Tag A-2411/C-2411
§489.24(f) Recipient Hospital Responsibilities      

 
A participating hospital that has specialized capabilities or facilities (including, but not limited to, facilities such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to 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 receiving hospital has the capacity to treat the individual. This requirement applies to any participating hospital with specialized capabilities, regardless of whether the hospital has a dedicated emergency department.
Interpretive Guidelines: §489.24(e)

A participating hospital that has specialized capabilities or facilities may not refuse to accept from a referring hospital an appropriate transfer of an individual who requires such specialized capabilities or facilities. This assumes that, in addition to its specialized capabilities the recipient hospital has the capacity to treat the individual, and that the transferring hospital lacks that capability or capacity. This requirement applies to any participating hospital with specialized capabilities, regardless of whether the hospital has a dedicated emergency department. See Tag A-2409/C-2409 for discussion of an appropriate transfer.

A hospital with specialized capabilities or facilities includes, but is not limited to, facilities such as burn units, shock-trauma units, or neonatal intensive care units. With respect to rural areas, this includes regional referral centers that meet the requirements of referral centers found at 42 CFR 412.96.

A hospital with specialized capabilities or facilities that has the necessary capacity to treat an individual with an emergency medical condition may not condition, or attempt to condition, its acceptance of an appropriate transfer of an individual on the use by the sending hospital of a particular transport services instead of the transport arrangements made by the attending physician at the sending hospital.

A hospital with specialized capabilities that delays the treatment of an individual who arrives as a transfer from another facility could be in violation of EMTALA, depending on the circumstances. Hospitals that deliberately delay moving an individual from an EMS stretcher do not thereby delay the point in time at which their EMTALA obligation begins. Furthermore, such a practice of “parking” patients arriving via EMS, refusing to release EMS equipment or personnel, jeopardizes patient health and adversely impacts the ability of the EMS personnel to provide emergency response services to the rest of the community. On the other hand, this does not mean that a hospital will necessarily have violated EMTALA and/or the hospital CoPs if it does not, in every instance, immediately assume from the EMS provider all responsibility for the individual, regardless of any other circumstances in the hospital.   

Lateral transfers, that is, transfers between facilities of comparable resources, are not mandated by §489.24(e), because the benefits of such transfer would not be likely to outweigh the risks, except where the sending hospital has a serious capacity problem, a  mechanical failure of equipment, or similar situations.

The number of patients that may be occupying a specialized unit, the number of staff on duty, or the amount of equipment on the hospital’s premises do not in and of themselves reflect the capacity of the sending or recipient hospital to care for additional patients. If a hospital generally has accommodated additional patients by whatever means (e.g., moving patients to other units, calling in additional staff, borrowing equipment from other facilities), it has demonstrated the ability to provide services to patients in excess of its occupancy limit. For example, a hospital may be able to care for one or more severe burn patient without opening up a “burn unit.” In this example, if the recipient hospital has the capacity, the hospital would have a duty to accept an appropriate transfer of an individual requiring the hospital’s capabilities, providing the sending hospital lacked the specialized services to treat the individual. The provisions of this requirement are applicable only when the sending hospital is located within the boundaries of the United States. Medicare participating hospitals with specialized capabilities or facilities are not obligated to accept transfers from hospitals located outside of the boundaries of the United States.

When investigating an allegation that a hospital has violated the EMTALA recipient hospital responsibility requirements, it is usually necessary to also obtain a copy of the patient’s medical record from the transferring facility.

Rural Regional Referral Centers

The criteria for classifying hospitals as rural regional referral centers are defined in 42 CFR §412.96 for the purpose of exemptions and adjustments of payment amounts under the Prospective Payment System. The criteria in 42 CFR §4 12.96 are applicable to the nondiscrimination provisions of §489.24. Check with the appropriate CMS RO for information as to whether the hospital is designated as a rural regional referral center. A designated rural regional referral center is obligated to accept appropriate transfers of individuals who require the hospital’s specialized capabilities if the hospital has the capacity to treat the individual.

If a hospital generally has accommodated additional patients by whatever means (e.g., moving patients to other units, calling in additional staff, borrowing equipment from other facilities), it has demonstrated the ability to provide services to patients in excess of its occupancy limit. For example, a hospital may be able to care for one or more severe burn patient without opening up a “burn unit.” In this example, if the recipient hospital has the capacity, the hospital would have a duty to accept an appropriate transfer of an individual requiring the hospital’s capabilities, providing the sending hospital lacked the specialized services to treat the individual. The provisions of this requirement are applicable only when the sending hospital is located within the boundaries of the United States. Medicare participating hospitals with specialized capabilities or facilities are not obligated to accept transfers from hospitals located outside of the boundaries of the United States.

When investigating an allegation that a hospital has violated the EMTALA recipient hospital responsibility requirements, it is usually necessary to also obtain a copy of the patient’s medical record from the transferring facility.

Rural Regional Referral Centers

The criteria for classifying hospitals as rural regional referral centers are defined in 42 CFR §412.96 for the purpose of exemptions and adjustments of payment amounts
under the Prospective Payment System. The criteria in 42 CFR §4 12.96 are applicable to the nondiscrimination provisions of §489.24. Check with the appropriate CMS RO for information as to whether the hospital is designated as a rural regional referral center. A designated rural regional referral center is obligated to accept appropriate transfers of individuals who require the hospital’s specialized capabilities if the hospital has the capacity to treat the individual.

Tags: accept, duty, EMTALA, transfers