(a) General.
  (1) The governing body of each facility shall adopt, implement, and enforce a policy relating to patient transfers that is consistent with this section and contains each of the requirements in subsection (b) of this section. The policies shall identify facility staff that has authority to represent the facility and the physician regarding transfers from the facility.
  (2) The governing body shall adopt the transfer policy after consultation with the medical staff, and the transfer policy shall apply to transfers to hospitals licensed under Texas Health and Safety Code Chapter 241 (relating to Hospitals) and Chapter 577 (relating to Private Mental Hospitals and Other Mental Health Facilities), as well as transfers to hospitals that are exempt from licensing.
  (3) The transfer policy shall govern transfers not covered by a transfer agreement.
  (4) The transfer policy shall include a written operational plan to provide for patient transfer transportation services if the facility does not provide its own patient transfer transportation services.
  (5) The governing body, after consultation with the medical staff, shall implement its transfer policy by adopting transfer agreements with hospitals in accordance with §509.66 of this subchapter (relating to Patient Transfer Agreements).
  (6) The transfer policy shall recognize and comply with the applicable requirements of Texas Health and Safety Code Chapter 61 (relating to Indigent Health Care and Treatment Act).
  (7) The transfer policy shall acknowledge contractual obligations and comply with statutory or regulatory obligations that may exist concerning a patient and a designated provider.
  (8) The transfer policy shall require that all reasonable steps are taken to secure the written informed consent of a patient, or a person acting on a patient's behalf, when refusing a transfer or related examination and treatment. Reasonable steps include:
    (A) a factual explanation of the increased medical risks to the patient reasonably expected from not being transferred, examined, or treated at the transferring hospital;
    (B) a factual explanation of any increased risks to the patient from not effecting the transfer; and
    (C) a factual explanation of the medical benefits reasonably expected from the provision of appropriate treatment at another hospital.
  (9) The informed refusal of a patient, or a person acting on a patient's behalf, to examination, evaluation, or transfer shall be documented and signed if possible by the patient or by a person acting on the patient's behalf, dated and witnessed by the attending physician or facility employee, and placed in the patient's medical record.
  (10) The transfer policy shall recognize the right of an individual to request a transfer into the care of a physician and a hospital of the individual's own choosing.
(b) Requirements for transfer of patients from facilities to hospitals.
  (1) The transfer policy shall provide that the transfer of a patient may not be predicated upon arbitrary, capricious, or unreasonable discrimination based upon race, religion, national origin, age, sex, physical condition, economic status, insurance status, or ability to pay.
  (2) The transfer policy shall recognize the right of an individual to request transfer into the care of a physician and hospital of the individual's own choosing; however, if a patient requests or consents to transfer for economic reasons and the patient's choice is predicated upon or influenced by representations made by the transferring physician or facility administration regarding the availability of medical care and hospital services at a reduced cost or no cost to the patient, physician or facility administration shall fully disclose to the patient the eligibility requirements established by the patient's chosen physician or hospital.
  (3) The transfer policy shall provide that each patient who arrives at the facility is:
    (A) evaluated by a physician at the time the patient presents; and
    (B) personally examined and evaluated by the physician before an attempt to transfer is made.
  (4) The policy of the transferring facility and receiving hospital shall provide that licensed nurses and other qualified personnel are available and on duty to assist with patient transfers. The policy shall provide that written protocols or standing delegation orders are in place to guide facility personnel when a patient requires transfer to another hospital.
  (5) Special requirements related to the transfer of patients who have emergency medical conditions:
    (A) If a patient at a facility has an emergency medical condition that has not been stabilized, or when stabilization of the patient's vital signs is not possible because the facility does not have the appropriate equipment or personnel to correct the underlying process, the facility shall evaluate and treat the patient and transfer the patient as quickly as possible.
    (B) The transfer policy shall provide that the facility may not transfer a patient with an emergency medical condition that has not been stabilized unless:
      (i) the individual or the individual's legally authorized representative, after being informed of the facility's obligations under this section and the risk of transfer, requests the transfer, in writing, and indicates the reasons for the request, as well as that he or she is aware of the risks and benefits of the transfer; or
      (ii) a physician has signed a certification, which includes a summary of the risks and benefits, that, based on the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at a hospital outweigh the increased risks to the patient and, in the case of labor, to the unborn child from effecting the transfer.
    (C) Except as is specifically provided in subsection (a)(6) and (7) of this section, the transfer policy shall provide that the transfer of patients who have emergency medical conditions, as determined by a physician, shall be undertaken for medical reasons only. The facility must provide medical treatment within its capacity that minimizes the risks to the individual's health and, in the case of a woman in labor, the health of the unborn child.
  (6) The transfer policy shall provide for the following physician's duties and standard of care requirements.
    (A) The transferring physician shall determine and order life support measures that are medically appropriate to stabilize the patient before transfer and to sustain the patient during transfer.
    (B) The transferring physician shall determine and order the utilization of appropriate personnel and equipment for the transfer.
    (C) In determining the use of medically appropriate life support measures, personnel, and equipment, the transferring physician shall exercise that degree of care that a reasonable and prudent physician exercising ordinary care in the same or similar locality would use for the transfer.
    (D) Except as allowed under paragraph (5)(B) of this subsection, before each patient transfer, the physician who authorizes the transfer shall personally examine and evaluate the patient to determine the patient's medical needs and to ensure that the proper transfer procedures are used.
    (E) Before transfer, the transferring physician shall ensure that a receiving hospital and physician that are appropriate to the medical needs of the patient have accepted responsibility for the patient's medical treatment and hospital care.
  (7) The facility's medical staff shall review appropriate records of patients transferred from the facility to determine that the appropriate standard of care has been met.
  (8) A facility shall comply with the following medical record requirements.
    (A) The facility's policy shall require that a copy of those portions of the patient's medical record that are available and relevant to the transfer and to the continuing care of the patient be forwarded to the receiving physician and receiving hospital with the patient. If all necessary medical records for the continued care of the patient are not available at the time the patient is transferred, the records shall be forwarded to the receiving physician and hospital as soon as possible.
    (B) The medical record shall contain at least:
      (i) a brief description of the patient's medical history and physical examination;
      (ii) a working diagnosis and recorded observations of physical assessment of the patient's condition at the time of transfer;
      (iii) the reason for the transfer;
      (iv) the results of all diagnostic tests, such as laboratory tests;
      (v) pertinent radiological films and reports; and
Cont'd...
(vi) any other pertinent information.
  (9) A facility shall comply with the following memorandum of transfer requirements.
    (A) The facility's policy shall require that a memorandum of transfer be completed for every patient who is transferred.
    (B) The memorandum shall contain the:
      (i) patient's full name, if known;
      (ii) patient's race, religion, national origin, age, sex, physical handicap, if known;
      (iii) patient's address and next of kin, address, and phone number, if known;
      (iv) names, telephone numbers, and addresses of the transferring and receiving physicians;
      (v) names, addresses, and telephone numbers of the transferring facility and receiving hospital;
      (vi) time and date on which the patient first presented or was presented to the transferring physician and transferring facility;
      (vii) time and date on which the transferring physician secured a receiving physician;
      (viii) name, date, and time hospital administration was contacted in the receiving hospital;
      (ix) signature, time, and title of the transferring facility administration who contacted the receiving hospital;
      (x) certification required by paragraph (5)(B)(ii) of this subsection, if applicable (the certification may be part of the memorandum of transfer form or may be on a separate form attached to the memorandum of transfer form);
      (xi) time and date on which the receiving physician assumed responsibility for the patient;
      (xii) time and date on which the patient arrived at the receiving hospital;
      (xiii) signature and date of receiving hospital administration;
      (xiv) type of vehicle and company used to transport the patient;
      (xv) type of equipment and personnel needed in the transfer;
      (xvi) name and city of hospital to which patient was transported;
      (xvii) diagnosis by transferring physician; and
      (xviii) attachments by transferring facility.
    (C) A copy of the memorandum of transfer shall be retained by the transferring facility. The memorandum shall be filed separately from the patient's medical record and in a manner that will facilitate its inspection by HHSC. All memorandum of transfer forms filed separately shall be retained for at least five years.
(c) Violations. A facility violates the Act and this section if:
  (1) the facility fails to comply with the requirements of this section; or
  (2) the governing body fails or refuses to:
    (A) adopt a transfer policy that is consistent with this section and contains each of the requirements in subsection (b) of this section;
    (B) adopt a memorandum of transfer form that meets the minimum requirements for content contained in this section; or
    (C) enforce its transfer policy and the use of the memorandum of transfer.

Source Note: The provisions of this §509.65 adopted to be effective December 4, 2023, 48 TexReg 7064