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EMTALA and Urgent Care

Three Things to Know

November 26, 2012

Urgent care, a burgeoning sector within healthcare, has been of particular interest to financial investors, including private equity, commercial payors and integrated health systems. The following are three key facts about the Emergency Medical Treatment and Active Labor Act (EMTALA) that those who own, operate or are considering investing in urgent care should know:

  • What is EMTALA? EMTALA, also known as the patient antidumping statute, sets forth federal requirements for medical screening examinations for those who seek emergency medical treatment, as well as necessary stabilizing treatment or appropriate transfer of those who have an emergency medical condition. Among other things, EMTALA specifically prohibits a delay in providing required screening or stabilization services in order to inquire about the individual’s payment method or insurance status.
  • To Whom Does EMTALA Apply? All Medicare-participating hospitals that have an emergency department, including critical access hospitals, must comply with EMTALA. Further, EMTALA’S requirements apply to all patients who come to a hospital emergency department and request examination or treatment for medical conditions, regardless of whether such patients are beneficiaries of Medicare or Medicaid.
  • Do Urgent Care Centers Constitute “Emergency Departments”? It depends. The EMTALA regulations define “hospital with an emergency department” to mean a hospital with a dedicated emergency department. In turn, the regulations define “dedicated emergency department” as any department or facility of a hospital that either (1) is licensed by the state as an emergency department; (2) is held out to the public as providing treatment for emergency medical conditions; or (3) in the preceding calendar year actually provided treatment for emergency medical conditions on an urgent basis on one-third of the visits to the department. As such, an urgent care center owned or operated by a hospital that provides emergency treatment in one-third of its cases may constitute a “dedicated emergency department.” The Medicare State Operations Manual underscores this analysis by specifically stating that “[h]ospitals that may meet this one-third criterion may be specialty hospitals (such as psychiatric hospitals), hospitals without ‘traditional’ emergency departments, and urgent care centers. In addition, it is not relevant if the entity that meets the definition of a dedicated ED is not located on the campus of the main hospital.”

Determining whether EMTALA applies to your urgent care center is a fact-based analysis. To avoid the imposition of civil monetary penalties for violations of EMTALA, urgent care center owners and operators should work with legal counsel to determine whether the urgent care center must comply with the requirements of EMTALA.

For more information about whether EMTALA applies to your urgent care center and for assistance with EMTALA policies and procedures, contact the attorneys on this page.