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October 17, 2007

EMTALA Signage Requirements

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 includes a form to order English and Spanish language versions of the required EMTALA signs.

General EMTALA Signage Requirement
Since 1990, the federal Emergency Medical Treatment and Active Labor Act (EMTALA) and its implementing regulations (42 C.F.R. 489.20(q)) have required hospitals to post a sign, in a form specified by the U.S. Dept. of Health and Human Services, specifying the rights of individuals with respect to examination and treatment for emergency medical conditions and women in labor. In 2003, the Centers for Medicare & Medicaid Services (CMS) issued a final rule clarifying EMTALA requirements and in 2004, CMS released revised interpretive guidelines to its surveyors.

Under the 2004 revised guidelines, EMTALA signs must:

  • Specify the rights of individuals with emergency conditions and women in labor who come to the emergency department for health care services;
  • Indicate whether the facility participates in the Medicaid program;
  • Contain wording that is clear and in simple terms and in language(s) that are understandable by the population served by the hospital; and
  • Be posted in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment (e.g., entrance, admitting area, waiting room, treatment area).

    • CMS used to require that signs be readable at a distance of 20 feet or the expected vantage point of the emergency department patron, however this requirement is now missing from the 2004 interpretive guidelines. Of course, the signs must still be readily visible in order to be noticed by all individuals.

    Signage Requirements Outside the Emergency Department
    The 2004 interpretive guidelines further clarified the meaning of "dedicated emergency department." A dedicated emergency department is defined as meeting one of the following criteria regardless of whether it is located on or off the main hospital campus. The entity:

    (1) is licensed by the State as an emergency room or emergency department; or

    (2) is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions (EMCs) on an urgent basis without requiring a previously scheduled appointment; or

    (3) the entity provides at least one-third of all of its visits for the treatment of EMCs on an urgent basis without requiring a previously scheduled appointment. The guidelines further state that this includes individuals who may present as unscheduled ambulatory patients to units (such as labor and delivery or psychiatric units of hospitals) where patients are routinely evaluated and treated for emergency medical conditions.

    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 described above.

    In the past, the Chicago Regional Office of CMS identified the lack of proper signage as one of the most common EMTALA violations by Illinois hospitals. Given the potential penalties associated with a violation, hospitals may want to take a conservative approach and post signs in several departments in addition to the emergency department. Such an approach will help demonstrate the hospital’s good faith efforts to comply with the law, in the event it is investigated for a more serious EMTALA violation.

    EMTALA Signs Available From IHA
    To assist hospitals in complying with the EMTALA signage requirement, the IHA Legal Department is pleased to offer the required EMTALA signs. The signs contain the wording required by CMS, measure approx. 12" x 20" and are printed on heavy paper stock to improve their durability. The signs are available in English and Spanish. The signs come in a kit of 5 and each kit costs $20.00 (including shipping and handling.) An order form is attached (    click here).

    We hope this information is helpful. 

    Staff Contact: Suzy McGary: (630) 276-5464 or smcgary@ihastaff.org