A (gray) clarification of the 250-yard rule

The government draws lines

Question: Is a hospital obligated to comply with the Emergency Treatment and Active Labor Act (EMTALA) whenever an individual presents for emergency medical care anywhere within 250 yards of the hospital’s main building, even if the individual is in an area that is not hospital-owned and operated?

Answer: No. Generally, a hospital campus is defined in regulations as the physical area immediately adjacent to the hospital’s main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis by the Centers for Medicaid and Medicare Services regional office to be part of the hospital campus [42 CFR § 413.65(a)(2)].

We consider the parking lot, sidewalk, and driveway that are on hospital property to be part of the hospital for EMTALA purposes [42 CFR § 489.24(b)]. For purposes of EMTALA, the parameters of a hospital’s campus are not determined by drawing a circle 250 yards around a hospital’s main building and concluding that every building, area, and structure that happens to be located within those boundaries is part of the hospital campus.

For EMTALA purposes, an individual seeking emergency care who presents to a location on the hospital campus as interpreted above will be considered to have "come to the hospital" if a request is made on the individual’s behalf for emergency care. A hospital has no EMTALA obligation with respect to individuals who present to other areas or structures that may be located within 250 yards of the hospital’s main building that are not part of the hospital (except those areas like parking lots that serve the hospital). Examples of separate entities that are not part of the hospital for EMTALA purposes, even when located within 250 yards of the hospital’s main building, including fast-food restaurants or independent medical practices.

(Note: The entire clarification can be found on-line at http://hcfa.gov/medlearn/emqsas.htm.)