Source: https://www.team-iha.org/advocacy-policy/legal-issues/emtala-signage-requirements
Timestamp: 2019-04-25 16:30:27+00:00

Document:
Synopsis: This memo summarizes the requirement under the federal Emergency Medical Treatment and Active Labor Act (“EMTALA”) for hospitals to post signs in the emergency department as well as certain off-campus and outpatient departments. It also provides examples of the language (in English and Spanish) that can be used on EMTALA signs.
Since 1986, hospitals participating in the Medicare program must meet the EMTALA statute (Section 1867 of the Social Security Act, 42 U.S.C. § 1395dd) and its implementing regulations in 42 C.F.R. §§ 489.24, 489.20(l), (m), (q), and (r). EMTALA requires hospitals with emergency departments to screen and stabilize emergency medical conditions of all patients that come into the emergency department requesting a screening and/or treatment regardless of ability to pay.
Signage Requirements Outside the Emergency Department.
Thus, outpatient departments where patients may seek care for an emergency medical condition, including off-campus locations (e.g., urgent care centers), are subject to the EMTALA signage requirement. Given the potential penalties associated with an EMTALA violation, hospitals may want to take a conservative approach and post signs in several departments in addition to the emergency department.
These new CMP amounts were released in the HHS Final Rule: Annual Civil Monetary Penalties Inflation Adjustment (“Final Rule”). Note that the Final Rule did not revise the EMTALA-stated penalty amounts themselves; the OIG’s CMP EMTALA regulations,[vii] as well as Section 1867(d) of the Social Security Act, continue to describe the penalties as $50,000 and $25,000. The increased CMPs can be found at 45 C.F.R. § 102.3, which lists HHS’ various CMPs as adjusted for inflation each year.
The following links provide examples of the language that can be used on EMTALA signs: English and Spanish.
This document is intended to be a guide for IHA members and does not constitute legal advice. For questions, please contact the IHA Legal Department.
[i] CMS, State Operations Manual, Appendix V – Interpretive Guidelines – Responsibilities of Medicare Participating Hospitals in Emergency Cases, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107ap_v_emerg.pdf (Rev. 60, July 16, 2010).
[ii] Id. at Part II, § 489.20(q) (Rev. 46, Issued May 29, 2009, Effective/Implementation May 29, 2009).
[iii] Id. at Part I – Investigative Procedures, General Information.
[iv] Id. at Part II, § 489.24(a) – Applicability of Provisions of this Section (Rev. 60, Issued July 16, 2010, Effective July 16, 2010, Effective July 16, 2010).
[v] Annual Civil Monetary Penalties Inflation Adjustment, 83 Fed. Reg. 51,369, 51,376 (Oct. 11, 2018) (codified at 45 C.F.R. § 102.3).
[vi] Note that the OIG’s CMP regulations (42 C.F.R. part 1003) codify and provide guidance for enforcement of the OIG’s authority under the Civil Monetary Penalties Law, which allows the OIG to punish violations of certain laws, including violations of EMTALA. Pursuant to the Federal Civil Penalties Inflation Adjustment Act Improvement Act of 2015, Pub. L. No. 114-74, § 701, HHS updates its regulations to reflect required annual inflation-related increases to CMPs. See Annual Civil Monetary Penalties Inflation Adjustment, 82 Fed. Reg. 9,175 (Feb. 3, 2017) (updating HHS’ regulations to reflect inflation-related increases in 2017 to the CMPs as required by the Federal Civil Penalties Inflation Adjustment Act Improvement Act of 2015).
[vii] 42 C.F.R. § 1003.510.
In 2010, CMS revised the 2004 guidelines for general EMTALA signage.
Signs must identify if the facility participates in the Medicaid program and specify the rights of patients with emergency conditions and women in labor.
Penalties for EMTALA violations have increased significantly.

References: § 1395
 § 102
 § 489
 § 489
 § 102
 § 701
 § 1003