Biden-Harris Administration Reaffirms Commitment to EMTALA Enforcement

CMS also announces creation of Spanish-language resources for filing EMTALA complaints, the latest step by the Department to promote compliance with federal law and raise awareness about Americans' right to emergency medical care

Following the Supreme Court's decision in Moyle v. United States, U.S. Department of Health and Human Services Secretary Xavier Becerra and the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure sent a letter to hospital and provider associations across the country today reminding them that it is a hospital's legal duty to offer necessary stabilizing medical treatment (or transfer, if appropriate) to all patients in Medicare-participating hospitals who are found to have an emergency medical condition. CMS also announced that the investigation of EMTALA complaints would proceed in Idaho while litigation continues in the lower courts.

In the letter, HHS and CMS also announced the launch of a Spanish-language version of the Emergency Medical Treatment and Active Labor Act (EMTALA) complaint form, the latest step taken by the Department to further educate the public about their rights to emergency medical care. The Spanish-language complaint form builds on new information resources on CMS' website to help individuals understand their protections under EMTALA and the process for submitting a complaint if they are denied emergency medical care. HHS and CMS also established a dedicated team of experts who are increasing the Department's capacity to support hospitals in complying with federal requirements under EMTALA.

In 2022, CMS issued guidance to reaffirm that EMTALA requires providers offer necessary stabilizing care for patients suffering emergency medical conditions, which might include abortion care in certain situations. Today's letter reinforces previous letters from Secretary Becerra and Administrator Brooks-LaSure to hospital and provider associations reminding them of their obligations under EMTALA.

Read the full letter to hospital and provider associations below.

July 2, 2024

Dear Hospital and Provider Associations:

Last week, the Supreme Court issued an order in Moyle v. United States that reinstates the protections of the Emergency Medical Treatment and Labor Act (EMTALA) for pregnant women experiencing emergency medical conditions in Idaho. Although the Court did not resolve the disputed legal questions in the case, its order means that women in Idaho can once again access the emergency medical care they need.

While this litigation continues in the lower courts, we write to you to reaffirm our view that EMTALA's protections remain in place - as they have for the last 40 years - and to share that the Centers for Medicare & Medicaid Services (CMS) remains committed, to the fullest extent of the law, to ensuring compliance with EMTALA's protections.

No pregnant woman or her family should have to even begin to worry that she could be denied the treatment she needs to stabilize her emergency medical condition in the emergency room. As health care providers, you know better than anyone how crucial it is for anyone experiencing a medical emergency to receive appropriate care and to receive it quickly. And yet, we have heard story after story describing the experiences of pregnant women presenting to hospital emergency departments with emergency medical conditions and being turned away because medical providers were uncertain about what treatment they were permitted to provide.¹

As the Secretary of Health and Human Services and the Administrator of CMS, we write to you today to affirm our unwavering commitment to the standards established by EMTALA nearly 40 years ago, and as outlined in CMS' 2022 memo to states.²

As we continue to defend our interpretation of EMTALA in court, CMS will investigate complaints from Idaho and other states³ in accordance with the statute, to promote compliance with federal law. Federal EMTALA requirements have not changed: EMTALA requires that hospitals offer stabilizing treatment, including abortion care (or transfer, if appropriate) when necessary to stabilize the patient's emergency medical condition and ensure that the patient's condition does not materially worsen.⁴

We have also heard concerns from many physicians regarding their individual liability in states with laws that directly conflict with EMTALA protections. As previously noted,⁵ if a pregnant patient presenting at an emergency department, including certain labor and delivery departments, is experiencing an emergency medical condition as defined by EMTALA, and that abortion is the stabilizing treatment necessary to resolve that condition, the provider must offer that treatment.⁶ And when a state law prohibits abortion and does not include an exception for the life and health of the pregnant individual - or draws the exception more narrowly than EMTALA's emergency medical condition definition - that state law is preempted.

In addition, we will continue to build on our recent actions to educate the public about their rights to emergency medical care and to help support efforts of hospitals and health care professionals to meet their obligations under EMTALA. We have also published new informational resources on CMS' website to help individuals understand their protections under EMTALA and the process for submitting a complaint if they are denied emergency medical care.⁷ And we've expanded our dedicated team of experts who are increasing the Department's capacity to support hospitals and health care providers in complying with federal requirements under EMTALA.

The enforcement of EMTALA is a complaint driven process. The investigation of a hospital's policies and procedures, or the actions of medical personnel, and any subsequent sanctions are initiated by a complaint. To help anyone easily submit an EMTALA complaint, CMS recently launched a new option on CMS.gov to allow individuals to file a complaint directly with CMS.⁸ And today, we are launching the Spanish-language version of this web form, to expand access to this important resource.

If the results of a complaint investigation indicate that a hospital violated one or more of the provisions of EMTALA, CMS will issue a notice of deficiency and provide the hospital with an opportunity to come into compliance. A hospital that fails to do so may be subject to termination of its Medicare provider agreement or the imposition of civil monetary penalties by the HHS Office of the Inspector General. We remain committed to working directly with hospitals, providers, and community leaders across the country to ensure compliance with EMTALA.

Thank you for all that you do to care for your patients. We will continue to do everything in our power to give you the clarity you need regarding the federal laws that protect you and your patients in emergency medical situations.

Sincerely,

Secretary Xavier Becerra

Administrator Chiquita Brooks-LaSure

Endnotes

¹https://www.hhs.gov/about/news/2023/05/01/hhs-secretary-xavier-becerra-statement-on-emtala-enforcement.html

² "Reinforcement of EMTALA Obligations specific to Patients who are Pregnant or are Experiencing Pregnancy Loss (QSO-21-22-Hospitals-updated August 25, 2022)," https://www.cms.gov/files/document/qso-22-22-hospitals.pdf.

³ The U.S. District Court for the Northern District of Texas issued an injunction prohibiting certain applications of the EMTALA Guidance issued on July 11, 2022 and Secretary Becerra's accompanying July 11, 2022 letter. Texas v. Becerra, No.5:22-cv-185H (N.D. Tex.). The U.S. Court of Appeals for the Fifth Circuit affirmed the injunction. Texas v. Becerra, 89 F.4th 529 (5th Cir. 2024).HHS is complying with the court's injunction, which states that: (1) The defendants may not enforce the Guidance and Letter's interpretation that Texas abortion laws are preempted by EMTALA; and (2) The defendants may not enforce the Guidance and Letter's interpretation of EMTALA-both as to when an abortion is required and EMTALA's effect on state laws governing abortion-within the State of Texas or against members of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) and the Christian Medical and Dental Association (CMDA). HHS has sought the Supreme Court's review of the Fifth Circuit's decision; that petition for review remains pending.

⁴ "Reinforcement of EMTALA Obligations specific to Patients who are Pregnant or are Experiencing Pregnancy Loss (QSO-21-22-Hospitals- UPDATED JULY 2022)," https://www.cms.gov/files/document/qso-22-22-hospitals.pdf.

⁵ Please see: https://www.hhs.gov/sites/default/files/emergency-medical-care-letter-to-health-care-providers.pdf.

⁶ HHS will continue to comply with all applicable federal conscience protections. See also "Safeguarding the Rights of Conscience Federal Statutes," https://www.federalregister.gov/documents/2024/01/11/2024-00091/safeguarding-the-rights-of-conscience-as-protected-by-federal-statutes.

⁷ For more information, please visit: https://www.cms.gov/newsroom/press-releases/cms-announces-new-actions-help-hospitals-meet-obligations-under-emtala and https://www.cms.gov/priorities/your-patient-rights/emergency-room-rights.

⁸ For more information, please visit: https://www.cms.gov/priorities/your-patient-rights/emergency-room-rights/how-to-file-complaint

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