AHA/ACEP, Others Urge CMS to Allow Hospitals to Post Anti-violence Signage in EDs

January 20, 2026

The Honorable Mehmet Oz, MD, MBA
Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Re: Clarifying Guidance on Emergency Department Signage and Workplace Violence

Dear Administrator Oz:

On behalf of the undersigned organizations representing emergency physicians, nurses, pharmacists, hospitals, health systems, and other frontline clinicians, we respectfully request that the Centers for Medicare & Medicaid Services (CMS) issue clear guidance enabling hospitals to post appropriate signage in emergency departments (EDs) to discourage threats and acts of violence against health care workers, consistent with the Emergency Medical Treatment and Labor Act (EMTALA).

Violence in the ED has escalated significantly in recent years. Emergency clinicians, nurses, and other staff routinely experience physical assaults, verbal abuse, and threats on an almost daily basis while delivering care. As a result, many are reaching their breaking point and leaving a health care workforce that is already stretched distressingly thin.

While many hospitals are investing in comprehensive workplace violence prevention programs to address these growing threats, the most basic element of prevention is often out of reach – that is, signage that sets expectations for respectful behavior and emphasizes that violence toward staff, patients, or visitors is unacceptable and could have consequences.

In prior correspondence with several of our organizations, CMS staff have noted that while CMS and the HHS Office of Inspector General discourage ED signage that could deter individuals from remaining for medical screening examinations and stabilizing treatment, hospitals may post additional signs if they can demonstrate that they would not be such a deterrent. But when pressed for clarity of what could, and could not, be considered a deterrent, CMS has thus far declined to provide further explanation and overarching guidance, and instead stated that potential EMTALA violations are considered on a case-by-case basis.

This essentially forces hospitals who want to protect vulnerable frontline staff to take a leap of faith in posting signage that is their “best guess” as compliant. Further confusing the issue, enforcement to date has been uneven, with hospitals reporting that surveyors sometimes question or cite even neutral workplace violence signs as potential EMTALA violations. The resulting uncertainty undermines and discourages hospitals’ efforts to protect staff while fully honoring EMTALA obligations.

To resolve this, we ask CMS to issue written guidance (for example, via a QSO memorandum or interpretive guidance update) providing clear guardrails for and examples of acceptable workplace violence signage that hospitals may display in EDs and other EMTALA-relevant areas.

We also urge CMS to communicate this clarification directly to state survey agencies and accrediting organizations, and to incorporate examples of acceptable workplace violence signage into surveyor training materials and FAQs. Doing so would promote consistency, reduce unnecessary citations, and support and encourage hospitals to maintain safe care environments.

Our organizations are fully committed to preserving unfettered access to emergency care for all patients and upholding the promise of EMTALA. At the same time, clinicians and staff must be protected from violence while they fulfill those obligations. Clear, practical guidance from CMS on permissible ED signage would be a meaningful step toward that goal.

We welcome the opportunity to work with you and your staff on sample signage language and educational materials for hospitals and surveyors. Please contact Laura Wooster, ACEP’s Associate Executive Director for Advocacy & Practice Affairs at <a href="mailto:lwooster@acep.org?subject=RE: AHA/ACEP, Others Urge CMS to Allow Hospitals to Post Anti-violence Signage in EDs letter">lwooster@acep.org</a>, or Priscilla Ross, AHA’s Senior Director, Federal Relations at <a href="mailto:pross@aha.org?subject=RE: AHA/ACEP, Others Urge CMS to Allow Hospitals to Post Anti-violence Signage in EDs letter">pross@aha.org</a> if you have any questions or would like to engage in further discussion on this important issue.

Sincerely,