Hospital Requirements

9115 – Hospital Requirements (Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16) Congress enacted the above provisions to prevent hospitals from refusing to treat individuals requiring emergency care or inappropriately transferring or discharging individuals with unstabilized emergency conditions. Refer to §9110 for the full definition of an emergency medical condition. Section 1866 of the Act contains requirements related to §1867. The related provisions require hospitals and rural primary care hospitals to: • Ensure compliance with and meet the requirements of §1867; • Maintain medical and other records related to individuals transferred to or from the hospital for five (5) years from the date of transfer; • Maintain a list of physicians who are on call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency condition; and • Post in the emergency department (ED) a conspicuous sign(s) informing individuals of their rights under §1867 to examination, treatment, and appropriate transfer, as necessary, for emergency medical conditions and women in labor, regardless of ability to pay. Section 1867 of the Act, as interpreted at 42 CFR 489.24(b), requires participating hospitals with emergency departments, as defined in the regulations, to provide an appropriate medical screening examination within the capacity of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to anyone (whether or not eligible for Medicare benefits and regardless of ability to pay) who comes by him/herself or with another person to the hospital (including the parking lot, ambulance owned or operated by the hospital regardless of location, and other units in the hospital) to determine whether or not he/she has an emergency medical condition. Unless the individual or a person acting on the individual’s behalf refuses treatment or transfer after being advised by the hospital of the risks and benefits involved, the hospital must provide to an individual who is determined to have an emergency medical condition either: • Further medical examination and treatment to stabilize the condition, including delivery of the child and placenta, if relevant; or • Appropriate transfer of the unstabilized individual or woman in labor to another medical facility after a physician has certified that such transfer is in the individual’s best medical interest or after request by the individual or person acting on his/her behalf. Patients who are not stable must either be treated until stabilized or transferred in accordance with the transfer requirements. The transfer requirements apply only to unstabilized patients. Appropriate transfers must be effected through qualified persons and transportation equipment (if medically necessary) to a receiving hospital that has available space and qualified personnel to treat the individual and that has agreed to accept the individual. The medical record must accompany the individual. In addition, a participating hospital that has specialized capabilities or facilities, including (but not limited to) burn units, shock-trauma units, neonatal intensive care units, or, in rural areas, regional referral centers may not refuse to accept from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual. This is the case regardless of whether the hospital with specialized capabilities has an emergency department or not. This law applies regardless of whether or not a hospital will receive payment for services rendered. Participating hospitals may not delay the provision of an appropriate medical screening examination or further medical examination and treatment to inquire about the individual’s method of payment or insurance status. In addition, a participating hospital may not penalize or take adverse action against a physician because the physician refuses to authorize the transfer of an individual with an emergency condition that has not been stabilized.