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CMS Issued Memo on EMTALA Responsibilities in the Midst of COVID-19

Wednesday, May 6th, 2020
EMTALA Emergency Treatment
EMTALA Obligations in COVID-19 Pandemic

CMS issued an update to Memo #QSO-20-15 addressing COVID-19 and Emergency Medical Treatment and Labor Act (EMTALA) requirements for Hospital and Critical Access Hospitals during the COVID-19 pandemic.  The Memo covers a number of topics related to obligations under EMTALA during the pandemic such as questions around patient presentation to the emergency department, EMTALA applicability across facility types, qualified medical professionals, medical screening exams, patient transfer and stabilization, telehealth, and other topics.

The new revisions focus on additional guidance related to the use of telehealth technologies, identification of appropriate triage process and screening examinations, drive through testing sites, and use of telehealth in connection with EMTALA.

For those of you who are not familiar, EMTALA is the federal law that requires Medicare-participating hospitals and critical access hospitals that have a dedicated emergency department to conduct a medical screening exam to all who come to the emergency department, to determine if the individual is in an emergency  medical condition. Emergency medical conditions are medical situations of such severity such that serious impairment of dysfunction can reasonably expected without immediate medical intervention.  If an emergency medical condition exists, the hospital is required to provide necessary stabilizing treatment within the hospital’s capability.  If the hospital does not have the necessary capabilities, there is an obligation to provide for a transfer when appropriate to treat the patient.

The obligations of EMTALA-obligated hospitals apply to patients who present with symptoms indicating that they may have been infected with the COVID-19 virus.  Emergency departments are prepared with appropriate COVID-19 screening criteria to facilitate the prompt identification of potentially infected patients so that they may be isolated and appropriate health officials can be contacted to ascertain next steps.  Most should have implemented the necessary policies and procedures already. 

Patients may experience the impact of COVID-19 on hospital EMTALA obligations.  For example, once initial stabilization occurs a patient could find themselves being transferred to another facility.  This could occur if the initial facility does not have adequate capacity.  A variety of other reason could present themselves in the midst of a pandemic that could necessitate a transfer from an emergency room to another facility once an emergency medical condition has been stabilized.

Hospitals and CAHs are expected to consider the guidance that has been released by the Center for Disease Control –  CDC and other state and local public health officials to guide their decisions about the extent of their capabilities to provide the type of isolation required at each step of the process including the provision of treatment necessary to stabilize an emergency medical condition through decisions on whether to continue to provide care once the medical emergency is ended.