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CMS trying to clarify EMTALA rules for on-call physicians

Specialists say proposed changes would address some, but not all, of the law's quandaries.

By Markian Hawryluk, amednews staff. May 27, 2002.

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Washington -- The Centers for Medicare & Medicaid Services is beginning to resemble major-league baseball. After years of expansion of federal patient dumping prohibitions, CMS is now talking contraction.

As part of a proposed regulation on Medicare hospital inpatient payments, CMS has proposed changes to the Emergency Medical Treatment and Active Labor Act that would limit the scope of the law and modify provisions that critics said inhibited, rather than expanded, access to care.

Specifically, CMS is seeking comments on proposals that would clarify requirements for on-call physicians, limit the scope of EMTALA to hospital departments that normally provide emergency care and stipulate that the regulations do not apply to inpatients, except in limited cases.

The proposed changes also would allow hospitals to meet managed care preapproval requirements as long as doing so did not delay required screening and stabilization services. In addition, ambulance services would be free to follow communitywide emergency medical service protocols without running afoul of the law.

"This is a bona fide attempt by the administration to address the inappropriate expansion of EMTALA over the years," said Katie Orrico, director of the American Assn. of Neurological Surgeons and the Congress of Neurological Surgeons in Washington, D.C. "I would say virtually every one of the issues it addressed are issues that we have raised over the years with CMS."

Rep. John Shadegg (R, Ariz.), whose district has been particularly hard hit by EMTALA problems, said he was encouraged by the proposal. Shadegg has pressured the Bush administration to address the unintended consequences of the law and has proposed legislative measures. [...]