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White House Seeks to Ease Regulations For Emergency Care at Medicare Sites
WASHINGTON -- The Bush administration is seeking to relax rules dictating that hospitals accepting Medicare provide emergency care to patients even at non emergency facilities. Under the proposed rule, hospitals that accept Medicare would no longer have to equip off-campus facilities, such as radiology and mammography clinics, to screen and stabilize patients who come in with emergencies. Only hospital facilities that provide emergency services, such as urgent-care centers, still would be required to respond to emergency patients on site. The proposed rule changes are set to be published Thursday by the Centers for Medicare and Medicaid Services, which oversee the federal-insurance programs for the elderly, disabled and poor. The hospital industry lobbied for the proposed changes, complaining that the current requirements on off-campus locations were an illogical expansion of 1986 legislation that was designed to prevent hospitals paid by Medicare from refusing to treat patients who couldn't pay. The law, called the Emergency Medical Treatment and Labor Act, is often called the "antidumping act," or Emtala. Bush administration officials agreed with the hospitals. "It caused a lot of havoc for hospitals," said Tom Scully, chief administrator of CMS, who previously served as president of the Federation of American Hospitals. "They spent a huge amount of money to be compliant." Receptionists at off-campus facilities, for example, had to get extra training to deal with emergencies, Mr. Scully said. In the proposed rule, which will be open for public comment until July, off-campus sites would simply have to write procedures outlining how they would respond if a patient went to an off-campus location with an emergency such as a heart attack or gunshot wound. One possibility is that they could call 911 and do what they could for the patient. Leslie Norwalk, policy director and counselor for Mr. Scully, said the proposed rule changes also affect other parts of the Emergency Medical Treatment and Labor Act. For example, Clinton-era expansions defined hospital-owned ambulances as subject to Emtala. So if a patient having a medical emergency approached an ambulance, it would be required to transport the patient back to the hospital that owned it, regardless of how far away it was. "That isn't necessarily the best thing for the patient," Ms. Norwalk said. Under the new proposal, the ambulance would be able to drop the patient wherever its hospital protocol allowed. "From a regulatory burden standpoint, it's clear that CMS has tried in this regulation to be more reasonable in terms of the concerns of hospitals," said Chip Kahn, who succeeded Mr. Scully as president of the Federation of American Hospitals. The same rule also will raise by 2.75% in fiscal 2003 the rate CMS will pay to hospitals providing inpatient services to Medicare patients. Medicare law requires CMS to update the payment rate to reflect changes in the costs of goods and services used by acute-care hospitals. Mr. Scully said the update is higher than most hospitals had expected. But Carmela Coyle, vice president for policy at the American Hospital Association, said the increase was still below inflation and that the rise merely reflected the rising costs hospitals are facing. FAIR USE NOTICE: This page contains copyrighted material the use of which has not been specifically authorized by the copyright owner. Global Action on Aging distributes this material without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107. If you wish to use copyrighted material from this site for purposes of your own that go beyond fair use, you must obtain permission from the copyright owner.
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