emergency medical treatment and labor act (emtala) “new and improved…plus stuff that’s not...
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Emergency Medical Treatment and Labor Act (EMTALA)
“New and Improved…plus stuff that’s not true.”
Emergency Medical Treatment and Labor Act (EMTALA)
“New and Improved…plus stuff that’s not true.”
David WrightCenters for Medicare and Medicaid
Services (CMS)
Dallas Regional Office
David WrightCenters for Medicare and Medicaid
Services (CMS)
Dallas Regional Office
Civil Liability versus Administrative Enforcement
Civil Liability versus Administrative Enforcement
Two Year statute of Limitations on Civil Cases alleging EMTALA Violation
CMS not involved, complainant not required to file complaint or have substantiated violation
Two Year statute of Limitations on Civil Cases alleging EMTALA Violation
CMS not involved, complainant not required to file complaint or have substantiated violation
EMTALA-Related RequirementsEMTALA-Related Requirements
EMTALA Compliance Plan Reporting Requirement Signage Medical Records Requirement On-Call Physician List Central Log
EMTALA Compliance Plan Reporting Requirement Signage Medical Records Requirement On-Call Physician List Central Log
Reporting RequirementReporting Requirement Report to CMS or the state any
time you have reason to believe the hospital received an individual who has been transferred in an unstable emergency medical condition from another hospital, in violation of the transfer requirements (489.24(d)).
Report to CMS or the state any time you have reason to believe the hospital received an individual who has been transferred in an unstable emergency medical condition from another hospital, in violation of the transfer requirements (489.24(d)).
SignageSignageIt’s the law!
If you have a Medical Emergency or are in labor, you have the right to receive, within the capabilities and capacity of this
hospital’s staff and facilities:
An Appropriate medical screening examination.
Necessary stabilizing treatment (including treatment for an unborn child) and, if necessary, an appropriate transfer to
another facility.
Even if you cannot pay or do not have medical insurance or you are not entitled to Medicare or Medicaid.
This hospital does / does not participate in Medicaid.
It’s the law!
If you have a Medical Emergency or are in labor, you have the right to receive, within the capabilities and capacity of this
hospital’s staff and facilities:
An Appropriate medical screening examination.
Necessary stabilizing treatment (including treatment for an unborn child) and, if necessary, an appropriate transfer to
another facility.
Even if you cannot pay or do not have medical insurance or you are not entitled to Medicare or Medicaid.
This hospital does / does not participate in Medicaid.
Medical Records RetentionMedical Records Retention
The hospital must maintain medical and other records related to individuals transferred to or from the hospital for a period of five years from the date of the transfer.
The hospital must maintain medical and other records related to individuals transferred to or from the hospital for a period of five years from the date of the transfer.
On-Call PhysiciansOn-Call Physicians Ensure ED is prospectively aware of
which physicians, including specialists and sub-specialists are available to provide treatment necessary to stabilize individuals with emergency medical conditions.
Hospital must determine and enforce response times.
Physician must come in, cannot refer patient with emergency medical condition to private physician’s office.
Ensure ED is prospectively aware of which physicians, including specialists and sub-specialists are available to provide treatment necessary to stabilize individuals with emergency medical conditions.
Hospital must determine and enforce response times.
Physician must come in, cannot refer patient with emergency medical condition to private physician’s office.
On-Call ContinuedOn-Call Continued Hospital Discretion, Simultaneous call,
Elective Surgery Still must provide for emergency
services if physician unavailable due to elective surgery or simultaneous call
If on-call chooses to send non-physician practitioner, treating physician may still request on-call present in person.
Hospital Discretion, Simultaneous call, Elective Surgery
Still must provide for emergency services if physician unavailable due to elective surgery or simultaneous call
If on-call chooses to send non-physician practitioner, treating physician may still request on-call present in person.
Central LogCentral Log To track the care provided to
each individual who comes to the hospital seeking care for an emergency medical condition, including whether the individual refused treatment, was refused treatment, admitted, treated, stabilized, transferred or discharged.
To track the care provided to each individual who comes to the hospital seeking care for an emergency medical condition, including whether the individual refused treatment, was refused treatment, admitted, treated, stabilized, transferred or discharged.
EMTALA RequirementsEMTALA Requirements
Screening
Stabilizing Treatment
Delay in examination or treatment
Appropriate Transfer
Recipient Hospital Responsibilities
Screening
Stabilizing Treatment
Delay in examination or treatment
Appropriate Transfer
Recipient Hospital Responsibilities
ScreeningScreening Determine presence/absence of
emergency medical condition. Performed by Qualified Medical
Personnel. EMTALA applies until patient
stabilized or determination that there is no emergency medical condition.
Determine presence/absence of emergency medical condition.
Performed by Qualified Medical Personnel.
EMTALA applies until patient stabilized or determination that there is no emergency medical condition.
Screening Cont’dScreening Cont’d Present to Dedicated ED (Licensed, Held Out, 1/3
Presentations-calendar year) Request for Medical
Treatment only. Everyone must be screened.
Non-Dedicated ED-Request for Emergency Medical
Treatment only (Prudent Layperson standard)
Eliminates application to non-emergency off-
campus sites.
Parking of EMS patients. Must still be assessed
upon presentation
Present to Dedicated ED (Licensed, Held Out, 1/3
Presentations-calendar year) Request for Medical
Treatment only. Everyone must be screened.
Non-Dedicated ED-Request for Emergency Medical
Treatment only (Prudent Layperson standard)
Eliminates application to non-emergency off-
campus sites.
Parking of EMS patients. Must still be assessed
upon presentation
Never say never…Never say never… FAMILY LAWYER: HOSPITAL WORKER
STEPPED OVER DEAD PATIENT DAYS BEFORE BODY WAS DISCOVERED. The Los Angeles Times (10/24, Dolan) reports on allegations that a hospital employee in San Francisco saw the body of a patient lying in an “emergency stairwell” and stepped over it days before the fatality was discovered. Haig Harris, an attorney representing the deceased patient’s family, says he was informed that the hospital employee saw the body of Lynne Spalding, 57 and reported it to a nurse, though it is unclear it took days for anyone to take action.
FAMILY LAWYER: HOSPITAL WORKER STEPPED OVER DEAD PATIENT DAYS BEFORE BODY WAS DISCOVERED. The Los Angeles Times (10/24, Dolan) reports on allegations that a hospital employee in San Francisco saw the body of a patient lying in an “emergency stairwell” and stepped over it days before the fatality was discovered. Haig Harris, an attorney representing the deceased patient’s family, says he was informed that the hospital employee saw the body of Lynne Spalding, 57 and reported it to a nurse, though it is unclear it took days for anyone to take action.
Stabilizing TreatmentStabilizing Treatment
Within capability and capacity of hospital, must ensure that: the Emergency Medical
Condition is removed, or the patient is Stable for
Discharge
Within capability and capacity of hospital, must ensure that: the Emergency Medical
Condition is removed, or the patient is Stable for
Discharge
Stabilizing TreatmentStabilizing Treatment EMTALA obligation ends when patient
admitted as inpatient, even if not
stabilized.
Expectation of overnight stay.
EMTALA obligation ends when patient
admitted as inpatient, even if not
stabilized.
Expectation of overnight stay.
Delay inExamination or Treatment
Delay inExamination or Treatment
Hospital may not delay providing an appropriate medical screening examination in order to inquire about the individual’s method of payment or insurance status.
Hospital may not delay providing an appropriate medical screening examination in order to inquire about the individual’s method of payment or insurance status.
Delay Cont’dDelay Cont’d Prior Authorization explicitly prohibited until
after screening and initiation of stabilizing
treatment
Reasonable registration, including insurance
information, allowed.
Prior Authorization explicitly prohibited until
after screening and initiation of stabilizing
treatment
Reasonable registration, including insurance
information, allowed.
Reason for TransferReason for Transfer
Patient request (in writing, with risk / benefit understanding).
Physician certification that benefits outweigh the risks.
Patient request (in writing, with risk / benefit understanding).
Physician certification that benefits outweigh the risks.
Appropriate TransferAppropriate Transfer
Transferring hospital minimizes risks (within capability and capacity).
Receiving facility agrees to accept. Transferring hospital sends all
medical records. Transfer effectuated with appropriate
personnel and transportation.
Transferring hospital minimizes risks (within capability and capacity).
Receiving facility agrees to accept. Transferring hospital sends all
medical records. Transfer effectuated with appropriate
personnel and transportation.
Recipient Hospital Responsibilities
Recipient Hospital Responsibilities
Participating hospitals with specialized capabilities may not refuse a request for an appropriate transfer of an individual requiring that capability if the facility has the capacity to treat the individual.
Participating hospitals with specialized capabilities may not refuse a request for an appropriate transfer of an individual requiring that capability if the facility has the capacity to treat the individual.
Recipient Hosp Resp Cont’dRecipient Hosp Resp Cont’d Capability or Capacity only reason for
refusal of transfer request under EMTALA This requirement applies to any
participating hospital with specialized capabilities, regardless of whether the hospital has a dedicated emergency department. (Effective, October 1, 2006)
Capability or Capacity only reason for refusal of transfer request under EMTALA
This requirement applies to any participating hospital with specialized capabilities, regardless of whether the hospital has a dedicated emergency department. (Effective, October 1, 2006)
EMTALA WaiverEMTALA Waiver 72 Hours after issuance of waiver and
activation of Hospital’s disaster protocol Allows for otherwise inappropriate
transfers due to circumstances arising out of emergency
Allows for screenings at alternate locations per State emergency plan
Evaluations still rest on capability and capacity
72 Hours after issuance of waiver and activation of Hospital’s disaster protocol
Allows for otherwise inappropriate transfers due to circumstances arising out of emergency
Allows for screenings at alternate locations per State emergency plan
Evaluations still rest on capability and capacity
Regulatory Changes (OPPS ’09)Regulatory Changes (OPPS ’09)
Continued non-application to unstabilized inpatients
Community Call Indefinite Pandemic Flu Waiver
Continued non-application to unstabilized inpatients
Community Call Indefinite Pandemic Flu Waiver
Recent EMTALA IssuesRecent EMTALA Issues False Labor-Mid-wives, and QMPs may determine
(effective October 1, 2006) On-call refusal to come in / refusal to accept
transfer Triage vs. Screening (or “Screening Out”) Coercion 250-Yard Rule Diversion/Parking of EMS Patients Helipads and Helicopter Transfers Hospital-Owned and Operated Ambulances Declared Emergency
False Labor-Mid-wives, and QMPs may determine (effective October 1, 2006)
On-call refusal to come in / refusal to accept transfer
Triage vs. Screening (or “Screening Out”) Coercion 250-Yard Rule Diversion/Parking of EMS Patients Helipads and Helicopter Transfers Hospital-Owned and Operated Ambulances Declared Emergency
CMS Review ProceduresCMS Review Procedures Possible Outcomes:
No violation Past Violation, No termination Violation, Immediate and Serious
Threat Violation, No Immediate and Serious
Threat All investigations referred to QIO prior to
finding of violation (MMA)
Possible Outcomes: No violation Past Violation, No termination Violation, Immediate and Serious
Threat Violation, No Immediate and Serious
Threat All investigations referred to QIO prior to
finding of violation (MMA)
EMTALA PenaltiesEMTALA PenaltiesCMS: Medicare Termination
DHHS Office of the Inspector General: Hospital
CMP of $50,000 per violation for hospital ($25,000 if less than 100 Beds)
Physician CMP of $50,000 per violation Exclusion from Medicare and Medicaid
programs
CMS: Medicare Termination
DHHS Office of the Inspector General: Hospital
CMP of $50,000 per violation for hospital ($25,000 if less than 100 Beds)
Physician CMP of $50,000 per violation Exclusion from Medicare and Medicaid
programs
Three Keys to Compliance:Three Keys to Compliance:Consistency
Complaint system
Knowledge
Consistency
Complaint system
Knowledge
18/12
CMS EMTALA WebsitesCMS EMTALA WebsitesGeneral EMTALA Information www.cms.gov/emtala
CMPs Imposed by the Office of the Inspector General http://oig.hhs.gov/fraud/enforcement/cmp/patient_dumping.asp
General EMTALA Information www.cms.gov/emtala
CMPs Imposed by the Office of the Inspector General http://oig.hhs.gov/fraud/enforcement/cmp/patient_dumping.asp
EMTALA ContactsEMTALA Contacts David Wright
PH: (214) 767-6426/ FAX: (214) 767-0270 E-Mail: [email protected]
Dodjie Guioa PH: (214) 767-6179/Fax: (214) 767-0270 E-Mail: [email protected]
Dorsey Sadongei PH: (214) 767-3570/Fax: (214) 767-0270 E-mail: [email protected]
Sergio MoraPH: (214) 767-4432/Fax: (214) 767-0270 E-Mail:[email protected]
David Wright PH: (214) 767-6426/ FAX: (214) 767-0270 E-Mail: [email protected]
Dodjie Guioa PH: (214) 767-6179/Fax: (214) 767-0270 E-Mail: [email protected]
Dorsey Sadongei PH: (214) 767-3570/Fax: (214) 767-0270 E-mail: [email protected]
Sergio MoraPH: (214) 767-4432/Fax: (214) 767-0270 E-Mail:[email protected]