TAFEC will regularly update this page with links to official sources on COVID-19. 

TAFEC Statement of Position on COVID-19 Billing Practices


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

AUSTIN - Texas Association of Freestanding Emergency Centers (TAFEC) is seeking rule changes from 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.

  1. 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.


 

PRESS RELEASE - Rep. Arrington Applauds Victory for Elderly & Vulnerable Patients as Freestanding ERs Gain CMS Recognition

Austin, TX –In response to notification by the federal Centers for Medicare and Medicaid (CMS) that freestanding emergency centers (FECs) are officially eligible to treat Medicare and Medicaid-insured patients, Representative Jodey Arrington, (R) Texas, stated the following:

“I’m pleased the Trump Administration activated freestanding emergency centers to help in the battle against COVID-19. By allowing these facilities to be reimbursed for Medicaid and Medicare, Texans have more options for care.  And, with 1,500 in new hospital bed capacity, the Lone Star State is better prepared for its economic recovery as well as any resurgence in the fall.”

The announcement from CMS comes on the heels of a letter to the agency authored by Rep. Arrington – with support from Sen. Cruz and many other members of the Texas delegation – advocating for CMS to utilize its authority to provide Medicare and Medicaid reimbursement to FECs that are ready and able to serve vulnerable patients during the COVID-19 pandemic. FECs’ recognition as Medicare and Medicaid-approved healthcare facilities will increase capacity to the overall healthcare system by alleviating overcrowding in hospitals and providing elderly, rural and underserved patients with more and easier access to care.

While this recent action by CMS is limited to the public health emergency, the National Association of Freestanding Emergency Centers (NAFEC) will continue to advocate for a long-term solution. Permanent CMS recognition equips FECs with greater ability to expand into rural and underserved communities where healthcare infrastructure can be scarce, and patients may have few options.


PRESS RELEASE - Victory for Elderly & Vulnerable Patients: ERs Now Able to Serve Medicare, Medicaid-Insured

Freestanding ERs gain CMS recognition after a decade of requests

Austin, TX – In response to notification by the federal Centers for Medicare and Medicaid (CMS) that freestanding ERs are now officially recognized healthcare providers eligible for reimbursement for treating Medicare and Medicaid patients, the National Association of Freestanding Emergency Centers (NAFEC) issued the following statement:

“Today’s announcement by the Centers for Medicare and Medicaid means the elderly, vulnerable and underserved in our nation will now have a host of high-quality options when it comes to emergency medical care, an improvement that is especially critical during our current healthcare crisis,” said Brad Shields, Executive Director of NAFEC.  “The freestanding ER community has advocated to be able to serve Medicare and Medicaid patients for more than a decade and we’re thrilled to finally be able to provide them with timely access to emergency medicine. We are grateful to Rep. Jodey Arrington, Sen. Ted Cruz and the many members of the Texas delegation who support freestanding ERs’ efforts to obtain CMS recognition and serve the communities we call home.”

Obtaining recognition by CMS means that freestanding emergency centers (FECs) will be able to increase capacity into the overall healthcare system and treat elderly Medicare-insured patients. FECs have shorter wait times and smaller facilities than traditional hospital ERs, are fully licensed, staffed with emergency medical personnel 24/7, and are fully equipped with ventilators and other critical equipment. While this recent action by CMS is limited to the public health emergency, NAFEC will continue to advocate for a long term solution. Permanent CMS recognition equips FECs with a greater ability to expand into rural and underserved communities where healthcare infrastructure can be scarce and patients may have few options.


PRESS RELEASE - Texas to CMS: “Let Nation’s ERs Treat Medicare Patients Now"

14 Members of Texas Congressional Delegation Call on Centers for Medicare & Medicaid Services to Give Freestanding ERs Recognition as Medicare/Medicaid-Eligible Healthcare Facilities
    Austin, TX – April 14, 2020
 – In a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma, 14 members of the Texas Congressional delegation requested that CMS utilize its authority to provide Medicare and Medicaid reimbursement to freestanding emergency centers (FECs) that are ready and able to serve Medicare and Medicaid patients during the COVID-19 pandemic.

“Across the state of Texas alone, there are more than 200 freestanding emergency centers with 1,500 beds that stand ready to relieve the burden on hospitals and treat both COVID-19 and non-COVID-19 patients needing emergent care,” the letter reads. “The FEC presence throughout the state is equivalent to three large, 500-bed hospitals whose estimated $1.5 billion of infrastructure can be turned on overnight without any capital expenditure at all by the government. FECs are located in rural, suburban and urban areas and their small size limits potential COVID-19 contagion between patients.”

The letter, authored by Rep. Jodey Arrington, (R) Texas, was dated April 13, 2020, and was also signed by the following Members of Congress from Texas:

      • Sen. Ted Cruz
      • Rep. Brian Babin, D.D.S.
      • Rep. Louie Gohmert
      • Rep. Michael Cloud
      • Rep. Vicente Gonzalez
      • Rep. Dan Crenshaw
      • Rep. Kenny Marchant
      • Rep. K. Michael Conaway
      • Rep. Chip Roy
      • Rep. Henry Cuellar
      • Rep. Van Taylor
      • Rep. Lizzie Fletcher
      • Rep. Randy K. Weber

FECs’ recognition as Medicare and Medicaid-approved healthcare facilities would alleviate over-crowding in hospitals, provide rural and underserved patients with more and easier access to care and help leverage untapped resources in the nation’s response to the pandemic.

Currently, FECs across the nation are not eligible for Medicare or Medicaid reimbursement because federal regulations have not caught up to this relatively new form of healthcare delivery. This cuts off many vulnerable and older patients dependent on Medicare and Medicaid who are at greatest risk during this healthcare crisis from a multitude of medical resources.

“The COVID-19 outbreak demands that health resources across America be fully available as we priority access and ability to treat this patient population,” said Brad Shields, Executive Director of the National Association of Freestanding Emergency Centers. “During this healthcare crisis, patients’ needs should take precedence in determining where they can seek medical care. The nation’s freestanding ERs are ready, willing and able to serve Medicare and Medicaid patients and relieve the pressure on the hospital system as soon as the federal government gives them the green light.” 

The nation’s more than 200 FECs are fully equipped emergency rooms staffed by emergency physicians, nurses and support staff and are required to provide 24/7 access to emergency health care under the same quality standards that apply to hospital emergency rooms. FECs possess key healthcare resources such as ventilators and isolation rooms that are badly needed during the pandemic.  Across the state of Texas alone there are more than 1,550 patient beds in freestanding emergency centers ready to relieve the burden on hospitals.

Letter from Members of the Texas Delegation to CMS Administrator Verma


 Petition for Governor Abbott: Let FECs be Part of the COVID-19 Solution Now!

Before activating retired, out-of-state, and not-yet-qualified medical personnel, let the thousands of committed professionals at more than 200 Texas FECs pitch in to help fellow Texans. Sign the petition to be heard!

TAFEC Members - your help is needed!

In order to support our goal of getting FECs fully mobilized and part of Texas’ plan to combat COVID-19, we have created a petition for staff, patients and supporters at our members’ facilities. 
 
Please have your teams, friends and families sign the petition and don’t forget to sign yourself! The results will be sent to Governor Abbott and released to the media, part of an on-going campaign to put pressure on our state government to get us in the game.
 
You can access and share the petition here.

We plan to wrap up the petition on MONDAY, April 13, so PLEASE CIRCULATE TO YOUR STAFF ASAP.
 
Together, we can continue to get the word out.
 
Thanks,
Brad Shields
TAFEC Executive Director


 

Texas Department of Health and Human Services 

DSHS is monitoring the new coronavirus outbreak originating in Wuhan, China. For prevention tips, symptoms, traveler information, and healthcare provider resources, read our coronavirus information.


Centers for Disease Control and Prevention

CDC is responding to the novel coronavirus outbreak.