TAFEC will regularly update this page with links to official sources on COVID-19.TAFEC Statement of Position on COVID-19 Billing PracticesEmergency Medicine Coalition Letter to EVAPPRESS RELEASE - Freestanding ERs Included in Landmark Legislation to End Surprise Medical Bills
AUSTIN, TX- Tonight Congress passed a year-end spending package, which included bipartisan language to protect patients from getting “surprise” medical bills. The landmark legislation adds Freestanding ERs into federal statute for the first time. Congress recognized that patients must be protected in all places of care, including Freestanding ERs by limiting their cost-sharing for out-of-network providers to the same rate as in-network providers. Freestanding ERs are a relatively new industry - only a decade old - and are licensed and regulated at the state level. The federal legislation also ensures that out-of-network Freestanding ERs are subject to the same Independent Dispute Resolution process available to other providers when resolving billing disputes with insurance companies. In 2019, the Texas state legislature passed a similar bill that only applied to state regulated health plans. Unlike Texas, the federal legislation applies to all federally regulated commercial health plans. Freestanding ERs’ federal recognition allows Americans the freedom to seek the emergency medical care of their choice without the risk of a surprise medical bill. See below statements from NAFEC’s Board Members on the passage of this legislation: “On behalf of the National Association of Freestanding Emergency Centers (NAFEC) and the many thousands of patients that receive their emergency care at our licensed centers, we are thankful Congress recognized that patients must be protected and covered in all sites of care, including Freestanding ERs. Although we are a relatively new delivery model, we are an essential part of the medical infrastructure in many communities and are glad to be part of the solution.” - Rhonda Sandel, NAFEC Board President “The passage of the ‘No Surprises Act’ means the hundreds of thousands of patients who visit Freestanding ERs across our country are now protected and will no longer receive a surprise medical bill. We are so thankful to Congress for their hard work on this landmark legislation and for taking patients out of the middle. Freestanding ERs, an essential part of the medical infrastructure in so many communities, are happy to now be part of the solution.”- Dr. Eric McLaughlin, NAFEC Board Member This is the second time in 2020 Freestanding ERs have been recognized by the federal government. In April, Centers for Medicare and Medicaid (CMS) provided a temporary waiver that allows Freestanding ERs to receive reimbursement for treating Medicare patients during the public health emergency (PHE). During this pandemic, Freestanding ERs across the country have been on the frontlines testing and treating COVID-19 patients helping to alleviate hospitals. They have proved to be an essential component to America’s pandemic response. Freestanding Emergency Centers have shorter wait times and smaller facilities than traditional hospital ERs, are fully licensed and regulated, and staffed with emergency medical personnel 24/7. PRESS RELEASE - As Hospitals Overflow, Texas Freestanding Emergency Centers Ready to Fill Gaps in HealthcareAUSTIN, TX- Texas Association of Freestanding Emergency Centers (TAFEC) filed a formal petition for rulemaking requesting Texas Health and Human Services Commission (HHSC) and Texas Department of State Health Services (DSHS) adopt a rule that allows freestanding emergency centers (FECs) to offer non-emergency care in addition to emergency care under their state licensure. “Freestanding Emergency Centers are an under-utilized resource in the Texas pandemic response plan. They can help fill the gaps where critical access to care is needed most,” said Kevin Herrington, President of the Board of Directors of TAFEC. The petition is asking HHSC to clarify whether FECs can offer non-emergent care so long as freestanding emergency centers clearly delineate between emergency medical care and non-emergency care. 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. “Texas Health and Safety Code restricts FECs to only provide emergency care and not allowing outpatient ancillary services,” said Herrington. “In fact, FECs are perhaps overqualified to provide non-emergency outpatient care since they’re licensed to provide healthcare 24/7, seven days a week.” TAFEC filed the petition after HHSC responded to a July written request from TAFEC seeking clarification and a waiver to offer non-emergent or out-patient care for the duration of the public health crisis. Despite the demands the COVID-19 pandemic has placed on the state’s healthcare system, HHSC denied the request, saying Texas Government Code does not authorize HHSC to suspend or to amend a statute. A petition for rulemaking is a formal request to a Texas State Agency within the Administrative Procedure Act in Texas Government Code §2001.001 et. seq. The petition is available to any interested person requesting the adoption of a rule by a state agency. The state agency has up to 60 days to respond to the petition by either denying the request or initiating a rulemaking proceeding. “There are more COVID-19 cases in Texas than any other state. Texans need policy solutions that will create more resources for Texans, not fewer,” said Herrington. “Allowing FECs to offer out-patient services would increase critical access to care around the state at a time when every resource is needed.” State Representative James White has filed House Bill 472, which would allow freestanding emergency medical care facilities the ability to offer out-patient acute care services. This bill is similar to one White filed during the 86th Legislative session that was voted unanimously out of the House Public Health Committee but never made it out of the Calendars Committee. If House Bill 1278 had been signed into law, FECs would have been able to offer out-patient acute care during the pandemic. Freestanding Emergency Centers Seek Solution to Alleviate Hospital Overcrowding, Make COVID-19 Tests More AffordableAUSTIN, TX - 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.
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. 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-InsuredFreestanding 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
“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:
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.
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