EMTALA Update

An Excerpt from EMTALA E-Bulletin #20
Frew Consulting Group, Ltd.

CONGRESS PROPOSES EMTALA CHANGES

On May 14, 2001 the House Ways and Means Committee that oversees Medicare sent recommendations for changes at HCFA, including EMTALA related changes.

The letter, signed by committee chair Nancy Johnson and ranking member Pete Stark ( the creator of EMTALA) recommends immediate administrative changes:

1. Remove the ABN requirement for ED's, so that hospitals that comply with EMTALA provisions against ABN's in the ED will still get paid for the services or be allowed to bill the patient for the services without conflicting with the ABN rule.

2. HCFA should re-examine the rules pertaining to presentation to non-emergency care sites on the hospital's main campus and reviewing the role of non-emergency staff.

3. Changing the 250-yard rule for non-hospital property to only apply to the main campus and areas in "close proximity" (perhaps reverting the previous "contiguous" standard?)

4. Not requiring emergency personnel to leave the premises unless an emergency situation was observed or reported.

(I honestly do not know why this would be needed because there is no requirement to respond even under the 250 yard rule if the hospital has not been notified of the need to assist the patient, but if it makes it clearer, that is fine.)

Under the ambulance billing rules, the letter wants a consistent billing and coding process so that all ambulance providers get paid on the same basis, and demanding a report by June 15 on condition codes, diagnosis codes and other methods for billing.

This is apparently in response to HCFA's determination that the levels of care approach was more feasible than new coding systems when they passed the ambulance billing regulations that went into effect on January 1, 2001.

In the "provider-based" regulation, the letter suggests that management companies should be allowed to be covered under OPPS.

Calls today indicate that Congressional reports on EMTALA may also suggest that follow-up care issues of physicians turning away referred patients for financial reasons would be off-limits to EMTALA enforcement.

Whether or not any of these changes become law or regulatory changes are made consistent with them is purely speculation at this point, but prospects of getting some modifications made or clarifications issued are much more likely with Stark's name on the letter.