Last updated: November 2026
A Texas freestanding emergency medical care facility is structurally separate from a hospital and receives individuals for emergency care. For developers preparing a Chapter 254 license application, Integral Healthcare Solutions (IHS) organizes the licensing calendar, application documents and draft policies using Chapter 254 and the licensing procedures in 26 TAC Chapter 509, Subchapter B. The owner approves the documents and files with HHSC.
What is Texas freestanding emergency medical care facility licensing?
It is a state license that Texas requires before a person establishes or operates this kind of facility. We read three government sources (page opened November 5, 2026 for each): the Texas Health and Safety Code Chapter 254, the 26 Texas Administrative Code Chapter 509 on the Texas Secretary of State rules portal (sections 509.21, 509.22, 509.24, 509.27, 509.28, 509.29 and 509.30) and the HHSC freestanding emergency medical care facilities page. What they record, in our words:
- License required. Section 254.051(a) says that, except as provided by section 254.052, a person may not establish or operate a freestanding emergency medical care facility in Texas without a license.
- One license per location. Each separate facility location must have a separate license (section 254.051(c)), and the license is not transferable or assignable (section 254.051(d)).
- Always open. Section 254.051(e) says a license may be issued only for a facility in continuous operation 24 hours per day and 7 days per week.
- Two-year term. Section 254.053(f) sets a two-year license term, and rule 509.24(i) says the license expires on the last day of the 24th month after issuance.
- Rule location. HHSC's page says 25 TAC Chapter 131 Subchapters F and G transferred to 26 TAC Chapter 509 on November 29, 2024.
Subchapters C through G of Chapter 509 (operations, physical plant and enforcement) were not opened for this page, so this page does not summarize them.
Who needs it and what triggers it?
A developer planning a new freestanding emergency facility in Texas needs it before opening. Section 254.052 lists facilities that are not required to be licensed, including a licensed hospital, a facility located within or connected to a licensed hospital, a facility owned or operated by a licensed hospital or a hospital owned and operated by the state, where the facility is either surveyed as a hospital service by a CMS-deemed hospital accrediting organization or granted provider-based status by CMS, and a licensed ambulatory surgical center. Whether an exception applies is a question for counsel. Triggers:
- A developer is planning a first freestanding emergency facility and needs a dated path to opening.
- A new owner is buying a licensed facility and must apply under rule 509.27.
- A licensed facility is relocating. Rule 509.28(e) treats the relocated site as an initial license.
How IHS helps
IHS starts with a gap assessment against the cited licensing provisions, maps documents and evidence to those provisions, drafts content for the client's clinicians to approve, and supports corrections after the mock review. The steps:
- Licensing calendar. IHS works back from the projected opening date to the 90-day application deadline in rule 509.24(b) and the 30-day lead times for ownership change and relocation.
- Disclosure and document checklist. IHS builds the checklist from rule 509.24(c), so each disclosure has a named owner and a source document.
- Policy drafts. IHS drafts the patient transfer policy, the memorandum of transfer form and the policies the facility's physicians and nurses approve.
- Notices and advertising review. IHS checks draft signs, website copy and marketing against sections 254.155, 254.157 and 254.161 and rule 509.21(a)(2).
- Mock inspection walk-through. IHS walks the owner through the file and the on-site items, then returns a ranked gap list.
The owner supplies the application forms, the fee, the architectural and fire records, the hospital transfer agreement, the clinical staffing decisions and all dealings with HHSC. The real limit: IHS does not file with, call or correspond with HHSC, and it does not predict a licensing outcome. IHS gives no legal advice.
What to have ready
This checklist cites 26 Texas Administrative Code, Chapter 509, in its current version reviewed November 5, 2026.
- The completed application form, the required information and the license fee, scheduled to reach HHSC 90 days before the projected opening date (26 TAC §509.24(b)).
- The ownership disclosures applicable to the facility's entity structure under 26 TAC §509.24(c)(1) to (3); identify the required individuals before assembling their personal information.
- The physician financial-interest disclosures and medical chief-of-staff credentials required by 26 TAC §509.24(c)(4) and (5), and the director of nursing's name, nursing license number and license expiration date under 26 TAC §509.24(c)(6).
- An affirmation that at least one Texas-licensed physician and at least one Texas-licensed registered nurse will be on site during all hours of operation (26 TAC §509.24(c)(7)).
- The enforcement, exclusion and criminal-history items for the applicant, affiliates and managers, the two-year look-back items and the number of emergency treatment stations (26 TAC §509.24(c)(8) to (10)).
- The patient transfer policy signed by the chairman and the secretary of the governing body, the memorandum of transfer form, and a written hospital transfer agreement (26 TAC §509.24(c)(11) to (13)).
- A passing fire inspection report from the local fire authority, dated no earlier than one year before the opening date (26 TAC §509.24(c)(14)).
- Attendance by the applicant or its representative at the prelicensure conference at the office designated by HHSC unless HHSC waives the conference, an approved architectural inspection conducted by HHSC, and HHSC's determination of compliance with 26 TAC §509.24(c) to (e) before issuance (26 TAC §509.24(f) and (g)).
- A request for the on-site inspection once the facility has provided services to at least one patient (26 TAC §509.24(l)).
If the 90-day date is already close, book the free introductory call below before the application is assembled.
How it compares
- Freestanding emergency facility license. The Chapter 254 route described above, for a facility structurally separate and distinct from a hospital.
- Hospital licensure and hospital-owned facilities. Section 254.052 exempts a licensed hospital and certain facilities connected to or owned by one. Those routes follow other rules, which this page does not cover.
- Medicare. HHSC's page says these facilities are not certified to participate in the federal Medicare program. IHS covers a federal emergency-care designation on the rural emergency hospital conversion page.
What it costs
Rule 509.30 sets the HHSC initial license fee, which includes change of ownership or relocation, at 14,820 dollars for a two-year term, and the renewal fee at 6,070 dollars for a two-year term (source: the rules portal linked above, page opened November 5, 2026). Verify current fees with HHSC. HHSC does not process an application until the fee is received and posted, according to its page. Fees are nonrefundable except as rule 509.29 provides.
IHS scope turns on the number of policies to draft, how much of the file already exists and whether an ownership change or relocation is involved. IHS scopes each engagement after a free introductory call.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm, and counsel advises on what Chapter 254 and Chapter 509 require and whether an exemption applies.
It is not a full summary of the rules. It covers the statute and Subchapter B of Chapter 509 as read on the dates above. The rules control.
It is not IHS acting for you with HHSC. IHS does not contact HHSC; IHS drafts, and the owner files and answers.
Frequently asked questions
Who needs a freestanding emergency medical care facility license in Texas?
Under Texas Health and Safety Code section 254.051(a), a person may not establish or operate a freestanding emergency medical care facility in Texas without a license, except as provided by section 254.052. The exceptions include a licensed hospital, a facility located within or connected to one, and a licensed ambulatory surgical center. Each separate facility location needs its own license.
How far ahead of opening must the application go to HHSC?
Rule 509.24(b) says the applicant submits the completed application, the required information and the nonrefundable license fee to HHSC 90 days before the projected opening date. The processing period in rule 509.29(d)(1) runs from HHSC's receipt of a complete application; issuance also depends on the compliance findings required by section 254.053(e).
What does the Texas license fee cost, and what does the license term cover?
Rule 509.30 sets the initial license fee, which includes change of ownership or relocation, at 14,820 dollars for a two-year term. The renewal fee is 6,070 dollars for a two-year term. Fees are nonrefundable except as rule 509.29 provides. Verify current fees with HHSC before budgeting.
What must the application disclose?
Rule 509.24(c) lists the disclosures, where applicable: owners and persons with more than 25 percent interest, physicians with a financial interest, the medical chief of staff, the director of nursing, an affirmation of a Texas physician and registered nurse on site during all hours of operation, enforcement and criminal history items, and the number of emergency treatment stations. It also asks for transfer documents and a fire inspection report.
Does the facility need an agreement with a hospital before it sees patients?
Yes. Section 254.153(b) says that before a facility accepts any patient for treatment or diagnosis, it shall enter into a referral, transmission, or admission agreement with a hospital licensed in Texas. Rule 509.24(c)(13) also asks for a copy of a written agreement with a hospital for prompt transfer and admission when services are unavailable or beyond the facility's capabilities.
What signs and notices must the facility post?
Section 254.155 requires prominent fee notices at the primary entrance, in every treatment room and at every payment location, with legible physical signs at least 8.5 by 11 inches; online, use the home page or a page reached through a prominent home-page link entitled Insurance Information. Follow section 254.155(a), (d) and (e) for notice content, the alternative for in-network-plan information and the prohibition on altering required language. Section 254.161 requires the attorney general's prescribed human trafficking sign, at least 11 by 17 inches with at least 16-point type, easily visible to all employees and posted separately in English, Spanish and any other primary language spoken by at least 10 percent of employees. Section 254.157 bars network-provider advertising unless the facility is a network provider of a health benefit plan issuer.
Is a freestanding emergency facility certified for Medicare?
HHSC's page says freestanding emergency medical care facilities are not certified to participate in the federal Medicare program. IHS does not advise on payer terms; counsel and the owner decide them.
Can the facility use the words emergency or ER before it is licensed?
Except for facilities covered by section 254.052, section 254.051(b) prohibits holding out as a freestanding emergency medical care facility, or using a similar term that implies emergency care, without the Chapter 254 license. Counsel should assess any claimed exemption before the facility uses emergency-care branding.
What happens on a change of ownership or a relocation?
The license is not transferable or assignable. For a change of ownership, the new owner submits an initial license application and fee no later than 30 calendar days before the change, under rule 509.27. For a relocation, rule 509.28(e) sets the same 30-day lead time and says the previous license is void on the date of relocation.
What does IHS prepare, and does IHS deal with HHSC?
IHS prepares the licensing calendar, the disclosure and document checklist, the draft policy set and a mock inspection walk-through. The owner and the facility's physicians approve clinical content. IHS does not file with, call or correspond with HHSC; the owner files and answers HHSC, with counsel.