[Federal Register: March 15, 2005 (Volume 70, Number 49)]
[Notices]
[Page 12691-12693]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15mr05-97]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1269-N3]
Medicare Program; Emergency Medical Treatment and Labor Act
(EMTALA) Technical Advisory Group (TAG) Meeting and Announcement of
Members
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice of meeting.
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SUMMARY: In accordance with section 10(a) of the Federal Advisory
Committee Act (FACA) (5 U.S.C. Appendix 2), this notice announces the
first meeting of the Emergency Medical Treatment and Labor Act (EMTALA)
Technical Advisory Group (TAG). The purpose of the EMTALA TAG is to
review regulations affecting hospital and physician responsibilities
under EMTALA to individuals who come to a hospital seeking examination
or treatment for medical conditions. This notice also announces the
newly appointed members of the EMTALA TAG. Interested parties are
invited to this meeting to present their comments on the EMTALA
regulations and implementation.
DATES: Meeting Date: The meetings of the EMTALA TAG announced in this
notice will be held on Wednesday, March 30, 2005 and Thursday, March
31, 2005, from 9 a.m. until 5 p.m. each day.
Registration Deadline for All Participants: All presenters must
register by March 22, 2005.
Comment Deadline: Comments or statements must be received by March
22, 2005.
ADDRESSES: Meeting Address: The EMTALA TAG meeting will be held in Room
305 A at the Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201.
Mailing and E-mail Addresses for Inquiries or Comments: Inquiries
or comments regarding this meeting may be sent to--Beverly J. Parker,
Division of Acute Care, Centers for Medicare & Medicaid Services, Mail
Stop C4-08-06, 7500 Security Boulevard, Baltimore, MD 21244-1850.
Inquiries or comments may also be e-mailed to EMTALATAG@cms.hhs.gov.
Web Site Address for Additional Information: For additional
information on the EMTALA TAG meeting agenda topics, updated
activities, and to obtain Charter copies, please search our Internet
Web site at: http://www.cms.hhs.gov/faca/emtalatag/emtalatagpage.asp.
Mailing Address for Copies of the EMTALA TAG Charter: Written
requests for copies of the EMTALA TAG Charter should be sent to--
Marianne M. Myers, Division of Acute Care, Centers for Medicare &
Medicaid Services, Mailstop C4-08-06, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Submission of Comments or Statements: Comments or statements
regarding EMTALA may be sent by postal mail or e-mail to the inquiry/
comment addresses listed above. We will accept written comments/
statements of three single-spaced, typed pages or less that are
received by March 22, 2005.
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 or have a request made on their behalf for
examination or treatment for a medical condition. EMTALA applies to all
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 examinations for emergency 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.
These provisions, taken together, frequently referred to as the
Emergency Medical Treatment and Labor Act (EMTALA), are 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.
Regulations implementing the EMTALA legislation are set forth at 42
CFR 489.20(l), (m), (q) and (r)(1), (r)(2), (r)(3), and 489.24. These
regulations incorporate changes made by a final rule published in the
September 9, 2003 Federal Register (68 FR 53222). We published a final
rule to clarify policies relating to the responsibilities of Medicare-
participating hospitals and physicians, under the provisions of EMTALA,
in treating individuals with emergency medical conditions who present
to a hospital.
Section 945 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (P.L. 108-173), requires that the
Secretary establish a Technical Advisory Group (TAG) for advice
concerning issues related to EMTALA regulations and implementation.
Section 945 of the MMA specifies that the EMTALA TAG--
Shall review the EMTALA regulations;
May provide advice and recommendations to the Secretary
concerning these regulations and their application to hospitals and
physicians;
Shall 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.
Section 945 of the MMA also specifies the structure 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 as specified in each of the following categories:
[[Page 12692]]
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 cardio-thoracic 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, both of whom shall be from areas other than the regions
represented by the CMS regional offices.
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) for the selection
of members and the conduct of all meetings.
In the May 28, 2004 Federal Register (69 FR 30654), we specified
the statutory requirements regarding the charter, general
responsibilities, and structure of the EMTALA TAG. That notice also
solicited nominations for members based on the statutory requirements
for the EMTALA TAG. In the August 27, 2004 Federal Register (69 FR
52699), we solicited nominations again for members in two categories
(patient representatives and a State survey agency representative) for
which no nominations were received in response to the May 28, 2004
Federal Register notice.
II. Membership Selection
The following individuals have been selected by the Secretary, to
serve on the EMTALA TAG along with Mark McClellan, M.D., Adminstrator,
CMS and Daniel R. Levinson, Acting Inspector General, DHHS:
Hospital Representatives--Julie Mathis Nelson, J.D.,
Coopersmith, Gordon, Schnermer, Owens & Nelson, P.L.C.; Carlos Perez,
South Manhattan Healthcare Network; Richard T. Perry, M.D., P.C.,
F.A.C.S.; and Brian C. Robinson, Hospital Corporation of America's Las
Vegas Market/Sunrise Hospital and Medical Center.
Physicians--Cesar A. Aristeguieta, M.D., Los Angeles
County Paramedic Training Institute; Carol Lynn Bayer, M.D., East
Jefferson General Hospital Metairie, Louisiana; James L. Biddle, M.D.,
Rio Grande Regional Hospital and McAllen Medical Center; John A.
Kusske, M.D., University of California; James Nepola, M.D. Health
Policy Committee Orthopedic Trauma Association; Michael J. Rosenberg,
M.D., Assistant Professor/Private Practice; and David W. Tuggle, M.D.,
University Oklahoma College of Medicine
Patient Representatives--Warren A. Jones, M.D., Office of
the Governor, State of Mississippi; and Mark Pearlmutter, M.D., St.
Elizabeth's Medical Center.
CMS Regional Office Representatives--Gretchen A. Kane CMS,
and Charlotte S. Yeh, M.D., FACEP.
State Survey Agency Representative--Azzie Conley, RN,
State of North Carolina.
QIO Representative--David Siegel, M.D., J.D., FACEP, FACP,
FCLM Senior Physician Consultant and Clinical Coordinator.
III. Meeting Format, Agenda, and Suggested Presentation Topics
A. Meeting Format
The initial portion of the meeting will involve opening remarks,
introductions and the swearing in of the EMTALA TAG members by Michael
O. Leavitt, Secretary, DHHS. After which and in accordance with section
945 of MMA, the EMTALA TAG members will elect their chairperson. The
afternoon portion of the first day and the morning portion of the
second day will be reserved for statements from registered presenters.
The afternoon portion of the second day will be reserved for the EMTALA
TAG members to ask questions, prioritize the topics presented, and to
conduct other necessary business.
The time allotted for each presentation will be approximately 5
minutes but will be based on the number of registered presenters.
Presenters will speak in their assigned order. If there are individuals
who cannot attend the meeting, we will accept and present their
comments/statements at the meeting if their comments/statements are
received via postal mail or email at the address list in the ADDRESSES
section of this notice by March 22, 2005. Comments from other
participants (individuals that are not registered presenters) may be
heard after the scheduled statements, if time permits.
B. Tentative Meeting Agenda
The tentative agenda for the EMTALA TAG meetings is as follows:
Day 1
Welcome, call to order, introductions, and opening remarks
Administrative and housekeeping issues
Swearing in of members and self-introductions
Comments from registered presenters
Day 2
Comments from registered presenters
Discussion of current business
C. Suggested Presentation Topics
The following are suggested presentation topics:
Inpatient Transfers--Under current EMTALA regulations, if
a hospital admits an individual in good faith for stabilizing treatment
on an inpatient basis, the admission ends the hospital's EMTALA
obligation to that individual. Does the fact that an individual no
longer is covered by EMTALA at the time transfer is sought make it more
difficult to find a suitable specialty hospital transfer?
Specialty Hospitals and EMTALA--Some specialty hospitals
apparently accept patients on an appointment basis only, and will
accept patients only for treatment of particular medical conditions or
for a narrow range of services. There are reports that such hospitals
are refusing to accept transfers of patients from general or community
hospitals, on the basis that because the specialty hospital does not
have a dedicated emergency department as defined in the new
regulations, it has no obligations under EMTALA.
On-Call Issues--Some concerns have been expressed that the
revised regulations regarding physician on-call responsibilities are
reducing the willingness of physicians to take call, especially at
receiving hospitals, thus leading to delays in arranging appropriate
transfers and thereby delaying stabilization of patients.
Psychiatric Patients--There continues to be much concern
about determining stability for patients who have a psychiatric
condition, even if the emergency medical condition is not based on a
psychiatric disorder.
Certified Nurse Midwives--Under current regulations,
certified nurse midwives (CNMs) are not able to certify that a patient
is in false labor. Current regulations state that only a physician may
certify that a patient is in false labor. There is concern that this
policy is not cost effective and is in conflict with the authority
provided CNMs by state law.
[[Page 12693]]
IV. Registration Instructions
The Center for Medicare Management is coordinating meeting
registration. While there is no registration fee, individuals must
register to attend. As specified in the DATES section of this notice,
individuals who wish to attend or make a presentation at the meeting or
both must register by March 22, 2005. You may register by sending an e-
mail to EMTALATAG@cms.hhs.gov, sending a fax to the attention of Ronda
Allen at fax number (410) 786-0681 or (410) 786-0169, or calling (410)
786-4548. All registration requests must include your name, name of the
organization (if applicable), address, telephone and fax numbers, e-
mail address (if available), and topic to be addressed (if you want to
do a presentation). You will receive a registration confirmation with
instructions for your arrival at the Hubert H. Humphrey Building. If
seating capacity has been reached, you will be notified that the
meeting has reached capacity. All registered presenters must submit a
hard copy of their presentation to the EMTALA TAG at the first meeting.
V. Security Information
Since this meeting will be held in a Federal government building,
Federal security measures are applicable. In planning your arrival
time, we recommend allowing additional time to clear security. In order
to gain access to the building, participants must bring a government-
issued photo identification (driver's license, passport, etc.) and a
copy of your confirmation of registration for the meeting. Access may
be denied to persons without proper identification.
All persons entering the building must pass through a metal
detector. In addition, all items brought to HHS, whether personal or
for the purpose of demonstration or to support a presentation, are
subject to inspection. We cannot assume responsibility for coordinating
the receipt, transfer, transport, storage, set-up, safety, or timely
arrival of any personal belongings or items used for demonstration or
to support a presentation.
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; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: March 10, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-5028 Filed 3-14-05; 8:45 am]
BILLING CODE 4120-01-P