Although the main push of this regulation is to determine what HCFA will pay for, and what they will not, in terms of levels of service, the EMTALA impact is that the regulation examples indicate that they recognize transfers to a higher level of care under EMTALA and that they will honor the PHYSICIAN designation of level of care, so long as it would not be appropriate to transfer the patient other than by ambulance under EMTALA.

This probably does not insulate EMTALA transfers from challenges for other reasons, such as a closer "minimally adequate" facility, but does emphasize that in determining the level of care for transport under EMTALA and under Medicare, the responsibility rests on the transferring physician.

Proper levels of care

The regulations specify the guidelines for non-emergency transports and EMTALA transports. The specification for transfers for "services not rendered here" would apply to services that are not certified as medically necessary for evaluation and stabilizing care under the EMTALA certification process.

For more information go to COBRA/EMTLA RESOURCES by Frew Consulting Group at: http://www.medlaw.com/ambpay.htm.