Although the Health Services Council voted against the initial licensure for two freestanding emergency rooms, one in Bristol and the other in West Warwick, Department of Health Director Dr. Nicole Alexander-Scott approved the Neighbors Emergency Centers’ application for initial licensure Monday.

The West Warwick site on Route 2 would be less than two miles from Kent Hospital. Representatives from both Kent Hospital and the Bristol Medical Center provided testimony at council meetings in opposition to Neighbors Emergency Center licensure.

For the past several months the Health Services Council has debated whether or not Neighbors Emergency Center, a freestanding emergency room based out of Texas, met the necessary criteria for licensure, including a commitment to work with underserved populations throughout the state.

By federal law, Neighbors cannot participate in Medicare or Medicaid, but the applicant assured numerous times that it “never turns a patient away” and that it is actively lobbying for change. Should the law be restructured, the freestanding ER would be happy to accept those patients.

Similarly, the council had questions concerning whether or not the applicant would augment the state’s coordinated efforts for a more comprehensive care system or just add to rising healthcare costs.

Throughout the deliberations, representatives from Neighbors said they wanted to be a positive addition to the healthcare system and would provide top quality care for the state.

In March the Health Services Council recommended denial of the licensure in a 5-6 vote. Alexander-Scott sided with the minority, claiming the organization meets the appropriate requirements. She noted in her letter that with 21 sites and another 14 planned to open in 2016, Neighbors has a good standing within their respective communities and even received the Joint Commission’s Gold Seal Approval.

In response to the approval, Jim Beardsworth, a Kent spokesman, said, “We respect the director’s decision on this matter and as such there is nothing further to comment on or add to the discussion.”

Although Alexander-Scott moved forward with the approval, in her nine-page decision letter the director set forward specific conditions for Neighbors, holding them to claims made during the council meetings.

In addition to meeting state rules and regulations, Neighbors must be nationally accredited and, should federal law change, the freestanding ER is required to accept Medicare and Medicaid patients.

Under Alexander-Scott’s conditions, patients seeking services possibly more suited for an urgent care center or a primary doctor, must receive both written and verbal “notification” that they can receive treatment elsewhere. Should those patients, after being notified, continue to receive treatment from Neighbors the organization cannot bill a patient more than three times. Similarly, those commercially insured patients cannot be balance billed.

To maintain the state’s efforts to increase comprehensive care, Neighbors will be required to contact a patient’s primary healthcare provider to either consult before hospital admission or to set up a follow up appointment upon discharge. For those patients without a primary physician, Neighbors must have a list of local doctors and make a “reasonable” effort to make a follow up appointment for a patient.

“This is important because consistent care from a primary care doctor is much healthier for the patient, and the financial viability of the system, than care in an emergency department,” Joseph Wedelken, public information officer for the department said, “Rhode Island is very focused right now on making sure that our healthcare system is paying for value and good health outcomes, instead of volume.”

Now Neighbors must go through the process of licensing through the Center for Health Facilities Regulation.