[Federal Register: May 28, 2004 (Volume 69, Number 104)]
[Notices]
[Page 30654-30656]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28my04-56]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1269-N]
Medicare Program; Establishment of the Emergency Medical
Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG) and
Request for Nominations for Members
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice announces the establishment of the Emergency
Medical Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG)
and discusses the group's purpose and charter. It also solicits
nominations for members.
DATES: Nominations for membership will be considered if they are
received by July 12, 2004.
ADDRESSES: Send nominations to--Division of Acute Care, Mail stop C4-
08-06, Centers for Medicare & Medicaid Services, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850; Attention: Beverly J.
Parker.
Send written requests for copies of the EMTALA TAG Charter to--
Division of Acute Care, Mail stop C4-08-06, Centers for Medicare &
Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850; Attention: Marianne M. Myers.
FOR FURTHER INFORMATION CONTACT: Beverly J. Parker (410) 786-5320.
Press inquiries are handled through the CMS Press Office at (202) 690-
6145.
SUPPLEMENTARY INFORMATION:
I. Background
Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Social
Security Act (the Act) impose specific obligations on Medicare-
participating hospitals that offer emergency services. These
obligations concern individuals who come to a hospital emergency
department and request examination or treatment for medical conditions,
and apply to all of these individuals, regardless of whether or not
they are beneficiaries of any program under the Act. Section 1867 of
the Act sets forth requirements for medical screening
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examinations of medical conditions, as well as necessary stabilizing
treatment or appropriate transfer. In addition, section 1867(h) of the
Act specifically prohibits a delay in providing required screening or
stabilization services in order to inquire about the individual's
payment method or insurance status. Section 1867(d) of the Act provides
for the imposition of civil monetary penalties on hospitals and
physicians responsible for negligently violating a requirement of that
section, through actions such as the following: (a) Negligently failing
to appropriately screen an individual seeking medical care; (b)
negligently failing to provide stabilizing treatment to an individual
with an emergency medical condition; or (c) negligently transferring an
individual in an inappropriate manner. (Section 1867(e)(4) of the Act
defines ``transfer'' to include both transfers to other health care
facilities and cases in which the individual is released from the care
of the hospital without being moved to another health care facility.)
These provisions, taken together, are frequently referred to as the
Emergency Medical Treatment and Labor Act (EMTALA), also known as the
patient antidumping statute. EMTALA was passed in 1986 as part of the
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
Congress enacted these antidumping provisions in the Social Security
Act because of its concern with an increasing number of reports that
hospital emergency rooms were refusing to accept or treat individuals
with emergency conditions if the individuals did not have insurance.
We presented and implemented these EMTALA provisions through
proposed and interim final rules published in the Federal Register on
June 16, 1988 (53 FR 22513), and June 22, 1994 (59 FR 32120),
respectively. In May 9, 2002, Federal Register (67 FR 31404), we
proposed further revisions to the EMTALA regulations. These proposals
were designed address issues and concerns which had arisen following
publication of the interim final rule with comment period by clarifying
policies relating to the responsibilities of Medicare-participating
hospitals in treating individuals with emergency medical conditions who
present to a hospital under the provisions of EMTALA. In the September
9, 2003, Federal Register (68 FR 53222), we finalized these proposals.
Section 945 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173), requires that the
Secretary establish a Technical Advisory Group (TAG) to solicit advice
concerning issues related to EMTALA regulations and implementation.
II. Charter, General Responsibilities, and Composition of the EMTALA
TAG
A. Charter Information and General Responsibilities
On May 11, 2004, the Secretary signed the charter establishing the
EMTALA TAG. This charter will terminate 30 months from the date of the
EMTALA TAG's first meeting. The EMTALA TAG, as chartered, under the
legal authority of section 945 of the MMA, is also governed by the
provisions of the Federal Advisory Committee Act (FACA), 5 U.S.C.
Appendix 2. In accordance with section 945 of the MMA, the EMTALA TAG
will meet at least twice a year and all meetings will be open to the
public.
You may obtain a copy of the Secretary's charter for the EMTALA TAG
by mailing a written request to the address specified in the ADDRESSES
section of this notice.
Section 945 of the MMA specifies that the EMTALA TAG--
Will review the EMTALA regulations;
May provide advice and recommendations to the Secretary
concerning these regulations and their application to hospitals and
physicians;
Will solicit comments and recommendations from hospitals,
physicians, and the public regarding implementation of such
regulations; and
May disseminate information concerning the application of
these regulations to hospitals, physicians, and the public.
B. Composition of the EMTALA TAG
Section 945 of the MMA also specifies the composition of the EMTALA
TAG. It states that the EMTALA TAG will be composed of 19 members
including the Administrator of the Centers for Medicare & Medicaid
Services (CMS) and the Inspector General of the Department of Health
and Human Services (DHHS) in addition to the number and type of
individuals specified in each of the following categories:
Four representatives of hospitals, including at least one
public hospital, that have experience with the application of EMTALA
and, at least, two hospitals that have not been cited for EMTALA
violations;
Seven practicing physicians drawn from the fields of
emergency medicine, cardiology or cardiothoracic surgery, orthopedic
surgery, neurosurgery, pediatrics or a pediatric subspecialty,
obstetrics-gynecology and psychiatry, with not more than one physician
from any particular field;
Two representatives of patients;
Two staff persons involved in EMTALA investigations from
different CMS regional offices;
One representative from a State survey agency involved in
EMTALA investigations and one representative from a Quality Improvement
Organization (QIO), both of whom shall be from areas other than the
regions represented by the CMS regional offices.
III. Submission of Nominations
We are requesting nominations for membership on the EMTALA TAG. The
Secretary will consider qualified individuals who are nominated by
organizations representing providers and patients when selecting
practicing physicians, patients, and hospital representatives. The
Secretary will also consider qualified individuals who are self-
nominated when selecting CMS regional office, State survey agency, and
QIO representatives. The Secretary will appoint members to serve on the
EMTALA TAG from among those candidates determined to have the technical
expertise required to meet the statutory requirements and in a manner
to ensure an appropriate balance of membership.
Nominations may be made for one or more qualified individuals for
each of the categories listed in section II.B. of this notice. Each
nomination must include the following:
1. A letter of nomination that contains--
a. Contact information for both the nominator and nominee (if not
the same); and
b. The category, as specified in section II.B. of this notice for
which the nomination is being made (for example, hospital
representative or practicing physician).
2. A statement from the nominee that he or she is willing to serve
on the EMTALA TAG for its duration (that is, at least 30 months from
date of the first meeting) and an explanation of interest in serving on
the EMTALA TAG. (For self-nominations, this information may be included
in the nomination letter.)
3. A curriculum vitae that indicates the nominee's educational and
EMTALA-related experiences.
4. Three letters of reference that support the nominee's
qualifications for participation on the EMTALA TAG. (For nominations
other than self-nominations, a nomination letter that includes
information supporting the nominee's qualifications may be
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counted as one of the letters of reference.)
5. Additional information is required for the following categories
of nominations:
a. Hospital representatives--In your statement regarding serving on
the EMTALA TAG indicate--
(1) Your hospital's Medicare provider number;
(2) The type of hospital (public or private); and
(3) Whether or not your hospital has been cited for an EMTALA
violation and, if so, the nature of the citation.
b. Practicing physicians--In your statement regarding serving on
the EMTALA TAG indicate--
(1) Your board or specialty society and certification (if any) for
your field of service;
(2) Your Unique Physician Identification Number (UPIN);
(3) Whether or not you have been cited for an EMTALA violation and,
if so, the nature of the violation.
c. Representatives from the CMS regional office, State survey
agency or Quality Improvement Organization--In your statement regarding
serving on the EMTALA TAG indicate the extent of your experience with
EMTALA investigations.
To ensure that a nomination is considered, we must receive all of
the nomination information specified in section III of this notice by
July 12, 2004.
Authority: Section 945 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA).
(Catalog of Federal Domestic Assistance Program No. 93.773 Medicare--
Hospital Insurance Program; and No. 93.774, Medicare--Supplementary
Medical Insurance Program.)
Dated: April 26, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-11936 Filed 5-27-04; 8:45 am]
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