Presents to the Dedicated ED
Any person who comes to the hospital’s dedicated ED requesting an evaluation or a treatment must be given an MSE. The request can be made on the patient’s behalf (eg, a minor). A dedicated ED is any department of the hospital (1) licensed by the state as an ED; (2) held out to the public as a place for emergency or unscheduled care; or (3) in which at least one third of the outpatient visits were for emergency care during the previous calendar year.
The ED does not have to be located on the main hospital campus. The CMS considers labor and delivery and psychiatric units to fall under the dedicated ED definition. However, EMTALA does not apply to a person who comes to a hospital outpatient department and an EMC unexpectedly develops during a scheduled visit.The “250-yard” rule has also been modified. The request for care, using the aforementioned criteria, may still occur anywhere on the hospital property (including driveways and sidewalks). However, the CMS uses other Medicare rules (42 CFR §413.65) to define the hospital campus. Areas such as physician offices, skilled nursing facilities (and similar separate Medicare-participating units), and nonmedical facilities are not included in the hospital’s zone of responsibility. Non-EDs off the main hospital campus no longer fall under EMTALA. They still must have written policies for dealing with emergencies.