Texas Regulations

Public Notice, Disclosure Statement, Advertising, and Signage

Requirements (HB 2041 & HB 1112-86R)

Health Facility Compliance Guidance Letter
Number: GL 19-2002
Title: Public Notice, Disclosure Statement, Advertising, and Signage
Requirements (HB 2041 & HB 1112-86R)
Provider Types: Freestanding Emergency Medical Care Facilities (FEMCs),
Hospitals
Date Issued: February 25, 2020
1.0 Subject and Purpose
This letter provides instruction regarding the passage of House Bill (HB)
2041, relating to the regulation of freestanding emergency medical care
facilities, and HB 1112, relating to the removal of signs indicating that a
freestanding emergency medical care facility is operational. These bills took
effect September 1, 2019.
HB 2041, among other things, imposes new public notice, disclosure
statement, advertising, and signage requirements on a freestanding
emergency medical care facility (FEMC), including a FEMC located within,
connected to, owned, or operated by a licensed hospital or by a hospital
owned and operated by the state. HB 1112 requires a FEMC that closes or
whose license has expired, been suspended, or revoked to remove the
facility’s signage that indicates the facility is in operation.
Under Chapters 241 and 254 of the Texas Health and Safety Code (HSC),
the Health Facility Compliance Unit of the Health Care Quality Department of
HHSC conducts surveys and complaint investigations of all licensed hospitals
and FEMCs in Texas to enforce these chapters, as well as the rules for these
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facilities at Title 25, Texas Administrative Code (TAC), Chapters 131 and
133.
This letter outlines provider responsibilities and expectations.
2.0 Policy Details & Provider Responsibilities
The Legislature requires all FEMCs to comply with all statutes and rules
regarding FEMCs. Accordingly, FEMCs are responsible for complying with the
provisions of Chapters 241 and 254, including those added by HB 2041 and
HB 1112.
2.1 HB 2041 Notice and Disclosure Requirements
HB 2041 revised HSC Chapter 254 (relating to freestanding emergency care
facilities) by amending Section 254.155 and adding Sections 254.156,
254.157, and 254.158, reprinted here for reference:
Sec. 254.155. NOTICE OF FEES. (a) A facility shall post notice that:
(1) states:
(A) the facility is a freestanding emergency medical care facility;
(B) the facility charges rates comparable to a hospital
emergency room and may charge a facility fee;
(C) a facility or a physician providing medical care at the facility
may be an out-of-network provider for the patient’s health
benefit plan provider network; and
(D) a physician providing medical care at the facility may bill
separately from the facility for the medical care provided to a
patient; and
(2) either:
(A) lists the health benefit plans in which the facility is an innetwork
provider in the health benefit plan’s provider network;
or
GL 19-2002 (HFC) February 25, 2020 Page 3 of 7
(B) states the facility is an out-of-network provider for all health
benefit plans.
(b) The notice required by this section must be posted prominently and
conspicuously:
(1) at the primary entrance to the facility;
(2) in each patient treatment room;
(3) at each location within the facility at which a person pays for
health care services; and
(4) on the home page of the facility’s Internet website or on a
different page available through a hyperlink that is:
(A) entitled “Insurance Information”; and
(B) located prominently on the home page.
(c) The notice required by Subsections (b)(1), (2), and (3) must be in
legible print on a sign with dimensions of at least 8.5 inches by 11 inches.
(d) Notwithstanding Subsection (b), a facility that is an in-network provider
in one or more health benefit plan provider networks complies with
Subsection (a)(2) if the facility:
(1) provides notice on the facility’s Internet website listing the health
benefit plans in which the facility is an in-network provider in the
health benefit plan’s provider network; and
(2) provides to a patient written confirmation of whether the facility is
an in-network provider in the patient’s health benefit plan’s provider
network.
(e) A facility may not add to or alter the language of a notice required by
this section.
Sec. 254.156. DISCLOSURE STATEMENT REQUIRED. (a) In addition to the
notice required under Section 254.155, a facility shall provide to a patient or
a patient’s legally authorized representative a written disclosure statement
in accordance with this section that:
GL 19-2002 (HFC) February 25, 2020 Page 4 of 7
(1) lists the facility’s observation and facility fees that may result from
the patient’s visit; and
(2) lists the health benefit plans in which the facility is a network
provider in the health benefit plan’s provider network or states that
the facility is an out-of-network provider for all health benefit plans.
(b) A facility shall provide the disclosure statement in accordance with the
standards prescribed by Section 254.153(a).
(c) The disclosure statement must be:
(1) printed in at least 16-point boldface type;
(2) in a contrasting color using a font that is easily readable; and
(3) in English and Spanish.
(d) The disclosure statement:
(1) must include:
(A) the name and contact information of the facility; and
(B) a place for the patient or the patient’s legally authorized
representative and an employee of the facility to sign and date
the disclosure statement;
(2) may include information on the facility’s procedures for seeking
reimbursement from the patient’s health benefit plan; and
(3) must, as applicable:
(A) state “This facility charges a facility fee for medical
treatment” and include:
(i) the facility’s median facility fee;
(ii) a range of possible facility fees; and
(iii) the facility fees for each level of care provided at the
facility; and
GL 19-2002 (HFC) February 25, 2020 Page 5 of 7
(B) state “This facility charges an observation fee for medical
treatment” and include:
(i) the facility’s median observation fee;
(ii) a range of possible observation fees; and
(iii) the observation fees for each level of care provided at
the facility.
(e) A facility may include only the information described by Subsection (d)
in the required disclosure statement and may not include any additional
information in the statement. The facility annually shall update the
statement.
(f) A facility shall provide each patient with a physical copy of the disclosure
statement even if the patient refuses or is unable to sign the statement. If a
patient refuses or is unable to sign the statement, as required by this
section, the facility shall indicate in the patient’s file that the patient failed to
sign.
(g) A facility shall retain a copy of a signed disclosure statement provided
under this section until the first anniversary of the date on which the
disclosure was signed.
(h) A facility is not required to provide notice to a patient or a patient’s
legally authorized representative under this section if the facility determines
before providing emergency health care services to the patient that the
patient will not be billed for the services.
(i) A facility complies with the requirements of Subsections (a)(1) and
(d)(3) if the facility posts on the facility’s Internet website in a manner that
is easily accessible and readable:
(1) the facility’s standard charges, including the fees described by
those subsections; and
(2) updates to the standard charges at least annually or more
frequently as appropriate to reflect the facility’s current charges.
GL 19-2002 (HFC) February 25, 2020 Page 6 of 7
(j) A facility’s failure to obtain the signed disclosure statement required by
this section from the patient or the patient’s legally authorized
representative may not be a determining factor in the adjudication of liability
for health care services provided to the patient at the facility.
Sec. 254.157. CERTAIN ADVERTISING PROHIBITED. (a) A facility may not
advertise or hold itself out as a network provider, including by stating that
the facility “takes” or “accepts” any insurer, health maintenance
organization, health benefit plan, or health benefit plan network, unless the
facility is a network provider of a health benefit plan issuer.
(b) A facility may not post the name or logo of a health benefit plan issuer
in any signage or marketing materials if the facility is an out-of-network
provider for all of the issuer’s health benefit plans.
(c) A violation of this section is a false, misleading, or deceptive act or
practice under Subchapter E, Chapter 17, Business & Commerce Code, and
is actionable under that subchapter.
Sec. 254.158. REMOVAL OF SIGNS. A facility that closes or for which a
license issued under this chapter expires or is suspended or revoked shall
immediately remove or cause to be removed any signs within view of the
general public indicating that the facility is in operation.
HB 2041 also revised HSC Chapter 241 (relating to hospitals) by amending
Section 241.202 and adding Section 241.205, reprinted here for reference:
Sec. 241.202. ADVERTISING. A facility described by Section 241.2011:
(1) may not advertise or hold itself out as a medical office, facility, or
provider other than an emergency room if the facility charges for its
services the usual and customary rate charged for the same service by
a hospital emergency room in the same region of the state or located
in a region of the state with comparable rates for emergency health
care services; and
(2) must comply with the regulations in Section 254.157.
1 HSC § 241.201 (relating to applicability) refers to an FEMC that is that is located within,
connected to, owned, or operated by a licensed hospital or by a hospital owned and
operated by the state.
GL 19-2002 (HFC) February 25, 2020 Page 7 of 7
Sec. 241.205. DISCLOSURE STATEMENT REQUIRED. A facility described by
Section 241.201 shall comply with Section 254.156.
2.2 HB 1112 Sign Removal Requirements
HB 1112 revised HSC Chapter 254 by adding a second Section 254.156,
reprinted here for reference:
Sec. 254.156. REMOVAL OF SIGNS. A facility that closes or for which a
license issued under this chapter expires or is suspended or revoked shall
immediately remove or cause to be removed any signs within view of the
general public indicating that the facility is in operation.
3.0 Background/History
The purpose of HB 2041 and HB 1112 is to protect Texans seeking
emergency medical services, and to ensure an FEMC discloses accurate
information to patients regarding accepted health benefit plans, fees charged
for medical services, and whether the FEMC is open for business.
4.0 Resources
None.
5.0 Contact Information
If you have any questions about this letter, please contact the Policy, Rules,
and Training Section by email at: HCQ_PRT@hhsc.state.tx.us