Question: Off-campus, hospital-based urgent care clinics are popping up like mushrooms all over the place.  Does the Emergency Medical Treatment and Active Labor Act (“EMTALA”) apply to them?

Answer: The first question is whether the off-campus urgent care center (“UCC”) is considered to be a part of the hospital under either the designation “provider-based” or “department of the hospital.”  The key determinant for this:  whether the UCC bills under the hospital’s CCN, previously known as a “provider number.”  If no, EMTALA does not apply to the UCC.  If yes, the key question is whether the UCC is considered to be a “dedicated emergency department” (“DED”) under EMTALA.  If the UCC is a DED, then all of EMTALA’s responsibilities that apply to any DED, like a hospital’s Emergency Department, apply to the UCC.  If the UCC is not a DED, EMTALA does not apply.

There are three ways in which the UCC can be determined to be a DED:  (1) it is licensed by the state as an emergency room or emergency department; (2) it is held out to the public as a place that provides care for emergency medical conditions through unscheduled appointments; or (3) a sampling of cases during the previous calendar year shows that at least one-third of all the UCC’s patient visits were for the treatment of emergency medical conditions without requiring a previously scheduled appointment.

The first criterion is pretty straightforward; the other two require a more sophisticated analysis.  All things considered, you probably don’t want your UCC to be a DED.  EMTALA doesn’t allow for copays with registration, for example.  (But no, you don’t need an on-call list or schedule for a UCC.)