Just days after new site review guidelines went into effect in April, CMS issued proposed new regulations that would implement some recommendations of the EMTALA Technical Advisory Group (TAG) that were issued before the committee went out of existence last year. 

Among the proposals:

The clear language of the duty to accept provisions and the Supreme Court ruling on EMTALA indicate that the in-patient status of the patient has no effect on the duty to accept. -- Publisher

1. Move the on-call requirements of the regulations from the regulations section pertaining to emergency responsibilities of hospitals to the section pertaining to terms of the Medicare Provider Agreement.  Contrary to the procedural intent of the industry advocates supporting the move, CMS's proposed regulation would retain on-call violations as an EMTALA violation.  The industry goal had been to move on-call violations into the general conditions of participation process and out of the EMTALA enforcement process.
2. Clarify that even though a patient has been admitted, hospitals with higher levels of care are required to accept the transfer of a patient with an emergency medical condition that remains unstabilized, even though the admission ends the sending hospital responsibilities under EMTALA.  CMS is also asking for comments on whether the rule should also apply to any in-patient, such as one that suffers a deterioration in condition while in the hospital for an elective procedure.
3. Allow hospitals to meet their on-call obligation by participating in a formal community-wide on-call system, but a patient presenting to the "wrong" hospital would still be subject to EMTALA requirements and could not be moved to the "on-call hospital" without full EMTALA compliance.

Full text experts of the proposals will be posted in subsequent announcements on this page. The regulations were included in the IPPS rules issued April 30, 2008 in the Federal Register.

Tags: CMS, EMTALA, Inpatient Prospective Payment, Medicare, Regulations