Legislative Agenda

Proactive Patient-Centered Agenda

During the 86th Legislative Session, the freestanding ER industry is committing itself to a wide-ranging effort to do more for Texas patients in need of emergency care. We’re calling it the “Patient’s Promise.”

Very simply, the Promise is this—

  • If it helps Texas patients to better understand their rights when it comes to ER care;
  • if it decreases consumer confusion;
  • if it helps to keep patients from financial harm;
  • if it has anything to do with protecting patients from overzealous health insurance actions (e.g. policies that violate the Prudent Layperson Standard); and/or
  • if it defends patients against a lack of TDI oversight, our industry is for it.

TAFEC intends to advocate for the following legislative actions this session:

Industry Standards

  • “Best Practices” legislation (essentially, an industry clean-up bill) that will ensure Texas ER patients have all the information they need and deserve. This is our industry-led effort to raise standards and ensure compliance for all FEC operators.
  • This reform measure would include data collection requirements, further clarifying which facilities can hold themselves out to be emergency facilities, and creating clearer guidelines for FEC operators related to marketing and advertising.

Holding Health Plans Accountable

  • We are strongly in favor of Prompt Pay protections for all emergency care services, including out-of-network providers. We support legislation that would give TDI—on behalf of all provider types—the ability to enforce and penalize health insurance companies when they delay providing coverage of legitimate health care claims.
  • We strongly support legislation that prohibits health insurance companies from steering patients in their time of need away from the quickest access to emergency care at any licensed emergency care facility.
  • We strongly support an EM Utilization Review by Board-certified EM Physicians—unequivocally, we believe that health insurance companies should be required to have emergency physicians reviewing patient records when examining emergency care claims.
  • We support a patient’s “right to shop” and access benefits for emergency care wherever they so choose.
  • We support legislation that would preserve the ability of in-network emergency providers to inform their patients they are contracted. Unfortunately, some health insurance companies have tried to restrict emergency care centers from marketing they are in-network.

Preserving Access to Care

  • We support Outpatient Acute Care Services and are in favor of legislation allowing FECs to be fully utilized, thus providing more acute care services.

Industry Protections Agenda

In addition to our proactive push on behalf of Texas ER patients this session, we are also committed to laying a stronger foundation for FECs across Texas that allows for fair treatment of our facilities so that patients can continue to have access to ER care where they live.

Leveling the Playing Field

  • We intend to work with the Legislature to ensure all licensed emergency care facilities across Texas are treated the same way and regulated in an equitable fashion.
  • We are committed to working with the Legislature on all matters of transparency that apply to any stakeholder group in the health care space, including health insurance companies.
  • The claims process of health insurance companies and the methodology for how they determine prices for fair reimbursement, in addition to contracted rates, should be made public.
  • This will help to ensure that providers are treated equally and not discriminated against by certain insurance companies based on in-network versus out-of-network classifications.