EMTALA Information

On September 9, the Centers for Medicare & Medicaid Services (CMS) issued a final rule clarifying hospital obligations to patients who request treatment for emergency medical conditions under the Emergency Medical Treatment and Labor Act (EMTALA). This rule became effective November 10, 2003.

Essentially, the new rule limits the scope of EMTALA by expanding the situations in which hospitals and their EDs are exempt from the law. “The overall effect,” according to the preamble to the regulation, “. . . will be to reduce the compliance burden for hospitals and physicians.”

A key provision of the new rule expands the definition of where patients are entitled to emergency care. A “Dedicated Emergency Department” is any department or facility of the hospital, whether situated on or off the main hospital campus, that:

The rule also makes it clear that, while the law defines “hospital property” as “the entire main hospital campus . . . including the parking lot, sidewalk, and driveway,” the definition does not apply to other entities that participate separately in Medicare, such as doctors’ offices, rural health clinics, nursing homes, or other “nonhospital entities,” even if they are next to the main hospital building and are owned or operated by the hospital.

Another key provision clarifies the circumstances in which physicians, particularly specialty physicians, must serve on hospital medical staff on-call lists. Under the revised regulation, hospitals will have discretion to develop their on-call lists in a way that best meets the needs of their communities. They will no longer be required to have doctors on call 24 hours a day seven days a week, and they may exempt senior medical staff members from their on-call lists. Physicians will be permitted to be on call simultaneously at more than one hospital, and to schedule elective surgery or other medical procedures during on-call times.

In addition, the final rule clarifies that EMTALA does not apply to individuals who come to off-campus outpatient clinics that do not routinely provide emergency services, or to those who have begun to receive scheduled, non-emergency outpatient services at the main campus. The rule also states that EMTALA does not apply after a patient has been seen, screened, and admitted for inpatient hospital services, unless the admission is made in bad faith to avoid EMTALA requirements. If an individual comes to the emergency department and is alone and incapable of requesting medical treatment, the final rule incorporates a new standard under which the hospital is obligated to provide a medical screening examination if a prudent layperson observing the individual would believe that the individual needed medical examination or treatment.

Under the existing regulations, hospitals are explicitly prohibited from delaying screening or stabilization services to verify the individual’s payment method or insurance status. The final rule, however, allows a hospital to seek other information from an insurer about the individual and to seek authorization for services, if doing so does not delay the required screening and stabilization services. The rule also clarifies that the prior authorization policies apply equally to hospital services, physician services, and nonphysician practitioner services. In addition, the rule specifies that, hospitals may follow reasonable registration processes for individuals for whom examination or treatment is required under EMTALA (e.g., informing patients of potential financial liability before services are furnished), if those procedures do not result in a delay in screening or treatment.

Also changed is the definition of “come to the emergency department” as it relates to the applicability of EMTALA to hospital-owned ambulances. The final rule clarifies that hospital-owned ambulances may comply with citywide and local community protocols for responding to medical emergencies and, thus, be used more efficiently for the benefit of their communities. Consequently, an individual in an ambulance owned and operated by the hospital is not considered to have come to the ED if the ambulance is operated under community wide emergency medical service protocols.

• EMTALA Interpretive Guidelines - 3/21/08 - Downloadable PDF
• EMTALA - "Parking" of Emergency Medical Service Patients in Hospitals - 07/13/06 - Downloadable PDF
• EMTALA Update - 9/20/03 - Powerpoint Presentation
• EMTALA Overview - 9/20/03 - Powerpoint Presentation
• EMTALA Revisions - 9/9/03 - Downloadable PDF