Summary of final changes to EMTALA regulations.

The Emergency Medical Treatment and Labor Act (EMTALA) was enacted in 1986. Its purpose was to ensure that all individuals receive necessary emergency services from hospitals and not be denied care (i.e., "patient dumping") because of their economic status or lack of insurance. In its application, EMTALA has reduced "patient dumping," but at great cost to hospitals and physicians as an unfunded mandate. Despite 17 years of experience with the law, providers have been uncertain as to where and when, and to whom, the EMTALA obligations apply. The law has also proven to be burdensome and has been interpreted as extending far beyond the hospital emergency room. After reviewing the law for some time, the Centers for Medicare and Medicaid Services (CMS) released its final rules redefining the scope of EMTALA, reaffirming certain guidelines and modifying or clarifying others. The new regulations attempt to restate the parameters of the law as it applies to the emergency department and the hospital, as well as to inpatients and outpatients. The new rules clarify on-call obligations for physicians, confirming guidance issued by CMS in June 2002. This article summarizes the salient features of these new regulations.