Patient departures pose EMTALA dilemmas
The Department of Health and Human Services (HHS) acknowledges that hospitals face several dilemmas in trying to comply with the Emergency Medical Treatment and Labor Act (EMTALA). In its recent bulletin, HHS discusses the following issues:
• Prior authorization before screening or commencing stabilizing treatment.
It is not appropriate for a hospital to seek, or direct a patient to seek, authorization to provide screening or stabilizing services from the individual’s health plan or insurance company until after the hospital has provided (1) an appropriate medical screening examination to determine the presence or absence of an emergency medical condition, and (2) any further treatment necessary to commence stabilization of an emergency medical condition. The hospital may seek authorization for payment for all services after providing a medical screening examination and once necessary stabilizing treatment is under way.
• Use of advance beneficiary notices (ABNs) and other financial responsibility forms.
A hospital would violate the patient anti- dumping statute if it delayed a medical screening examination or necessary stabilizing treatment to prepare an ABN and obtain a beneficiary signature. It normally is permissible to ask for general registration information prior to performing an appropriate medical screening. In accordance with Health Care Financing Administration guidelines, a hospital may continue to follow reasonable registration processes, including asking whether an individual is insured and, if so, what that insurance is, as long as the inquiry does not delay screening or treatment.
• Medical screening examinations by qualified medical personnel and transfer authorization by physicians.
A hospital should ensure that either a physician or other qualified medical personnel provides an appropriate medical screening examination to all individuals seeking emergency care. If the individual has an emergency medical condition and the individual requires a transfer, only a physician, or if a physician is not physically present in the emergency department at the time, a qualified medical person in consultation with a physician, may authorize a transfer.
• Patient inquiries about financial liability for emergency services.
If a patient inquires about payment obligations for emergency services, the discussion should be deferred until after treatment whenever possible. Such an inquiry should be answered by a staff member who has been well-trained to provide information regarding potential financial liability. This staff member should clearly inform the patient that, regardless of the patient’s ability to pay, the hospital will provide a medical screening and stabilizing treatment, if necessary.
• Voluntary withdrawal.
If a hospital is aware that an individual intends to leave prior to the screening examination, it should take the following steps: 1) Offer the individual further medical examination and treatment within the facilities available at the hospital as may be required to identify and stabilize an emergency medical condition. 2) Inform the individual of the benefits of such examination and treatment and of the risks of withdrawal prior to receiving such examination and treatment. 3) Take all reasonable steps to secure the individual’s written informed consent to refuse such examination and treatment.
Source
o Timothy Jost, The Ohio State University College of Law, 55 W. 12th Ave., Columbus, OH 43210. Telephone: (614) 292-3381.
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