* CM: – Emergency Medical Treatment and Labor Act (EMTALA) Requirements & Conflicting Payor Requirements or Collection Practices[®] S&C: 14-06-Hospitals /CAHs EC News December 13, 2013 [REF: JGB, LDR, MD, PtAd] CMs1312_B7

In this guidance document, the Centers for Medicare & Medicaid Services (CMS) is making it very clear that Medicare-participating hospitals are required to comply with and provide services required by EMTALA, “regardless of any conflicting requirements of third-party payors, including when those payors are State Medicaid programs… regardless of the individual’s payment method and/or the ability to pay”.  They further clarify that for EMTALA-protected persons, it is “not acceptable” for a hospital to request immediate payment for services prior to having rendered the service. The letter also describes additional protections (fair practices) for the receipt of emergency services out-of-network under provisions of the Affordable Care Act to help ensure “appropriate emergency services without concerns of undue payment hardship”. The balance of the letter provides examples of payor/hospital debt collection practices that might cause EMTALA violations and gives more compliance advice.
Tip: State and Psychiatric hospital leaders should pay particular attention to the clarification of “stabilized” vs “Stable for transfer”.  The latter term is not used in EMTALA and as discussed on page 4, is not necessarily equivalent to the former term.