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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