(a) Definitions.
  (1) For purposes of this section, a transferring facility is a private psychiatric hospital licensed under Health and Safety Code (HSC), Chapter 577.
  (2) For purposes of this section, a receiving facility is one of the following:
    (A) a private psychiatric hospital licensed under HSC, Chapter 577;
    (B) a general or special hospital licensed under HSC, Chapter 241;
    (C) a hospital operated by the Texas Department of Mental Health and Mental Retardation;
    (D) a hospital operated by a federal agency; or
    (E) a chemical dependency treatment facility licensed under HSC, Chapter 464.
  (3) For purposes of this section, patient is defined as an individual:
    (A) seeking treatment who may or may not be under the immediate supervision of a personal attending physician, and who, within reasonable medical probability, requires immediate or continuing services and medical care; or
    (B) admitted as a patient.
(b) Applicability.
  (1) If a transferring facility or a receiving facility is licensed under HSC, Chapter 577, it must comply with all requirements of this section.
  (2) Receiving facilities, other than those licensed under HSC, Chapter 577, are not governed by these rules.
(c) General.
  (1) The governing body of each transferring 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 (d) of this section. Facility administration has the authority to represent a facility during the transfer from or receipt of patients into the facility.
  (2) The transfer policy shall be adopted by the governing body of the facility after consultation with the medical staff.
  (3) The policy shall govern transfers not covered by a transfer agreement in accordance with §134.61 of this title (relating to Patient Transfer Agreements).
  (4) The movement of a stable patient from a transferring facility to a receiving facility is not considered to be a transfer under this section if it is the understanding and intent of both facilities that the patient is going to the receiving facility only for tests, the patient will not remain overnight at the receiving facility, and the patient will return to the transferring facility. This paragraph applies only when a patient remains stable during transport to and from the facilities and during testing.
  (5) The policy shall include a written operational plan to provide for patient transfer transportation services if the transferring facility does not provide its own patient transfer transportation services.
  (6) Each governing body, after consultation with the medical staff, may implement its transfer policy by adopting transfer agreements with other receiving facilities in accordance with §134.61 of this title.
(d) Requirements for transfer of patients between facilities.
  (1) Discrimination. Except as is specifically provided in paragraphs (5)(E) and (F) and (6)(A) and (B) of this subsection, relating, respectively, to mandated providers and designated providers, the 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, or economic status.
  (2) Disclosure. The policy shall recognize the right of an individual to request transfer into the care of a physician and a receiving facility of his own choosing; however, if a patient is transferred for economic reasons and the patient's choice is predicated upon or influenced by representations made by the transferring physician or transferring facility administration regarding the availability of medical care and services at a reduced cost or no cost to the patient, the physician or facility administration shall fully disclose to the patient the eligibility requirements established by the patient's chosen physician or receiving facility.
  (3) Patient evaluation. The policy shall provide that each patient who arrives at a transferring facility is evaluated in accordance with the Texas Department of Mental Health and Mental Retardation §411.468 of this title (relating to Responding to an Emergency Medical Condition of a Patient, Prospective Patient, or Individual who Arrives on Hospital Property Requesting Examination or Treatment).
    (A) After receiving a report on the patient's condition from the nursing staff by telephone or radio, if the physician on call determines that an immediate transfer of the patient is medically appropriate and that the time required to conduct a personal examination and evaluation of a patient will unnecessarily delay the transfer to the detriment of the patient, the physician on call may order the transfer by telephone or radio.
    (B) Physician orders for the transfer of a patient which are issued by telephone or radio shall be reduced to writing in the patient's medical record, signed by the staff member receiving the order, and countersigned by the physician authorizing the transfer as soon as possible. The patient transfers resulting from physician orders issued by telephone or radio shall be subject to automatic review by the medical staff pursuant to paragraph (8) of this subsection.
  (4) Facility personnel, written protocols, standing delegation orders, eligibility and payment information. The policy of the transferring facility and receiving facility shall provide that licensed nurses and other qualified personnel are available and on duty to assist with patient transfers and to provide accurate information regarding eligibility and payment practices. The policy shall provide that written protocols or standing delegation orders are in place to guide personnel when a patient requires transfer.
  (5) Transfer of patients who have emergency medical conditions.
    (A) If a patient has an emergency medical condition which has not been stabilized or when stabilization of the patient's vital signs is not possible because the transferring facility does not have the appropriate equipment or personnel to correct the underlying process, evaluation and treatment shall be performed and transfer shall be carried out as quickly as possible.
    (B) The policy shall provide that the transferring facility may not transfer a patient with an emergency medical condition which has not been stabilized unless:
      (i) the patient or a legally responsible person acting on the patient's behalf, after being informed of the transferring facility's obligations under this section and of the risks and benefits of transfer, requests transfer in writing;
      (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 receiving facility outweigh the increased risks to the patient and, in the case of labor, to the unborn child from effecting the transfer; or
      (iii) if the physician who made the determination to transfer a patient with an emergency condition is not physically present at the time of transfer, a qualified medical person, as designated by facility policy, may sign a certification described in clause (ii) of this subparagraph after consultation with the physician. The physician shall countersign the physician certification within a reasonable period of time.
    (C) Except as provided by subparagraphs (E) and (F) of this paragraph and paragraph (6)(A) and (B) of this subsection, the 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.
    (D) Except as expressly permitted in clauses (i) and (ii) of this subparagraph, the policy shall provide for the receipt of patients who have an emergency medical condition so that upon notification of and prior to a transfer, the receiving facility shall, after determining whether or not space, personnel and services necessary to provide appropriate care for the patient are available, respond to the transferring facility, within 30 minutes, either accepting or refusing the transfer. The 30-minute time period begins at the time a member of the staff of the receiving facility receives the call initiating the request to transfer.
      (i) The policy may permit response within a period of time in excess of 30 minutes but no longer than one hour if there are extenuating circumstances for the delay. If the transfer is accepted, the reason for the delay shall be documented on the memorandum of transfer.
Cont'd...
(ii) The response time may be extended before the expiration of the initial 30 minutes period by agreement among the parties to the transfer. If the transfer is accepted, the agreed extension shall be documented in the memorandum of transfer.
    (E) The policy shall recognize and comply with the requirements of the Indigent Health Care and Treatment Act, HSC, §§61.030-61.032 and §§61.057-61.059 (relating to Mandated Providers) since those requirements may apply to a patient.
    (F) The policy shall acknowledge contractual obligations and comply with statutory or regulatory obligations which may exist concerning a patient and a designated provider.
    (G) The policy shall require that all reasonable steps are taken to secure the informed refusal of a patient refusing a transfer or a related examination and treatment or of a person acting on a patient's behalf refusing a transfer or a related examination and treatment. Reasonable steps include:
      (i) a factual explanation of the increased medical risks to the patient reasonably expected from not being transferred, examined, or treated at the transferring facility;
      (ii) a factual explanation of any increased risks to the patient from not effecting the transfer; and
      (iii) a factual explanation of the medical benefits reasonably expected from the provision of appropriate treatment at a receiving facility.
    (H) The informed refusal of a patient, or of 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.
    (I) Transfer of patients may occur routinely or as part of a regionalized plan for obtaining optimal care for patients at a more appropriate or specialized health care entity.
  (6) Transfer of patients who do not have emergency medical conditions.
    (A) The policy shall recognize and comply with the requirements of the Indigent Health Care and Treatment Act, HSC, §§61.030-61.032 and §§61.057-61.059 (relating to Mandated Providers) as those requirements may apply to a patient.
    (B) The policy shall acknowledge contractual obligations and comply with statutory or regulatory obligations which may exist concerning a patient and a designated provider.
    (C) The policy shall require that all reasonable steps are taken to secure the informed refusal of a patient refusing a transfer or a related examination and treatment or of a person acting on a patient's behalf refusing a transfer or a related examination and treatment. Reasonable steps include:
      (i) a factual explanation of the increased medical risks to the patient reasonably expected from not being transferred, examined, or treated at the transferring facility;
      (ii) a factual explanation of any increased risks to the patient from not effecting the transfer; and
      (iii) a factual explanation of the medical benefits reasonably expected from the provision of appropriate treatment at a receiving facility.
    (D) The informed refusal of a patient, or of 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.
    (E) Transfer of patients may occur routinely or as part of a regionalized plan for obtaining optimal care for patients at a more appropriate or specialized health care entity.
    (F) The policy shall recognize the right of an individual to request a transfer into the care of a physician and a receiving facility of the individual's own choosing.
  (7) Physician's duties and standard of care.
    (A) The policy shall provide that the transferring physician shall determine and order life support measures which are medically appropriate to stabilize the patient prior to transfer and to sustain the patient during transfer.
    (B) The policy shall provide that the transferring physician shall determine and order the utilization of appropriate personnel and equipment for the transfer.
    (C) The policy shall provide that in determining the use of medically appropriate life support measures, personnel, and equipment, the transferring physician shall exercise that degree of care which a reasonable and prudent physician exercising ordinary care in the same or similar locality would use for the transfer.
    (D) The policy shall provide that except as allowed under paragraph (3)(B) of this subsection, prior to 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) The policy shall provide that prior to transfer, the transferring physician shall secure a receiving physician and a receiving facility that are appropriate to the medical needs of the patient and that will accept responsibility for the patient's medical treatment and care.
  (8) Record review for standard of care. The policy shall provide that the medical staff review appropriate records of patients transferred to determine that the appropriate standard of care has been met.
  (9) Medical record.
    (A) The policy shall provide that a copy of those portions of the patient's medical record which are available and relevant to the transfer and to the continuing care of the patient be forwarded to the receiving physician and receiving facility 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 receiving facility as soon as possible.
    (B) The medical record shall contain at a minimum:
      (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 X-ray films and reports; and
      (vi) any other pertinent information.
  (10) Memorandum of transfer.
    (A) The policy shall provide that a memorandum of transfer be completed for every patient who is transferred.
    (B) The memorandum shall contain the following information:
      (i) the patient's full name, if known;
      (ii) the patient's race, religion, national origin, age, sex, physical handicap, if known;
      (iii) the patient's address and next of kin, address, and phone number if known;
      (iv) the names, telephone numbers and addresses of the transferring and receiving physicians;
      (v) the names, addresses, and telephone numbers of the transferring and receiving facilities;
      (vi) the time and date on which the patient first presented or was presented to the transferring physician and transferring facility;
      (vii) the time and date on which the transferring physician secured a receiving physician;
      (viii) the name, date, and time administration was contacted in the receiving facility;
      (ix) signature, time, and title of the transferring facility administration who contacted the receiving facility;
      (x) the 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) the time and date on which the receiving physician assumed responsibility for the patient;
      (xii) the time and date on which the patient arrived at the receiving facility;
      (xiii) signature and date of receiving administration;
      (xiv) type of vehicle and company used;
      (xv) type of equipment and personnel needed in transfers;
      (xvi) name and city of facility to which patient was transported;
      (xvii) diagnosis by transferring physician; and
Cont'd...
(xviii) attachments by transferring facility.
    (C) A copy of the memorandum of transfer shall be retained by the transferring and receiving facilities. The memorandum shall be filed separately from the patient's medical record and in a manner which will facilitate its inspection by the department. All memorandum of transfer forms filed separately shall be retained for five years.
(e) Violations. A facility violates HSC, Chapter 577 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 which is consistent with this section and contains each of the requirements in subsection (d) of this section;
    (B) adopt a memorandum of transfer form which 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 §510.43 adopted to be effective January 1, 2004, 28 TexReg 5154; transferred effective June 1, 2019, as published in the Texas Register May 17, 2019, 44 TexReg 2469