Appendix G
Federal Requirements for Patient
Screening and Transfer*
In 1986, the United States Congress first enacted legal requirements specify-
ing how Medicare-participating hospitals with emergency services must handle
individuals with emergency medical conditions or women who are in labor.
Since then, the patient screening and transfer law has undergone numerous
refinements and revisions. Physicians should expect that this law will continue
to evolve and that there will be additional modifications to it in the future.
Requirements for an Appropriate Medical Screening
Federal law requires that all Medicare-participating hospitals with a dedicated
emergency department must provide an “appropriate medical screening exami-
nation” for any individual who comes to the emergency department for medical
treatment or examination to determine whether the patient has an emergency
medical condition. This examination must be made within the capability of the
hospital’s emergency department, including ancillary services routinely available
to the emergency department. For example, “[i]f a hospital has a department of
obstetrics and gynecology, the hospital is responsible for adopting procedures
under which the staff and resources of that department are available to treat a
woman in labor who comes to its emergency department.”
Medical screening examinations also must “…be conducted by individuals
determined qualified by hospital by-laws or rules and regulations.” Therefore, it
is up to a hospital to designate who is a qualified medical person to provide an
appropriate medical screening examination. The law does not require that phy-
sicians perform all screening examinations. Therefore, a hospital can determine
*Data from Emergency Medical Treatment and Labor Act. P.L. 99-272, 100 Stat.164 (1986)
codified at 42 U.S.C. SS 1395dd et seq. (2010). Available at: http://www.gpo.gov/fdsys/
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March 21, 2012.
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