EMTALA

The Emergency Medical Treatment and Active Labor Act (EMTALA) was included in the COBRA legislation of 1986. It was promulgated to combat the discriminatory practice of some hospitals transferring, discharging, or refusing to treat indigent patients coming to the emergency department because of the high cost associated with diagnosing and treating these patients with emergency medical conditions. While the Act applies to all Medicare participating hospitals, it protects anyone coming to a hospital seeking emergency medical services, not just Medicare beneficiaries. EMTALA imposes strict penalties including fines and exclusion from the Medicare program for violations of the Act. The Act imposes three primary requirements on Medicare participating hospitals that provide emergency medical services.

1. The hospital must provide an appropriate medical screening exam to anyone coming to the ED seeking medical care;
2. For anyone that comes to the hospital and the hospital determines that the individual has an emergency medical condition, the hospital must treat and stabilize the emergency medical condition, or the hospital must transfer the individual; and
3. A hospital must not transfer an individual with an emergency medical condition that has not been stabilized unless several conditions are met that includes effecting an appropriate transfer.
   
   

• EMTALA Resources and References

To help members understand the basic requirements of EMTALA, AAEM has prepared the following reports.

• EMTALA - The Basic Requirements, Recent Court Interpretations, and More HCFA Regulations To Come
• The Effect of EMTALA on Provider-Based Entities: Frequently Asked Questions

Another good resource for questions about EMTALA is the following website organized by the Frew Consulting Group of Rockford, IL.

• COBRA/EMTALA Online: How to Understand and Comply with the Complex "Anti-Dumping" Regulations for Hospitals, Physicians, Staff, and Attorneys

HCFA also periodically issues reports and updates on the issue of EMTALA. Some of the most recent updates pertinent to Emergency Medicine are included below.

• AAEM Update: CMS issues updated interpretive guidelines on EMTALA (added 4/4/08)
• CMS Memo Regarding EMTALA On-Call Requirements & Remote Consultation (PDF) (added 7/25/07)
• CMS Comments on 'Parking Patients' (PDF) (added 8/11/06)
• Implications for EMTALA - Hospital Payment System Final Rule (added 8/11/06)
• Federal Appeals Court Rules on EMTALA Screening (added 2/7/03)
• General Accounting Office Issues EMTALA Report (added 12/10/01)
• AAEM Writes Amicus Brief in $4.9 Million "Patient Dumping" Case (added 10/1/01)
• Recent Changes to EMTALA Requirements for Provider-Based Entities (added 11/6/00)
• Hospital's Duty to Accept Transfers under EMTALA (added 9/11/00)
• EMTALA Now Extends to Off-Campus Outpatient Departments
• Summary of Special Advisory Bulletin on EMTALA
• OIG EMTALA Update: On-Call Physician Requirements (added 8/7/00)
• Letters from HCFA to State Medicaid Directors Re-Emphasizing the EMTALA Requirements Regarding Payment of Emergency Services by Managed Care Organizations
• Examination and Treatment for Emergency Medical Conditions and Women in Labor
• OIG/HCFA Special Advisory Bulletin on the Patient Anti-Dumping Statute