CMS Proposes Changes To EMTALA Requirements
CMS has proposed clarifications and changes to EMTALA
regulations regarding hospital inpatients and
"on-call" obligations."
The Centers for Medicare and Medicaid Services (CMS) has
recently proposed changes relating to the Emergency Medical
Treatment and Labor Act of 1986 (EMTALA), and, in particular,
requirements to hospital inpatients and physician
"on-call" obligations.† The
changes, proposed in the April 30, 2008, edition of the
Federal Register, would take effect in October
2008.†
Applicability Of EMTALA Requirements To Hospital
Inpatients
In its 2003 final rule, CMS took the position that a
hospital has satisfied its EMTALA obligations when a patient
with an unstable emergency medical condition is admitted in
good faith as an inpatient.† However, the
2003 final rule did not address whether EMTALA's
"specialized care" requirements applied to
inpatients.† The "specialized care"
requirements provide that hospitals with specialized
capabilities or facilities (including, but not limited to,
facilities such as burn units, shock-trauma units, neonatal
intensive care units orówith respect to rural
areasóregional referral centers) may not refuse to accept
an appropriate transfer of an individual who requires such
specialized capabilities or facilities if the receiving
hospital has the capacity to treat the
individual.† CMS has not further defined what
"hospitals with specialized capabilities or
facilities" means.
CMS based certain of its proposed changes on the
recommendations of the EMTALA Technical Advisory Group (TAG), a
group established by CMS composed of industry representatives
tasked with reviewing EMTALA regulations and providing advice
and recommendations concerning the regulations and their
application to hospitals and physicians.† As
noted in the Federal Register, the changes are intended to
"clarify" that even after inpatient admission at one
hospital, EMTALA obligations are not extinguished for all
hospitals.† Specifically, where an unstable
patient is admitted at one hospital (the "admitting
hospital") and is subsequently transferred in an unstable
condition via an appropriate transfer to a facility with
specialized capabilities, that the "receiving
hospital" has an EMTALA obligation to accept the
individual so long as the receiving hospital has the capacity
to treat the individual.†
According to CMS, the proposed clarifications would extend
EMTALA protections "to those who need it most" until
such time as individuals with emergency medical conditions are
admitted as inpatients and covered by the hospital Conditions
of Participation.
CMS acknowledges provider concerns that the...
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