Proposal: Eliminate most off-campus surgery centers from EMTALA regulations
Under a proposed rule for new Emergency Medical Treatment and Labor Act (EMTALA) regulations from the Baltimore-based Centers for Medicare & Medicaid Services (CMS), most off-campus hospital surgery centers would no longer fall under EMTALA. EMTALA has never applied to surgery centers that are certified by Medicare as freestanding.
"Under the 5/9/02 proposal, hospital-based surgical facilities would be subject to EMTALA only if located on the main hospital campus and treated by Medicare as a department of the hospital, or located off-campus of the main hospital and qualifying as a dedicated emergency department [ED],’" says Eric Zimmerman, JD, MBA, an attorney at McDermott, Will & Emery in Washington, DC.
For the first time, CMS gives a description of a "dedicated ED," says Robert A. Bitterman, MD, JD, FACEP, director of risk management and managed care for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC. "This is new. It means that if you hold yourself out as offering emergency or urgent services, CMS is going to call you a real ED," Bitterman says.
However, other types of facilities, such as off-campus surgery centers, radiology clinics, mammography clinics, primary care clinics, and rehab centers, where patients come in for scheduled visits and aren’t seeking emergency care, would no longer fall under EMTALA. "They really backpedaled on that, which is very good for hospitals," he says. "The change eliminates a whole bunch of the off-campus rules, but EMTALA never should have reached that far in the first place."
Off-campus sites that face a patient with an emergency condition now could use existing emergency medical system protocols instead of contacting the ED, says Charlotte Yeh, MD, FACEP, medical director for Medicare policy at the Hingham, MA-based National Heritage Insurance Co. CMS has begun to distinguish who is asking for emergency care and who isn’t, Yeh says. If it’s clear that someone is coming in for a scheduled visit and there is no emergency medical condition, then obligations under EMTALA will end at that point, she adds.
"This explains something that people had trouble grasping," Yeh says. Much of the anxiety about EMTALA requirements stemmed from confusion over which sites fall under EMTALA and which don’t, she says. Yeh offers the following summary of the two new definitions that address this:
• The "dedicated ED."
— A specially equipped and staffed area of the hospital is used a significant portion of the time for initial evaluation and treatment of outpatients with emergency medical conditions.
— This may be an on-campus or off-campus department of the hospital.
— This includes not only the ED, but other hospital departments (such as labor and delivery or psychiatric units), which are held out to the public as places to come for urgent, nonappointment visits.
• Hospital property.
— This includes parking lot, sidewalk, driveway.
— This excludes areas and structures that are within 250 yards of the main hospital building, but are not part of the hospital (e.g., physician offices, entities with separate Medicare provider numbers, restaurants, shops, other nonmedical facilities).
The proposed rule was published in the May 9, 2002, Federal Register. The deadline for comments is July 8, 2002. A final rule will be published later this year and is expected to become effective Oct. 1, 2002.
EMTALA sources and resources
For more about the proposed rule, contact:
• Robert A. Bitterman, MD, JD, FACEP, Department of Emergency Medicine, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232-2861. Telephone: (704) 355-5291. Fax: (704) 355-8356. E-mail: [email protected].
• Charlotte S. Yeh, MD, FACEP, Medical Director, Medicare Policy, National Heritage Insurance Co., 75 Sgt. William Terry Drive, Hingham, MA 02043. Telephone: (781) 741-3122. Fax: (781) 741-3211. E-mail: [email protected].
• Eric Zimmerman, McDermott, Will & Emery, 600 13th St. N.W., Washington, DC 20005. Telephone: (202) 756-8148. Fax: (202) 756-8087. E-mail: [email protected]. Web: www.mwe.com.
The proposed rule is Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2003 Rates. Comments from the public will be accepted until July 8, 2002. Refer to file code CMS-1159-P. No faxed comments will be accepted. Mail written comments (an original and three copies) to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Atten-tion: CMS-1203-P, P.O. Box 8010, Baltimore, MD 21244-1850.
To order a copy of the Federal Register with the proposed rule, contact New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date requested (May 9, 2002). Credit card orders also can be placed by calling the order desk at (202) 512-1800 or by faxing to (202) 512-2250. The cost for each copy is $9. The Federal Register is available at many libraries and on the web: www.access.gpo.gov/nara/index.html.
Thomson American Health Consultants offers a compact disc of EMTALA Update 2002, its successful audio conference presented by Charlotte Yeh, MD, FACEP, and Nancy Brent, RN, MS, JD, nationally recognized speakers on the Emergency Medical Treatment and Labor Act (EMTALA). The anticipated date for the new rules to go into effect is Oct. 1.
Don’t miss out on important information to bring your facility into compliance. The cost of the CD is $249, which includes 1 nursing contact hour or 1 AMA Category 1 CME credit for each member of your staff. To order this invaluable teaching tool, please call Thomson American Health Consultants’ customer service department at (800) 688-2421, or order on-line at www.ahcpub.com.
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