma is between the benefits of transparent, near real-time capacity data (better situational awareness, reduced ED boarding, and improved EMS throughput) and the burdens of producing that data (privacy risk, heavy IT integration costs, inconsistent data quality across hospitals, and potential political fallout from publicly visible capacity shortages). The bill pushes for visibility and pilot testing, but delivering accurate, interoperable, and privacy-compliant systems requires resources and governance that the statute does not itself guarantee.
The bill sets direction but leaves many implementation details open. It does not appropriate a discrete funding stream for expanded data systems or CMMI pilots—rather it broadens allowable uses of existing grant and demonstration authorities—so the scale of actual deployment depends on future appropriations and grant solicitations. ‘‘Appropriate entities’’ and the technical standards for ‘‘real-time’’ reporting will be defined administratively; those choices will determine whether systems are interoperable, clinically useful, and feasible for smaller providers.
The public-facing dashboard requirement raises operational and legal trade-offs. Transparency can improve system-wide decisions and public accountability, but public dashboards risk misinterpretation of momentary capacity snapshots and require robust redaction and aggregation rules to avoid HIPAA or state-law breaches.
Achieving ‘‘seamless’’ EMR integration is technically demanding: hospitals use varied vendor systems and interfaces; national standards (e.g., FHIR) help, but mapping operational bed-status to clinical EMR signals is nontrivial. Finally, the CMMI model expansions point CMMI toward structural and workforce reforms that are costly and time-consuming; pilots will need realistic timelines and accompanying payment reforms to be sustainable beyond demonstration phases.
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