The Texas ER Disclosure Requirement Most Websites Get Wrong

Section 254.156 of the Texas Health and Safety Code sets out a disclosure that every freestanding emergency medical care facility must post. It is specific in a way that most website requirements are not, and that specificity is exactly why so many sites fail it.

Published research on Texas freestanding ER compliance found fee disclosure to be the single most commonly missed requirement. In our own audit work, that matches. When we check an ER site, this is the item most likely to be absent, incomplete, or formatted incorrectly.

What the Disclosure Has to Contain

The statement must cover the facility's observation and facility fees, and it must address network status. The point is that a patient walking in should understand, before treatment, that a freestanding ER carries fees a walk-in clinic does not, and where the facility stands with their insurer.

The Formatting Is Part of the Requirement

This is what trips people up. The disclosure must be:

• 16-point boldface type
• In a contrasting color to its background
• In both English and Spanish

Those are not stylistic suggestions. A disclosure that exists but sits in 12-point grey text in a footer does not satisfy a 16-point boldface contrasting color requirement. Neither does an English-only version.

On a website this creates a genuine design question, because 16-point boldface is large, and designers instinctively shrink it. We have seen sites where the disclosure was clearly written to comply and then styled into non-compliance by whoever built the theme.

The Five Failure Modes We See

• Missing entirely. Most common on sites built by general agencies with no healthcare experience.
• English only. The Spanish version was planned and never delivered, or it lives on a separate page nobody links to.
• Wrong size. Present and correct in content, rendered at whatever the theme's body size happens to be.
• Low contrast. Grey on light grey in a footer, which fails both the letter of the rule and its purpose.
• Hidden behind a click. Linked from a footer as a PDF rather than posted where a patient will see it.

That last one is worth dwelling on. A PDF linked in a footer is not a disclosure a patient encounters. It is a disclosure a regulator can find, which is not the same thing and arguably not what the statute intends.

Where It Should Live on the Site

Our practice is to place it on the pages where a patient is forming an expectation about cost: the billing or insurance page certainly, the homepage in an appropriate position, and any page that discusses what a visit involves.

It also needs to survive a phone. A 16-point boldface block that looks fine on a desktop can overflow its container on a 375-pixel screen, and a disclosure that is cut off is not a disclosure. We test it at mobile width every time.

How to Check Your Own Site Today

Three steps, about ten minutes:

• Find the disclosure. If you cannot find it in under a minute, a patient will not either.
• Right-click it and inspect the element, or ask whoever maintains your site to confirm the rendered font size and weight. You are looking for at least 16 points and genuine boldface.
• Check the Spanish version exists, is complete rather than machine-translated nonsense, and is as prominent as the English one.

Then open the same pages on a phone and confirm nothing is cut off or collapsed.

Why This Is Worth Fixing Even Setting Aside the Rule

There is a commercial argument as well as a compliance one. Patients arriving at a freestanding ER are frequently surprised by the bill, and surprise turns into complaints, bad reviews, and disputed charges.

A facility that states its fee position plainly, up front, in a way people actually read, converts slightly fewer visits and generates substantially fewer angry phone calls afterward. Most operators we work with consider that a good trade once they see the review data.

Designing a 16-Point Disclosure That Does Not Look Broken

The practical objection we hear from designers is that 16-point boldface in a contrasting color is visually loud, and it disrupts an otherwise careful page. That is true, and it is not a reason to shrink it.

What works is treating the disclosure as a deliberate design element rather than an intrusion. Give it a bounded container with generous padding, a background that establishes the contrast cleanly, and enough space above and below that it reads as intentional. Done that way it looks like a considered notice rather than a mistake.

The two things to avoid are shrinking it to fit and hiding it behind an accordion. Both defeat the requirement, and an accordion is arguably worse because it looks like compliance while functioning as concealment.

Test the result at 375 pixels wide. Large boldface text overflows narrow containers easily, and a disclosure with its right edge cut off satisfies nobody.

The Spanish Version Deserves Real Translation

The bilingual requirement is not a formality, and machine translation handles billing and legal language poorly. Terms like "observation fee," "facility fee," and "network status" have specific meanings, and a translation that renders them loosely produces a notice that is technically present and practically useless.

Have it translated once by someone who works in healthcare, then reuse it. The cost is small and it removes a recurring worry.

Give it the same prominence as the English version rather than tucking it below or behind a language toggle nobody notices. In many Texas markets a substantial share of patients will read the Spanish version first.

Documenting That You Complied

Worth doing and almost nobody does it: keep a dated record of the disclosure as published. A screenshot of the live page, the date, and a note of who approved the wording.

Websites change. Themes get updated, plugins alter typography, a redesign moves a block. If a question is ever raised about what your site displayed at a particular time, a dated record is considerably better than trying to reconstruct it afterward.

Add it to whatever annual review cycle you already run, alongside the advertising language check. The two belong together because they fail together.

What Else to Check While You Are There

In our audits, sites missing the disclosure are usually missing other things too. The cluster is consistent:

• Network status language that implies a relationship the facility does not have
• No Notice of Privacy Practices published, or one that only exists as a PDF
• Billing content written before the No Surprises Act and never revisited
• Wait-time claims the facility cannot evidence

These share a root cause, which is that the site was built by people with no reason to know any of it applied. Fixing them together is faster than fixing them one at a time, and it means one compliance review rather than four.

Common Questions

Does the disclosure need to be on every page?

The statute concerns posting rather than repetition on every URL. Our practice is to place it where cost expectations form, and to make it easy to find from anywhere. Your compliance advisor should confirm the placement you settle on.

Can we use Google Translate for the Spanish version?

We would not. Machine translation of legal and billing language produces text that is sometimes wrong and often reads as careless, which undermines the trust the disclosure is meant to build. Have it translated properly once.

What if we are not in Texas?

Section 254.156 is Texas law. Other states regulate freestanding ERs differently, and some barely at all. The general principle, that a facility should disclose fees a patient would not expect, holds more widely than the specific statute.

Who is responsible if it is wrong, us or our web agency?

The facility. That is the uncomfortable part, and it is why this is worth checking rather than assuming the people who built your site knew about it. Most general agencies have never heard of Chapter 254.