Emergency Medical Treatment and Active Labor Act (1986)

The Emergency Medical Treatment and Active Labor Act
(EMTALA) is a U.S. Act of Congress passed in 1986 as part
of the Consolidated Omnibus Budget Reconciliation Act
(COBRA). It requires hospitals and ambulance services to
provide care to anyone needing emergency healthcare
treatment regardless of citizenship, legal status or
ability to pay. There are no reimbursement provisions. As
a result of the act, patients needing emergency treatment
can be discharged only under their own informed consent or
when their condition requires transfer to a hospital better
equipped to administer the treatment.

EMTALA applies to "participating hospitals", i.e., those
that accept payment from the Department of Health and Human
Services, Centers for Medicare and Medicaid Services (CMS)
under the Medicare program. However, in practical terms,
EMTALA applies to virtually all hospitals in the U.S., with
the exception of the Shriners Hospitals for Children, Indian
Health Service hospitals, and Veterans Affairs hospitals. The
combined payments of Medicare and Medicaid, $602 billion in
2004, or roughly 44% of all medical expenditures in the U.S.,
make not participating in EMTALA impractical for nearly all
hospitals. EMTALA's provisions apply to all patients, and not
just to Medicare patients.