Critical Access Hospital (CAH) Emergency Services and Telemedicine: Implications for Emergency Services Condition of Participation
(CoPs) and Emergency Medical Treatment and Labor Act (EMTALA) On-Call Compliance
• The Center for Medicare & Medicaid Services (CMS) Welcomes use of Telemedicine by CAHs: Telemedicine has great potential
to expand availability of specialty care services, including emergency medicine services, to rural populations. However,
misconceptions about CAH CoP and EMTALA requirements may cause unnecessary concerns about, or create barriers to, using telemedicine.
• The CAH Emergency Services CoP does not Require a Physician to Appear On-site Whenever an Individual Comes to the Emergency
• Under 42 CFR 485.618(d), a doctor of medicine (MD), a doctor of osteopathy (DO), a physician assistant (PA), a nurse practitioner
(NP), or a clinical nurse specialist (CNS), with training or experience in emergency care, must be immediately available by
telephone or radio, and available on-site within 30 minutes (60 minutes for CAHs in frontier areas that meet certain conditions).
Under the CAH CoPs an MD or DO is not required to be available in addition to a non-physician practitioner.
• Under the CoP at §485.618(e), an MD or DO must be immediately available by telephone or radio contact on a 24-hours a day
basis to receive emergency calls, provide information on treatment of emergency patients, and refer patients. This requirement
can be met by the use of a telemedicine MD/DO as well as by an MD/DO who practices on-site at the CAH.
• EMTALA is Not a Barrier to Using Telemedicine to Extend CAH Emergency Services:
• If using telemedicine for emergency and other services, a CAH is not required to include the telemedicine physicians on
its physician on-call list mandated under the EMTALA regulations at 42 CFR 489.20(r)(2) and §489.24(j), nor would it be advisable
for a CAH to do so.
• The CAH is required under EMTALA to have an on-call list reasonably related to the services it offers, composed of physician(s)
who practice on-site at the CAH. This does not mean that physicians who practice on site must be on-call and available to
appear in person at all times. Nor does it mean that an on-call physician must be called to appear on-site in every case
involving an emergency medical condition.