Quick guide to specifics of the final EMTALA rule

These highlights of the final EMTALA rule were summarized by the Centers for Medicare & Medicaid Services (CMS):

• The new rule changes the definition of emergency department to mean any department or facility of the hospital, whether situated on or off the main hospital campus, that: 1) is licensed by the state as an emergency room or emergency department; 2) is held out to the public as providing care for emergency medical conditions without requiring an appointment; or 3) during its previous calendar year, has provided at least one-third of all its outpatient visits for the treatment of emergency medical conditions on an urgent basis.

• CMS clarified the circumstances in which physicians, particularly specialty physicians, must serve on hospital medical staff on-call lists. Under the revised regulations, hospitals will have discretion to develop their on-call lists in a way that best meets the needs of their communities. In keeping with traditional practices of "community call," CMS says physicians will be permitted to be on call simultaneously at more than one hospital, and to schedule elective surgery or other medical procedures during on-call times.

• The rule confirms that hospital-owned ambulances may comply with citywide and local community protocols for responding to medical emergencies and thus be used more efficiently for the benefit of their communities.

• Hospital departments that are off-campus can now provide the most effective way of caring for emergency patients without requiring that the patient be moved to the main campus, when this would not be best for the patient.

• The final rule clarifies that EMTALA does not apply to individuals who come to off-campus outpatient clinics that do not routinely provide emergency services or to those who have begun to receive scheduled, nonemergency outpatient services at the main campus — for example, routine laboratory tests. Other regulations and state licensing laws already cover the hospital’s obligations to patients in such circumstances.

• The rule clarifies that EMTALA does not apply after a patient has been seen, screened, and admitted for inpatient hospital services, unless the admission is made in bad faith to avoid the EMTALA requirements. This provision was adopted to conform to the decisions of five circuits of the United States Courts of Appeals.