The Emergency Medical Treatment and Active Labor Act of 1986, amended in 1989, was enacted by Congress to guard against patient dumping in hospital emergency rooms. The law and its corresponding regulations is called by different names, most particularly EMTALA, COBRA (because its provisions were part of the major 1986 Consolidated Omnibus Budget Reconciliation Act of 1986), or PADS (referencing patient dumping). Since its inception, complaints under the law have increased and governmental enforcement, particularly through the Office of Inspector General (OIG), can be aggressive.
The basic requirements of the law include:
- appropriate medical screening for all persons coming to the emergency room;
- necessary stabilization of the emergency medical condition, if any;
- transfer only if stable or the patient requests or a physician certifies that the transfer benefits outweigh transfer risks; and
- prohibited initial inquiry about insurance or ability to pay
Complaints alleging EMTALA violations are first inspected by the Iowa Department of Inspections and Appeals (DIA), the federal Medicare surveying agency, which files its findings with the federal Department of Health and Human Services; those reports are available to the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG), both of which can bring enforcement actions against hospitals and physicians for EMTALA violations.
Regulations are important to understanding the definitional and interpretative framework for EMTALA. EMTALA regulations are found at 42 CFR 489.24 (Code of Federal Regulations). Those regulations were amended in 2003 to clarify the enforcement meaning and intent of EMTALA in several respects including physician on-call coverage.
Iowa Medicine Articles re: EMTALA
"At Long Last! EMTALA Regulations Have Been Revisited," (PDF 534KB)
Iowa Medicine (November-December 2003)
"Patient Dumping Law: Physicians Beware: The Bite is Bitter," (PDF 273KB)
Iowa Medicine (July/August 1999)
CMS Resources re: EMTALA
The CMS Web site can be searched from its home page at http://www.cms.hhs.gov/.
Currently there are two ways to specifically access EMTALA information through the CMS web page:
http://www.cms.hhs.gov/EMTALA/ or through Medlearn at http://www.cms.hhs.gov/medlearn/default.asp
AMA Resources re: EMTALA
EMTALA regulations are accessible by searching the AMA web site at http://www.ama-assn.org or specifically going to http://www.ama-assn.org/ama/pub/category/11558.html.
On-call physician responsibilities under EMTALA
The Organized Medical Staff Section (OMSS) of the AMA has developed an EMTALA quick reference guide for on-call physicians. Go to http://www.ama-assn.org/ama1/pub/upload/mm/21/emtalarefguide.doc (Word).
AMA Statement to the EMTALA Technical Advisory Group
Congress established a technical advisory group (TAG) on EMTALA in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The TAG, appointed in March 2005, has a 30-month working window to study issues and make recommendations to CMS and the OIG striking a better balance between EMTALA enforcement and burdens upon hospitals and physicians. The AMA issued an extensive statement to the TAG on March 30, 2005, focusing on physician on-call coverage requirements under EMTALA and recommending several clarifications. That statement can be found at http://www.ama-assn.org/ama/pub/category/14950.html.
AMA/IMS Letter to Health Plans re: EMTALA and Fair Compensation
An ongoing challenge under EMTALA is denial by health plans of emergency room services hospitals and physicians are required to provide under EMTALA. The AMA and members of the Federation, including the Iowa Medical Society, jointly sent a letter to America 's Health Insurance Plans and to the BlueCross Blue Shield Association on September 18, 2005, highlighting concerns related to lack of adequate or delayed payment for EMTALA-mandated services.
The following are copies of those two letters:
- Letter to America's Health Insurance Plans (PDF 29KB)
- Letter to BlueCross Blue Shield Association (PDF 28KB)
EMTALA and the Federal Born-Alive Infants Protection Act
CMS issued interpretative guidance to state surveying agencies regarding the potential EMTALA implications of the federal Born-Alive Infants Act granting infants born alive at any stage of development that same protections under law that persons, human beings, children, or individuals enjoy. The guidance states that "it is clear that there may be some circumstances where EMTALA protections can attach to an infant who is born alive" and advises that EMTALA complaints involving an infant born-alive should be investigated. To review the guidance, go to http://www.cms.gov/medicaid/survey-cert/sc0526.pdf (PDF).