In an April 26, 2007 letter to state survey agency directors, CMS clarified and expanded emergency service requirements for hospitals. While the guidance applies to all Medicare participating hospitals, the letter arises out of continued efforts by CMS to address issues with specialty hospitals. Notably, the guidance states unequivocally that a hospital relying on calling 9-1-1 in order for EMS to provide the hospital's emergency response fails to satisfy the expanded requirements.

The guidance focuses on Medicare Conditions of Participation (CoPs) requiring, among other things, that hospitals appraise persons with emergencies, provide needed initial treatment, and refer the patient to other resources for situations outside the hospital's capabilities. The guidance instructs surveyors to evaluate each hospital's capabilities to address emergencies whether or not the hospital operates an emergency department. Because the CoPs do not define "emergency," the guidance instructs surveyors to consider the definition of "emergency medical condition" contained in EMTALA. This is significant for hospitals not operating emergency departments, since such hospitals are not generally subject to EMTALA requirements. This CMS guidance may be a first step toward piggybacking EMTALA's obligations onto the more widely-applicable CoPs in order to press specialty hospitals into compliance.

Hospitals should expect surveyors to require more information about policies and procedures for emergency response and compliance with related CoPs as a result of this guidance.

The opinions expressed in this bulletin are intended for general guidance only. They are not intended as recommendations for specific situations. As always, readers should consult a qualified attorney for specific legal guidance.