CMS Publishes New EMTALA Regulations

The Centers for Medicare & Medicaid Services published new final regulations in the Federal Register on Tuesday, September 9, 2003 under the Emergency Medical Treatment and Labor Act (EMTALA). EMTALA is the Federal law that requires hospitals to screen and stabilize patients with an emergency medical condition before they can be transferred to other hospitals in most cases.

The final regulations contain several provisions that address ambulances, whether hospital-owned or non-hospital-owned, and the implications of each under EMTALA. The regulations make it clear that a person “comes to” the emergency department for purposes of EMTALA if the individual “is in a ground or air ambulance owned and operated by the hospital for purposes of examination and treatment for a medical condition at a hospital’s dedicated emergency department, even if the ambulance is not on hospital grounds.”

The final regulations also make it clear that hospital owned and operated ambulances may transport individuals to hospitals other than the hospital that owns the ambulance without an EMTALA violation if doing so under “communitywide EMS protocols” that direct the ambulance to transport the patient to a different destination.

Additionally, an individual is considered to “come to the emergency department” when they are transported by a non-hospital owned ambulance that is on hospital property (for instance, in the parking lot). But, if a non-hospital owned ambulance is off hospital property, then the patient has not come to the emergency department, even if a staff member from the ambulance contacts the hospital via telephone or telemetry and informs the hospital that the patient is being transported to the emergency department.

Hospitals also retain the ability under the new regulations to go on “diversionary status” when the hospital lacks the staff or facilities to accept additional emergency patients. However, if the ambulance crew disregards the diversionary status and transports the patient to the hospital, the hospital’s EMTALA obligations are triggered, and the hospital must provide the medical screening examination and stabilizing treatment of an emergency medical condition.

In addition to the EMS-specific sections of the new regulation, some other sections of interest include the definition of a “dedicated emergency department.” To be considered a dedicated emergency department a facility must meet one of the three following criteria:

  • The facility is licensed by the state as an emergency department;
  • The facility is held out to the public (by name, signage, advertising, or other means) as an emergency department; or
  • The facility provides at least one-third of all of its outpatient services on an emergency basis.

The regulation also modifies the requirements for the availability of on-call physicians who may now be on call at several facilities and schedule elective procedures during on-call hours. Further, hospitals are relieved of EMTALA duties if the individual needing care is an inpatient or refuses care.

The new regulations go into effect on November 10, 2003.

To download a complete copy of the new EMTALA regulations, visit www.pwwemslaw.com and go to either the “Ambulance Service Compliance Resource Page” or “Medicare Resource Page.”

(c) Copyright, 2003, Page, Wolfberg & Wirth, LLC.

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