EMTALA Update 2020- Frequently Cited Deficiencies by CMS for Hospitals- 3 Part Webinar Series

This webinar series consists of 3 parts:-

• EMTALA Part 1- Wednesday, Feb 19, 2020, 11:00 PM EST- 1:00 PM EST, 120 Minutes
• EMTALA Part 2- Wednesday, Feb 19, 2020, 1:00 PM EST- 3:00 PM EST, 120 Minutes
• EMTALA Part 3- Thursday, Feb 20, 2020, 1:00 PM EST- 3:00 PM EST, 120 Minutes

Did you know that the EMTALA manual was updated in July of 2019? Did you know there were five recent documents or survey memos that have promulgated by CMS? Did you know the OIG regulations are not contained in the CMS EMTALA CoP manual?

EMTALA is a hot topic and should now be on the radar screen for every hospital. There have been a recent increased number of deficiencies and increased CMS and OIG activity. Would you know what to do if a CMS surveyor walked into your hospital today to investigate an EMTALA complaint? 

Did you know that the EMTALA penalties have more than doubled plus a cost of living so it is almost $105,000 per violation for hospitals over 100 beds? A recent article found that 30% of US hospitals and 34% of Critical Access Hospitals have violated EMTALA in the last decade. Violations were most likely to occur in the southeast region and with hospitals with fewer than 100 beds. CMS has also made a change in that some EMTALA investigations will occur 2 days after notification of a complaint. CMS also issued an MLN article on the Born-Alive Infant Protection Act on June 27, 2019. CMS also updated the survey memo on this in July 2019 in addition to a survey memo with seven FAQs.

Do you know when are you required to report a potential EMTALA violation? Don’t be caught off guard. CMS issued a recent deficiency memo showing that over 4,754 hospitals received deficiencies for failure to comply with the federal EMTALA law. Most hospitals were unprepared. This makes it the most frequent area of noncompliance. Common deficiencies will be discussed.

This program will also discuss a recent case against a South Carolina hospital which was the largest EMTALA settlement of 1.2 million dollars. It is anticipated that healthcare will see larger EMTALA fines and more activity because of the higher fines and the OIG final changes. These changes are not in the CMS CoPs and will be discussed.

It will also discuss the Quality Improvement Organization process which is now be done by the two BFCC QIOs. This program will discuss the CMS memos including three CMS survey memos on Ebola and EMTALA.

Every hospital that has an emergency department and accepts Medicare and Medicaid patients must follow the federal law and the Center for Medicare and Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines on the Emergency Medical Treatment and Labor Act (EMTALA). Hospitals without emergency departments must comply with EMTALA if they have specialized capabilities. EMTALA can also impact obstetrical patients and behavioral health patients. 

This 3 part webinar will include the regulations and interpretive guidelines. It will include all 12 sections and an expanded section for on-call physicians and the shared and community care plan process. 

Hospitals will need to ensure their policies, procedures, and training is adequate to ensure compliance with EMTALA. The hospital must know how to do a medical screening exam, how to stabilize a patient and what constitutes an emergency medical condition. Transfers must be compliant with these requirements.

This three-part webinar will include the discussion of a case that has created an enormous expansion of hospital and practitioner liability under federal law. The case, Moses v. Providence Hospital and Medical Centers, Inc., No. 07-2111 (6th Cir. April 2009), overruled the CMS regulation that EMTALA obligations end when the hospital admits the patient in good faith. Those states in the 6th Circuit (Ohio, Kentucky, Tennessee, and Michigan) must now follow this case as precedent. Sometimes the result may be different if the patient files a lawsuit as opposed to filing a complaint with CMS. This case illustrates the importance of understanding the role that case law has on the outcome of EMTALA litigation. Patients can complain to CMS and request an investigation or they have the option of going and directly filing a lawsuit.

Failure to comply and follow the federal EMTALA for all hospitals, including critical access hospitals, could result in loss of Medicare and Medicaid payments. Money fines can be assessed against hospitals and physicians who negligently violate the EMTALA law. There has been increased activity in the area of EMTALA.

The federal EMTALA law and the accompanying regulations are complex. This program is structured to make the requirements understandable with the liberal use of examples. 

Session Objectives:-

• Discuss that EMTALA is a frequently cited deficiency for hospitals (Part 1)
• Recall that CMS has a manual on EMTALA that all hospitals that accept Medicare must follow (Part 1)
• Describe that the hospital must maintain a central log (Part 2)
• Discuss the hospital's requirement to maintain a list of the specific names of physicians who are on call to evaluate emergency department patients (Part 2)
• Recall that CMS has requirements on what must be in the EMTALA sign (Part 2)
• Describe the hospital's requirements regarding a minor who is brought to the ED by the babysitter for a medical screening exam (Part 3)
• Discuss when the hospital must complete a certification of false labor (Part 3)

Session Agenda:-

This program will cover the following (Part 1 of 3):

• OIG changes that every hospital should be aware of
• BFCC QIOs process
• If immediate jeopardy 2-day visit required
• Common deficiency report by CMS
• The basic concept of EMTALA
• Who are the players?
• CMS EMTALA website
• Revised manual
• New survey memos
• Penalties have more than doubled
• AmHealth 1.3 million dollar settlement
• How to locate a copy of the EMTALA regulations
• OCR memo and EMTALA investigations
• OIG advisory opinions on EMTALA
• CMS Deficiency memo
• Compliance program
• CMS Survey memos
  • EMBOLA and EMTALA memo
  • CMS Memo on EMTALA and telemedicine
  • CMS memo on payment and collections
• EMTALA definitions and requirements 
• The Joint Commission standards
• EMTALA sign requirements
• Who does EMTALA apply?

This program will cover the following (Part 2 of 3):

• Payment issues
• Reasonable registration process
• Financial questions from patients
• Patients who sign out AMA
• Specialized capability
• Policies and procedures required
• On-call physicians issues
• Hospital recommendations
• Dedicated emergency department
• Central log
• Special responsibilities
• Meaning of “comes to the ED”
• Definition of hospital property
• EMTALA and outpatients
• Capacity
• Dedicated emergency department
• Inpatients and observation patients

This program will cover the following (Part 3 of 3):

• Medical screening exam
• Certification of false labor
• Born alive law and EMTALA and new memos and MLN article
• Minor child request for treatment
• CMS memo with 7 FAQs
• Telemetry
• When can you be on diversion?
• Parking of patients
• Helipad
• State plans and EMTALA
• Who can be a QMP?
• The Moses case
• Waiver of sanctions
• Requests for medications
• Blood alcohol tests
• Emergency medical condition
• Stabilization
• OB patients
• Born-Alive Infant Protection Act and  MLN clarification
• Transfer and transfer forms
• Behavioral health patients
• QIO role with EMTALA

Who Should Attend?

• Emergency Department Managers
• Emergency Department Physicians
• Emergency Department Nurses
• ED Medical Director
• Risk Managers
• OB Managers and Nurses
• Behavioral Health Director and Staff
• Chief Nursing Officer
• Nurse Supervisors
• Nurse Educators
• Staff Nurses
• Outpatient Directors
• Compliance Officers
• Legal Counsel
• Directors of Hospital-Based Ambulance Services
• Director of registration
• Registration staff and director
• ED education staff
• On-call physicians
• Chief Medical Officer (CMO)
• Chief Nursing Officer (CNO)
• Chief Operating Officer (COO)
• Chief Financial Officer
• Patient Safety Officer
• Joint Commission Coordinator