Procedures for Termination when the EMTALA Violation is an

5470.1 - Procedures for Termination when the EMTALA Violation is an Immediate Jeopardy to Patient Health and Safety (Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26) In cases where the CMS location determined that an immediate jeopardy existed, after a 5-day QIO advisory review has been completed, the CMS location follows the termination procedures in §3010. The processing timeframes are the maximum allowed. The termination procedures are not postponed or stopped unless evidence of correction of the deficiencies or proof that the violation did not exist is provided by the hospital to the CMS location. The CMS location forwards the supporting documents to the QIO (for a 60 day QIO review) in order to provide a medical opinion on the case. The CMS location refers the case to the OIG that has the responsibility for assessment of CMPs against the hospital and/or physician and physician exclusion provisions for violations of 42 CFR 489.24. The case is also referred to the Office for Civil Rights (OCR) because OCR may take action under the Hill-Burton Subpart G Community Services regulations at 42 CFR 124.603(b) (1). The termination track starts on the date that the CMS location makes the determination of noncompliance with 42 CFR 489.24. It is the date of the preliminary determination letter. The letter is forwarded to the hospital by the fastest method available (fax, e-mail or telephone). In addition, a written letter follows up by mail. The preliminary determination letter informs the hospital of: • The CMS location’s findings based on the investigation and the results of medical review; • The projected termination date (the 23rd calendar day from the date of the preliminary determination letter); • The date on which the CMS location issues a Notice of Termination Letter and notifies the public (at least two calendar days, but no more than four calendar days prior to the termination date); and • That the hospital may avoid the termination action and notice to the public by either providing acceptable POCs for the deficiencies or by successfully showing that the deficiencies did not exist. In either case, the necessary information must be furnished to the CMS location in time for the SA to verify the corrections before the projected termination date. If, during the resurvey, the SA finds that the provider had implemented systems and processes to ensure that the likelihood of further violation is remote and there is adequate evidence that the provider is in compliance with the requirements, the termination action is rescinded and the provider is put back in compliance. If, during the resurvey, the SA finds that the provider has not adequately implemented systems and processes to ensure compliance, the CMS location gives the hospital an additional 67 days or a total of 90 days (23 plus 67) to achieve compliance. This allows the hospital time to prove that the corrective action is good for the long-term (i.e., the corrective action is adequate to ensure that no further violations will occur). The CMS location directs the SA to conduct a second survey by the 60th calendar day. On the resurvey, the surveyor(s) reviews patients’ emergency department (ED) records and other relevant documents for the period since the last survey to assess continued compliance. If the hospital fails to achieve compliance, it is terminated from the Medicare program. The CMS location sends the complainant a letter reporting the final results of the investigation. If the termination takes place and the hospital desires to become re-certified as a Medicare provider, the hospital must provide reasonable assurance that compliance will be maintained. The procedures at §2016 are followed.