Critical Access Hospital On-Duty Coverage — 42 CFR § 485.631

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Answer the questions below. The result shows the rules that turn on your answers, the statutory text behind them, and the facts you still need to confirm yourself.

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A record-keeping aid built from what the law makes relevant.

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The text, verbatim

Everything above is derived from the text reproduced here. Read it before relying on any summary.

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What this page does not cover

• This tool reproduces the text of § 485.631. It does not reproduce CMS interpretive guidelines, State Operations Manual appendices, or surveyor guidance, and it does not predict how a surveyor would score any situation. Last verified 2026-09-17
• Federal Conditions of Participation and state law operate in parallel. Meeting § 485.631 does not excuse compliance with state nurse-staffing or overtime law, and vice versa. Last verified 2026-09-17
• This tool addresses § 485.631 only. It does not address the other CAH Conditions of Participation in Subpart F, bed-count or length-of-stay limits, EMTALA, or any state licensing rule. Last verified 2026-09-17

Other checks

• Screening and stabilising — the orderWhat has to happen when someone arrives at a Medicare hospital's emergency department, what may not happen first, and the one sentence in the section that protects an employee who reports it.
• The transfer itself — three routes, a list of papers, and a nameWhat has to be true before an unstabilized individual is moved: two conditions joined by "and", three routes each producing a different paper, four elements, and a list of records that runs on two clocks — ending with the name and address of a physician who did not come.
• The receiving hospital — what it may not refuse, and what it has to reportThe other end of the transfer: four limits inside one sentence, the definition of capacity that puts qualified staff inside the switch, the two paragraphs that cut against each other, and a reporting duty aimed at the hospital up the road.
• Overnight gap — disposition pathwaysA nurse has said no and someone still has to be there. Every option, and what each one rests on.
• The paper trail — what the hospital has to keep, post and reportThe central log, the on-call list and its policies, five years of records for transferred individuals, two postings, and the duty to report a transfer received in an unstable emergency medical condition.
• Observation status — what has to be said, by when, and who signsTwenty-four hours triggers it and thirty-six hours caps it. Two items the notice has to contain, an oral explanation with no person named, and two signature paths — one of which tells a staff member exactly what to write.
• Inpatient status — who countsTwo paragraphs turn on the word inpatient and neither defines it. The one that does defines it for payment.
• On-call and standby — six textsDefined once in Texas law, banned once as a substitute, and prescribed three times in the federal CAH rules — with a different answer each time.
• Nurse staffing plan — ch. 257The chapter before chapter 258: what a hospital must plan for, what the committee must look like, and the two numbers that must be given at the start of every shift.
• Retaliation — ch. 257 and ch. 258Two anti-retaliation sections that protect different acts, one enforcement bridge shared by both, and the single federal sentence that uses the word the other way.
• After the report — inspection, confidentiality, publicationWho may inspect a hospital and on what basis, whether anyone has to investigate, what stays confidential and from whom, and the two numbers the Texas section gives for publishing the outcome.
• Texas nurse mandatory overtimeCan a hospital require it? Ch. 258 definition, prohibition, four exceptions.
• Chapter 258 complaint — filing and what comes backWhat HHSC must put in the written decision notice, what stays confidential, and what the chapter never says.