CMS warns hospitals: Remember EMTALA obligations, particularly with pregnant patients

Editor's note: The following is an excerpt from an article from Accreditiation & Quality Compliance Center.

As many hospitals across the nation continue to face COVID-19 patient surges that overwhelm emergency rooms and ICUs, CMS also issued a reminder to hospitals to remember their obligations under the Emergency Medical Treatment and Active Labor Act (EMTALA).

CMS issued a Quality, Safety & Oversight Group (QSO) memo Friday September 17 on “Reinforcement of EMTALA Obligations Specific to Patients who are Pregnant or are Experiencing Pregnancy Loss.”

The memo, QSO-21-22-Hospitals, not only reminded hospitals to “ensure all staff who may come into contact with a patient seeking emergency care are aware of the hospital’s obligation under EMTALA,” but had an express message for clinicians.

“A physician’s professional and legal duty to provide stabilizing medical treatment to a patient who presents to the emergency department and is found to have an emergency medical condition preempts any directly conflicting state law or mandate that might otherwise prohibit or prevent such treatment,” said the memo’s summary.

“Patients, including pregnant people, are entitled to the full rights and protections afforded under this federal statute.”

EMTALA requires hospitals to screen and stabilize patients with emergent conditions, regardless of their ability to pay and before sending the patient to another hospital if that is necessary for treatment.

Noting that EMTALA does not apply to inpatients, the memo stresssed that hospitals are “still bound by” the Medicare Conditions of Participation (CoP):

  • “In particular, four CoPs are potentially applicable when a hospital provides treatment for an admitted patient. For example, the governing body must ensure that the medical staff as a group is accountable to the governing body for the quality of care provided to patients (42 C.F.R. 482.12(a)(5)).
  • “Further, the discharge planning CoP (42 C.F.R. 482.43), which requires that hospitals have a discharge planning process, applies to all patients. Hospitals must also have an organized medical staff that is responsible to the hospital’s governing body for the quality of medical care provided to patients (42 C.F.R. 482.22).
  • “Finally, the hospital governing body must ensure that the hospital has an organization-wide quality assessment and performance improvement program to evaluate the provision of patient care (42 C.F. R. 482.21).
  • “These CoPs are intended to protect patient health and safety, and to ensure that high quality medical care is provided to all patients. Failure to meet these CoPs could result in a finding of noncompliance at the condition level for the hospital and lead to termination of the hospital’s Medicare provider agreement.”

CMS noted that nothing in the memo was new but was simply reiterating current requirements.

The memo further outlined the specific requirements under EMTALA, including the care of pregnant patients. It noted that if a complaint investigation validates an EMTALA violation, an organization could face not only civil monetary penalties but also termination of its Medicare provider agreement.

The memo also noted that individual physicians “may also be subject to exclusion from the Medicare and Medicaid programs.”