[Federal Register Volume 70, Number 49 (Tuesday, March 15, 2005)]
[Notices]
[Pages 12691-12693]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-5028]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1269-N3]


Medicare Program; Emergency Medical Treatment and Labor Act 
(EMTALA) Technical Advisory Group (TAG) Meeting and Announcement of 
Members

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

ACTION: Notice of meeting.

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SUMMARY: In accordance with section 10(a) of the Federal Advisory 
Committee Act (FACA) (5 U.S.C. Appendix 2), this notice announces the 
first meeting of the Emergency Medical Treatment and Labor Act (EMTALA) 
Technical Advisory Group (TAG). The purpose of the EMTALA TAG is to 
review regulations affecting hospital and physician responsibilities 
under EMTALA to individuals who come to a hospital seeking examination 
or treatment for medical conditions. This notice also announces the 
newly appointed members of the EMTALA TAG. Interested parties are 
invited to this meeting to present their comments on the EMTALA 
regulations and implementation.

DATES: Meeting Date: The meetings of the EMTALA TAG announced in this 
notice will be held on Wednesday, March 30, 2005 and Thursday, March 
31, 2005, from 9 a.m. until 5 p.m. each day.
    Registration Deadline for All Participants: All presenters must 
register by March 22, 2005.
    Comment Deadline: Comments or statements must be received by March 
22, 2005.

ADDRESSES: Meeting Address: The EMTALA TAG meeting will be held in Room 
305 A at the Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201.
    Mailing and E-mail Addresses for Inquiries or Comments: Inquiries 
or comments regarding this meeting may be sent to--Beverly J. Parker, 
Division of Acute Care, Centers for Medicare & Medicaid Services, Mail 
Stop C4-08-06, 7500 Security Boulevard, Baltimore, MD 21244-1850. 
Inquiries or comments may also be e-mailed to [email protected].
    Web Site Address for Additional Information: For additional 
information on the EMTALA TAG meeting agenda topics, updated 
activities, and to obtain Charter copies, please search our Internet 
Web site at: http://www.cms.hhs.gov/faca/emtalatag/emtalatagpage.asp.
    Mailing Address for Copies of the EMTALA TAG Charter: Written 
requests for copies of the EMTALA TAG Charter should be sent to--
Marianne M. Myers, Division of Acute Care, Centers for Medicare & 
Medicaid Services, Mailstop C4-08-06, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.
    Submission of Comments or Statements: Comments or statements 
regarding EMTALA may be sent by postal mail or e-mail to the inquiry/
comment addresses listed above. We will accept written comments/
statements of three single-spaced, typed pages or less that are 
received by March 22, 2005.

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 or have a request made on their behalf for 
examination or treatment for a medical condition. EMTALA applies to all 
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 examinations for emergency 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.
    These provisions, taken together, frequently referred to as the 
Emergency Medical Treatment and Labor Act (EMTALA), are 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.
    Regulations implementing the EMTALA legislation are set forth at 42 
CFR 489.20(l), (m), (q) and (r)(1), (r)(2), (r)(3), and 489.24. These 
regulations incorporate changes made by a final rule published in the 
September 9, 2003 Federal Register (68 FR 53222). We published a final 
rule to clarify policies relating to the responsibilities of Medicare-
participating hospitals and physicians, under the provisions of EMTALA, 
in treating individuals with emergency medical conditions who present 
to a hospital.
    Section 945 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (MMA) (P.L. 108-173), requires that the 
Secretary establish a Technical Advisory Group (TAG) for advice 
concerning issues related to EMTALA regulations and implementation.
    Section 945 of the MMA specifies that the EMTALA TAG--
     Shall review the EMTALA regulations;
     May provide advice and recommendations to the Secretary 
concerning these regulations and their application to hospitals and 
physicians;
     Shall 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.
    Section 945 of the MMA also specifies the structure 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 as specified in each of the following categories:

[[Page 12692]]

     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 cardio-thoracic 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, both of whom shall be from areas other than the regions 
represented by the CMS regional offices.
    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) for the selection 
of members and the conduct of all meetings.
    In the May 28, 2004 Federal Register (69 FR 30654), we specified 
the statutory requirements regarding the charter, general 
responsibilities, and structure of the EMTALA TAG. That notice also 
solicited nominations for members based on the statutory requirements 
for the EMTALA TAG. In the August 27, 2004 Federal Register (69 FR 
52699), we solicited nominations again for members in two categories 
(patient representatives and a State survey agency representative) for 
which no nominations were received in response to the May 28, 2004 
Federal Register notice.

II. Membership Selection

    The following individuals have been selected by the Secretary, to 
serve on the EMTALA TAG along with Mark McClellan, M.D., Adminstrator, 
CMS and Daniel R. Levinson, Acting Inspector General, DHHS:
     Hospital Representatives--Julie Mathis Nelson, J.D., 
Coopersmith, Gordon, Schnermer, Owens & Nelson, P.L.C.; Carlos Perez, 
South Manhattan Healthcare Network; Richard T. Perry, M.D., P.C., 
F.A.C.S.; and Brian C. Robinson, Hospital Corporation of America's Las 
Vegas Market/Sunrise Hospital and Medical Center.
     Physicians--Cesar A. Aristeguieta, M.D., Los Angeles 
County Paramedic Training Institute; Carol Lynn Bayer, M.D., East 
Jefferson General Hospital Metairie, Louisiana; James L. Biddle, M.D., 
Rio Grande Regional Hospital and McAllen Medical Center; John A. 
Kusske, M.D., University of California; James Nepola, M.D. Health 
Policy Committee Orthopedic Trauma Association; Michael J. Rosenberg, 
M.D., Assistant Professor/Private Practice; and David W. Tuggle, M.D., 
University Oklahoma College of Medicine
     Patient Representatives--Warren A. Jones, M.D., Office of 
the Governor, State of Mississippi; and Mark Pearlmutter, M.D., St. 
Elizabeth's Medical Center.
     CMS Regional Office Representatives--Gretchen A. Kane CMS, 
and Charlotte S. Yeh, M.D., FACEP.
     State Survey Agency Representative--Azzie Conley, RN, 
State of North Carolina.
     QIO Representative--David Siegel, M.D., J.D., FACEP, FACP, 
FCLM Senior Physician Consultant and Clinical Coordinator.

III. Meeting Format, Agenda, and Suggested Presentation Topics

A. Meeting Format

    The initial portion of the meeting will involve opening remarks, 
introductions and the swearing in of the EMTALA TAG members by Michael 
O. Leavitt, Secretary, DHHS. After which and in accordance with section 
945 of MMA, the EMTALA TAG members will elect their chairperson. The 
afternoon portion of the first day and the morning portion of the 
second day will be reserved for statements from registered presenters. 
The afternoon portion of the second day will be reserved for the EMTALA 
TAG members to ask questions, prioritize the topics presented, and to 
conduct other necessary business.
    The time allotted for each presentation will be approximately 5 
minutes but will be based on the number of registered presenters. 
Presenters will speak in their assigned order. If there are individuals 
who cannot attend the meeting, we will accept and present their 
comments/statements at the meeting if their comments/statements are 
received via postal mail or email at the address list in the ADDRESSES 
section of this notice by March 22, 2005. Comments from other 
participants (individuals that are not registered presenters) may be 
heard after the scheduled statements, if time permits.

B. Tentative Meeting Agenda

    The tentative agenda for the EMTALA TAG meetings is as follows:
Day 1
     Welcome, call to order, introductions, and opening remarks
     Administrative and housekeeping issues
     Swearing in of members and self-introductions
     Comments from registered presenters
Day 2
     Comments from registered presenters
     Discussion of current business

C. Suggested Presentation Topics

    The following are suggested presentation topics:
     Inpatient Transfers--Under current EMTALA regulations, if 
a hospital admits an individual in good faith for stabilizing treatment 
on an inpatient basis, the admission ends the hospital's EMTALA 
obligation to that individual. Does the fact that an individual no 
longer is covered by EMTALA at the time transfer is sought make it more 
difficult to find a suitable specialty hospital transfer?
     Specialty Hospitals and EMTALA--Some specialty hospitals 
apparently accept patients on an appointment basis only, and will 
accept patients only for treatment of particular medical conditions or 
for a narrow range of services. There are reports that such hospitals 
are refusing to accept transfers of patients from general or community 
hospitals, on the basis that because the specialty hospital does not 
have a dedicated emergency department as defined in the new 
regulations, it has no obligations under EMTALA.
     On-Call Issues--Some concerns have been expressed that the 
revised regulations regarding physician on-call responsibilities are 
reducing the willingness of physicians to take call, especially at 
receiving hospitals, thus leading to delays in arranging appropriate 
transfers and thereby delaying stabilization of patients.
     Psychiatric Patients--There continues to be much concern 
about determining stability for patients who have a psychiatric 
condition, even if the emergency medical condition is not based on a 
psychiatric disorder.
     Certified Nurse Midwives--Under current regulations, 
certified nurse midwives (CNMs) are not able to certify that a patient 
is in false labor. Current regulations state that only a physician may 
certify that a patient is in false labor. There is concern that this 
policy is not cost effective and is in conflict with the authority 
provided CNMs by state law.

[[Page 12693]]

IV. Registration Instructions

    The Center for Medicare Management is coordinating meeting 
registration. While there is no registration fee, individuals must 
register to attend. As specified in the DATES section of this notice, 
individuals who wish to attend or make a presentation at the meeting or 
both must register by March 22, 2005. You may register by sending an e-
mail to [email protected], sending a fax to the attention of Ronda 
Allen at fax number (410) 786-0681 or (410) 786-0169, or calling (410) 
786-4548. All registration requests must include your name, name of the 
organization (if applicable), address, telephone and fax numbers, e-
mail address (if available), and topic to be addressed (if you want to 
do a presentation). You will receive a registration confirmation with 
instructions for your arrival at the Hubert H. Humphrey Building. If 
seating capacity has been reached, you will be notified that the 
meeting has reached capacity. All registered presenters must submit a 
hard copy of their presentation to the EMTALA TAG at the first meeting.

V. Security Information

    Since this meeting will be held in a Federal government building, 
Federal security measures are applicable. In planning your arrival 
time, we recommend allowing additional time to clear security. In order 
to gain access to the building, participants must bring a government-
issued photo identification (driver's license, passport, etc.) and a 
copy of your confirmation of registration for the meeting. Access may 
be denied to persons without proper identification.
    All persons entering the building must pass through a metal 
detector. In addition, all items brought to HHS, whether personal or 
for the purpose of demonstration or to support a presentation, are 
subject to inspection. We cannot assume responsibility for coordinating 
the receipt, transfer, transport, storage, set-up, safety, or timely 
arrival of any personal belongings or items used for demonstration or 
to support a presentation.

    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; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: March 10, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 05-5028 Filed 3-14-05; 8:45 am]
BILLING CODE 4120-01-P