Medicare Compliance & Reimbursement

Under a final rule scheduled for Sept. 9 publication by the Centers for Medicare and Medicaid Services, off-campus hospital facilities that do not routinely provide emergency care will be relieved of their obligations under the Emergency Medical Treatment and Active Labor Act.

Currently, off-campus facilities that are staffed by physicians, registered nurses, and/or licensed practical nurses, such as primary and urgent care centers, must have personnel trained to screen and stabilize emergency patients when possible. Personnel at off-campus facilities not staffed by these professionals, such as physical therapy and radiology centers, must have procedures in place for obtaining directions from the main hospital. All off-campus facilities must have procedures for transferring patients to the main hospital, or an appropriate alternative facility in cases where the main hospital lacks the necessary treatment capabilities.

Under the new rule, only off-campus facilities that qualify as "dedicated emergency departments" will remain covered under EMTALA, which was passed by Congress in 1986 to guarantee access to emergency care for the indigent and the uninsured. Other off-campus facilities will only be required to call an emergency medical facility if they are incapable of treating the patient, and to furnish any assistance possible while awaiting the arrival of the EMS.

Whether it is off-campus or on the main hospital property, a facility is a dedicated emergency facility under the new rule if it meets at least one of three requirements: it is licensed by the state in which it is located as an emergency department; it "is held out to the public" as "a place that provides care for emergency medical conditions on an urgent basis without previously scheduled appointments;" or a "representative sample" during the previous calendar year reveals that at least one-third of all outpatient visits to the facility were for emergency care without previous appointments.

The final rule also gives hospitals greater discretion in arranging the on-call arrangements mandated by EMTALA. In the preamble, CMS expresses agreement with several commenters that the regulations should be revised "to explicitly acknowledge the limits on availability of on-call staff in many specialties and geographic areas."

Therefore, the final rule requires hospitals to "maintain an on-call list of physicians on its medical staff in a manner that best meets the needs of the hospital's patients ... in accordance with the resources available to the hospital, including the availability of on-call physicians."