Medicare-participating hospitals must meet the Emergency Medical Treatment and Labor Act (EMTALA) statute codified at section 1867 of the Social Security Act, the accompanying regulations in 42 CFR §489.24 and the related requirements at 42 CFR 489.20(l), (m), (q), and (r).
EMTALA requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition (EMC). The provisions of EMTALA apply to all individuals (not just Medicare beneficiaries) who attempt to gain access to a hospital for emergency care. The regulations define “hospital with an emergency department” to mean a hospital with a dedicated emergency department (ED). In turn, the regulation defines “dedicated emergency department” as any department or facility of the hospital that either (1) is licensed by the state as an emergency department; (2) held out to the public as providing treatment for emergency medical conditions; or (3) on one-third of the visits to the department in the preceding calendar year actually provided treatment for emergency medical conditions on an urgent basis.
Every day in hospitals around the country, good people are trying very hard to do the right thing – to respond to individuals in need of emergency care, to deliver quality services, and to comply with a wide array of local and federal regulations. But for regulations to be effective, they must be understood, clearly communicated, and enforced fairly. Conflicting standards, confusion about interpretation of the EMTALA regulations, and lack of clear examples for those who work in behavioral healthcare delivery systems often lead to frustration. NAPHS is committed to working with the EMTALA TAG, the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Health and Human Services (HHS) to find ways to lessen confusion that can take away from facilities’ ability to deliver what we all want…..safe, high-quality care.
NAPHS is also working to address the conflict between EMTALA and a Medicaid statutory provision called the Institution for Mental Disease (IMD) exclusion that means that patients receiving care in these hospitals are not covered for their care if the patients are between the ages of 21-64 (and the hospitals cannot get Medicaid federal matching payments for these services). See the Medicaid Emergency Psychiatric Care Demonstration.
NAPHS comment letter to CMS on EMTALA application to specialized capabilities hospitals [View]
CMS release: "Affordable Care Act Demonstration to Expand Access to Emergency Psychiatric Care; New Demonstration Program to Help States Improve the Quality of Care for Patients with Psychiatric Emergency." Also see additional information.
CMS request for comments: "Medicare Program; EMTALA Applicability to Hospital Inpatients and Hospitals with Specialized Capabilities" [View]
NAPHS statement: Reform law includes provisions important to Americans facing mental and addictive disorders. Includes IMD/EMTALA demonstration on emergency psychiatric care. [View]
NAPHS comment letter to CMS on "EMTALA" regulations within April 30, 2008, inpatient PPS proposed rule (CMS-1390-P)
CMS interpretive guidelines [View]