Emergency Medical Treatment and Labor Act (EMTALA) Requirements & Conflicting Payor Requirements or Collection Practices

• EMTALA & Payor Requirements: Some proposed or existing payment policies of third party payors of hospital services have generated confusion among providers about their EMTALA obligations. The Centers for Medicare & Medicaid Services (CMS) is clarifying for Medicare-participating hospitals and critical access hospitals (CAH) that they are required to comply with EMTALA, regardless of any conflicting requirements of third-party payors, including when those payors are State Medicaid programs.
• Certain Hospital Collection Practices May Also Conflict with EMTALA: It is not acceptable for a hospital or CAH to request immediate payment, by cash or other methods, for services provided to an individual who is protected under EMTALA prior to the receipt of such services. A hospital may only request on-the-spot payment after it has conducted an appropriate medical screening examination (MSE) and, if applicable, stabilized an individual’s emergency medical condition (EMC) or admitted the individual. Hospital patients are further protected under the patient’s rights Condition of Participation at 42 CFR 482.13(c)(3), which protects patients from abuse or harassment.
• Provisions of the Affordable Care Act May Mitigate Future Problems: The Affordable Care Act contains provisions requiring certain insurance issuers to cover emergency services, including stabilization, without preauthorization.