[Federal Register Volume 69, Number 104 (Friday, May 28, 2004)]
[Notices]
[Pages 30654-30656]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-11936]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1269-N]


Medicare Program; Establishment of the Emergency Medical 
Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG) and 
Request for Nominations for Members

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice.

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SUMMARY: This notice announces the establishment of the Emergency 
Medical Treatment and Labor Act (EMTALA) Technical Advisory Group (TAG) 
and discusses the group's purpose and charter. It also solicits 
nominations for members.

DATES: Nominations for membership will be considered if they are 
received by July 12, 2004.

ADDRESSES: Send nominations to--Division of Acute Care, Mail stop C4-
08-06, Centers for Medicare & Medicaid Services, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850; Attention: Beverly J. 
Parker.
    Send written requests for copies of the EMTALA TAG Charter to--
Division of Acute Care, Mail stop C4-08-06, Centers for Medicare & 
Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850; Attention: Marianne M. Myers.

FOR FURTHER INFORMATION CONTACT: Beverly J. Parker (410) 786-5320. 
Press inquiries are handled through the CMS Press Office at (202) 690-
6145.

SUPPLEMENTARY INFORMATION:

I. Background

    Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Social 
Security Act (the Act) impose specific obligations on Medicare-
participating hospitals that offer emergency services. These 
obligations concern individuals who come to a hospital emergency 
department and request examination or treatment for medical conditions, 
and apply to all of these individuals, regardless of whether or not 
they are beneficiaries of any program under the Act. Section 1867 of 
the Act sets forth requirements for medical screening

[[Page 30655]]

examinations of medical conditions, as well as necessary stabilizing 
treatment or appropriate transfer. In addition, section 1867(h) of the 
Act specifically prohibits a delay in providing required screening or 
stabilization services in order to inquire about the individual's 
payment method or insurance status. Section 1867(d) of the Act provides 
for the imposition of civil monetary penalties on hospitals and 
physicians responsible for negligently violating a requirement of that 
section, through actions such as the following: (a) Negligently failing 
to appropriately screen an individual seeking medical care; (b) 
negligently failing to provide stabilizing treatment to an individual 
with an emergency medical condition; or (c) negligently transferring an 
individual in an inappropriate manner. (Section 1867(e)(4) of the Act 
defines ``transfer'' to include both transfers to other health care 
facilities and cases in which the individual is released from the care 
of the hospital without being moved to another health care facility.)
    These provisions, taken together, are frequently referred to as the 
Emergency Medical Treatment and Labor Act (EMTALA), also known as the 
patient antidumping statute. EMTALA was passed in 1986 as part of the 
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). 
Congress enacted these antidumping provisions in the Social Security 
Act because of its concern with an increasing number of reports that 
hospital emergency rooms were refusing to accept or treat individuals 
with emergency conditions if the individuals did not have insurance.
    We presented and implemented these EMTALA provisions through 
proposed and interim final rules published in the Federal Register on 
June 16, 1988 (53 FR 22513), and June 22, 1994 (59 FR 32120), 
respectively. In May 9, 2002, Federal Register (67 FR 31404), we 
proposed further revisions to the EMTALA regulations. These proposals 
were designed address issues and concerns which had arisen following 
publication of the interim final rule with comment period by clarifying 
policies relating to the responsibilities of Medicare-participating 
hospitals in treating individuals with emergency medical conditions who 
present to a hospital under the provisions of EMTALA. In the September 
9, 2003, Federal Register (68 FR 53222), we finalized these proposals.
    Section 945 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (Pub. L. 108-173), requires that the 
Secretary establish a Technical Advisory Group (TAG) to solicit advice 
concerning issues related to EMTALA regulations and implementation.

II. Charter, General Responsibilities, and Composition of the EMTALA 
TAG

A. Charter Information and General Responsibilities

    On May 11, 2004, the Secretary signed the charter establishing the 
EMTALA TAG. This charter will terminate 30 months from the date of the 
EMTALA TAG's first meeting. The EMTALA TAG, as chartered, under the 
legal authority of section 945 of the MMA, is also governed by the 
provisions of the Federal Advisory Committee Act (FACA), 5 U.S.C. 
Appendix 2. In accordance with section 945 of the MMA, the EMTALA TAG 
will meet at least twice a year and all meetings will be open to the 
public.
    You may obtain a copy of the Secretary's charter for the EMTALA TAG 
by mailing a written request to the address specified in the ADDRESSES 
section of this notice.
    Section 945 of the MMA specifies that the EMTALA TAG--
     Will review the EMTALA regulations;
     May provide advice and recommendations to the Secretary 
concerning these regulations and their application to hospitals and 
physicians;
     Will solicit comments and recommendations from hospitals, 
physicians, and the public regarding implementation of such 
regulations; and
     May disseminate information concerning the application of 
these regulations to hospitals, physicians, and the public.

B. Composition of the EMTALA TAG

    Section 945 of the MMA also specifies the composition of the EMTALA 
TAG. It states that the EMTALA TAG will be composed of 19 members 
including the Administrator of the Centers for Medicare & Medicaid 
Services (CMS) and the Inspector General of the Department of Health 
and Human Services (DHHS) in addition to the number and type of 
individuals specified in each of the following categories:
     Four representatives of hospitals, including at least one 
public hospital, that have experience with the application of EMTALA 
and, at least, two hospitals that have not been cited for EMTALA 
violations;
     Seven practicing physicians drawn from the fields of 
emergency medicine, cardiology or cardiothoracic surgery, orthopedic 
surgery, neurosurgery, pediatrics or a pediatric subspecialty, 
obstetrics-gynecology and psychiatry, with not more than one physician 
from any particular field;
     Two representatives of patients;
     Two staff persons involved in EMTALA investigations from 
different CMS regional offices;
     One representative from a State survey agency involved in 
EMTALA investigations and one representative from a Quality Improvement 
Organization (QIO), both of whom shall be from areas other than the 
regions represented by the CMS regional offices.

III. Submission of Nominations

    We are requesting nominations for membership on the EMTALA TAG. The 
Secretary will consider qualified individuals who are nominated by 
organizations representing providers and patients when selecting 
practicing physicians, patients, and hospital representatives. The 
Secretary will also consider qualified individuals who are self-
nominated when selecting CMS regional office, State survey agency, and 
QIO representatives. The Secretary will appoint members to serve on the 
EMTALA TAG from among those candidates determined to have the technical 
expertise required to meet the statutory requirements and in a manner 
to ensure an appropriate balance of membership.
    Nominations may be made for one or more qualified individuals for 
each of the categories listed in section II.B. of this notice. Each 
nomination must include the following:
    1. A letter of nomination that contains--
    a. Contact information for both the nominator and nominee (if not 
the same); and
    b. The category, as specified in section II.B. of this notice for 
which the nomination is being made (for example, hospital 
representative or practicing physician).
    2. A statement from the nominee that he or she is willing to serve 
on the EMTALA TAG for its duration (that is, at least 30 months from 
date of the first meeting) and an explanation of interest in serving on 
the EMTALA TAG. (For self-nominations, this information may be included 
in the nomination letter.)
    3. A curriculum vitae that indicates the nominee's educational and 
EMTALA-related experiences.
    4. Three letters of reference that support the nominee's 
qualifications for participation on the EMTALA TAG. (For nominations 
other than self-nominations, a nomination letter that includes 
information supporting the nominee's qualifications may be

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counted as one of the letters of reference.)
    5. Additional information is required for the following categories 
of nominations:
    a. Hospital representatives--In your statement regarding serving on 
the EMTALA TAG indicate--
    (1) Your hospital's Medicare provider number;
    (2) The type of hospital (public or private); and
    (3) Whether or not your hospital has been cited for an EMTALA 
violation and, if so, the nature of the citation.
    b. Practicing physicians--In your statement regarding serving on 
the EMTALA TAG indicate--
    (1) Your board or specialty society and certification (if any) for 
your field of service;
    (2) Your Unique Physician Identification Number (UPIN);
    (3) Whether or not you have been cited for an EMTALA violation and, 
if so, the nature of the violation.
    c. Representatives from the CMS regional office, State survey 
agency or Quality Improvement Organization--In your statement regarding 
serving on the EMTALA TAG indicate the extent of your experience with 
EMTALA investigations.
    To ensure that a nomination is considered, we must receive all of 
the nomination information specified in section III of this notice by 
July 12, 2004.

    Authority: Section 945 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (MMA).

(Catalog of Federal Domestic Assistance Program No. 93.773 Medicare--
Hospital Insurance Program; and No. 93.774, Medicare--Supplementary 
Medical Insurance Program.)


    Dated: April 26, 2004.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 04-11936 Filed 5-27-04; 8:45 am]
BILLING CODE 4120-01-P