Legal Alert
Legal Alerts/Details

CMS Updates COVID-19 Guidance As It Relates to EMTALA

April 09, 2020

By Vinnie Lichvar

On March 30, Centers for Medicare and Medicaid Services ("CMS") updated its guidance previously issued on March 9 regarding a hospital’s ongoing obligations under Emergency Medical Treatment and Labor Act ("EMTALA") amidst the current COVID-19 pandemic.1 CMS specifically addressed screening sites setup outside Emergency Departments (“ED”) now being utilized by hospitals to address the overflow of patients and concerns related to the spread of the virus. The following chart details this guidance as it relates to three options for hospitals considering the use of alternative testing sites and treatment locations (On-Campus, Hospital-Controlled Offsite and Non-Hospital Controlled Testing Sites).

Alternative Screening Locations

 

On Campus

Hospital-Controlled Offsite

Testing Sites

EMTALA’S

APPLICATION

Applies. Medical screening examinations (“MSE”) may take place at screening sites on the hospital campus

Does not apply unless the location is already a dedicated ED of the hospital2

Does not apply to these locations – even if hospital personnel assist at the locations

REDIRECTING

PATIENTS

Individuals may be redirected to the on-campus site AND may be logged in and screened at this site. An RN, or other qualified providers capable of safely triaging patients, must be the personnel redirecting individuals from the ED to the on-campus site3

Hospitals may redirect patients to an offsite location for an MSE, in accordance with a state emergency preparedness or pandemic plan

Hospitals may not redirect individuals to these locations if they first arrive at an ED, until an MSE has been performed and it has been determined that the patient does not have an emergency medical condition

ADVERSTISING

Site may be held out as a respiratory or potential COVID-19 patient screening center

Site may be held out as a respiratory or potential COVID-19 patient screening center. May not advertise these locations as though they provide care for EMCs in general

Hospitals may encourage the public to use these sites for COVID-19 testing

 

STAFFING

Must be staffed with medical personnel trained to evaluate patients with respiratory or potential/presumed COVID-19 symptoms

Should be staffed with medical personnel trained to evaluate patients with respiratory or potential/presumed COVID-19 symptoms

Encouraged to be staffed with medical personnel trained to evaluate individuals with respiratory or potential/presumed COVID-19 symptoms

TRANSFER

Must provide stabilizing treatment (or appropriate transfer) to individuals with an EMC, which can include moving them to another on-campus department

Should arrange and coordinate with EMS that will be available to transfer patients with conditions in need of additional emergency medical treatment

Should be protocols or a process in place to deal with patients who arrive in medical distress and need transport to a hospital which may be as simple as calling 911

 

In addition to the above-described guidance, CMS clarified that hospitals cannot use signage that presents a barrier to individuals coming to the hospital who are suspected of having COVID-19, and that require an MSE. However, signage may direct individuals to on-campus locations being used for to perform these examinations.  Signage can also be used to inform individuals seeking COVID-19 tests, but that do not want an MSE or believe they have an emergency medical condition, about non-hospital-controlled sites.

In addition, CMS noted that hospitals must be cognizant of the requirements for handling patients suspected of having COVID-19.  These requirements include immediately isolating the patient, implementing appropriate respiratory hygiene (i.e., using a mask on patients and appropriate PPE for healthcare personnel), and maintaining coordination with their State or local public health officials.

Throughout this crisis, CMS has adjusted their guidance to keep up with emerging issues occurring across the country.  While using these sites are proving to be effective measures for hospitals seeking to control the flow of patients and isolate those with COVID-19 symptoms, hospitals should stay well-informed regarding changes in guidance to ensure continued compliance with EMTALA’s obligations.

Footnotes:
  1. https://www.cms.gov/files/document/qso-20-15-hospital-cah-emtala-revised.pdf
  2. See 42 CFR 489.24(b)
  3. A hospital’s non-clinical staff stationed at non-ED entrances at the hospital may redirect individuals seeking COVID-19 testing to the on-campus site.
Read Bio Vinnie Lichvar
Vinnie Lichvar
vlichvar@swlaw.com
vCard Icon vCard
©2024 Snell & Wilmer L.L.P. All rights reserved. The purpose of this publication is to provide readers with information on current topics of general interest and nothing herein shall be construed to create, offer, or memorialize the existence of an attorney-client relationship. The content should not be considered legal advice or opinion, because it may not apply to the specific facts of a particular matter. As guidance in areas is constantly changing and evolving, you should consider checking for updated guidance, or consult with legal counsel, before making any decisions.
One East Washington Street | Suite 2700 | Phoenix, AZ 85004
The material in this newsletter may not be reproduced, distributed, transmitted, cached or otherwise used, except with the written permission of Snell & Wilmer.