EMTALA Requirements Aren’t Just for the Emergency Department

The Emergency Medical Treatment & Labor Act was enacted by Congress in 1986 to ensure access to emergency services. When EMTALA is mentioned, the Emergency Department and the 250-yard rule come to mind. But EMTALA stretches far beyond the ED, featuring requirements for accepting transfer patients.

CMS Sections §489.20 and §489.24 require that any Medicare-participating hospital is required to accept appropriate transfers of individuals with emergency medical conditions if the healthcare facility has the specialized capabilities and the capacity to treat those individuals. Healthcare facilities must have a process in place for receiving appropriate transfers. The risks for unreasonable rejection of transfer includes citations, penalties, and possible termination from the Medicare program. Remember that possible EMTALA violations may be reported by a patient or an individual at a facility seeking transfer that was unreasonably declined.

Here are some frequently asked questions about EMTALA requirements, the responsibilities of your healthcare facility, and patient transfers.

What does "capabilities of a medical facility" mean?

“Capabilities of a facility” means that the healthcare facility has physical space, equipment, supplies, and specialized services to treat medical emergencies. For staff, this means that the level of care necessary can be provided within the training and scope of the facility staff’s professional license. This includes the medical facilities on-call staff. The transferring healthcare facility must obtain permission from the receiving hospital to transfer a patient. All communication with the receiving healthcare facility should be documented with the name of the person accepting the transfer in the medical record.

How does CMS define capacity?

Capacity is not simply defined by the number of patients in a specialized unit. Capacity includes what a hospital usually does to accommodate patients over their occupancy limit. If a medical facility regularly accommodates patients over its occupancy limits by moving patients or calling in additional staff, that facility has demonstrated its ability to provide services despite their census.

What if a patient refuses to transfer to another facility?

CMS Section 489.24 (d)(5) states that if the healthcare facility offers to transfer the patient to another medical facility and informed consent of the risks and benefits have been met, but the individual or person authorized on their behalf refuses consent for transfer, the healthcare facility should be protected from any EMTALA violation. The healthcare facility must obtain written refusal that includes that the person understands the risks and the reasons for their refusal of transfer.

Can a receiving medical facility refuse to receive a patient from another facility if we do not have a dedicated Emergency Department?

CMS regulations state that any Medicare-participating healthcare facility with specialized capabilities must accept appropriate transfers regardless of whether the facility has a dedicated ED. While some obligations under EMTALA apply to those healthcare facilities with an ED, the recipient obligations can also apply to facilities without an ED. (Reference §489.24(f) Recipient Hospital Responsibilities)

What are an on-call physician's obligations under EMTALA?

Capabilities of a medical facility means that there is physical space, equipment, supplies, and specialized services that the healthcare facility provides. If a physician is on call for the ED for their specialty, then that physician is part of the healthcare facility’s EMTALA obligation. Being on call for the ED is different than a practice or clinical setting. The healthcare facility has a legal obligation to treat emergency patients when a physician is on call for the ED. A specialty physician cannot refuse a call because they no longer want to do a procedure if they have privileges to do that procedure.

We encourage regular audits of your facility’s transfer acceptance policies and practices to ensure compliance with EMTALA requirements in the ED and as a receiving facility.

If you have questions about EMTALA in the ED, please contact us for access to our webinar about the 250-yard rule on demand through our CHER Online Learning Portal or patient safety and risk services team for further assistance.