CMS sparks controversy with EMTALA comments
On-call issue is addressed
A top official Centers for Medicare & Medicaid Services (CMS) official recently made a startling public statement on another aspect of the Emergency Medical Treatment and Labor Act (EMTALA), says EMTALA expert and web site publisher Stephen A. Frew, JD.
After announcing in a letter to state Medicaid directors at the end of 2002 a new policy allowing states to place certain limits on coverage of emergency services "to facilitate more appropriate use of preventive care and primary care," CMS reversed its position in late January in a letter to leaders of the Senate Finance Committee.
Significant opposition
The original policy change had generated significant opposition from both Democrats and Republicans and led to the introduction by Sens. Bob Graham (D-FL) and Edward Kennedy (D-MA) of an amendment that would prevent CMS from implementing the change. The American Hospital Association and other hospital and health care organizations sent a letter to all senators urging support for the amendment.
Frew had warned that the worst-case scenario resulting from such a policy change would be that hospitals would be required to continue to provide EMTALA care, but that some states would stop paying for it for several years while the issue was on appeal in the courts.
In rescinding the original letter, Frew explains, CMS advised that EMTALA requires Medicaid patients to receive a full medical screening exam at every ED visit.
But Frew noted in an on-line EMTALA bulletin that a CMS official was captured on tape at an American Health Lawyers Association program saying that CMS will not cite hospitals for failing to have reasonable on-call physician coverage in the ED.
The statement, by CMS official Tom Baker, "was in the same spirit of ignoring the clear language of the law and regulations" as the original announcing regarding the treatment of Medicaid patients, he says, speculating that Baker’s statement was made "in either a moment of total insanity of with the express intent to completely cripple emergency department operations."
Frew points out that the Office of the Inspector General took a case involving one hospital all the way to the U.S. Court of Appeals to establish the legal precedent that hospitals will be held liable for inadequate on-call coverage and response.
"I could be wrong here, but I think this is another one that will come back to bite CMS," he adds, "but in the meantime, docs and lawyers that hear this may well be tempted to defy call systems."
A top official Centers for Medicare & Medicaid Services (CMS) official recently made a startling public statement on another aspect of the Emergency Medical Treatment and Labor Act (EMTALA), says EMTALA expert and web site publisher Stephen A. Frew, JD.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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