Hospitals should pay particular attention to when an individual must receive a medical screening exam to determine whether that individual is suffering from an emergency medical condition. When such a screening or treatment of an emergency medical condition is required, it cannot be delayed to inquire about an individual’s method of payment or insurance status. If the hospital’s emergency department (ED) is ‘‘on diversion’’ and an individual comes to the ED for evaluation or treatment of a medical condition, the hospital is required to provide such services despite its diversionary status.

Hospital emergency departments may not transfer an individual with an unstable emergency medical condition unless the benefits of such a transfer outweigh the risks. In such circumstances, the hospital must arrange for a transfer that will minimize the risks to the individual and that has been prearranged with the facility to which the individual is being transferred. Moreover, when a hospital receives a call from another facility requesting that it accept an appropriate transfer of a patient with an emergency, it must accept that patient for transfer if it has specialized capabilities to treat the patient that the transferring hospital does not have and it has the capacity to treat the patient.

A hospital must provide appropriate screening and treatment services within the full capabilities of its staff and facilities. This includes access to specialists who are on call. Thus, hospital policies and procedures should be clear on how to access the full services of the hospital and all staff should understand the hospital’s obligations to patients under EMTALA. In particular, on-call physicians need to be educated as to their responsibilities to emergency patients, including the responsibility to accept appropriately transferred patients from other facilities. In addition, all persons working in emergency departments should be periodically trained and reminded of the hospital’s EMTALA obligations and hospital policies and procedures designed to ensure that such obligations are met.

For further information about EMTALA, hospitals are directed to: (i) The anti-dumping statute at section 1867 of the Act; (ii) the anti-dumping statute’s implementing regulations at 42 CFR part 489; (iii) our 1999 Special Advisory Bulletin on the Patient Anti-Dumping Statute, 64 FR 61353 (November 10, 1999), available on our webpage at
http://oig.hhs.gov/fraud/docs/alertsandbulletins/frdump.pdf; and (iv) CMS’s EMTALA resource webpage located at http://www.cms.gov/providers/emtala/emtala.asp.