(a) General provisions.
  (1) Transfer agreements between hospitals are voluntary.
  (2) Transfer agreements must comply with the transfer policies required under §133.44 of this title (relating to Hospital Patient Transfer Policy).
  (3) The transfer agreement shall be submitted to the Department of State Health Services (department) for review to determine if the agreement meets the requirements of subsection (b) of this section.
  (4) Multiple transfer agreements may be entered into by a hospital based upon the type or level of medical services available at other hospitals.
(b) Minimum requirements for hospital patient transfer agreements. Patient transfer agreements must include specific language consistent with the following requirements:
  (1) §133.44(c)(1) of this title (relating to prohibiting discrimination);
  (2) §133.44(c)(6)(A) - (B) of this title (relating to the transfer of patients with emergency medical conditions);
  (3) §133.44(b)(8) of this title (relating to compliance with the Indigent Health Care and Treatment Act);
  (4) §133.44(b)(11) of this title (relating to the patient's right to request transfer);
  (5) §133.44(c)(7) of this title (relating to the physician's duties and standard of care); and
  (6) §133.44(c)(9) and (10) of this title (relating to medical record and memorandum of transfer).
(c) Review of transfer agreements.
  (1) In order that the department may review the transfer agreements for compliance with the minimum requirements, each party to the transfer agreement shall jointly submit the following documents to the department:
    (A) a copy of the current or proposed agreement signed by each hospital's representative;
    (B) the date of the adoption of the agreement; and
    (C) the effective date of the agreement.
  (2) The department may waive the submittal of the documents required under paragraph (1) of this subsection to avoid the repetitious submission of required documentation and approved agreements.
  (3) If a governing body or a governing body's designee executes a transfer agreement and the entire text of that agreement consists of the entire text of an agreement that has been previously approved by the department, the governing body or the governing body's designee is not required to submit the later agreement for review. On the date the later agreement is fully executed and before the later agreement is implemented, the governing body or the governing body's designee must give adequate notice to the department that the later agreement has been executed.
  (4) The department shall review the agreement within 30 calendar days after the department's receipt of the agreement to determine if the agreement is consistent with the requirements of this section.
  (5) After the department's review of the agreement, if the department determines that the agreement is consistent with the requirements contained in this section, the department shall notify the hospital administration that the agreement has been approved.
  (6) If the department determines that the agreement is not consistent with the requirements contained in this section, the department shall give notice to the hospital administration that the agreement is deficient and provide recommendations for correction.
  (7) A transfer agreement will be considered in compliance if it is consistent with the rules that were in effect at the time the transfer agreement was executed and approved by the department.
(d) Appeals.
  (1) If the department rejects a patient transfer agreement, the hospitals that are parties to the agreement may jointly request reconsideration of the department's decision.
  (2) A hospital that is party to a rejected agreement shall appeal the rejection jointly with an appeal by other appealing parties or waive that hospital's opportunity to appeal.
  (3) To initiate the appeal process, the party hospitals shall notify the department, in writing, that each party hospital requests formal reconsideration of the department's decision.
  (4) The request must be received by the department within 20 calendar days from the receipt of the department's rejection notice by the hospital that submitted the proposed agreement for review and approval.
  (5) Failure of the party hospitals to provide a written request for appeal shall be deemed a waiver of the opportunity for an internal reconsideration by the department, and the rejection shall become final.
  (6) An internal review of a rejection shall consist of a review of the actions taken to-date concerning the rejection of the agreement.
  (7) The review shall be conducted by a three member panel. The members shall be appointed by the commissioner of state health services. The panel members shall not have participated in the department's decision.
    (A) The panel shall meet as necessary.
    (B) The panel shall review all agreement submissions for which an appeal has been requested.
    (C) The review shall be based primarily on the documentation provided with the request for an appeal, but the party requesting the appeal may appear before the panel, if they desire.
    (D) The panel's decision is binding on the department and the hospital(s).
(e) Amendments to an agreement.
  (1) The governing body of a hospital or governing body's designee may adopt proposed amendments to a transfer agreement which has been approved by the department. However, before the amendments are implemented, the governing body or the governing body's designee shall submit the proposed amendments to the department for review in the same manner as the agreement to be amended was submitted.
  (2) The department shall review the amendments and shall approve or reject them in the same manner as provided for the review of the agreement to be amended.
(f) Complaints. Complaints alleging a violation of a transfer agreement shall be treated in the same manner as complaints alleging violations of the Act or this chapter.

Source Note: The provisions of this §133.61 adopted to be effective June 21, 2007, 32 TexReg 3587