The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital emergency departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.
EMTALA applies to "participating hospitals." The statute defines participating hospitals as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals. The combined payments of Medicare and Medicaid, $602 billion in 2004, or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients.
The cost of emergency care required by EMTALA is not directly covered by the federal government, so it has been characterized as an unfunded mandate. Uncompensated care represents 6% of total hospital costs.
Prior legislation
The Hill-Burton Act of 1946, which provided federal assistance for the construction of community hospitals, had established non-discrimination requirements for any institutions that received this federal assistance - including the requirement that a "reasonable volume" of free emergency care be provided to community members who could not pay, for a period for 20 years after the hospital's construction. Amendments to the Act in 1975 removed the 20-year expiration date and instead required any hospitals receiving Hill-Burton funding to provide free care in perpetuity. However, the provisions of the Act were vague and rarely enforced.
Mandated and non-mandated care
Congress passed EMTALA to eliminate the practice of "patient dumping", i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs. The law applies when an individual seeks treatment for a medical condition "or a request is made on the individual's behalf for examination or treatment for that medical condition."
The U.S. government defines an emergency department as "a specially equipped and staffed area of the hospital used a significant portion of the time for initial evaluation and treatment of outpatients for emergency medical conditions." This means, for example, that outpatient clinics not equipped to handle medical emergencies are not obligated under EMTALA and can simply refer patients to a nearby emergency department for care.
An emergency medical condition (EMC) is defined as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs." For example, a pregnant woman with an emergency condition and/or currently in labor must be treated until delivery is complete, the mother and fetus are stabilized, or a qualified personnel identifies the labor as a "false labor", or Braxton Hicks contractions, unless a transfer under the statute is appropriate.
Patients treated under EMTALA may not be able to pay or have insurance or other programs pay for the associated costs but are legally responsible for any costs incurred as a result of their care under civil law.
Non-covered medical conditions
Not all medical conditions qualify for uncompensated mandated services imposed by EMTALA, which is contrary to the misperception that many individuals assume that if they are ill, they will be treated, regardless of their ability to pay.