Regulations underway could redefine EMTALA
Regulations underway could redefine EMTALA
The ability of the Department of Health and Human Services (HHS) Office of Inspector General’s (OIG) to expand the reach of the Emergency Medical Treatment and Active Labor Act (EMTALA) — otherwise known as the patient dumping law — will likely turn on regulations and guidance now in the works.
The Health Care Financing Administration (HCFA) and OIG both confirmed last week that a proposed rule is being drafted that is designed to clarify the expectations of hospitals and other providers under EMTALA.
But one source says the OIG and HCFA are sharply at odds over the shape of that regulation. "The OIG wants to be much more aggressive," reports the source, who points to a bootleg copy of a HCFA regulation on EMTALA that the OIG views as too docile. That rule was never published, largely because of the OIG’s objections.
HCFA takes the position that once a patient is stabilized EMTALA is over, says the source. But that view is directly at odds with the OIG’s interpretation, which says it applies continually as long as the patient is in the hospital.
There is currently no single entity responsible for educating hospitals and other providers about EMTALA, concedes OIG spokeswoman Alwyn Cassil. Instead, Medicare contractors and trade groups have stepped in to fill the breach. "We are aware there are questions and gray areas." But the HCFA/OIG regulation will answer those questions and fill that vacuum, she adds.
In any case, both HCFA and the OIG say that a proposed rule on EMTALA won’t be out any time soon. "It won’t be out for at least a year," predicts HCFA spokeswoman Michelle Robinson.
Further complicating matters is an amendment to EMTALA included in the proposed PPS outpatient regulations. That amendment would expand the law significantly by making it apply to all outpatient departments of a hospital regardless of whether they are on-campus or off-campus.
Finally, there is the OIG’s draft compliance program for Medicare+Choice plans that also includes a section on EMTALA. The Chicago-based American Hospital Association (AHA) has asked the OIG to entirely rewrite that portion of the guidance because it misinterprets the law regarding inquiries hospitals make to patients about payment and insurance status. "There is no prohibition on making inquiries," asserts AHA Executive Vice President Rick Pollack. "Delay is the issue, not the inquiry."
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