`
`United States Code Annotated
`Title 42. The Public Health and Welfare
`Chapter 7. Social Security (Refs & Annos)
`Subchapter XVIII. Health Insurance for Aged and Disabled (Refs & Annos)
`Part E. Miscellaneous Provisions (Refs & Annos)
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`42 U.S.C.A. § 1395dd
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`§ 1395dd. Examination and treatment for emergency medical conditions and women in labor
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`Effective: October 21, 2011
`Currentness
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`(a) Medical screening requirement
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`In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this
`subchapter) comes to the emergency department and a request is made on the individual's behalf for examination or treatment
`for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the
`hospital's emergency department, including ancillary services routinely available to the emergency department, to determine
`whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.
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`(b) Necessary stabilizing treatment for emergency medical conditions and labor
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`(1) In general
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`If any individual (whether or not eligible for benefits under this subchapter) comes to a hospital and the hospital determines
`that the individual has an emergency medical condition, the hospital must provide either--
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`(A) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may
`be required to stabilize the medical condition, or
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`(B) for transfer of the individual to another medical facility in accordance with subsection (c) of this section.
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`(2) Refusal to consent to treatment
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`A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the
`individual the further medical examination and treatment described in that paragraph and informs the individual (or a person
`acting on the individual's behalf) of the risks and benefits to the individual of such examination and treatment, but the
`individual (or a person acting on the individual's behalf) refuses to consent to the examination and treatment. The hospital
`shall take all reasonable steps to secure the individual's (or person's) written informed consent to refuse such examination
`and treatment.
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`(3) Refusal to consent to transfer
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`A hospital is deemed to meet the requirement of paragraph (1) with respect to an individual if the hospital offers to transfer
`the individual to another medical facility in accordance with subsection (c) of this section and informs the individual (or a
`person acting on the individual's behalf) of the risks and benefits to the individual of such transfer, but the individual (or
`a person acting on the individual's behalf) refuses to consent to the transfer. The hospital shall take all reasonable steps to
`secure the individual's (or person's) written informed consent to refuse such transfer.
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`(c) Restricting transfers until individual stabilized
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`(1) Rule
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`If an individual at a hospital has an emergency medical condition which has not been stabilized (within the meaning of
`subsection (e)(3)(B) of this section), the hospital may not transfer the individual unless--
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`(A)(i) the individual (or a legally responsible person acting on the individual's behalf) after being informed of the hospital's
`obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility,
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`(ii) a physician (within the meaning of section 1395x(r)(1) of this title) has signed a certification that 1 based upon the
`information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate
`medical treatment at another medical facility outweigh the increased risks to the individual and, in the case of labor, to
`the unborn child from effecting the transfer, or
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`(iii) if a physician is not physically present in the emergency department at the time an individual is transferred, a qualified
`medical person (as defined by the Secretary in regulations) has signed a certification described in clause (ii) after a physician
`(as defined in section 1395x(r)(1) of this title), in consultation with the person, has made the determination described in
`such clause, and subsequently countersigns the certification; and
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`(B) the transfer is an appropriate transfer (within the meaning of paragraph (2)) to that facility.
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`A certification described in clause (ii) or (iii) of subparagraph (A) shall include a summary of the risks and benefits upon
`which the certification is based.
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`(2) Appropriate transfer
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`An appropriate transfer to a medical facility is a transfer--
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`(A) in which the transferring hospital provides the medical treatment within its capacity which minimizes the risks to the
`individual's health and, in the case of a woman in labor, the health of the unborn child;
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`(B) in which the receiving facility--
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`(i) has available space and qualified personnel for the treatment of the individual, and
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`(ii) has agreed to accept transfer of the individual and to provide appropriate medical treatment;
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`(C) in which the transferring hospital sends to the receiving facility all medical records (or copies thereof), related to the
`emergency condition for which the individual has presented, available at the time of the transfer, including records related
`to the individual's emergency medical condition, observations of signs or symptoms, preliminary diagnosis, treatment
`provided, results of any tests and the informed written consent or certification (or copy thereof) provided under paragraph
`(1)(A), and the name and address of any on-call physician (described in subsection (d)(1)(C) of this section) who has
`refused or failed to appear within a reasonable time to provide necessary stabilizing treatment;
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`(D) in which the transfer is effected through qualified personnel and transportation equipment, as required including the
`use of necessary and medically appropriate life support measures during the transfer; and
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`(E) which meets such other requirements as the Secretary may find necessary in the interest of the health and safety of
`individuals transferred.
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`(d) Enforcement
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`(1) Civil money penalties
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`(A) A participating hospital that negligently violates a requirement of this section is subject to a civil money penalty of not
`more than $50,000 (or not more than $25,000 in the case of a hospital with less than 100 beds) for each such violation. The
`provisions of section 1320a-7a of this title (other than subsections (a) and (b)) shall apply to a civil money penalty under this
`subparagraph in the same manner as such provisions apply with respect to a penalty or proceeding under section 1320a-7a(a)
`of this title.
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`(B) Subject to subparagraph (C), any physician who is responsible for the examination, treatment, or transfer of an individual
`in a participating hospital, including a physician on-call for the care of such an individual, and who negligently violates a
`requirement of this section, including a physician who--
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`(i) signs a certification under subsection (c)(1)(A) of this section that the medical benefits reasonably to be expected from
`a transfer to another facility outweigh the risks associated with the transfer, if the physician knew or should have known
`that the benefits did not outweigh the risks, or
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`(ii) misrepresents an individual's condition or other information, including a hospital's obligations under this section,
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`is subject to a civil money penalty of not more than $50,000 for each such violation and, if the violation is gross and
`flagrant or is repeated, to exclusion from participation in this subchapter and State health care programs. The provisions
`of section 1320a-7a of this title (other than the first and second sentences of subsection (a) and subsection (b)) shall apply
`to a civil money penalty and exclusion under this subparagraph in the same manner as such provisions apply with respect
`to a penalty, exclusion, or proceeding under section 1320a-7a(a) of this title.
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`(C) If, after an initial examination, a physician determines that the individual requires the services of a physician listed by
`the hospital on its list of on-call physicians (required to be maintained under section 1395cc(a)(1)(I) of this title) and notifies
`the on-call physician and the on-call physician fails or refuses to appear within a reasonable period of time, and the physician
`orders the transfer of the individual because the physician determines that without the services of the on-call physician the
`benefits of transfer outweigh the risks of transfer, the physician authorizing the transfer shall not be subject to a penalty under
`subparagraph (B). However, the previous sentence shall not apply to the hospital or to the on-call physician who failed or
`refused to appear.
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`(2) Civil enforcement
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`(A) Personal harm
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`Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this
`section may, in a civil action against the participating hospital, obtain those damages available for personal injury under
`the law of the State in which the hospital is located, and such equitable relief as is appropriate.
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`(B) Financial loss to other medical facility
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`Any medical facility that suffers a financial loss as a direct result of a participating hospital's violation of a requirement
`of this section may, in a civil action against the participating hospital, obtain those damages available for financial loss,
`under the law of the State in which the hospital is located, and such equitable relief as is appropriate.
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`(C) Limitations on actions
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`No action may be brought under this paragraph more than two years after the date of the violation with respect to which
`the action is brought.
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`(3) Consultation with quality improvement organizations
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`In considering allegations of violations of the requirements of this section in imposing sanctions under paragraph (1) or in
`terminating a hospital's participation under this subchapter, the Secretary shall request the appropriate quality improvement
`organization (with a contract under part B of subchapter XI of this chapter) to assess whether the individual involved had
`an emergency medical condition which had not been stabilized, and provide a report on its findings. Except in the case in
`which a delay would jeopardize the health or safety of individuals, the Secretary shall request such a review before effecting
`a sanction under paragraph (1) and shall provide a period of at least 60 days for such review. Except in the case in which
`a delay would jeopardize the health or safety of individuals, the Secretary shall also request such a review before making a
`compliance determination as part of the process of terminating a hospital's participation under this subchapter for violations
`related to the appropriateness of a medical screening examination, stabilizing treatment, or an appropriate transfer as required
`by this section, and shall provide a period of 5 days for such review. The Secretary shall provide a copy of the organization's
`report to the hospital or physician consistent with confidentiality requirements imposed on the organization under such part
`B of subchapter XI of this chapter.
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`(4) Notice upon closing an investigation
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`The Secretary shall establish a procedure to notify hospitals and physicians when an investigation under this section is closed.
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`(e) Definitions
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`In this section:
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`(1) The term “emergency medical condition” means--
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`(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the
`absence of immediate medical attention could reasonably be expected to result in--
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`(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn
`child) in serious jeopardy,
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`(ii) serious impairment to bodily functions, or
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`(iii) serious dysfunction of any bodily organ or part; or
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`(B) with respect to a pregnant woman who is having contractions--
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`(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
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`(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.
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`(2) The term “participating hospital” means a hospital that has entered into a provider agreement under section 1395cc of
`this title.
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`(3)(A) The term “to stabilize” means, with respect to an emergency medical condition described in paragraph (1)(A), to
`provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that
`no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility,
`or, with respect to an emergency medical condition described in paragraph (1)(B), to deliver (including the placenta).
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`(B) The term “stabilized” means, with respect to an emergency medical condition described in paragraph (1)(A), that no
`material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the
`transfer of the individual from a facility, or, with respect to an emergency medical condition described in paragraph (1)(B),
`that the woman has delivered (including the placenta).
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`(4) The term “transfer” means the movement (including the discharge) of an individual outside a hospital's facilities at the
`direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include
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`such a movement of an individual who (A) has been declared dead, or (B) leaves the facility without the permission of any
`such person.
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`(5) The term “hospital” includes a critical access hospital (as defined in section 1395x(mm)(1) of this title).
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`(f) Preemption
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`The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement
`directly conflicts with a requirement of this section.
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`(g) Nondiscrimination
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`A participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive
`care units, or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse
`to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the
`capacity to treat the individual.
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`(h) No delay in examination or treatment
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`A participating hospital may not delay provision of an appropriate medical screening examination required under subsection
`(a) of this section or further medical examination and treatment required under subsection (b) of this section in order to inquire
`about the individual's method of payment or insurance status.
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`(i) Whistleblower protections
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`A participating hospital may not penalize or take adverse action against a qualified medical person described in subsection (c)
`(1)(A)(iii) of this section or a physician because the person or physician refuses to authorize the transfer of an individual with
`an emergency medical condition that has not been stabilized or against any hospital employee because the employee reports
`a violation of a requirement of this section.
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`CREDIT(S)
`(Aug. 14, 1935, c. 531, Title XVIII, § 1867, as added Apr. 7, 1986, Pub.L. 99-272, Title IX, § 9121(b), 100 Stat. 164; amended
`Oct. 21, 1986, Pub.L. 99-509, Title IX, § 9307(c)(4), 100 Stat. 1996; Oct. 22, 1986, Pub.L. 99-514, Title XVIII, § 1895(b)(4),
`100 Stat. 2933; Dec. 22, 1987, Pub.L. 100-203, Title IV, § 4009(a), 101 Stat. 1330-56, 1330-57; Dec. 22, 1987, Pub.L. 100-203,
`Title IV, § 4009(a)(1), formerly § 4009(a)(1), (2), 101 Stat. 1330-56, 1330-57; renumbered and amended July 1, 1988, Pub.L.
`100-360, Title IV, § 411(b)(8)(A)(i), 102 Stat. 771; Oct. 13, 1988, Pub.L. 100-485, Title VI, § 608(d)(18)(E), 102 Stat. 2419;
`Dec. 19, 1989, Pub.L. 101-239, Title VI, §§ 6003(g)(3)(D)(xiv), 6211(a) to (h), 103 Stat. 2154, 2245; Nov. 5, 1990, Pub.L.
`101-508, Title IV, §§ 4008(b)(1) to (3)(A), 4207(a)(1)(A), (2), (3), (k)(3), 104 Stat. 1388-44, 1388-117, 1388-124; renumbered
`and amended Oct. 31, 1994, Pub.L. 103-432, Title I, § 160(d)(4), (5)(A), 108 Stat. 4444; Aug. 5, 1997, Pub.L. 105-33, Title IV,
`§ 4201(c)(1), 111 Stat. 373; Dec. 8, 2003, Pub.L. 108-173, Title VII, § 736(a)(14), Title IX, § 944(b), (c)(1), 117 Stat. 2355,
`2423; Pub.L. 112-40, Title II, § 261(a)(3)(A), (E), Oct. 21, 2011, 125 Stat. 423.)
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`Notes of Decisions (504)
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` © 2015 Thomson Reuters. No claim to original U.S. Government Works.
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`Footnotes
`1
`So in original. Probably should be followed by a comma.
`42 U.S.C.A. § 1395dd, 42 USCA § 1395dd
`Current through P.L. 114-61 (excluding P.L. 114-52, 114-54, 114-59, and 114-60) approved 10-7-2015
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`End of Document
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`© 2015 Thomson Reuters. No claim to original U.S. Government Works.
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` © 2015 Thomson Reuters. No claim to original U.S. Government Works.
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