The Receiving Hospital — What It May Not Refuse, And What It Has To Report

Check your situation

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.

What to document

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

If you need to escalate

The text, verbatim

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

What this page does not cover

• Sec. 489.24(f) switches the duty on where the receiving hospital has the capacity to treat the individual, and Sec. 489.24(b) defines capacity to include numbers and availability of qualified staff. Neither paragraph says who measures that, at what point in the request it is measured, or what record the measurement leaves. This page names no test. Last verified
• Sec. 489.24(f) gives four examples and says 'including, but not limited to'. The paragraph provides no test for whether a capability a hospital holds is the one the individual requires, and it does not say who compares the two. Last verified
• Sec. 489.24(g) makes failure to meet paragraph (a) through (f) a ground on which CMS may terminate the provider agreement. It is written as a discretion and it attaches to failure to meet the paragraphs, not to any one refusal. Nothing in (f) or (g) states a consequence for a single refusal, and this page names none. Last verified
• Sec. 489.24(f) prohibits refusing and gives no period within which a request has to be answered. Sec. 489.24(e)(2)(ii)(B) requires the receiving facility to have agreed to accept but does not say how long it may take to agree. This page names no number. Last verified
• Sec. 489.20(m) requires a report 'any time' the hospital has reason to believe it may have received an individual transferred in violation of Sec. 489.24(e). No deadline, no form, and no statement of what happens after the report is made. The paragraph does not say whether the hospital must investigate before reporting or may report on suspicion alone. Last verified
• Sec. 489.24(f) reaches 'hospitals meeting the requirements of referral centers found at Sec. 412.96'. Sec. 412.96 says CMS classifies a hospital as a referral center, and Sec. 412.96(g) lets a hospital cancel that status at any time, effective no later than 30 days after the request. No provision states whether a cancellation changes the scope of (f), or whether meeting the requirements without holding the classification is enough. This page states the gap and does not close it. Last verified

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.
• CAH on-duty coverage — 42 CFR 485.631Who has to be available, and who has to be on duty, and when each clock runs.
• 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.