CMS Guidance Clarifies Medicare Emergency Services Requirements For Hospitals
May 9th, 2007
Nearly all hospitals (including specialty hospitals) participating in Medicare must be capable of providing emergency care interventions at all times, regardless of whether they have an emergency department, according to new guidance issued April 26 by the Centers for Medicare and Medicaid Services (CMS).
The guidance, sent as survey and certification letters to state surveyors, makes clear that, to comply with Medicare Conditions of Participation (CoPs), hospitals must be capable of appraising an emergency situation, providing initial treatment, and referring or transferring patients where appropriate.
The guidance also stresses that a hospital “may not rely on 911 services to provide appraisal or initial treatment of individuals in lieu of its own capability to do so.”
CMS adds that the guidance does not apply to critical access hospitals, which are small rural hospitals that are subject to separate regulation.
As the guidance explains, hospitals must have a registered nurse immediately available who is qualified to assess whether an individual needs emergency care and who can provide initial treatment when a medical emergency arises.
And hospital policies and procedures should provide that the physician onsite or on-call will directly provide appraisals of emergencies, and initial treatment if necessary, or be available to provide medical direction to onsite staff.
Hospitals also must have policies and procedures that enable staff members responding to emergencies to recognize when a referral or transfer is called for and to assure that it is appropriately handled, the guidance says.
A hospital may call 911 to obtain transport of a patient to another hospital but this does not relieve the hospital of its obligation to arrange for the transfer and to ensure the necessary medical information is sent along with the patient.
The guidance notes that while the Medicare CoPs do not define a medical emergency, the definition under the Emergency Medical Treatment and Labor Act “might be a helpful reference when considering a hospital’s compliance.”
CMS notes that the guidance, although applicable to all hospitals, also implements one element of its strategic plan addressing specialty hospitals, which the agency reported to Congress in August 2006.
Read the guidance.
Read CMS’ press release.
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