In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services. They are required to provide an appropriate medical screening examination (MSE), within the capacity of the hospitals emergency department (ED), including ancillary services routinely available to the ED. These services must be provided to anyone making a request for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for those patients determined to have an EMC. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.

When requested by Centers for Medicare & Medicaid Services (CMS), CIMRO of Nebraska is required to assess whether an individual received an appropriate MSE, whether an EMC existed and, if so, whether appropriate stabilizing treatment was provided.