(a) General provisions.      
        (1) Transfer agreements between transferring facilities and receiving facilities as those terms are defined in §134.43 of this title (relating to Patient Transfer Policy) are voluntary.       
        (2) If transfer agreements are executed that are consistent with the requirements of subsection (b) of this section, any patient transfers shall be governed by the agreement. The memorandum of transfer described in §134.43(d)(10) of this title is not required for transfers governed by an agreement.       
        (3) Multiple transfer agreements may be entered into based upon the type or level of medical services available at other facilities.       
      (b) Rules for patient   transfer agreements.      
        (1) A patient transfer agreement shall contain the following.                  (A) Except as specifically provided in paragraph (4) of this subsection, relating to mandated providers, the transfer of a patient shall not be predicated upon arbitrary, capricious, or unreasonable discrimination based upon race, religion, national origin, age, sex, physical condition, or economic status.                   (B) The transfer or receipt of patients in need of emergency care shall not be based upon the individual's inability to pay for the services rendered.         
        (2) The patient transfer agreement shall require that patient transfers be accomplished in a medically appropriate manner by determining the availability of   appropriate facilities, services, and staff for providing care to the patient and by providing:                  (A) medically appropriate life support measures which a reasonable and prudent physician in the same or similar locality exercising ordinary care would use to stabilize the patient prior to transfer and to sustain the patient during the transfer;                   (B) appropriate personnel and equipment which a reasonable and prudent physician in the same or similar locality exercising ordinary care would use for the transfer; and                   (C) all necessary records for continuing the care for the patient.         
        (3) The facility shall recognize the right of an individual to request transfer into the care of a physician and   facility of the individual's own choosing.       
        (4) The facility shall recognize and comply with the requirements of the Indigent Health Care and Treatment Act, Health and Safety Code, Chapter 61 (relating to the Transfer of Patients to Mandated Providers).       
        (5) The patient transfer agreement shall provide that a patient with an emergency medical condition which has not been stabilized shall not be transferred unless the following occurs.                  (A) The patient, or a legally responsible person acting on the patient's behalf, after being informed of the facility's obligations under this section and of the risk of transfer, has requested transfer to another facility in writing.                   (B) 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 another facility outweigh the increased risks to the patient and, in the case of labor, to the unborn child from effecting the transfer.                   (C) If a physician is not physically present at the time a patient is transferred, a qualified medical person has signed a certification described in subparagraph (B) of this paragraph after consultation with a physician who has made the determination described in subparagraph (B) of this paragraph and who will subsequently countersign the certification within a reasonable period of time.         
     Source Note:        The provisions of this §510.61 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