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* Title 42 — Public Health — Code of Federal Regulations (CFR)
Sec. 489.24 Special responsibilities of Medicare hospitals in emergency cases.
In the case of a hospital that has an emergency department, if any individual (whether or not eligible for Medicare benefits and regardless of ability to pay) comes by him or herself or with another person to the emergency department and a request is made on the individual’s behalf for examination or treatment of a medical condition by qualified medical personnel (as determined by the hospital in its rules and regulations), the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examinations must be conducted by individuals determined qualified by hospital bylaws or rules and regulations and who meet the requirements of Sec. 482.55 concerning emergency services personnel and direction.
(d) Restricting transfer until the individual is stabilized —
(1)(ii)(C) If a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bylaws or rules and regulations) has signed a certification described in paragraph (d)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act) in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification. The certification must contain a summary of the risks and benefits upon which it is based.
* Health Care Financing Administration EMTALA State Operations Manual — May 1998
Tag A406: Interpretive Guidelines: §489.24(a)
This delegation should be set forth in a document approved by the governing body of the hospital. If the rules and regulations of the hospital are approved by the board of trustees or other governing body, those personnel qualified to perform these examinations may be set forth in the rules and regulations, instead of placing this information in the hospital bylaws. It is not acceptable for the hospital to allow informal personnel appointments that could frequently change.
Tag A409: Interpretive Guidelines: §489.24(d)(1)(ii)(B)
Section 1861(r) of the Act [EMTALA] defines physicians as:
(i) A doctor of medicine or osteopathy. (This provision is not to be construed to limit the authority of a doctor of medicine or osteopathy to delegate tasks to other qualified health care personnel to the extent recognized under state law or a state’s regulatory mechanism);
Tag A409: Interpretive Guidelines: §489.24(d)(1)(C)
Individuals other than physicians may sign the certification of benefits versus risks of a transfer. These individuals must be identified in hospital bylaws, rules and regulations, or another board-approved document.
If a certification of benefits versus risks was signed by a qualified medical person, a physician’s countersignature must be present. Hospital bylaws or policies and procedures will describe the maximum amount of time allowed to obtain physician countersignatures on hospital documents.
Source: Health Care Financing Administration, Baltimore.