EMTALA FAQs

UW Medicine’s EMTALA Compliance policy, COMP.301, can be found on our website here: https://depts.washington.edu/comply/docs/comp_301.pdf

In Fall 2022, UW Medicine leadership provided a press release with substantial information and resources, including a Q&A on the 2022 US Supreme Court’s overturning of Roe v. Wade and was updated in June 2023: https://newsroom.uw.edu/news-releases/uw-medicine-responds-legal-decisions-abortion

There is no specific list of procedures/services that must be provided during the MSE; rather, the MSE is specific to the patient’s presenting signs and symptoms. The purpose of the MSE is to determine whether a patient has an Emergency Medical Condition (EMC) and, if so, we are required to provide stabilizing treatment for the EMC within our capacity and capabilities; for pregnant patients in active labor, this includes delivering the child and placenta. If we are unable to stabilize the EMC, we must provide the patient with an appropriate transfer as described further in Q&A #9. In meeting its EMTALA obligations, including MSEs, UW Medicine does not discriminate against individuals based on financial status, ability to pay, diagnosis, age, race, color, creed, ethnicity, religion, national origin, marital status, sex, sexual orientation, gender identity or expression, disability, veteran or military status or any other basis prohibited by federal, state or local law.

The registration process for patients seeking emergency medical care can include asking the patient for their name, date of birth, or other demographic information and identification cards. For example, you can ask if they have a Washington State ID card or Driver License, health insurance ID card, or other forms of identification for the purpose of trying to positively identify them. However, the registration process cannot include any inquiry about the patient’s ability to pay for their medical care or any insurance authorization, and cannot delay or discourage the patient from receiving an appropriate Medical Screening Exam (MSE) and any necessary stabilizing treatment. The basic EMTALA principle is a patient’s emergency medical care needs are the top priority; the paperwork side of the patient’s emergency medical care encounter can be initiated after the patient has begun receiving their MSE and any necessary stabilizing treatment.

Yes. Hospital personnel should not delay a minor’s Medical Screening Exam (MSE) by waiting for parental consent. If after screening the minor, it is determined that no EMC is present, the staff can wait for parental consent before proceeding with further examination and treatment.

Yes. Physicians and Advanced Practice Professionals (Physician Assistants [PAs] and Advanced Registered Nurse Professionals [ARNPs]) are the only types of medical personnel who may perform MSEs at UW Medical Center, Harborview Medical Center and
Valley Medical Center. Additionally, triage (which is typically performed by a nurse) is not equivalent to the MSE.

For patients with behavioral health conditions, EMTALA specifies that patients who are expressing suicidal ideation (SI) and/or homicidal ideation (HI) are considered to have an Emergency Medical Condition (EMC). Therefore, we must provide the necessary evaluation and stabilizing treatment by a qualified behavioral health provider within our capacity and capabilities (per the applicable UW Medicine entity policy) to protect and prevent these patients from injuring themselves and/or others. Some of these patients’ treatment needs may ultimately require the specialized capabilities of an inpatient psychiatric facility, so we must coordinate an appropriate transfer to those types of facilities in these situations.

The OSH should contact our UW Medicine Transfer Center (TC) at 206.520.7575 or 877.520.7575. The TC serves as a single point of contact for urgent and emergent transfer requests and physician-to-physician consultations. Specialty trained registered nurses are available 24 hours a day, seven days a week to coordinate inter-facility transfers to
UW Medicine. The TC also assists with Airlift Northwest (Airlift) air transport as needed, and facilitates the transfer of a patient’s clinical documentation to ensure continuity of care. More information about the TC can be found here: https://www.uwmedicine.org/practitioner-resources/patient-transfers

There are four (4) requirements for an “appropriate transfer” under EMTALA:

• The transferring hospital provides medical treatment within its capacity which minimizes the medical risks to the patient (and in the case of a pregnant patient in labor, the medical risks to the fetus as well).
• The receiving hospital has available space and qualified personnel for the treatment and agrees to accept the transfer.
• The transferring hospital sends the receiving hospital all medical records related to the emergency condition that are available at the time of the transfer and any other records not yet available as soon as practicable.
• The patient is transferred using appropriate personnel and transportation, including the use of necessary and medically appropriate life support measures during the
  transfer.^[1] 

^[1]The transferring hospital is required to arrange transport that minimizes the risk to the patient who is being transferred. Moreover, it is the responsibility of the transferring physician/hospital to determine the mode of transfer to be used, and the receiving physician/hospital cannot condition its acceptance of the patient on a particular mode of transfer. This means UW Medicine cannot require a transferring physician/hospital to use Airlift Northwest (Airlift) as a condition for our acceptance of a transfer request. However, we can recommend Airlift as UW Medicine’s preferred air transport to the transferring physician/hospital, as long as we ultimately allow them to decide.

Depending on the specific facts of an OSH’s emergency transfer request, UW Medicine generally would be obligated under EMTALA to accept the patient if the OSH does not have the capabilities (i.e., the services/technology to provide the specific type/level of emergency care needed) or the capacity at the time of their request, and we do have the capabilities and capacity to do so. This could include situations in which we do not have an available bed but we have procedures for accommodating additional patients by various means, such as moving patients from one unit to another, calling in additional staff, borrowing additional equipment from other departments, etc. In other words, our capacity is determined by the case-specific circumstances and our history of implementing various capacity management actions to accommodate patient overflow.

• There is no arrangement/agreement by a UW Medicine hospital to accept the transfer.
• The transfer occurred against our recommendations or despite us declining the transfer request.
• The patient’s condition indicates the OSH may not have provided stabilizing treatment within its capacity and capabilities.
• The patient arrives to us without the OSH sending us any of their medical records.
• The patient’s condition arguably could have been handled by the OSH’s on-call physician, but that physician did not personally see the patient.
• The patient (or their family member or friend) drove themself from the OSH
  to our ED.^[2] 

^[2] If the patient (or their family member or friend) informs us they decided to drive themselves and that the OSH did not compel them to make that decision, then that should be considered. For example, there may not have been an ambulance (either ground or air transport, such as Airlift Northwest) available for several hours – which can sometimes be the case in rural communities, and/or the patient does not want to use an ambulance because they cannot afford it or do not want to pay the out-of-pocket costs, and therefore the patient/family member/friend decides to drive the patient themselves.

Take the following steps:

1. Contact Compliance directly by either emailing comply@uw.edu or calling 206.543.3098.
2. Notify your supervisor immediately, and work with them to notify your facility’s Emergency Department (ED) leadership as well as the Medical Director’s office.
3. Enter the information you have about the situation into your facility’s patient safety system (e.g., SafetyNet or RL Datix).

You should immediately assist the person and follow your hospital’s policies/procedures for assisting people who may need emergency assistance while on campus outside of a hospital building (e.g., calling 911, even though the person is on the hospital campus). Once the ambulance arrives, they can assess the person and then safely move/transport them to the Emergency Department (ED).

You should ensure that the patient has been triaged, and then explain to them it is in their best interest to stay, and that UW Medicine wants to take care of them and they will be seen as soon as possible. However, if the patient refuses to wait any longer and insists on leaving, then we must allow them to do so. Our obligation is to communicate to the patient that we want to take care of them, just like any other UW Medicine patient.

In general, if an emergency patient is discharged appropriately after receiving the necessary stabilizing medical care but then returns later with a medical complaint (regardless of whether their medical complaint is similar or different than their previous encounter for which they received emergency care), they should be offered a Medical Screening Exam (MSE) to determine if, in fact, they have an Emergency Medical Condition (EMC). If the MSE reveals they have an EMC, EMTALA requires us to provide them with the necessary stabilizing treatment (within our capacity and capabilities). On the other hand, if the MSE determines they do not have an EMC, then we have met our EMTALA obligation and can discharge the patient accordingly. Also, we cannot deny patients access to either the ED or emergency medical care.

Yes. The following are examples for which EMTALA does not apply:

• Patients who are “inpatient” status, including those who are inpatient at an outside hospital (OSH) which requests a transfer of that patient to UW Medicine. In these situations, the patient is protected by Medicare’s overarching Conditions of Participation (CoP) from being inappropriately transferred or discharged. Therefore, because EMTALA does not apply here, the EMTALA requirements for an appropriate transfer as listed in Q&A #8 likewise do not apply.
• The transfer of stable patients (i.e., those whose emergency medical conditions (EMCs) have been stabilized or who have been determined to not have an EMC) from one UW Medicine hospital to another UW Medicine hospital in order to provide the best access to all patients across the enterprise.
• Patients who come to a hospital’s emergency department and request nonemergency-related services, such as COVID-19 testing, and do not have any complaints, symptoms or other medical needs for which they are requesting care. Patients who present solely for the purpose of COVID-19 testing and are not making a request for treatment of a medical condition do not necessarily require a Medical Screening Exam (MSE). However, if they complain of or exhibit any symptoms of a medical condition, then they should receive an appropriate MSE to determine whether an EMC exists. The EMTALA obligation is satisfied if the MSE determines the patient does not have an EMC.
• Patients who are at an outpatient clinical appointment on the hospital campus and develop a potential EMC. In this situation, calling 911 and/or mounting a field response (e.g., initiating basic life support and other medical care to the patient, based on the nature of their condition and the applicable hospital policy/procedure – such as Code Blue, etc.) could both be appropriate responses.

Absolutely! Contact UW Medicine Compliance directly at comply@uw.edu or 206.543.3098, and a staff member will work with you to coordinate a session that meets your needs.

UW Medicine Compliance Glossary:
http://depts.washington.edu/comply/docs/Glossary.pdf

UW Medicine EMTALA Compliance Policy (COMP.301):
https://depts.washington.edu/comply/docs/comp_301.pdf

Social Security Act, Title 18, Section 1866 (42 United States Code Section1395cc): Agreements with Providers of Services; Enrollment Services:
https://www.ssa.gov/OP_Home/ssact/title18/1866.htm

Social Security Act, Title 18, Section 1867 (42 United States Code Section1395dd): Examination and Treatment for Emergency Medical Conditions and Women in Labor: https://www.ssa.gov/OP_Home/ssact/title18/1867.htm

Centers for Medicare and Medicaid Services (CMS), 42 Code of Regulations Section 489.24: Special responsibilities of Medicare hospitals in emergency cases:
https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-489/subpart-B/section-489.24

Centers for Medicare and Medicaid Services (CMS), State Operations Manual: Appendix V – Interpretive Guidelines – Responsibilities of Medicare Participating Hospitals in Emergency Cases, CMS Pub. 100-07, (Rev. 191, July 19, 2019):
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_v_emerg.pdf

CMS Policy Memo QSO-20-15 Hospital/CAH/EMTALA REVISED – Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19) (Revised):
https://www.cms.gov/files/document/qso-20-15-hospital-cah-emtala-revised.pdf

CMS Policy Memo QSO-21-22-HOSPITALS (Revised) – Reinforcement of EMTALA Obligations specific to Patients who are Pregnant or are Experiencing Pregnancy Loss (Revised October 2022):
https://www.cms.gov/files/document/qso-21-22-hospital-revised.pdf