(a) A limited services rural hospital (LSRH) shall have in effect an agreement with at least one general hospital that is a level I or level II trauma center as designated by the Texas Department of State Health Services (DSHS), certified by the Centers for Medicare & Medicaid Services for the referral and transfer of patients requiring emergency medical care beyond the capabilities of the LSRH, and is:      
        (1) licensed under Texas Health and Safety Code (HSC) Chapter 241;       
        (2) maintained or operated by the state or an agency of the federal government and exempt from licensure under HSC Chapter 241; or       
        (3) maintained or operated by the federal government or an agency of the federal government and exempt from licensure under HSC Chapter 241.       
      (b) An LSRH shall submit the transfer agreement to the Texas Health and Human Services Commission (HHSC) for review to determine whether the agreement meets the requirements of subsection (a) of this section.     
      (c) An LSRH may enter into multiple transfer agreements based on the type or level of medical services available at other hospitals.     
      (d) A patient transfer agreement shall include specific language that is consistent with the following.      
        (1) HSC Chapter 61 (relating to Indigent Health Care Treatment Act) in accordance with §511.65(f) of this subchapter (relating to Patient Transfer Policy);       
        (2) discrimination in accordance with §511.65(j) of this subchapter;       
        (3) patient's right to request a transfer in accordance with §511.65(k) of this subchapter;       
        (4) transfer of patients with emergency medical conditions in accordance with §511.65(n) and (o) of this subchapter;       
        (5) physician's duties and standard of care in accordance with §511.65(q) of this subchapter;       
        (6) medical records in accordance with §511.65(r) of this subchapter; and       
        (7) memorandum of transfer in accordance with §511.65(s) of this subchapter.       
      (e) In order for HHSC to review the transfer agreements to determine compliance with the requirements of this section, an LSRH shall submit the following documents to HHSC:      
        (1) a copy of the current or proposed agreement signed by the representatives of the LSRH and the general or special hospital subject to the agreement;       
        (2) the agreement's adoption date; and       
        (3) the agreement's effective date.       
      (f) HHSC may waive the document submission requirements under subsection (e) of this section at its sole discretion to avoid the repetitious submission of required documentation and approved agreements.     
      (g) When an LSRH's governing body or governing body's designee executes a transfer agreement and the text of that agreement is the same text of a previously HHSC-approved agreement, the governing body or the governing body's designee is not required to submit the later agreement for review.     
      (h) HHSC shall review the patient transfer agreement not later than 45 calendar days after the date HHSC receives the agreement to determine whether the agreement complies with the requirements of this section.      
        (1) After HHSC's review of the agreement, if HHSC determines the agreement complies with the requirements contained in this section, HHSC shall notify the LSRH's administration that HHSC has approved the agreement.       
        (2) If after reviewing the agreement, HHSC determines the agreement is not consistent with the requirements contained in this section, HHSC shall give notice to the LSRH's administration that the agreement is deficient and provide recommendations for correction.       
      (i) HHSC considers a transfer agreement in compliance with this section if the agreement complies with the rules in effect at the time the LSRH executed the transfer agreement and HHSC approved the agreement.     
      (j) HHSC shall treat complaints alleging a transfer agreement violation in the same manner as complaints alleging violations of HSC Chapter 241, Subchapter K (relating to Limited Services Rural Hospitals) or this chapter.     
     Source Note:        The provisions of this §511.66 adopted to be effective October 5, 2023, 48 TexReg 5668