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Dec 6, 2023

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Regulation Staff Presentation Stephanie Thornton Walden University
Emergency Medical Treatment and Labor Act (EMTALA) Congress enacted the EMTALA in 1986, to ensure public access to emergency medical treatment, regardless of insurance status or ability to pay. Medicare participating hospitals, offering emergency services are obligated to provide screening and medical care, including for women in active labor. Hospitals are required to medically stabilize patients, or transfer to another hospital if unable to stabilize at current facility. Example of EMTALA: an uninsured chronic asthmatic presenting with acute shortness of breath to emergency department.
Regulation of EMTALA Centers for Medicare & Medicaid Service (CMS) enforces the EMTALA. Hill- Burton Act of 1946, mandated hospitals to provide care to patients regardless of ability to pay. Despite mandate, refusal of care was still prevalent particularly to minorities, low-income, or uninsured. In 1986, there were an estimated 250, 000 unstable patients transported annually (Rhodes & Smith, 2017). Federal enforcement is complaint driven.
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In year 2020,during the COVID-19 public health crisis, a waiver to lessen the restrictions imposed by EMTALA on hospitals and providers was created by the United States President and Section 1135 of the Social Security Act (Brown, 2021). While the exceptions within the waiver do not invalidate a hospital and provider responsibility with regard to assessing patients who seek emergency care regardless of ability to pay, what constitutes as a quality exam and stabilization changed. During the pandemic, resources were scarce, under the waiver hospitals were able to direct patient to alternate locations prior to evaluation such as urgent care facilities. Additionally, patients could be screened offsite in testing tents and via telehealth. These could be done in effort to preserve resources for prioritized medically unstable patients. Secondly, provisions to the process of transferring patients were made as a result of the waiver. Transfer of patients who were not medically stabilized was potentially allowed, as long as care is taken to minimize risk to patient or unborn child (Brown, 2021). However, facilities were required to align alternative plans with local state regulations and guidelines, to remain in compliance with EMTALA (Brown, 2021). The declaration expired May of 2023.However states may still apply to CMS to waive the requirements (Centers for Medicaid Service, 2023). EMTALA Provisions
References Brown, H. L. (2021). Emergency care EMTALA alterations during the COVID-19 pandemic in the United States. Journal of Emergency Nursing , 47 (2), 321–325. https://doi.org/10.1016/j.jen.2020.11.009 Centers for Medicare & Medicaid Services. (2023, February 27). Fact sheet CMS waivers, flexibilities, and the transition forward from the COVID-19 Public Health emergency . CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency. https://www.cms.gov/newsroom/fact- sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health- emergency#:~:text=CMS %20will%20end%20this%20emergency,apply%20to%20waive%20the%20requir ement. Rhodes, K. V., & Smith, K. L. (2017). Short-term care with long-term costs: The unintended consequences of Emtala. Annals of Emergency Medicine , 69 (2), 163–165. https://doi.org/10.1016/j.annemergmed.2016.08.433