[Federal Register Volume 77, Number 22 (Thursday, February 2, 2012)]
[Proposed Rules]
[Pages 5213-5217]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-2287]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 489
[CMS-1350-NC]
RIN 0938-AQ51
Medicare Program; Emergency Medical Treatment and Labor Act
(EMTALA): Applicability to Hospital Inpatients and Hospitals With
Specialized Capabilities
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Request for comments.
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SUMMARY: This request for comments addresses the applicability of the
Emergency Medical Treatment and Labor Act (EMTALA) to hospital
inpatients.
DATES: Comment Date: To be assured consideration, comments on the
Applicability of EMTALA to Hospitals with Specialized Capabilities
(section II.B. of this document) must be received at one of the
addresses provided below, no later than 5 p.m. EST on April 2, 2012.
ADDRESSES: In commenting, please refer to file code CMS-1350-NC.
Because of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one
of the ways listed):
1. Electronically. You may submit electronic comments on this
regulation to http://www.regulations.gov. Follow the ``Submit a
comment'' instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-1350-NC, P.O. Box 8013,
Baltimore, MD 21244-8013.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-1350-NC, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments before the close of the comment period
to either of the following addresses:
a. For delivery in Washington, DC--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, Room 445-G, Hubert
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal government
identification, commenters are encouraged to leave their comments in
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing
by stamping in and retaining an extra copy of the comments being
filed.)
b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid
Services, Department of Health and Human Services, 7500 Security
Boulevard, Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address,
please call telephone number (410) 786-1066 in advance to schedule your
arrival with one of our staff members.
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Renate Dombrowski, (410) 786-4645,
Ankit Patel, (410) 786-4537.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to
view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication
[[Page 5214]]
of a document, at the headquarters of the Centers for Medicare &
Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244,
Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule
an appointment to view public comments, phone 1-800-743-3951.
I. Background
Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Social
Security Act (the Act) were enacted as parts of the Emergency Medical
Treatment and Labor Act (EMTALA). These statutory provisions impose
specific obligations on certain Medicare-participating hospitals and
critical access hospitals (CAHs). (Throughout this document, when we
reference the obligation of a ``hospital'' under these sections of the
Act and in our regulations, we mean to include CAHs as well.) These
obligations concern individuals who come to a hospital's ``dedicated
emergency department'' (as defined at 42 CFR 489.24(b)) and request
examination or treatment for a medical condition and apply to all of
these individuals regardless of whether they are beneficiaries of any
program under the Act.
EMTALA, also known as the patient antidumping statute, was passed
in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act
of 1985 (COBRA), Public Law 99-272. Congress incorporated these
antidumping provisions within the Social Security Act to ensure that
any individual with an emergency medical condition (EMC), regardless of
the individual's insurance coverage, is not denied essential lifesaving
services. Under section 1866(a)(1)(I)(i) of the Act, a hospital that
fails to fulfill its EMTALA obligations under these provisions may be
subject to termination of its Medicare provider agreement which would
result in the loss of Medicare and Medicaid payments. In addition,
section 1867(d) of the Act provides for the imposition of civil
monetary penalties on a hospital or physician who negligently violates
a requirement of EMTALA under section 1867 of the Act.
Section 1867 of the Act sets forth requirements for medical
screening examinations for individuals who come to the emergency
department of a hospital and request examination or treatment for a
medical condition. The statute further provides that, if a hospital
finds that such an individual has an EMC, it is obligated to provide
that individual with either necessary stabilizing treatment or an
appropriate transfer to another medical facility where stabilization
can occur. The EMTALA statute also separately outlines the obligation
of hospitals to receive appropriate transfers from other hospitals.
Section 1867(g) of the Act states that ``A participating hospital that
has specialized capabilities or facilities (such as burn units, shock-
trauma units, neonatal intensive care units, or (with respect to rural
areas) regional referral centers as identified by the Secretary in
regulation) shall not refuse to accept an appropriate transfer of an
individual who requires such specialized capabilities or facilities if
the hospital has the capacity to treat the individual.'' The
regulations implementing section 1867 of the Act are found at 42 CFR
489.24. The regulations at 42 CFR 489.20(l), (m), (q), and (r) also
refer to certain EMTALA requirements outlined in section 1866 of the
Act. The Interpretive Guidelines concerning EMTALA are found at
Appendix V of the CMS State Operations Manual: http://www.cms.gov/manuals/Downloads/som107ap_v_emerg.pdf.
A. Applicability of EMTALA to Hospital Inpatients
The focus of EMTALA routinely involves the treatment of individuals
who ``come to the emergency department,'' as we have defined that term
at 42 CFR 489.24(b); that is, the individual is in a hospital-owned and
operated ambulance or ``has presented at a hospital's dedicated
emergency department * * * and requests examination or treatment for a
medical condition, or has such a request made on his or her behalf [or]
[h]as presented on hospital property * * * other than the dedicated
emergency department, and requests examination or treatment for what
may be an emergency medical condition, or has such a request made on
his or her behalf.''
However, concerns have also arisen about the continuing
applicability of EMTALA to hospital inpatients. We have previously
discussed the applicability of EMTALA to hospital inpatients in the May
9, 2002 (67 FR 31475) Hospital Inpatient Prospective Payment System
(IPPS) proposed rule entitled ``Medicare Program; Changes to the
Hospital Inpatient Prospective Payment Systems and Fiscal Year 2003
Rates'' (hereinafter referred to as the FY 2003 IPPS proposed rule) and
the September 9, 2003 (68 FR 53243) stand-alone final rule on EMTALA
entitled ``Medicare Program; Clarifying Policies Related to the
Responsibilities of Medicare-Participating Hospitals in Treating
Individuals With Emergency Medical Conditions'' (hereinafter referred
to as the 2003 EMTALA final rule). As we noted in these prior proposed
and final rules, in 1999, the United States Supreme Court considered a
case (Roberts v. Galen of Virginia, 525 U.S. 249 (1999)) that involved,
in part, the question of whether EMTALA applies to hospital inpatients.
In the context of that case, the United States Solicitor General
advised the Court that HHS would develop a regulation clarifying its
position on this issue. In the FY 2003 IPPS proposed rule, we proposed
that EMTALA continues to apply to admitted individuals who are not
stabilized (who presented under EMTALA), but that it would not
otherwise apply to inpatients. We indicated that individuals whose
conditions go in and out of apparent stability rapidly and frequently
would not be considered ``stabilized'' and the hospital would continue
to have an obligation to such individuals even after they are admitted.
However, for all other inpatients we stated that EMTALA was intended to
provide protection to individuals coming to a hospital to seek care for
an EMC. Therefore, we stated that we believe the EMTALA requirements do
not extend to stabilized inpatients even if they subsequently become
unstable because those inpatients are protected by a number of Medicare
conditions of participation (CoPs) as well as the hospital's other
legal, licensing, and professional obligations with respect to the
continued proper care and treatment of its patients.
In the 2003 EMTALA final rule, we refined this position to state
that a hospital's obligation under EMTALA ends either when the
individual is stabilized or when that hospital, in good faith, admits
an individual with an EMC as an inpatient in order to provide
stabilizing treatment. That is, we stated that EMTALA does not apply to
any inpatient, even one who was admitted through the dedicated
emergency department and for whom the hospital had initially incurred
an EMTALA obligation to stabilize an EMC, and who remained unstabilized
after admission as an inpatient. We noted that other patient safeguards
protect all inpatients, including the hospital CoPs as well as State
malpractice law. In addition, we noted that judicial interpretation of
the matter and comments we received on the proposed rule helped shape
the policy articulated in the final rule. However, we also stated in
the rule that a hospital could not escape liability under EMTALA by
admitting an individual with no intention of treating the individual
and then inappropriately
[[Page 5215]]
transferring or discharging that individual without having met the
stabilization requirement.
B. EMTALA Technical Advisory Group Recommendation Regarding
Responsibilities of Hospitals With Specialized Capabilities
Section 945 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA), Public Law 108-173, required the
Secretary to establish a Technical Advisory Group (TAG) to advise the
Secretary on issues related to the regulations and implementation of
EMTALA. The EMTALA TAG's functions, as identified in the charter for
the EMTALA TAG, were as follows:
Review EMTALA regulations.
Provide advice and recommendations to the Secretary
concerning these regulations and their application to hospitals and
physicians.
Solicit comments and recommendations from hospitals,
physicians, and the public regarding the implementation of such
regulations.
Disseminate information concerning the application of
these regulations to hospitals, physicians, and the public.
The TAG met 7 times during its 30-month term, which ended on
September 30, 2007. At its meetings, the TAG heard testimony from
representatives of physician groups, hospital associations, and others
regarding EMTALA issues and concerns. During each meeting,
recommendations developed by subcommittees established by the TAG were
discussed and voted on by members of the TAG. One of these
recommendations, presented by the TAG to CMS during its September 2007
meeting, called for CMS to revise its regulations to address the
situation of an individual who: (1) Presents to a hospital that has a
dedicated emergency department and is determined to have an EMC; (2) is
admitted to the hospital as an inpatient for purposes of stabilizing
the EMC; and (3) subsequently needs a transfer to a hospital with
specialized capabilities to receive stabilizing treatment that cannot
be provided by the referring hospital that originally admitted the
individual. This recommendation can be found at the following Web site:
http://www.cms.gov/EMTALA/Downloads/EMTALA_Final_Report_Summary.pdf.
C. Applicability of EMTALA to Hospital Inpatients and Responsibilities
of Hospitals With Specialized Capabilities
To further clarify our position on the applicability of EMTALA and
the responsibilities of hospitals with specialized capabilities to
accept appropriate transfers, the agency included as part of the April
30, 2008 Hospital IPPS proposed rule (73 FR 23669) entitled, ``Medicare
Program; Proposed Changes to the Hospital Inpatient Prospective Payment
Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of
Physician Ownership in Hospitals and Physician Self-Referral Rules;
Proposed Collection of Information Regarding Financial Relationships
Between Hospitals and Physicians'' (hereinafter referred to as the FY
2009 IPPS proposed rule), two proposals that addressed the issue of
hospital inpatients. First, we stated that we believe that the
obligation of EMTALA does not end for all hospitals once an individual
is admitted as an inpatient to the hospital where the individual first
presented with a medical condition that was determined to be an EMC.
Rather, once the individual is admitted, the admission only affects the
EMTALA obligation of the hospital where the individual first presented
(the admitting hospital). In the FY 2009 IPPS proposed rule (73 FR
23670), we stated that section 1867(g) of the Act (which refers to
responsibilities of hospitals with specialized capabilities)
* * * requires a receiving hospital with specialized capabilities to
accept a request to transfer an individual with an unstable
emergency medical condition as long as the hospital has the capacity
to treat that individual, regardless of whether the individual had
been an inpatient at the admitting hospital.
We stated that we believe that permitting inpatient admission at
the admitting hospital to end EMTALA obligations for another hospital
would seemingly contradict the intent of section 1867(g) of the Act to
ensure that hospitals with specialized capabilities provide medical
treatment to individuals with EMCs in order to stabilize those
conditions. We further noted that while a hospital inpatient is
protected under Medicare CoPs and may also have additional protections
under State law, the obligations of another hospital under the CoPs
apply only to that hospital's patients, and there is no CoP that
requires a hospital to accept the transfer of a patient from another
facility. We proposed to interpret section 1867(g) of the Act as
creating an obligation on hospitals with specialized capabilities to
accept appropriate transfers of individuals for whom the admitting
hospital originally had an EMTALA obligation under section 1867 of the
Act, if the hospital with specialized capabilities has the capacity to
treat the individuals. Thus, in the FY 2009 IPPS proposed rule (73 FR
23670), we proposed to amend the regulations
* * * to add a provision to state that when an individual covered by
EMTALA was admitted as an inpatient and remains unstabilized with an
emergency medical condition, a receiving hospital with specialized
capabilities has an EMTALA obligation to accept that individual,
assuming that the transfer of the individual is an appropriate
transfer and the participating hospital with specialized
capabilities has the capacity to treat the individual.
We received many comments opposing the proposal concerning
hospitals with specialized capabilities included in the FY 2009 IPPS
proposed rule. The commenters stated that the proposed rule would
effectively ``reopen'' EMTALA for the admitting hospital by extending
EMTALA's requirements for an ``appropriate transfer'' despite the fact
that the admitting hospital's general EMTALA obligations ended, under
regulation, when it admitted an individual as an inpatient. The
commenters also stated that, because the original admitting hospital
may claim that it lacks the capability to stabilize the individual's
EMC, finalizing the proposed policy would result in an increase in
patient dumping and inappropriate transfers, especially to teaching
hospitals, tertiary care centers, and urban safety net hospitals.
Commenters further asserted that finalizing CMS' policy as proposed
would exacerbate confusion surrounding the determination of whether an
individual is considered stable. That is, the hospital would be
required to continuously monitor the individual to determine if at any
point in the emergency department or even as an inpatient, the
individual experienced a period of stability since such stability would
end EMTALA obligations for all hospitals that might otherwise have
obligations under the law. Under this scenario, the commenters asserted
that the hospital with specialized capabilities would be forced to
accept the transfer of an individual, potentially increasing the number
of inappropriate or unnecessary transfers, because that hospital would
be unable, with complete certainty, to determine whether the individual
being transferred had ever experienced a period of stability.
As a result, in the August 19, 2008 IPPS final rule (73 FR 48659)
entitled, ``Medicare Program; Changes to the Hospital Inpatient
Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for
Graduate Medical Education in Certain Emergency Situations; Changes to
Disclosure of
[[Page 5216]]
Physician Ownership in Hospitals and Physician Self-Referral Rules;
Updates to the Long-Term Care Prospective Payment System; Updates to
Certain IPPS-Excluded Hospitals; and Collection of Information
Regarding Financial Relationships Between Hospitals'' (hereinafter
referred to as the FY 2009 IPPS final rule) we stated that,
Due to the many concerns that the commenters raised which are noted
above, we believe it is appropriate to finalize a policy to state
that if an individual with an unstable emergency medical condition
is admitted, the EMTALA obligation has ended for the admitting
hospital and even if the individual's emergency medical condition
remains unstabilized and the individual requires special services
only available at another hospital, the hospital with specialized
capabilities does not have an EMTALA obligation to accept an
appropriate transfer of that individual.
Put another way, we finalized a policy that a hospital with
specialized capabilities does not have an EMTALA obligation to accept
an appropriate transfer of an individual who has been admitted in good
faith as an inpatient at the first hospital. In the FY 2009 IPPS final
rule (73 FR 48659), we stated that we believe that,
* * * finalizing the policy as proposed may negatively impact
patient care, due to an increase in inappropriate transfers which
could be detrimental to the physical and psychological health and
well-being of patients [and we were] concerned that finalizing our
proposed rule could further burden the emergency services system and
may force hospitals providing emergency care to limit their services
or close, reducing access to emergency care.
In addition, we stated that we were concerned about the possible
disparate treatment of inpatients under the proposed policy because an
individual who presented to a hospital under EMTALA might have
different transfer rights than an inpatient who was admitted for an
elective procedure. In the FY 2009 IPPS final rule (73 FR 48659) we
stated--
[W]e believe that, in the case where an individual is admitted
and later found to be in need of specialized care not available at
the admitting hospital, hospitals with specialized capabilities
generally do accept the transfer, even in the absence of a legal
requirement to do so.
Finally, while we adopted a final rule that limits the EMTALA
responsibilities of a hospital with specialized capabilities (73 FR
48661), we
* * * encourage[d] the public to make CMS aware if this
interpretation of section 1867(g) of the Act should result in
harmful refusals by hospitals with specialized capabilities to
accept the transfer of inpatients whose emergency medical condition
remains unstabilized, or any other unintended consequences.
D. Litigation Related to the Applicability of EMTALA to Hospital
Inpatients
We are aware that there continues to be a range of opinions, even
at the Federal circuit court level, on the topic of EMTALA's
application to inpatients. For example, in Thornton v. Southwest
Detroit Hospital, 895 F.2d 1131, 1134 (6th Cir. 1990), the Sixth
Circuit stated that, ``once a patient is found to suffer from an [EMC]
in the emergency room, she cannot be discharged until the condition is
stabilized * * *.'' However, other courts have concluded that a
hospital's obligations under EMTALA end at the time that a hospital
admits an individual to the facility as an inpatient. (See Bryan v.
Rectors and Visitors of the University of Virginia, 95 F.3d 349 (4th
Cir. 1996) and Bryant v. Adventist Health System/West, 289 F.3d 1162
(9th Cir. 2002)). More recently, in Moses v. Providence Hospital and
Medical Centers Inc., 561 F.3d 573 (6th Cir. 2009), the Sixth noted
that the policy articulated in the 2003 EMTALA final rule that a
hospital's obligation under EMTALA would end when that hospital, in
good faith, admits an individual with an EMC as an inpatient was
contrary to the plain language of the EMTALA statute. Rather, the court
stated that a hospital's EMTALA obligations to an individual continue
until that individual's EMC is stabilized regardless of the
individual's status as an inpatient or outpatient.
E. Advance Notice of Proposed Rulemaking: Applicability of EMTALA to
Hospital Inpatients and Hospitals With Specialized Capabilities
In 2010, United States Solicitor General advised the Supreme Court
that HHS had committed to initiating a rulemaking process to reconsider
the policy articulated in its current regulations, which state that a
hospital's EMTALA obligations end upon the good faith admission as an
inpatient of an individual with an EMC. In the December 23, 2010
Federal Register (75 FR 80762), we published an advance notice of
proposed rulemaking (ANPRM) entitled ``Medicare Program; Emergency
Medical Treatment and Labor Act: Applicability to Hospital and Critical
Access Hospital Inpatients and Hospitals With Specialized
Capabilities'' to solicit comments regarding whether we should revisit
the policies established in the 2003 EMTALA final rule and the FY 2009
IPPS final rule. In addition, we sought real world examples that would
inform our understanding of the current policy's impact on patients'
access to care for an EMC. We noted that we would find it particularly
helpful whether commenters could submit specific real-world examples
that demonstrate if it would be beneficial to revisit these policies.
We stated (75 FR 80765) that we--
* * * are interested in hearing whether commenters are aware of
situations where an individual who presented under EMTALA with an
unstable EMC was admitted to the hospital where he or she first
presented and was then transferred to another facility, even though
the admitting hospital had the capacity and capability to treat that
individual's EMC.
We further stated (75 FR 80765) that we were ``* * * interested in
receiving information regarding the accuracy of our statement in the
August 19, 2008 IPPS final rule that a hospital with specialized
capabilities would accept the transfer of an inpatient with an
unstabilized EMC absent an EMTALA obligation.'' Lastly, we stated (75
FR 80765) that we were interested in learning whether commenters were
``* * * aware of situations where an individual with an unstabilized
EMC was admitted as an inpatient and continued to have an unstabilized
EMC requiring the services of a hospital with specialized capabilities
that refused to accept the transfer of the individual because current
policy does not obligate hospitals with specialized capabilities to do
so.''
II. Provisions of the Request for Comments
A. Applicability of EMTALA to Hospital Inpatients
In the 2003 EMTALA final rule, we took the position that a
hospital's obligation under EMTALA ends when that hospital, in good
faith, admits an individual with an unstable emergency medical
condition as an inpatient to that hospital. In that rule, we noted that
other patient safeguards including the CoPs as well as State
malpractice law protect inpatients. In response to our request for
comments in the ANPRM as to whether we should revisit the policies that
were established in the 2003 EMTALA final rule, very few commenters
took the position that the admitting hospital should continue to have
an EMTALA obligation after the individual is admitted as an inpatient.
While some commenters advocated extending EMTALA to inpatients who do
not experience a period of stability, the commenters did not provide
any evidence that the existing policy has resulted in patients being
admitted and then subsequently discharged before
[[Page 5217]]
they were stable, adversely affecting the clinical outcome of those
patients. Most commenters expressed support for the current policy that
EMTALA does not apply to any inpatient of a hospital, even a patient
who was admitted through that hospital's dedicated emergency department
and continues to be unstable. These commenters referred to our 2003
EMTALA final rule and concurred with our assessment that, under our
existing policy, the numerous hospital CoPs that protect inpatients as
well as inpatients' rights under State law afford individuals admitted
to a hospital with sufficient protection. Moreover, commenters
appreciated the clarity and predictability of a bright line policy.
Commenters also noted that our current policy regarding inpatients is
achieving Congress' intent by ensuring that every individual,
regardless of their ability to pay for emergency services, should have
access to hospital services provided in hospitals with emergency
departments.
Therefore, in light of the comments we received regarding the
extension of the EMTALA obligations for hospitals admitting an
individual through their dedicated emergency departments, we are not
proposing to change the current EMTALA requirements for these
hospitals. That is, we are maintaining our current policy that, if an
individual ``comes to the [hospital's] emergency department,'' as we
have defined that term in regulation, and the hospital provides an
appropriate medical screening examination and determines that an EMC
exists, and then admits the individual in good faith in order to
stabilize the EMC, that hospital has satisfied its EMTALA obligation
towards that patient. We continue to believe that this policy is a
reasonable interpretation of the EMTALA statute and is supported by
several Federal courts that have held that an individual's EMTALA
protections end upon admission as a hospital inpatient. For further
explanation, we refer readers to the 2003 EMTALA final rule (68 FR
53244), in which we finalized the policy that a hospital's EMTALA
obligations end upon admission.
B. Applicability of EMTALA to Hospitals With Specialized Capabilities
The second issue upon which the ANPRM solicited comment was,
whether EMTALA should apply to situations where a hospital seeks to
transfer an individual, who was admitted by that hospital as an
inpatient after coming to the hospital's dedicated emergency department
with an EMC, to a hospital with specialized capabilities because the
admitted inpatient continues to have an unstabilized EMC that requires
specialized treatment not available at the admitting hospital. Under
current regulations, if an individual comes to the hospital's dedicated
emergency department, is determined to have an EMC, is admitted as an
inpatient, and continues to have an unstabilized EMC which requires the
specialized capabilities of another hospital, the EMTALA obligation for
the admitting hospital has ended and a hospital with specialized
capabilities also does not have an EMTALA obligation towards that
individual.
Although we received some comments that supported amending the
current regulations to require hospitals with specialized capabilities
to accept the appropriate transfer of an inpatient who had presented to
the admitting hospital under EMTALA and requires specialized
capabilities to stabilize his or her EMC not available at the admitting
hospital, most comments supported making no change to the current
policies regarding the applicability of EMTALA to hospitals with
specialized capabilities.
Therefore, at this time, we are making no proposals with respect to
our policies regarding the applicability of EMTALA to hospitals with
specialized capabilities. However, we will continue to monitor whether
it may be appropriate in the future to reconsider this issue. Thus, we
are providing a 60-day comment period to allow the public to submit
data or real world examples that are relevant to this issue.
III. Response to Comments
Because of the large number of public comments we normally receive
on Federal Register documents, we are not able to acknowledge or
respond to them individually. We will consider all comments we receive
by the date and time specified in the DATES section of this preamble.
If we proceed to issue a subsequent document on the issues raised
therein, we will respond to those comments in the preamble to that
document.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774)
Dated: January 9, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
Approved: January 26, 2012.
Kathleen Sebelius,
Secretary, Department of Health and Human Services.
[FR Doc. 2012-2287 Filed 1-31-12; 4:15 pm]
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