EMTALA Guidelines Shed More Light on Rule Revisions

Does your hospital policy for on call physician coverage of the emergency department specify the expected response time in minutes? Does it avoid terms such as "reasonable" or "prompt"? In its latest guidance to state surveyors on enforcing regulations for the Emergency Medical Treatment and Labor Act (EMTALA), the Centers for Medicare & Medicaid Services (CMS) expands on some of the rule's provisions, such as on-call physician coverage, with information that will help risk managers draft and revise policies and procedures to ensure EMTALA compliance. One such example is a statement that hospital policies or medical staff bylaws are expected to state on-call physician response time in minutes. Anything less specific is "not enforceable by the hospital and therefore inappropriate," CMS says.

Generally, the CMS interpretive guidelines on EMTALA regulations follow revisions to the anti-patient dumping rule issued in 2003. But in some areas—such as requirements for on-call physician coverage, medical screening exams, and appropriate transfers—CMS provides additional examples and specifics to assist hospitals and physicians in complying with the rule. The new interpretive guidelines, written in clear language, appear as Appendix V of the Medicare State Operations Manual and are used by state surveyors to investigate complaints that a hospital or physician has failed to meet EMTALA obligations.

The guidelines also provide guidance to surveyors on determining whether a hospital department or facility located on or off of the hospital main campus meets CMS's new definition of a dedicated emergency department. Risk managers should review the criterion for dedicated emergency departments because some hospital owned sites such as urgent care centers and psychiatric facilities may qualify. The 50-page guidelines are...