On March 30, Centers for Medicare and Medicaid Services ("CMS") updated its guidance previously issued on March 9 regarding a hospital’s ongoing obligations under Emergency Medical Treatment and Labor Act ("EMTALA") amidst the current COVID-19 pandemic. CMS specifically addressed screening sites setup outside Emergency Departments (“ED”) now being utilized by hospitals to address the overflow of patients and concerns related to the spread of the virus. The following chart details this guidance as it relates to three options for hospitals considering the use of alternative testing sites and treatment locations (On-Campus, Hospital-Controlled Offsite and Non-Hospital Controlled Testing Sites).
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Alternative Screening Locations
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On Campus
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Hospital-Controlled Offsite
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Testing Sites
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EMTALA’S
APPLICATION
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Applies. Medical screening examinations (“MSE”) may take place at screening sites on the hospital campus
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Does not apply unless the location is already a dedicated ED of the hospital
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Does not apply to these locations – even if hospital personnel assist at the locations
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REDIRECTING
PATIENTS
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Individuals may be redirected to the on-campus site AND may be logged in and screened at this site. An RN, or other qualified providers capable of safely triaging patients, must be the personnel redirecting individuals from the ED to the on-campus site
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Hospitals may redirect patients to an offsite location for an MSE, in accordance with a state emergency preparedness or pandemic plan
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Hospitals may not redirect individuals to these locations if they first arrive at an ED, until an MSE has been performed and it has been determined that the patient does not have an emergency medical condition
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ADVERSTISING
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Site may be held out as a respiratory or potential COVID-19 patient screening center
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Site may be held out as a respiratory or potential COVID-19 patient screening center. May not advertise these locations as though they provide care for EMCs in general
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Hospitals may encourage the public to use these sites for COVID-19 testing
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STAFFING
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Must be staffed with medical personnel trained to evaluate patients with respiratory or potential/presumed COVID-19 symptoms
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Should be staffed with medical personnel trained to evaluate patients with respiratory or potential/presumed COVID-19 symptoms
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Encouraged to be staffed with medical personnel trained to evaluate individuals with respiratory or potential/presumed COVID-19 symptoms
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TRANSFER
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Must provide stabilizing treatment (or appropriate transfer) to individuals with an EMC, which can include moving them to another on-campus department
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Should arrange and coordinate with EMS that will be available to transfer patients with conditions in need of additional emergency medical treatment
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Should be protocols or a process in place to deal with patients who arrive in medical distress and need transport to a hospital which may be as simple as calling 911
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In addition to the above-described guidance, CMS clarified that hospitals cannot use signage that presents a barrier to individuals coming to the hospital who are suspected of having COVID-19, and that require an MSE. However, signage may direct individuals to on-campus locations being used for to perform these examinations. Signage can also be used to inform individuals seeking COVID-19 tests, but that do not want an MSE or believe they have an emergency medical condition, about non-hospital-controlled sites.
In addition, CMS noted that hospitals must be cognizant of the requirements for handling patients suspected of having COVID-19. These requirements include immediately isolating the patient, implementing appropriate respiratory hygiene (i.e., using a mask on patients and appropriate PPE for healthcare personnel), and maintaining coordination with their State or local public health officials.
Throughout this crisis, CMS has adjusted their guidance to keep up with emerging issues occurring across the country. While using these sites are proving to be effective measures for hospitals seeking to control the flow of patients and isolate those with COVID-19 symptoms, hospitals should stay well-informed regarding changes in guidance to ensure continued compliance with EMTALA’s obligations.
