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.
- The hospital must provide an appropriate medical screening exam to anyone coming to the ED seeking medical care;
- 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
- 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.
Balance Billing and Out of Network ChargesPosition Any regulations or laws that restrict out-of-network fees and balance billing from the emergency department should provide that insurers reimburse emergency physicians for their professional services at rates consistent with “usual and customary charges.” The “usual and customary charge” for a service should be defined using a source of unbiased, third party data such […]
Definition of Negligence for EMTALA-Mandated Emergency CareThe American Academy of Emergency Medicine (hereinafter AAEM or the Academy) supports an increased level of scienter for EMTALA mandated care.1 Specifically, AAEM supports state laws that require plaintiffs to prove gross negligence or recklessness, by clear and convincing evidence, in cases alleging negligence for emergency department care, and for subsequent care to stabilize emergency […]
AAEM Position Statement on Documentation and Payment for EMTALA RequirementsAAEM Position Statement on Documentation and Payment for EMTALA Requirements Whereas, The existing system of submitting forms documenting total body medical history and total body examination during time critical and condition specific emergency treatment in order to obtain payment for emergency services rendered is both antiquated and burdensome, directly reducing time spent in bedside patient […]
Funding for EMTALA RequirementsWhereas, One in five Americans currently does not possess health insurance, Emergency Medicine is experiencing a crisis in overcrowding and inadequate funding, Emergency departments are more than ever before expected to act as the front line for medical services in the event of regional or national disasters, It is the position of the American Academy […]