CMS Seeks Input on Application of EMTALA to Hospital Inpatients - January 25, 2011

On Dec. 23, 2010, the federal Centers for Medicare & Medicaid Services (CMS) issued an advance notice of proposed rulemaking regarding the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients. Specifically, CMS seeks comments on whether it should extend a hospital’s obligations under EMTALA to patients admitted through the emergency department. Currently, a hospital’s EMTALA duties end once an individual has been admitted as an inpatient. In addition, CMS requests feedback on a proposal that would require hospitals with specialized services to accept previously admitted, unstabilized emergency patients from hospitals that do not have such capabilities.

CMS’s contemplated changes track policies that the agency previously proposed in 2003 and 2008 – in both of those instances, NAPH opposed the expansion of EMTALA requirements beyond emergency care. To guide CMS’s decision, the notice seeks the following:

1. Input as to whether CMS should revisit its current policy and real world examples to illustrate the advisability of doing so;
2. Descriptions of situations in which an individual with an unstabilized emergency medical condition was admitted as an inpatient and then transferred to another hospital, even though the admitting hospital was capable of treating the condition; and 
3. Examples of when hospitals with specialized capabilities have refused to accept the transfer of an inpatient with an unstabilized emergency medical condition from another hospital.

Comments are due by Feb. 22. To inform possible NAPH comments, NAPH is also interested in feedback from NAPH members. If you have information on these issues or real world examples, please contact Xiaoyi Huang at xhuang@naph.org.