On June 12, 2018, Connecticut Governor Dannel P. Malloy signed into law Public Act No. 18-149 “An Act Concerning Outpatient Clinics, Urgent Care Centers and Freestanding Emergency Departments” (PA 18-149). This legislation makes several changes to Connecticut laws concerning urgent care centers, facility fees charged at off-site hospital-based facilities, and freestanding emergency departments. PA 18-149 is effective as of October 1, 2018.

Urgent Care Centers

Existing law prohibits an urgent care center from operating in Connecticut unless it is licensed as an outpatient clinic by the Department of Public Health (DPH). An urgent care center is currently defined as a freestanding facility that is distinct from an emergency department and which provides certain non-emergency treatment without requiring an appointment and during times when a primary care provider is typically closed. This legislation revises the definition of an urgent care center to provide that an urgent care center:

• is no longer required to be freestanding;
• must be distinct from both an emergency department and a primary care setting;
• must provide “urgent care services,” which are defined by reference to 42 C.F.R. § 405.400 (which, in turn, defines urgent care services as “services furnished to an individual who requires services to be furnished within 12 hours in order to avoid the likely onset of an emergency medical condition”), as opposed to providing “non-emergency treatment”;
• must offer diagnostic imaging and intravenous administration of fluids; and
• must be able to employ minimal resuscitative methods.

Notably, this legislation does not define what constitutes a primary care “setting,” nor how a facility must distinguish itself from such a setting to constitute an urgent care center for purposes of licensure in Connecticut.

Facility Fees

Current law prohibits hospitals, health systems and hospital-based facilities from collecting a facility fee (1) for outpatient services that use a Current Procedural Terminology evaluation and management code and that are provided at a hospital-based facility that is not on a hospital’s campus, or (2) from an uninsured patient for outpatient services that exceeds the applicable Medicare facility fee rate. Current law exempts services provided at emergency departments from this facility fee limitation. PA 18-149 revises current law to clarify that the above facility fee limits do not apply to freestanding emergency departments, and defines “freestanding emergency department” as a freestanding facility that (A) is structurally separate and distinct from a hospital, (B) provides emergency care, (C) is a department of a Connecticut-licensed hospital; and (D) has received a certificate of need to operate as a freestanding emergency department. PA 18-149 also clarifies that the facility fee limitation with respect to uninsured patients applies to outpatient services provided at off-site hospital-based facilities.

Freestanding Emergency Departments Signage

Lastly, PA 18-149 introduces new signage requirements for freestanding emergency departments (as defined above). Under this legislation, a freestanding emergency department must clearly identify itself as a hospital emergency department, including by prominently displaying the following: (1) external lighted signs that include the name of the hospital and the word “emergency”; and (2) signs stating “THIS IS A HOSPITAL EMERGENCY DEPARTMENT,” which must be located in readily accessible areas, such as the facility’s entrance and patient waiting areas.

Signage at a freestanding hospital emergency department must also indicate whether the department includes within its facility an urgent care center, primary care center, or clinic. If the facility includes such a center or clinic, signs must state the location, hours, contact information and services of the center or clinic. If the facility does not include a center or clinic, the signs identifying the freestanding emergency department as a hospital emergency department must include the following statement: “THIS IS NOT AN URGENT CARE OR PRIMARY CARE CENTER.” The legislation clarifies that the newly-added signage requirements are in addition to any applicable signage or notice requirements under state or federal laws, including without limitation, the requirements of the federal Emergency Medical Treatment and Labor Act (known as EMTALA and commonly referred to as the patient anti-dumping statute), on which additional information may be found here.

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