EMTALA

MHA Notices and Resources

CMS Revises Appendix V Of The State Operations Manual

CMS' Outlines EMTALA On-call Requirements and Remote Consultation Via Telecommunications

CMS’ EMTALA Memo Addresses EMS Issues

CMS Issues Guidance On Hospital Emergency Services Requirements

EMTALA Resource Manual

Analysis of Revised EMTALA Interpretive Guidelines (MHA members only)

A Detailed Look at the Final EMTALA Regulations (MHA members only)

Information from the Centers for Medicare & Medicaid Services

Responsibilities of Medicare Participating Hospitals in Emergency Cases

EMTALA Issues Related to Emergency Transport Services (April 2007)

CMS Issues Guidance to Hospitals on Emergency Services Requirements (April 2007)

"Parking" of Emergency Medical Service Patients in Hospitals (July 2006)

CMS Overview

CMS Revises Appendix V Of The State Operations Manual
The survey and certification memo from the Centers for Medicare & Medicaid Services contains an advanced copy of Appendix V, “Survey Protocol, Regulations and Interpretive Guidelines for the Emergency Medical Treatment and Labor Act,” that is available in the State Operations Manual.

CMS' Outlines EMTALA On-call Requirements and Remote Consultation Via Telecommunications
A survey and certification memo from the Centers for Medicare & Medicaid Services addresses EMTALA on-call requirements and remote consultation via telecommunications. A treating physician may use any telecommunications medium to consult on a patient’s case with a physician who is not present in the emergency department. The consulting physician may or may not be on the hospital’s on-call list. However, if the physician is on a hospital’s on-call list and has been requested by the treating physician to appear at the hospital but fails or refuses to appear within a reasonable period of time, the on-call physician may be in violation of EMTALA.

CMS’ EMTALA Memo Addresses EMS Issues
The Centers for Medicare & Medicaid Services has issued a survey and certification memo to state surveyors addressing EMTALA. Effective immediately, the memo states it is an EMTALA violation for a receiving hospital to condition its acceptance of an appropriate transfer on the sending hospital’s use of a particular transport service instead of the transport arrangements made by the attending physician at the sending hospital.

The memo also clarifies a previous memo that was intended to address concerns about the “parking” of patients transported by emergency medical services to hospitals. The CMS did not intend for this earlier correspondence to be interpreted to mean that a hospital must immediately assume all responsibility from the EMS provider upon its arrival on the hospital property, regardless of the situation in the hospital’s emergency department. The CMS recognizes there may be situations when a hospital does not have the capacity or capability to provide an immediate medical screening and stabilizing treatment, and the EMS staff may need to stay with an individual transported by EMS. However, the hospital is still required to provide an immediate triage of the individual’s condition to ensure an emergent intervention is not required.

If you have questions, please contact Sharon Burnett.

CMS Issues Guidance On Hospital Emergency Services Requirements
The Centers for Medicare & Medicaid Services has issued a survey and certification memo to state surveyors outlining the requirements for all hospitals, excluding critical access hospitals, to provide emergency services, effective immediately. In the memo, the CMS emphasizes that nearly all hospitals, including specialty hospitals and others without emergency departments, must be able to evaluate people with emergencies, provide initial treatment and refer or transfer these individuals when appropriate. In addition, the CMS states a hospital may not rely on 911 services to provide this initial assessment and treatment.

The memo also reviews applicable Medicare Conditions of Participation. It explains the appropriate appraisal, treatment and referral policies and procedures in emergencies and appropriate emergency patient transport methods.

In a separate but related development, a proposed CMS rule would require a hospital to provide written notification to all patients if a physician is not present in the hospital 24 hours a day, seven days a week. The rule is part of the fiscal year 2008 acute care hospital inpatient prospective payment system and complies with the Deficit Reduction Act of 2005.

Under the proposed rule, a hospital must disclose how it would meet the medical needs of a patient who develops an emergency condition if no doctor is on-site. The CMS seeks comments on whether current emergency service requirements should be strengthened to include the following.

• clinical personnel who should be present at all times and required competencies
• emergency response equipment that should be available at all times
• if hospital emergency departments should be required to operate 24 hours per day, seven days a week

As a reminder, the FY 2007 inpatient PPS rules added language to the EMTALA rules that clarified every participating hospital with specialized capabilities, regardless of whether or not it operates an emergency department, must accept an appropriate transfer for which it has capacity and the necessary specialized capabilities to treat the patient. The CMS also expects to implement a revised Medicare provider enrollment application form in September that clearly identifies specialty hospitals as a separate category of hospitals.

If you have questions, please contact Sharon Burnett.