Executive Summary:
On August 29, 2003, the Center for Medicare & Medicaid Services (CMS) published the revised EMTALA obligations for the perusal of hospitals and doctors. In summary, these regulations try to define the cases where EMTALA is applicable, and also the circumstances and situations that warrant its application. The statutes framed therein define the obligations of various parties in a variety of emergency situations and conditions. In effect, the statutes
- Address prior authorization obligations on delivery of healthcare;
- Clarify what is expected of “Dedicated Emergency Departments”
- Makes clear the application of EMTALA to inpatient, outpatient, provider based, and other hospital facilities
- Re-defines on-call obligations and the responsibility of on-call physicians
- Explains its applicability to hospital owned ambulances
- And finally, elucidates requirements during national emergencies and other contingencies.
Effects of EMTALA on Healthcare
The Emergency Medical Treatment and Active Labor Act (EMTALA) is an important legislation that governs a healthcare professional’s code of conduct in dealing with a patient in an Emergency Room. It defines the conditions and circumstances under which a patient may be denied treatment or transferred to another hospital.
The EMTALA is part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) that was passed in 1986. EMTALA has a broad range of implications that determines the provisions of emergency care treatment for patients, including the ones who are registered under Medicare. It has to be remembered that EMTALA is applicable only to hospitals and other medical centers that have entered into “provider agreements” with the Federal government. The Federal government agency The Department of Health and Human Services provides payment to these hospitals for treatment provided to patients enrolled with their program. Since a majority of the American demography are beneficiaries of one program or the other offered by this government agency, hospital managements don’t have an option other than adopting EMTALA rules and regulations in dealing with patients (Rosenbaum, 2003). So, when hospitals are bound by the EMTALA, they cannot overlook patient needs in favor of monetary gains. In other words, patients needing critical care and immediate attention cannot be turned away or directed to other hospitals just because they are not in a position to pay for the services. In this sense, the Act can also be interpreted as a “non-discrimination statute”. The Act ensures that patients who are subscribed to government insurance programs get all the benefits that are afforded by private insurance programs (Westfall, 2003).
Some of the essential provisions under EMTALA are as follows:
- All patients who are brought to a hospital under an emergency situation should be properly screened so as to determine the exact nature and intensity of their medical condition. If the condition is deemed an emergency, then the patient “should” be provided with all necessary care that is required at that moment. Only when the patient recovers to a state of stability can the hospital management delve into such matters as his/her health insurance, etc. If the results of the screening examination don’t term the condition as an emergency, then the hospital is allowed to act as per its internal policies.
- In case the patient being brought in is a woman in active labor, then it is imperative on part of the hospital to cater to all the needs of the patient till she delivers (Bristol, 2006).
There are some other technical qualifiers attached with EMTALA. One such is that the screening examination must be carried out only by a qualified medical officer as recognized by the government. This means that the medical officer should meet all the requirements of 42 CFR 482.55. Another requirement imposed on the hospital is to display signs within the hospital premises where patients can learn about their rights under EMTALA (Westfall, 2003).