The Centers for Medicare & Medicaid Services (CMS) issued guidance clarifying the responsibility of hospitals to provide emergency services if they participate in the Medicare program. The guidance makes it clear that nearly all hospitals -- including specialty hospitals and others without emergency departments -- must be able to evaluate persons with emergencies, provide initial treatment, and refer or transfer these individuals when appropriate. The guidance does not apply to critical access hospitals (CAHs), which are small, rural hospitals that are subject to separate regulation.

The guidance was issued in a Survey and Certification letter. The announcement was made at the annual meeting between CMS and the Directors of the State Agencies that contract with CMS to survey hospitals and other Medicare providers and suppliers to ensure compliance with quality of care standards.

Survey and Certification letters guide State Agency surveyors in determining whether hospitals meet all conditions of participation required to participate in the Medicare program. Today's letter reiterates Medicare's long-standing requirement that hospitals have appropriate policies and procedures in place to address individuals' emergency care needs 24 hours per day, 7 days per week.

"Any hospital participating in Medicare, regardless of the type of hospital and apart from whether the hospital has an emergency department must have the capability to provide basic emergency care interventions." said Leslie V. Norwalk, Esq., Acting Administrator of the Centers for Medicare & Medicaid Services. "The guidance we are issuing today is part of an overall strategy to ensure quality care by assuring the rapid response to emergencies for all people with Medicare."

Three key requirements are (a) the capability to appraise the emergency situation, (b) providing initial treatment, and (c) referral when appropriate. The letter clarifies that the Medicare Conditions of Participation (CoPs) do not permit a hospital to rely upon 9-1-1 services as a substitute for the hospital's own ability to provide these services.

In a separate development, CMS issued a proposed rule on April 13, 2007 that would increase transparency and public disclosure concerning emergency services. The FY 2008 acute care hospital inpatient prospective payment system (IPPS) proposed rule would require a hospital to notify all patients in writing if a doctor of medicine or doctor of osteopathy is not present in the hospital 24 hours a day, seven days per week. The hospital would be required to disclose how it would meet the medical needs of a patient who develops an emergency condition while no doctor is on site. CMS also invited comments on whether current requirements for emergency service capabilities in hospitals with and without emergency departments should be strengthened in certain areas, such as the types of clinical personnel that should be present at all times and their competencies; the type of emergency response equipment that should be available; and whether hospital emergency departments should be required to operate 24 hours per day, 7 days per week.

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