CMS Pub. 100-01, ch. 5, § 10.1.9

Effective December 1, 1991, participating hospitals must comply with the advance

directive provisions of §4206 of OBRA 1990. Therefore, an agreement per §1866 of the

Act with a hospital includes that the hospital must, in accordance with written policies

and procedures, for all adult individuals: inform them, in writing, of state laws regarding

advance directives; inform them, in writing, of its policies regarding the implementation

of advance directives (including a clear and concise explanation of a conscientious

objection, to the extent that state law permits for a hospital or any agent of a hospital that,

as a matter of conscience, cannot implement an advance directive); document in the

individual's medical record whether the individual has executed an advance directive; not

condition the provision of care or otherwise discriminate against an individual based on

whether that individual has executed an advance directive (since the law does not require

the individual to do so); and educate staff and the community on issues concerning

advance directives.

10.1.10 - Posting of Signs in Hospital Emergency Departments

Section 6018(a)(2) of the Omnibus Budget Reconciliation Act of 1989 (OBRA §89),

effective July 1, 1990, requires hospitals with emergency departments to post signs which

specify the rights (under section 1867 of the Social Security Act) of women in labor and

individuals with emergency medical conditions to examination and treatment.

To comply with these requirements, hospitals must post signs that meet the following

criteria:

• At a minimum, the signs must specify the rights of unstable individuals with

emergency conditions and women in labor who come to the emergency

department for health care services;

• It must indicate whether the facility participates in the Medicaid program;

• The wording of the sign must be clear and in simple terms understandable by the

population serviced;

• Print the signs in English and other major languages that are common to the

population of the area serviced;

• The letters within the signs must be clearly readable at a distance of at least 20

feet or the expected vantage point of the emergency department patrons; and

• Post signs in a place or places likely to be noticed by all individuals entering the

emergency department, as well as those individuals waiting for examination and

treatment (e.g., entrance, admitting area, waiting room, treatment area).

The sample below may be adapted, contains sufficient information to satisfy these

requirements, and may be adapted to satisfy the visibility requirement.

IT'S THE LAW!

IF YOU HAVE A MEDICAL EMERGENCY OR ARE IN LABOR

YOU HAVE THE RIGHT TO RECEIVE, WITHIN THE CAPABILITIES OF THIS

HOSPITAL'S STAFF AND FACILITIES:

An appropriate medical SCREENING EXAMINATION

Necessary STABILIZING TREATMENT (including treatment for an unborn child)

And if necessary

An appropriate TRANSFER to another facility

Even if

YOU CANNOT PAY OR DO NOT HAVE MEDICAL INSURANCE

OR

YOU ARE NOT ENTITLED TO MEDICARE OR MEDICAID

This hospital (does/does not) participate in the Medicaid program