MHA's Executive Briefing

No changes to EMTALA policies needed, AHA tells CMS

The American Hospital Association strongly agrees with the Centers for Medicare & Medicaid Service’s January decision not to propose changes to the current Emergency Medical Treatment and Labor Act regulations, the association said in comments submitted to the agency March 26. In January, CMS said it would maintain its current EMTALA policies, but would accept data or real-world examples for 60 days concerning the applicability of EMTALA to hospitals with specialized capabilities.

“As we explained in our prior comments on whether any changes in policy were needed, the current policies are the appropriate interpretation of the law and actual experience in the field demonstrates that they are achieving what Congress intended,” AHA wrote. “…We believe that the agency’s decision following a year-long consideration of the issue and thorough review of all the input submitted was the correct one, and no modifications for hospitals with specialized capabilities are necessary.”

CMS elects not to propose changes to EMTALA

As requested by the American Hospital Association, the Centers for Medicare & Medicaid Services on Jan. 31 said it has decided not to propose changes to the current Emergency Medical Treatment and Labor Act regulations. While the agency said that a hospital has satisfied its EMTALA obligation when it admits an individual "in good faith in order to stabilize the [emergency medical condition]," it is providing an additional 60 days to comment on the applicability of EMTALA to hospitals with specialized capabilities.

"Hospitals fully support the intent of EMTALA - to ensure individuals get an appropriate screening and needed emergency services," said AHA President and CEO Rich Umbdenstock. "CMS' current policy is the most appropriate way to achieve EMTALA's goals, and we support CMS' decision not to change those policies. We appreciate CMS' approach. Hospitals take seriously their EMTALA responsibilities - and all other responsibilities - to their patients and will continue to provide care to patients at the right time and in the right setting."

The notice will be published in the Feb. 2 Federal Register. AHA intends to urge that the regulations for hospitals with specialized capabilities remain unchanged.

AHA to CMS: Do not apply EMTALA to inpatients

The Centers for Medicare & Medicaid Services does not need to revisit its current policies on the application of the Emergency Medical Treatment and Labor Act to inpatients, the American Hospital Association said Feb. 15 in a letter to the agency. "The current policies are the appropriate interpretation of the law and are achieving what Congress intended," AHA said, responding to a CMS request for public comments on the issue.

Existing Medicare conditions of participation for hospitals, coupled with state laws, accreditation and other oversight entities, "provide appropriate and uniform protections for an individual admitted as an inpatient," AHA said. Attempting to use EMTALA for more than it was designed "is legally unsound, and most importantly, would adversely affect patient care," the letter adds.

EMTALA was designed "to assure that all individuals in need of emergency services have access to care" and achieves that goal, the letter notes.

CMS seeks comment on whether EMTALA should apply to inpatients

CMS on Dec. 22 issued a request for comment on whether there is a need to revisit its Emergency Medical Treatment and Labor Act policies regarding hospital inpatients and the responsibilities of hospitals with specialized capabilities. Under current regulations, a hospital's EMTALA responsibilities are complete when a hospital, in good faith, admits an individual with an unstable emergency medical condition as an inpatient.

CMS is specifically asking for comment on individuals who are admitted as inpatients through the emergency department with a known emergency medical condition that has not been stabilized and subsequently need to be transferred to another hospital with specialized capabilities for stabilizing treatment. Comments will be accepted until Feb. 21, 2011.

MHA hosting webinar on EMTALA/ED compliance

On Dec. 14, the Mississippi Hospital Association will host a webinar on EMTALA/ED compliance from 10 a.m. until 11:30 a.m. Duane Abbey will be the instructor.

The objectives of the webinar are:

• To review Current Changes to EMTALA Rules and Regulations Including Pertinent Litigation Cases
• To review the need for developing a special ED compliance plan
• To discuss the current and evolving requirements for EMTALA compliance
• To review the definitions and conditions for EMTALA
• To compare and contrast EMTALA with the Conditions for Participation (CoPs)
• To understand the special coding and billing requirements for the ED relative to EMTALA
• To appreciate the provider-based clinic interface to EMTALA
• To review different approaches to audits and reviews of the ED relative to coding, billing and
  EMTALA

Register online here. For more informaton, contact Karen Anding at (800) 289-8884, (601) 368-3263 or kanding@mhanet.org.

EMTALA and the Acute Care Setting

EMTALA’s interpretive guidelines can leave hospitals vulnerable to legal action. A policy development and revision process can help protect the organization. Read more here.

CMS updates criteria for EMTALA waivers

During certain kinds of emergencies, your hospital may be able to expect a relaxation of Emergency Medical Treatment and Labor Act (EMTALA) rules based on new language that CMS has added to the State Operations Manual's Interpretive Guidelines relating to EMTALA waivers.

Under the updated guidelines, hospitals and critical access hospitals operating under an EMTALA waiver will not be sanctioned for:

• Redirecting an individual who comes to the ED from another location for a medical screening exam, according to a state emergency preparedness plan or state pandemic preparedness plan.
• Inappropriately transferring an individual protected under EMTALA, when the transfer is necessitated by the circumstances of the declared emergencies.

Read more here.

AHA supports bill extending Section 1011

The American Hospital Association on July 29 expressed support for the Border Health Care Relief Act (H.R. 6394), which would provide $250 million annually through 2012 to help hospitals offset the costs of providing emergency care to undocumented immigrants. Sponsored by Rep. Gabrielle Giffords (D-AZ), the legislation would extend Section 1011 of the 2003 Medicare Modernization Act, set to expire Sept. 30 without congressional action.

According to a report by the United States-Mexico Border Counties Coalition, hospitals in border states provided more than $200 million in uncompensated care to undocumented immigrants in 2002. “Since that report was released, the problem has become even more serious because of the rising number of undocumented immigrants who continue to come to the U.S. and who require emergency health care services,” AHA wrote Giffords.

Under the Emergency Medical Treatment and Labor Act, hospitals must treat anyone who needs emergency care, regardless of their ability to pay and citizenship status.

[ via AHA News Now ]

EMTALA flexibility proposed to relieve on-call MD shortages

In a new Medicare hospital payment rule released in late April, CMS included a proposal clarifying its on-call policies under EMTALA. If finalized, the proposal would let a group of hospitals in a region designate one of them as the on-call site for a specific time period or service, rather than each struggling to keep up on-call coverage. For example, two hospitals could agree that for half of the month, one hospital would be the official on-call facility, while the other would serve that role for the second half.

In making such a proposal, CMS hopes to address the steadily worsening problem hospitals face with finding adequate on-call coverage by specialists. In 2005, the most recent year for which survey data was available, 73 percent of ED directors reported to the American College of Emergency Physicians that they were having trouble making on-call arrangements.

Regardless of what arrangements they made, individual hospitals with emergency departments would still be required to do a standard medical screening exam and have a plan for how to proceed if an on-call physician wasn't available. CMS wouldn't give preapproval to plans, but would review each plan if EMTALA violations arose after those plans were put in place. (The lack of pre-approval seems to me like a glaring problem--everyone wants a safe harbor determination in place when weighty federal violations may be in the offing-but we'll see, I suppose.)

To learn more about the EMTALA plan, read this AMNews article.

[ via Fierce Healthcare ]

CMS: "Parking" EMS Patients in Hospital May Violate EMTALA

In a July 13, 2006, letter to state survey agency directors (pdf), the Centers for Medicare & Medicaid Services (CMS) indicated that if a hospital prevents emergency medical services (EMS) staff from transferring patients from the ambulance stretcher to a hospital bed or gurney, it may result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA). CMS says it has received reports of patients being left on stretchers for extended periods of time with EMS personnel in attendance. CMS says that while it recognizes the enormous strain and crowding many hospital emergency departments face every day, the practice of "parking" patients is not a solution, as it impedes the ability of EMS personnel to provide emergency services to the rest of the community.