CMS posted Survey & Certification Letter 06-21 on July 13.  The official summary reads as follows:

CMS has received reports from hospital emergency departments concerning patients being left on stretchers for extended periods of time with emergency medical service personnel in attendance, possibly in violation of the Emergency Medical Treatment and Labor Act. CMS recognizes the enormous strain and crowding many hospital emergency departments face every day; however, this practice is not a solution. "Parking" patients in hospitals impacts the ability of the emergency medical service personnel to provide emergency services to the rest of the community.

State survey agencies are required to disseminate this letter to the provider community by August 12.  This policy had been announced previously by CMS Region IV (Atlanta office) in December 2005 and by Region VI (Dallas) back in 2002.

There are many factors contributing to ED crowding, e.g., hospital closures, aging of the population, health insurance issues, diversion of ambulances as other EDs close to incoming ambulance traffic.  These factors are not likely to improve on their own in the near future, and will be exacerbated by seasonal and other issues as well (e.g., flu).  Due to the nature of the root causes of the problem, hospitals alone should not be held accountable for the solution.  In the near term, however, CMS is requiring that hosiptals and their ED staffs refrain from making this an ambulance service problem.