Q: California vs Federal Emtala standards for MSE. Question.

A: The California Emtala statute, as per Cal Health & Saf Code § 1797.98e, mandates that payment should be made for medical screening examinations required by law to determine whether an emergency condition exists, regardless of the determination after the examination that a medical emergency does not exist. Payments from the fund are limited to claims for care rendered by physicians and surgeons to patients who are initially medically screened, evaluated, treated, or stabilized in specific facilities.

Additionally, Cal Ins Code § 10112.7 defines "emergency services" as a medical screening examination within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate that emergency medical condition. It also states that a group or individual health insurance policy that provides or covers any benefits with respect to services in an emergency department of a hospital shall cover emergency services without the need for any prior authorization determination.

Cal Health & Saf Code § 1317 states that emergency services and care shall be provided to any person requesting the services or care, or for whom services or care is requested, for any condition in which the person is in danger of loss of life, or serious injury or illness, at any health facility licensed under this chapter that maintains and operates an emergency department to provide emergency services to the public when the health facility has appropriate facilities and qualified personnel available to provide the services or care.

When comparing the California Emtala statute with the national standard, it is noted that the federal Emergency Medical Treatment and Active Labor Act (EMTALA) is designed to prevent hospitals that have entered into Medicare provider agreements from inappropriately transferring or refusing to treat patients requiring emergency medical treatment. A civil claim may be brought based either on the failure to provide an appropriate medical screening examination within the capabilities of the hospital’s emergency department or, if the patient is determined to have an emergency medical condition, on the failure to provide such medical treatment as required to stabilize the patient’s condition.

The Supreme Court noted that when a successful suit is brought under EMTALA, the statute specifically provides for recovery of “those damages available for personal injury under the law of the State in which the hospital is located”. The cap on noneconomic damages of Civ. Code § 3333.2 applies to actions brought under EMTALA when the cap would apply if the claim were brought under state law.

The Emergency Medical Treatment and Labor Act, 42 U.S.C. § 1395dd, requires Medicare-participating hospitals and critical access hospitals (CAHs) with dedicated emergency departments to provide a medical screening exam to every individual who comes to the emergency department to determine if they have an emergency medical condition (EMC), necessary stabilizing treatment for individuals with EMCs, and transfers of individuals with EMCs, when appropriate.