CMS Reminds Providers About EMTALA Obligations With COVID-19 Patients

By A.J. Plunkett

In response to questions from hospitals both large and small, CMS is reminding providers with emergency departments that they must abide by federal regulations to offer help to anyone seeking medical attention, including screening those “suspected of having COVID-19, and regardless of whether they arrive by ambulance or are walk-ins.”

CMS has also revised its guidance for nursing homes that need to control visitors in light of the rapid spread of COVID-19 and has also now issued guidance for hospices.

The new information was posted on CMS’ online list of Quality, Safety and Oversight Group (QSO) memos. (It may be necessary to click on the posting date column arrows twice to see the most recent memos posted.)

Hospitals should read all the memos even if they don’t have association with nursing homes or hospices because they offer good guidance regarding discharge expectations to those post-acute organizations, notes Patton Healthcare Consulting in its March newsletter on compliance.

In a 17-page memo to CMS surveyors in state and regional offices, CMS reminds hospitals of their obligations under the Emergency Medical Treatment and Labor Act (EMTALA).

“Due to increasing public concerns with COVID-19, CMS is receiving inquiries from the hospital industry concerning implications for their compliance with EMTALA,” according to memo QSO-20-15 Hospital/CAH/EMTALA.

“This Memorandum conveys information in response to inquiries from hospitals and critical access hospitals (CAHs) concerning implications of COVID-19 for their compliance with EMTALA. This guidance applies to both Medicare and Medicaid providers,” according to CMS officials.

“Every ED is expected to have the capability to apply appropriate COVID-19 screening criteria when applicable, to immediately identify and isolate individuals who meet the screening criteria to be a potential COVID-19, to contact their state or local public health officials to determine next steps,” says the memo.

Under EMTALA, hospitals with emergency departments must also follow obligations for stabilization and transfer to other organizations. Plus, recipient hospitals have requirements as well, reminds CMS officials.

“In the case of individuals with suspected or confirmed COVID-19, hospitals and CAHs are expected to consider current guidance of CDC and public health officials in determining whether they have the capability to provide appropriate isolation required for stabilizing treatment and/or to accept appropriate transfers. In the event of any EMTALA complaints alleging inappropriate transfers or refusal to accept appropriate transfers, CMS will take into consideration the public health guidance in effect at the time.”

The memo points hospitals and other providers to several online resources, as well as answering several frequently asked questions regarding COVID-19 patients and suspected patients. Specifically, it “strongly” urges providers and surveyors to monitor the CDC Health Alert Network website for COVID-19 related issues,

The updated CMS infection control memo for nursing homes, QSO-20-14-NH Revised, now offers extensive guidance for restricting or limiting visitors. This includes who should be restricted, what signs should be up to guide limited visitation, and if and how to go about allowing visitors.

“Facilities should actively screen and restrict visitation by those who meet the following criteria:

  1. Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat.
  2. In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID19, or under investigation for COVID-19, or are ill with respiratory illness.
  3. International travel within the last 14 days to countries with sustained community transmission. For updated information on affected countries visit:
  4. Residing in a community where community-based spread of COVID-19 is occurring.”

The memo then breaks up some of the guidance into three sections, beginning with definitions:

  • Restricting: the individual should not be allowed in the facility at all until they no longer meet the criteria above.
  • Limiting: the individual should not be allowed to come into the facility except for certain cases, such as end-of-life situations, or when the visitor is essential for the resident’s emotional well-being and care.
  • Discouraging: the facility allows normal visitation practices (except for those individuals meeting the restricted criteria). However, the facility advises individuals to defer visitation until further notice through signage, calls, etc..

The hospice memo, QSO-20-16-Hospice, offers similar guidance, including how to monitor or restricting hospice volunteers.

“We encourage all Hospice Agencies to monitor the CDC website for updated information and resources and contact their local health department when needed (CDC Resources for Health Care Facilities:”

In addition, CMS has created an FAQ related to COVID-19 with information for physicians offices as well as other providers.

The FAQ includes information on:

  • How to bill and receive payment for testing patients at risk of COVID-19
  • Details of Medicare’s payment policies for laboratory and diagnostic services, drugs and vaccines under Medicare Part B, ambulance services, and other medical services delivered by physicians, hospitals, and facilities accepting government resources; and
  • Information on billing for telehealth or in-home provider services.

A.J. Plunkett is editor of Inside Accreditation & Quality, a Simplify Compliance publication.