Conducting the Investigation

5440.4 - Conducting the Investigation (Rev. 18, Issued: 03-17-06; Effective/Implementation Dates: 03-17-06) A complete investigation consists of assessment of the following components: • Completeness, adequacy and enforcement of policies and procedures which address the provisions of 42 CFR 489.24; • Prompt reports to the SA or CMS of receipt of an improperly transferred individual by the receiving hospital; • Presence and completeness of signs posted in emergency departments specifying the rights of individuals under 42 CFR 489.24, and information indicating whether the hospital participates in the Medicaid program; • Maintenance of medical and other records related to individuals transferred to or from the hospital for a period of five years from the date of transfer, including discharged patients; • Maintenance of a list of physicians who are on call to provide necessary stabilizing treatment; • Maintenance of a central log on each individual who comes to the hospital seeking emergency services; • Provision of an appropriate medical screening examination sufficient to determine the presence of an emergency medical condition; • Provision of necessary stabilizing treatment; • Provision of no delay in examination or treatment in order to inquire about insurance status or capability for payment; • Provision of an appropriate transfer to another medical facility/provider; • Provision of whistleblower protections; and • Adequacy of responsibilities of the recipient hospital with specialized capabilities (nondiscrimination). The survey tasks are listed below for easy reference. See Appendix V for detailed guidance. • Task 1: Entrance Conference; • Task 2: Case Selection Methodology; • Task 3: Record review; • Task 4: Interviews; • Task 5: Exit Conference; • Task 6: Professional Medical Review; and • Task 7: Assessment of Compliance and Completion of the Deficiency Report. After the investigation is concluded, complete a Form CMS-1541B (Exhibit 137). If one or more of the provisions of EMTALA are not met, complete Form CMS-2567, using “Principles of Documentation.” Describe in detail the facts of each individual case. In addition, specify whether the hospital was aware of the problem and took steps to remedy it prior to the survey. If a SA physician was a member of the investigation team, include the medical review of the case. Use the “Physician Review Outline for Emergency Care Obligations of Medicare Hospitals,” (Exhibit 138) for this purpose. In addition, complete Form CMS-562. All the forms must be signed, showing the professional titles of all participating surveyors, and dated. A hospital may have multiple sites listed under its Medicare provider number. These sites may not be in close proximity of each other and each site may have its own dedicated emergency department (DED). In cases where the alleged EMTALA violation is against a specific site of the hospital, the surveyors should focus their survey investigation at the hospital site mentioned in the complaint intake. However, the surveyors should review all EMTALA related Policies and Procedures of all sites of the hospital. The surveyors need to survey the other sites of the hospital if the survey findings indicate that the potential EMTALA violation maybe widespread.