CMS Pub. 100-10, ch. 9, § 9100

Sections 9100–9135 provide a comprehensive description of the Emergency Medical

Treatment and Labor Act (EMTALA) statutory and regulatory requirements and the

supporting QIO review process and procedures. In addition, these sections provide a

clear description of the process that QIOs must follow when they receive a request for

review from the CMS Division of Survey and Certification (DSC). The process involves a

coordinated effort between the CMS DSC and the QIO.

In 1986, Congress enacted EMTALA to ensure public access to hospital emergency

services regardless of ability to pay. Section 1867 of the Social Security Act imposes

specific obligations on Medicare-participating hospitals. Hospitals that offer emergency

services are required to provide a medical screening examination to individuals who

“come to the emergency department” to determine if they have an emergency medical

condition, regardless of an individual's ability to pay. Hospitals are then required to

provide stabilizing treatment for individuals with emergency medical conditions. If a

hospital within its capability is unable to stabilize an individual, or if the individual

requests, an appropriate transfer should occur. Hospitals with specialized capabilities,

regardless of whether they offer emergency services, must accept appropriate transfers of

individuals requiring those specialized capabilities, if they have capacity at the time of the

transfer request.