Freestanding Emergency Centers Seek Solution to Alleviate Hospital Overcrowding, Make COVID-19 Tests More Affordable

AUSTIN, TX - Texas Association of Freestanding Emergency Centers (TAFEC) is seeking rule changes from the Texas Health and Human Services Commission (HHSC) to help with COVID-19 billing and hospital overcrowding. On Tuesday, TAFEC sent Commissioner Cecile Young a letter emphasizing the need for a waiver or a rule change to allow Freestanding Emergency Centers (FEC) to provide non-emergent care during this public health crisis.

As it stands, due to HHSC interpretation of the regulations, FECs are prohibited from providing outpatient services, even though they possess all the medical staff, resources, lab, radiology staff and equipment required to do so. The waiver seeks to create a billing solution for COVID-19 tests and help reduce certain costs for non-emergent patients.

“Thousands of Texans have come to our doors in need of a COVID-19 test,” said Dr. Edward Wright, founding member of Prestige Emergency Room in San Antonio. “Since FECs are not permitted to offer outpatient services, a non-emergent patient that comes only needing a test, could face a much higher charge than expected or even be turned away. While the test itself might be offered at no cost to the patient, FECs are emergency rooms, and must bill the visit as an emergency room visit under Texas Law.”

With increased cases in Texas, COVID-19 testing is not slowing down, and allowing FECS to offer outpatient services would increase billing transparency.

FECs across the state are included in Texas’s Regional Advisory Councils’ COVID-19 response plans, and as such, have been encouraged to keep patients at their facilities to help hospitals and alleviate crowding. Current HHSC rules state FECs must file an incident report form if they hold a patient over 23 hours. Allowing a patient to remain at an FEC for longer than 23 hours, without penalty or compliance issues to the operator, will reduce hospital admissions, preserve hospital beds and keep non-COVID-19 patients out of hospitals where they might increase their exposure to the coronavirus.

“I encourage HHSC to ease the regulatory burden and adjust to allow FECs to offer outpatient services during this healthcare crisis,” said Dr. Wright. “Our members and their staff have been an integral part of fighting COVID-19 in Texas, and they will continue to work to keep our communities safe and healthy.”

TAFEC offered Commissioner Young the following proposals on how HHSC could accomplish a wavier or rule change to allow FECs to further assist during this public health crisis.

1. HHSC can modify “Freestanding emergency medical care facility” in the Health and Safety Code §254.001(5) and the corresponding rules at 25 TAC §131.2(12) to include “non-emergent services” or “outpatient services” or include language similar to the ASC rules which adds “other healthcare services.”

Non-emergent services and those healthcare claims would not include the technical components and would resemble billing often seen at other hospitals, outpatient facilities, physician offices, and urgent care clinics. Any reimbursement disputes will already be subject to new SB 1264 and subsequent Texas Department of Insurance rules.

2. By releasing FECs from the reporting requirements (and any associated disciplinary actions) related to patients that stay at an FEC for more than 23 hours as a result of COVID-19 pandemic, as set out in 25 TAC §131.61(a)(2) (reporting requirement for patients that stay longer than 23 hours) and 25 TAC §131.101 (enforcement actions for failure to comply with rules prohibiting non-emergency treatment).

During the 2019 Texas Legislative Session, Representative James White authored House Bill 1278 which would have allowed freestanding emergency medical care facilities the ability to offer outpatient acute care services. The bill was voted unanimously out of House Public Health Committee but never made it out of calendars. If House Bill 1278 had made it into law, FECs would have been able to operate and offer outpatient acute care during this pandemic.

Read the full letter TAFEC sent to Commissioner Young here.