EMTALA Signage Requirements
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
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