Every hospital that has a dedicated emergency department and accepts Medicare and Medicaid payment must follow the federal law and the Center for Medicare and Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines on the Emergency Medical Treatment and Labor Act (EMTALA).

Hospitals without such emergency departments must comply with EMTALA if they have specialized capabilities. For example, EMTALA can impact obstetrical patients and behavioral health patients. CMS made changes to include the Born-Alive Infant Protection Act with an updated survey memo on the issue.

This 2-part webinar will cover the regulations and interpretive guidelines regarding EMTALA. It will cover all 12 sections – Tag Numbers – plus an additional section for on-call physicians and the shared and community care plan process.

This 2-part webinar series will include discussion of a case that has created an enormous expansion of hospital and practitioner liability under federal law. The case, Moses v. Providence Hospital and Medical Centers, Inc., No. 07-2111 (6th Cir. April 2009), overruled the CMS regulation that EMTALA obligations end when the hospital admits the patient in good faith. The case illustrates the importance of understanding the role that case law has on the outcome of EMTALA litigation: patients can complain to CMS and request an investigation, or they have the option of going and directly filing a lawsuit.

This program will also discuss a recent case against a hospital which was the largest EMTALA settlement of 1.2 million dollars. It is anticipated that healthcare will see larger EMTALA fines and more activity because of the higher fines and the OIG final changes. These changes are not in the CMS CoPs and will be discussed.

EMTALA Part 1

Learning Objectives:

• Recognize EMTALA as a frequently cited deficiency for hospitals.
• Recall that CMS has a manual on EMTALA that all hospitals that accept Medicare must follow.
• Describe the requirement that hospitals must maintain a central log.
• Discuss the hospital’s requirement to maintain a list of the specific names of physicians who are on call to evaluate emergency department patients.
• Describe the CMS requirements on what must be in the EMTALA sign.
• Describe the hospital’s requirements regarding a minor who is brought to the ED by a non-parent for a medical screening exam.
• Discuss when the hospital must complete a certification of false labor.

• Agenda:

• OIG and EMTALA
• Two-day visit with immediate jeopardy
• Common deficiency report by CMS
• QIO EMTALA physician worksheet
• EMTALA deficiencies
• Introduction and CMS manual
• Basic concept of EMTALA
• Cases in the News – EMTALA
• History of EMTALA
• CMS EMTALA website
• EMTALA memos
• OIG advisory opinions on EMTALA
• Compliance program
• Joint Commission standards and EMTALA
• CMS Conditions of Participation – EMTALA
• Basic section and provider agreement essentials
• EMTALA sign requirements
• To whom EMTALA applies
• Reasonable registration process
• Financial questions from patients
• Patients who sign out AMA
• Whistle Blower protections
• Specialized capability
• Capacity definitions
• Policies and procedures required
• OB and behavior health violations
• EMTALA violations and money penalty cases
• Hospital reporting requirements – “Dumping”
• EMTALA signs examples
• Retention of medical records

Learning Objectives:

• Recognize EMTALA as a frequently cited deficiency for hospitals.
• Recall that CMS has a manual on EMTALA that all hospitals that accept Medicare must follow.
• Describe the requirement that hospitals must maintain a central log.
• Discuss the hospital’s requirement to maintain a list of the specific names of physicians who are on call to evaluate emergency department patients.
• Describe the CMS requirements on what must be in the EMTALA sign.
• Describe the hospital’s requirements regarding a minor who is brought to the ED by a non-parent for a medical screening exam.
• Discuss when the hospital must complete a certification of false labor.

Agenda:

• On-call physician issues
• Community Call Plan (CCP)
• Simultaneous on-call
• Elective surgeries and on-call
• Sending a representative
• Telemedicine and on-call
• Response times
• Central log
• Special responsibilities
• Meaning of “comes to the ED”
• Definition of hospital property
• EMTALA and outpatients
• Medical screening exam
• Certification of false labor
• Born alive law and EMTALA
• Minor child request for treatment
• Ambulance and EMTALA
• Telemetry
• When diversion is allowed
• Parking of patients
• Helipad
• Qualified Medical Provider (QMP)
• Definition of Inpatient
• Moses Case
• Waiver of sanctions
• Requests for medications
• Blood alcohol tests
• Emergency medical condition and stabilization
• OB patients
• Born-Alive Infant Protection Act and MLN clarification
• Transfer and transfer forms
• Behavioral health patients
• QIO role with EMTALA

Who should Attend 

Emergency department managers, medical director, ED physicians and nurses and ED education staff; OB managers and nurses; behavioral health director and staff; CNO, nursing supervisors, nurse educators and staff nurses; outpatient directors; compliance officers, legal counsel, and risk manager; directors of hospital-based ambulance services; director of registration and staff; on-call physicians, chief medical officer, chief financial officer, patient safety officer and Joint Commission coordinator.