Medicare Compliance & Reimbursement

Feds continue to protect patients’ access to emergency care.

With EMTALA violations on the rise, CMS puts a new complaint system in place to ensure patients get the emergency medical care they need.

Background: Since the U.S. Supreme Court overturned Roe vs. Wade in June 2022 with its 6-3 ruling on Dobbs vs. Jackson Women’s Health Organization, the nation has grappled with a changing landscape as abortion laws have been pushed to the states. This massive shift has impacted patients’ EMTALA rights and has instigated federal involvement (see Medicare Compliance & Reimbursement, Vol. 49, No. 11 and Vol. 50. Nos. 3 and 9).

Now: On May 21, the Centers for Medicare & Medicaid Services (CMS) instituted a complaint process on CMS.gov, making it easier for patients to lodge a grievance if turned away for emergency medical care. This update is a follow-up to the Biden-Harris administration’s Jan. 22 announcement that the feds would be releasing more guidance, training materials, and support to hospitals struggling with the intersection between federal and state laws.

“HHS is committed to protecting access to emergency medical care for everyone in America and making sure appropriate steps are taken if they don’t get that care,” said Health and Human Services (HHS) Secretary Xavier Becerra in a release. “We will continue to uphold the law and the right to emergency care, to inform people of their rights under EMTALA, and to make it easier for someone denied care to file a complaint.”

CMS Administrator Chiquita Brooks-LaSure added, “If an individual believes their EMTALA rights have been violated, it is important that they can easily file a complaint. We want to make sure that everyone knows their rights and can take action to help make sure the health care system is safe for everyone.”

Here’s the Scoop on the Complaint Process

Previously, CMS updated its online guidance with a three-part breakdown on what emergency departments (EDs) are required to offer patients under EMTALA. They include the following:

1. An appropriate medical screening examination by a licensed medical provider

2. Treatment by the ED until the patient’s condition is stable.

3. Transfer to another emergency facility if the treatment isn’t possible at the current one.

As part of the new complaint option, CMS added tips and tools on filing an EMTALA complaint. First, the agency reminds that filing a complaint isn’t a legal action, but it does help “make sure hospitals stabilize emergency medical conditions and follow the law,” CMS says on its EMTALA webpage.

Second, CMS instructs patients to review the regulation and their rights under EMTALA. If a violation has occurred, the individual making the complaint against the hospital should collect these details: patient’s name; the hospital where the violation occurred; the details of the incident; and the date of the interaction. Complaints can be made anonymously and in a timely manner to allow the feds to better “track the facts,” CMS indicates.

Finally, individuals have two complaint reporting options. They can either go through the state survey agency where the incident happened or they can lodge a complaint via this portal at CMS.gov.

Tip: EMTALA complaint investigators will communicate through an email if address is given and may contact patients, providers, and hospitals during their reviews.