77 Ill. Adm. Code 250.710
Classification of Emergency Services
Section 250
Section 250.710Â
Classification of Emergency Services
a)Â Â Â Â Â Â Â Â Each hospital
, except long-term acute care hospitals and
rehabilitation hospitals identified in Section 1.3 of
the Hospital
Emergency Service
Act
and in subsection (d) of this Section (Section 1
of the Hospital Emergency Service Act), shall provide emergency services
according to one of the following categories:
1)Â Â Â Â Â Â Â Â Comprehensive
Emergency Treatment Services
A)Â Â Â Â Â Â Â At least one licensed physician shall be in the emergency
department at all times.
B)Â Â Â Â Â Â Â Physician specialists who represent the major specialties and
sub-specialties, such as plastic surgery, dermatology and ophthalmology, shall
be available within minutes.
C)Â Â Â Â Â Â Â Ancillary services, including laboratory and x-ray, shall be
staffed at all times. The pharmacy shall be staffed or on call at all times.
2)Â Â Â Â Â Â Â Â Basic
Emergency Treatment Services
A)Â Â Â Â Â Â Â At least one licensed physician shall be in the emergency
department at all times.
B)Â Â Â Â Â Â Â Physician specialists who represent the specialties of
medicine, surgery, pediatrics and obstetrics shall be available within minutes.
C)Â Â Â Â Â Â Â Ancillary services, including laboratory, x-ray and pharmacy,
shall be staffed or on call at all times.
3)Â Â Â Â Â Â Â Â Standby
Emergency Treatment Services
A)Â Â Â Â Â Â Â A registered nurse on duty in the hospital shall be available
for emergency services at all times.
B)Â Â Â Â Â Â Â A licensed physician shall be on call to the emergency
department at all times.
b)Â Â Â Â Â Â Â Â All hospitals, irrespective of the category of services
provided, shall provide immediate first aid and emergency care to persons
requiring first aid emergency treatment on arrival at the hospital.
A
hospital, in accordance with Section 1395dd(a) and 1395dd(b) of the Social
Security Act, shall not delay provisions of a required appropriate medical
screening examination or further medical examination and treatment for a
patient in order to inquire about the individual's method of payment or
insurance status.
(Section 6.34 of the Act)
c)
Every hospital, except long-term
acute care hospitals and rehabilitation hospitals identified in
Section 1.3
of the Hospital Emergency Service Act
, shall furnish hospital emergency
services to any applicant who applies for the same in case of injury or acute
medical condition where the same is liable to cause death or severe injury or
serious illness.
(Section 1(a) of the Hospital Emergency Service Act)
1)Â Â Â Â Â Â Â Â These services shall be furnished
in accordance with the
procedures required by the federal Emergency Medical Treatment and Active Labor
Act (EMTALA), including, but not limited to, medical screening, the provision
of necessary stabilizing treatment, procedures for refusals to consent,
restricting transfers until the individual is stabilized, appropriate transfers
of patients, nondiscrimination, no delay in examination or treatment, and
whistleblower protections
. (Section 1(a) of the Hospital Emergency Service
Act)
2)Â Â Â Â Â Â Â Â For the purposes of this Section:
A)
"Applicant" includes
any person who
presents at the hospital or who is brought to a hospital by ambulance or
specialized emergency medical services vehicle as defined in the Emergency
Medical Services (EMS) Systems Act
. (Section 1(a) of the Hospital
Emergency Service Act)
B)Â Â Â Â Â Â Â "
Injury or acute medical condition where the same is
liable to cause death or severe injury or serious illness
"
includes,
but is not limited to, when a pregnant patient is experiencing ectopic
pregnancy, complications of pregnancy loss, risks to future fertility,
previable preterm premature rupture of membranes (PPROM), or emergent
hypertensive disorders, such as preeclampsia
. (Section (b-1) of the
Hospital Emergency Service Act)
C)Â Â Â Â Â Â Â "
Stabilizing treatment
"
includes
, but
is not limited to,
abortion when abortion is necessary to resolve the
patient's injury or acute medical condition that is liable to cause death or
severe injury or serious illness
. (Section (b-2) of the Hospital Emergency
Service Act)
d)
General acute care hospitals designated by Medicare as
long-term acute care hospitals and rehabilitation hospitals are not required to
provide hospital emergency services described in
this Section or
Section
1 of
the Hospital Emergency Service
Act. Hospitals defined in this
subsection (d)
may provide hospital emergency services at their option
.
1)
Any
hospital
defined in this subsection (d)
that opts to discontinue or
otherwise
not provide emergency services shall
:
A)
Comply with all provisions of EMTALA
and the Hospital
Emergency Service Act;
B)
Comply with all provisions required under the Social
Security Act
;
C)
Provide annual notice to communities in the hospital's
service area about available emergency medical services; and
D)
Make educational materials available to individuals who are
present at the hospital concerning the availability of medical services within
the hospital's service area
.
2)
Long-term acute care hospitals that operate standby
emergency services as of January 1, 2011 may discontinue hospital emergency
services by notifying the Department. Long-term acute care hospitals that
operate basic or comprehensive emergency services must notify the Health
Facilities and Services Review Board and follow the appropriate procedures
.
(Section 1.3 of the Hospital Emergency Service Act)
3)
Any
rehabilitation hospital that opts to discontinue or otherwise not provide
emergency services
shall comply with subsection (d)(1),
shall not use
the term "hospital" in its name or on any signage, and shall notify
in writing the Department, the Health Facilities and Services Review Board
,
and
the Division of Emergency Medical Services and Highway Safety
of
the discontinuation
. (Section 1.3 of the Hospital Emergency Service Act)
A)Â Â Â Â Â Â Â "Signage"
means any signs or system of signs affixed to, adjacent to, or directing the
public to the hospital, including but not limited to informational road signs.
B)Â Â Â Â Â Â Â Signage
does not include materials for advertising, licensure, certification or patient
referral materials.
e)Â Â Â Â Â Â Â Â Violations.
The Department
will
investigate violations of
the Hospital
Emergency Service Act,
which may include a medical clinical review by a
physician, and
may
issue a minimum monetary penalty of $50,000 for
violating
the Hospital Emergency Service Act.
The Department may assess
a fine only if there are no fines assessed for the violation by the federal
government.Â
(Section 2.1 of the Hospital Emergency Service Act) The Department will
consider the following identifying factors in determining whether or not to
issue a fine:
1)Â Â Â Â Â Â Â Â The
applicant presented to the hospital requesting examination or treatment of
an
injury or acute medical condition liable to cause death or severe injury or
serious illness
(Section 1(b-1) of the Hospital Emergency Service Act)
and
was denied necessary stabilizing treatment;
2)Â Â Â Â Â Â Â Â The
applicant suffered harm that resulted from the failure to provide services as
required by Section 1(a) of the Hospital Emergency Service Act and subsection
(c)(1) of this Section;
3)Â Â Â Â Â Â Â Â The
applicant was transferred without documentation by the transferring physician
that the transfer was necessary and that the benefits of the treatment provided
by the receiving hospital would outweigh the risks of the transfer;
4)Â Â Â Â Â Â Â Â The
hospital's prior violations of the Hospital Emergency Service Act;
5)Â Â Â Â Â Â Â Â The
hospital's failure to take appropriate corrective action to remedy the
violation prior to the Department's investigation;
6)Â Â Â Â Â Â Â Â The
hospital's failure to properly train staff and employees regarding their duties
under this Section; and
7)Â Â Â Â Â Â Â Â Any misrepresentation
made by hospital staff to the applicant concerning the applicant's condition or
other information, including the hospital's obligations under the Hospital
Emergency Service Act.
f)Â Â Â Â Â Â Â Â Aggravating
Factors. In determining whether to issue a fine greater than $50,000, the
Department will consider aggravating factors, including, but not limited to:
1)Â Â Â Â Â Â Â Â The hospital's
violation caused serious or permanent physical, mental, or emotional harm;
2)Â Â Â Â Â Â Â Â The hospital's
violation proximately caused death;
3)Â Â Â Â Â Â Â Â The
hospital's prior violations of the Hospital Emergency Service Act;
4)Â Â Â Â Â Â Â Â The
hospital's failure to self-report a violation to the Department; or
5)Â Â Â Â Â Â Â Â The
hospital's request for proof of insurance, prior authorization, or a monetary
payment prior to appropriately screening or initiating stabilizing treatment
for an emergency medical condition, or requesting a monetary payment prior to
stabilizing an emergency medical condition.
g)Â Â Â Â Â Â Â Â The
presence of any single aggravating circumstance may justify imposing a larger penalty
even when one or more mitigating factors is present.