Regulation of fast growing freestanding EDs varies among states

October 27, 2016

Freestanding EDs (FSEDs) are a growing alternative to traditional hospital-based emergency care but come with controversy. FSEDs began in the 1970s as a critical care option for rural areas, but have recently grown across the nation. FSEDs can be independent or affiliated with a hospital. A new study published in this month’s Health Affairs finds that those two types vary substantially in size, reimbursement options, types of services offered, and integration of care. The study also found that states vary considerably in whether and how they regulate FSEDs. For instance, states that require Certificate of Need approval, have fewer FSEDs. State regulations also vary in FSED location, staffing and services.


CSG-ERC states considerably both in the number of FSEDs and state decisions to regulate them. As of December 2015, New Jersey has the most FSEDs in the region and both regulates them and requires an affiliation to an acute care hospital. But two out of three FSEDs in the CSG-ERC region are in two states, Connecticut and New York, with no FSED regulatory policies. Five ERC states do not yet have FSEDs.

Number of FSEDs Policies re. FSEDs? Require hospital affiliation?
CT 5 N Y
DE 2 Y N
MA 4 Y Y
MD 3 Y Y
ME 0 N Not addressed in regulation
NH 0 Y Y
NJ 9 Y Y
NY 7 N Y
PA 0 N Y Not addressed in regulation
RI 0 N
VT 0 N N
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