EMTALA
The Emergency Medical Treatment and Active Labor Act (EMTALA) is the federal law that gives all individuals the right to be treated for an emergency medical condition regardless of their ability to pay. This important law helps protect patients who are uninsured as well as those who have Medicare, Medicaid, or private insurance. EMTALA requires all hospitals that accept Medicare for any patient to provide necessary emergency care to all patients who come to the emergency department. Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals.
Rights under EMTALA:
- If a patient goes to a hospital emergency department for treatment of a medical condition and a “prudent layperson” (that is, a person who is not medically trained but who uses good judgment) would believe the patient needs to be examined or treated, the hospital must conduct a screening exam. If an emergency exists, the hospital must treat the patient until stable or, if the hospital is not capable of treating the condition, it must transfer the patient to an appropriate facility.
- If the patient goes to any other department in a hospital (this may not apply to a separate suite of doctors’ offices or a separate nursing home that is on the hospital grounds, but it does apply to other wings of the hospital) that has an emergency department (such as the non-emergency admitting office) and his/her appearance or behavior would lead a prudent layperson to believe that the patient needs emergency treatment, the hospital must likewise provide a screening exam. If necessary, the hospital must also provide stabilizing treatment or a transfer to an appropriate facility.
- If the patient goes to an off-campus facility of a hospital (such as an outpatient clinic not on the main hospital grounds) and that off-campus facility does not have an emergency department, the facility must have procedures to determine if the patient has an emergency and procedures to refer the patient to emergency care either at the facility’s own hospital or at another hospital.
- Screening services and stabilizing treatment must be provided without regard to ability to pay. The hospital cannot delay emergency screening or necessary emergency treatment to wait for an insurance company’s authorization.
Once patients are admitted to a hospital for inpatient care, EMTALA no longer applies. However, other laws require the hospital to provide appropriate inpatient care or an appropriate transfer and to plan properly for discharge.
EMTALA does not preclude the hospital from billing. Although EMTALA requires hospitals to treat emergency cases even if the patient cannot afford to pay, hospitals are still allowed to bill patients and/or their insurance for the care that is provided.
Resources
Helpful Information from the Centers for Medicaid and Medicare Services (CMS)
Other Resources
