On March 6, the Centers for Medicare & Medicaid Services (CMS) summarized recent changes to the Emergency Medical Treatment and Labor Act (EMTALA) regulations in a letter to state officials. The changes were included in the 2009 Inpatient Prospective Payment System (IPPS) final rule.

The revisions cover on-call obligations, responsibilities for hospitals with specialized capabilities, and emergency waivers, and were effective on Oct. 1, 2008.

On-Call Obligations

A new provision in the 2009 IPPS rule allows hospitals to share on-call responsibilities by participating in a formal community call plan (CCP). Participation in a CCP is entirely voluntary. The new regulation requires that a formal CCP have:

  • "A clear delineation of on-call coverage responsibilities; that is, when each participating hospital is responsible for on-call coverage (for a specific time period, or for a specific service, or both);
  • A description of the specific geographic area to which the plan applies;
  • A signature by an appropriate representative of each hospital in the plan;
  • Assurances that any local and regional EMS system protocol formally includes information on community on-call arrangements;
  • A statement specifying that even if an individual arrives at a hospital that is not designated
  • as the on-call hospital, that hospital still has an obligation under 42 C.F.R. § 489.24 to
  • provide a medical screening exam and stabilizing treatment within its capability, and that
  • hospitals participating in the community call plan must abide by the regulations under
  • Section 489.24 governing appropriate transfers; and
  • An annual assessment of the community call plan by the participating hospitals."

The regulation does not relieve any participating hospital of its EMTALA obligations to anyone who comes to the hospital's emergency department when that hospital is not on-call for a specific specialty service.

Hospitals with Specialized Capabilities

The 2009 IPPS rule clarified that an admitting hospital will have satisfied its EMTALA obligation for an individual once the individual is admitted in good faith, even if the individual remains unstabilized. Thereafter, a hospital with specialized capabilities does not have an EMTALA obligation to accept a transfer of that individual. However, this rule does not apply to an individual who is protected under EMTALA and placed in observation status rather than admitted as an inpatient. This individual will be considered an outpatient.

The full memorandum can be found here.