| (a) Definitions.
(1) For purposes of this section, a transferring facility
is a private psychiatric hospital licensed under Health and Safety
Code (HSC), Chapter 577.
(2) For purposes of this section, a receiving facility
is one of the following:
(A) a private psychiatric hospital licensed under HSC,
Chapter 577;
(B) a general or special hospital licensed under HSC,
Chapter 241;
(C) a hospital operated by the Texas Department of
Mental Health and Mental Retardation;
(D) a hospital operated by a federal agency; or
(E) a chemical dependency treatment facility licensed
under HSC, Chapter 464.
(3) For purposes of this section, patient is defined
as an individual:
(A) seeking treatment who may or may not be under the
immediate supervision of a personal attending physician, and who,
within reasonable medical probability, requires immediate or continuing
services and medical care; or
(B) admitted as a patient.
(b) Applicability.
(1) If a transferring facility or a receiving facility
is licensed under HSC, Chapter 577, it must comply with all requirements
of this section.
(2) Receiving facilities, other than those licensed
under HSC, Chapter 577, are not governed by these rules.
(c) General.
(1) The governing body of each transferring facility
shall adopt, implement, and enforce a policy relating to patient transfers
that is consistent with this section and contains each of the requirements
in subsection (d) of this section. Facility administration has the
authority to represent a facility during the transfer from or receipt
of patients into the facility.
(2) The transfer policy shall be adopted by the governing
body of the facility after consultation with the medical staff.
(3) The policy shall govern transfers not covered by
a transfer agreement in accordance with §134.61 of this title
(relating to Patient Transfer Agreements).
(4) The movement of a stable patient from a transferring
facility to a receiving facility is not considered to be a transfer
under this section if it is the understanding and intent of both facilities
that the patient is going to the receiving facility only for tests,
the patient will not remain overnight at the receiving facility, and
the patient will return to the transferring facility. This paragraph
applies only when a patient remains stable during transport to and
from the facilities and during testing.
(5) The policy shall include a written operational
plan to provide for patient transfer transportation services if the
transferring facility does not provide its own patient transfer transportation
services.
(6) Each governing body, after consultation with the
medical staff, may implement its transfer policy by adopting transfer
agreements with other receiving facilities in accordance with §134.61
of this title.
(d) Requirements for transfer of patients between facilities.
(1) Discrimination. Except as is specifically provided
in paragraphs (5)(E) and (F) and (6)(A) and (B) of this subsection,
relating, respectively, to mandated providers and designated providers,
the policy shall provide that the transfer of a patient may not be
predicated upon arbitrary, capricious, or unreasonable discrimination
based upon race, religion, national origin, age, sex, physical condition,
or economic status.
(2) Disclosure. The policy shall recognize the right
of an individual to request transfer into the care of a physician
and a receiving facility of his own choosing; however, if a patient
is transferred for economic reasons and the patient's choice is predicated
upon or influenced by representations made by the transferring physician
or transferring facility administration regarding the availability
of medical care and services at a reduced cost or no cost to the patient,
the physician or facility administration shall fully disclose to the
patient the eligibility requirements established by the patient's
chosen physician or receiving facility.
(3) Patient evaluation. The policy shall provide that
each patient who arrives at a transferring facility is evaluated in
accordance with the Texas Department of Mental Health and Mental Retardation
§411.468 of this title (relating to Responding to an Emergency
Medical Condition of a Patient, Prospective Patient, or Individual
who Arrives on Hospital Property Requesting Examination or Treatment).
(A) After receiving a report on the patient's condition
from the nursing staff by telephone or radio, if the physician on
call determines that an immediate transfer of the patient is medically
appropriate and that the time required to conduct a personal examination
and evaluation of a patient will unnecessarily delay the transfer
to the detriment of the patient, the physician on call may order the
transfer by telephone or radio.
(B) Physician orders for the transfer of a patient
which are issued by telephone or radio shall be reduced to writing
in the patient's medical record, signed by the staff member receiving
the order, and countersigned by the physician authorizing the transfer
as soon as possible. The patient transfers resulting from physician
orders issued by telephone or radio shall be subject to automatic
review by the medical staff pursuant to paragraph (8) of this subsection.
(4) Facility personnel, written protocols, standing
delegation orders, eligibility and payment information. The policy
of the transferring facility and receiving facility shall provide
that licensed nurses and other qualified personnel are available and
on duty to assist with patient transfers and to provide accurate information
regarding eligibility and payment practices. The policy shall provide
that written protocols or standing delegation orders are in place
to guide personnel when a patient requires transfer.
(5) Transfer of patients who have emergency medical
conditions.
(A) If a patient has an emergency medical condition
which has not been stabilized or when stabilization of the patient's
vital signs is not possible because the transferring facility does
not have the appropriate equipment or personnel to correct the underlying
process, evaluation and treatment shall be performed and transfer
shall be carried out as quickly as possible.
(B) The policy shall provide that the transferring
facility may not transfer a patient with an emergency medical condition
which has not been stabilized unless:
(i) the patient or a legally responsible person acting
on the patient's behalf, after being informed of the transferring
facility's obligations under this section and of the risks and benefits
of transfer, requests transfer in writing;
(ii) a physician has signed a certification, which
includes a summary of the risks and benefits, that, based on the information
available at the time of transfer, the medical benefits reasonably
expected from the provision of appropriate medical treatment at a
receiving facility outweigh the increased risks to the patient and,
in the case of labor, to the unborn child from effecting the transfer;
or
(iii) if the physician who made the determination to
transfer a patient with an emergency condition is not physically
present at the time of transfer, a qualified medical person, as designated
by facility policy, may sign a certification described in clause (ii)
of this subparagraph after consultation with the physician. The physician
shall countersign the physician certification within a reasonable
period of time.
(C) Except as provided by subparagraphs (E) and (F)
of this paragraph and paragraph (6)(A) and (B) of this subsection,
the policy shall provide that the transfer of patients who have emergency
medical conditions, as determined by a physician, shall be undertaken
for medical reasons only.
(D) Except as expressly permitted in clauses (i) and
(ii) of this subparagraph, the policy shall provide for the receipt
of patients who have an emergency medical condition so that upon
notification of and prior to a transfer, the receiving facility shall,
after determining whether or not space, personnel and services necessary
to provide appropriate care for the patient are available, respond
to the transferring facility, within 30 minutes, either accepting
or refusing the transfer. The 30-minute time period begins at the
time a member of the staff of the receiving facility receives the
call initiating the request to transfer.
(i) The policy may permit response within a period
of time in excess of 30 minutes but no longer than one hour if there
are extenuating circumstances for the delay. If the transfer is accepted,
the reason for the delay shall be documented on the memorandum of
transfer.
Cont'd... |
