Title: Section 400.9 - Transfer and affiliation agreements

400.9 Transfer and affiliation agreements. Effective January 1, 1970 the admission, discharge or transfer of any patient or resident from each facility having an operating certificate under the provisions of any Article of Subchapter C of this Chapter to a facility issued an operating certificate under any other Article of Subchapter C of this Chapter or to a certified home health agency shall conform to the following provisions:

(a) The governing authority or operator of each such facility shall have in effect a transfer and/or affiliation agreement acceptable to the department with:

(1) one or more facilities having a valid operating certificate under Articles 2, 4 and 5 of this Subchapter and located in or near the same community; and

(2) one or more home health agencies certified by the department and serving a geographic area of coverage appropriate to the area of coverage of this facility.

(b) The governing authority or operator of each such facility shall:

(1) maintain in the administrator's office and available to the department a written copy of each transfer or affiliation agreement;

(2) include in such agreement reasonable assurance that there will be transfer of the patient or resident whenever deemed medically appropriate and mutually agreed upon by the physician responsible for the medical care in the referring facility, or by the midwife responsible for the medical care in the case of a referring midwifery birth center, and by the physician who will become responsible for the medical care in the receiving facility, or, in the case of a certified home health agency, by the physician who will become responsible for the medical care when such patient or resident is to receive services from the certified home health agency;

(3) include in such agreement reasonable assurance that the originating facility will transfer promptly such medical and other information as is relevant to proper care by the receiving facility or home health agency including medical, social, nursing and other care plans; and

(4) include in the agreement reasonable assurance that there is sharing of diagnostic and other services when the department finds that such sharing is in the interest of efficiency, economy and quality of care.

(c) For each admission to or transfer or discharge from each such facility, the governing authority or operator shall assure that:

(1) the personal, alternate or staff physician requests or agrees to the admission, transfer or discharge unless the patient or resident signs out or is signed out against medical advice;

(2) admission information is obtained and transfer and discharge information is furnished as required by the provisions of this Chapter;

(3) the method of physically transporting the patient or resident is safe and medically approved by the responsible physician; and

(4) the patient's or resident's personal effects, especially his monies and valuables, are transported and stored safely in a place known and reasonably accessible to the patient or resident or to a person or agency legally authorized to act in his behalf and full information about same is on file and readily available in the administrator's office or other site acceptable to the department.

(d) If the personal, alternate or staff physician or the director or acting or assistant director of nursing approves an emergency or unusual admission, transfer or discharge, the requirements of paragraph (c)(1) of this section may be waived providing the circumstances and reasons are recorded in the medical record.

(e) The governing authority or operator of each facility having a valid operating certificate under the provisions of Article 6 of Subchapter C of this Chapter shall have an affiliation agreement with at least one facility having an operating certificate under the provisions of Article 2, 4 or 5 of this Subchapter which includes assurance that:

(1) the affiliating facility has the capability of providing strong backup support, including but not limited to medical, diagnostic, emergency and other services; and

(2) the affiliating facility furnishes such backup support by providing, as needed, medical, medically related and other supportive services to enhance the effectiveness of operation of the treatment center and diagnostic center.

(f) Where it is in the interest of the community and where it is essential to assure that inpatient or resident care will continue to be available for those requiring such care, the department may except the governing authority or operator from specific requirements of this section when the operator or governing authority provides documented verification acceptable to the department that all reasonable attempts have been made in good faith to make such an agreement.