NHeLP Comments to CMS on Medicare Program; Emergency Medical Treatment and Labo

Executive Summary

NHeLP notes that the Emergency Medical Treatment and Labor Act (EMTALA) is a crucial last resort to access care for critically ill uninsured individuals. The recommendations to strengthen the EMTALA rules include closing loopholes whereby hospitals may admit patients to avoid EMTALA obligations.

Centers for Medicare & Medicaid Services 
Department of Health and Human Services, 
Attention: CMS?1350?ANPRM 
P.O. Box 8013 
Baltimore, MD 21244?8013 
Re: Comments on Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital and Critical Access Hospital Inpatients and Hospitals With Specialized Capabilities 

Dear Sir/Madam: 
The National Health Law Program (NHeLP) is a public interest law firm working to advance access to quality health care and protect the legal rights of low-income and underserved people. NHeLP works to improve health care for America?s working and unemployed poor, minorities, the elderly and people with disabilities. NHeLP serves legal services programs, community-based organizations, the private bar, providers and individuals who work to preserve a health care safety net for the millions of uninsured or underinsured low-income people. NHeLP also works to support laws, regulations, and policies which low-income individuals depend upon to receive timely and high-quality medical treatment. 
Accordingly, NHeLP is pleased to offer our comments on the Advance Notice of Proposed Rulemaking (CMS-1350-ANPRM) on the applicability of EMTALA to the inpatient setting: 

I. Background 
Millions upon millions of hard-working Americans live without health insurance, because they work in jobs that don?t offer insurance, they can?t afford insurance, and/or no one will sell them insurance due to their illness. For these Americans, EMTALA is their only protection when they need emergent medical treatment. EMTALA literally amounts to the difference between life and death. The integrity of EMTALA is among the most critical protections in our health care system. This is particularly true for highly vulnerable and sometimes unpopular populations who might otherwise be unable to obtain charitable treatment due to discrimination ? the homeless, individuals with mental health disability, racial and ethnic minorities, etc.

While the Affordable Care Act (ACA) will provide affordable insurance coverage to 31 million Americans by 2019, millions will remain uninsured or still unable to afford coverage. The majority of the residual uninsured patients will be immigrants, who remain excluded from any affordable health insurance under the ACA. In addition, the remaining uninsured will also include individuals who for reasons other than their immigration status are unable to establish or maintain eligibility for coverage. This may include individuals who are over-income for Medicaid but unable to afford subsidized coverage, the homeless population, and individuals with limited English proficiency. The needs of this diverse uninsured population, and the needs of the nation?s safety net hospitals, for EMTALA?s protection will be greater than ever. The phase-down of Disproportionate Share Hospital (DSH) payments, which will occur as the ACA is implemented, will limit the capacity of safety net hospitals to care for uninsured patients who are dumped by other hospitals in violation of EMTALA. 
As an organization that serves the most vulnerable communities who will continue to rely on EMTALA, we support CMS?s proposal to address existing problems with EMTALA compliance, for we know how important the law is, and will remain.1

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