Miss. Code. tit. 15, pt. 12, subpt. 31, ch. 10, app 15-12-31-10-7

Current through December 10, 2024
Appendix 15-12-31-10-7 - RELATED COBRA REGULATIONS H.R. 3128-83 Subpart B-Miscellaneous Provisions Sec. 9121. Responsibilities of Medicare Hospitals in Emergency Cases

Requirement of Medicare Hospital Provider Agreements.-Section 1866(a)(1) of the Social Security Act ( 42 USC 1395 cc (a)(1) is amended-

by striking out "and" at the end of subparagraph (G),

by striking out the period at the end of subparagraph (H) and inserting in lieu thereof", and ", and

by inserting after subparagraph (H) the following new subparagraph: "(I) in the case of a hospital, to comply with the requirements of section 1867 to the extent applicable."

Requirements-Title XVIII of such Act is amended by inserting after section 1866 the following new section:

Examination and Treatment for Emergency Medical Conditions and Women in Active Labor: "Spec. 1867 (a) Medical Screening Requirement.-In the case of a hospital that has a hospital emergency department, if any individual (whether or not eligible for benefits under this title) comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition (within the meaning of subsection (3)(1) exists or to determine if the individual is in active labor (within the meaning of subsection (e)(2)).

Necessary Stabilizing Treatment for Emergency Medical Conditions and Active Labor.- In general.-If any individual (whether or not eligible for benefits under this title) comes to a hospital and the hospital determines that the individual has an emergency medical condition or is in active labor, the hospital must provide either-within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition or to provide for treatment of the labor, or for transfer of the individual to another medical facility in accordance with subsection (c).

Refusal to Consent to Treatment - A hospital is deemed to meet the requirement of paragraph (1)(A) with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph but the individual (or a legally responsible person acting on the individual's behalf) refuses to consent to the examination or treatment.

H.R.3128-84

Refusal to Consent to Transfer - A hospital is deemed to meet the requirement of paragraph (1) with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with subsection (c) but the individual (or a legally responsible person acting on the individual's behalf) refuses to consent to the transfer.

Restricting Transfers Until Patient Stabilized -

Rule. - If a patient at a hospital has an emergency medical condition which has not been stabilized (with the meaning of subsection (e)(4)(B) or is in active labor, the hospital may transfer the patient unless-(i) the patient (or a legally responsible person acting on the patient's behalf) requests that the transfer be effected, or a physician (within the meaning of section 1861(r)(1), or other qualified medical personnel when a physician is not readily available in the emergency department, has signed a certification that, based upon the reasonable risks and benefits to the patient, and based upon the information available at the time, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual's medical condition from effecting the transfer; and

in which the transferring hospital provides the receiving facility with appropriate medical records (or copies thereof) of the examination and treatment effected at the transferring hospital;

in which the transfer is effected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer; and

which meets such other requirements as the Secretary may find necessary in the interest of the health and safety of patients transferred.

Enforcement-

As Requirement of Medicare Provider Agreement. - If a hospital knowingly and willfully, or negligently, fails to meet the requirements of this section, such hospital is subject to-termination of its provider agreement under this title in accordance with section 1866(b), or

at the option of the Secretary, suspension of such agreement for such period of time as the Secretary determines to be appropriate, upon reasonable notice to the hospital and to the public.

Civil Monetary Penalties. - In addition to the other grounds for imposition of a civil money penalty under section 1128A(a), a participating hospital that knowingly violates a requirement of this section and the responsible physician in the hospital with respect to such a violation are each subject, under that section, to a civil money penalty of not more than $25,000 for each such violation. As used in the previous sentence, the term "responsible physician" means, with respect to a hospital's, a physician who- is employed by, or under contract with, the participating hospital, and

acting as such an employee or under such a contract, has professional responsibility for the provision of examinations or treatments for the individual, or transfers of the individual, with respect to which the violation occurred.

Civil Enforcement-

Personal Harm.- Any individual who suffers personal harm as a direct result of a participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for personal injury under the law of the State in which the hospital is located, and such equitable relief as appropriate.

Financial Loss To Other Medical Facility.- Any medical facility that suffers a financial loss as a direct result of participating hospital's violation of a requirement of this section may, in a civil action against the participating hospital, obtain those damages available for financial loss, under the law of the State in which the hospital is located, and such equitable relief as is appropriate.

Limitations On Actions.- No action may be brought under this paragraph more than two years after the date of the violation with respect to which the action is brought.

Definitions.- In this section:

The term `emergency medical condition' means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part.

The term `participating hospital' means hospital that has entered into a provider agreement under section 1866 and has, under the agreement, obligated itself to comply with the requirements of this section.

(A) The term `to stabilize' means, with respect to an emergency medical condition, to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from the transfer of the individual from a facility.

The term `stabilized' means with respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from the transfer of the individual from a facility.

The term `transfer' means the movement (including the discharge) of a patient outside a hospital's facilities at the direction of any person employed by (or affiliated or associated, directly or indirectly, with) the hospital, but does not include such movement of a patient who (A) has been declared dead, or (B) leaves the facility without the permission of any such person.

Preemption.- The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section.

Effective Date.- The amendments made by this section shall take effect on the first day of the first month that begins at least 90 days after the date of the enactment of this Act.

Report.- The Secretary of Health and Human Services shall, not later than 6 months after the effective date described in subsection (c), report to Congress on the methods to be used for monitoring and enforcing compliance with section 1867 of the Social Security Act.

Sec. 9122. Requirement For Medicare Hospitals for Participate In Champus and Champva Programs.

In General.- Section 1866(a)(1) of the Social Security Act ( 42 U.S.C. 1395 cc(a)(1) is amended-

by striking out "and" at the end of subparagraph (H),

by striking out the period at the end of subparagraph (I) and inserting in lieu thereof", and", and

by inserting after subparagraph (I) the following new subparagraph:

in the case of hospitals which provide inpatient hospital services for which payment may be made under this title, to be a participating provider of medical care under any health plan contracted for under section 1079 or 1086 of title 10, or under section 613 of title 38, United States Code, in accordance with admission practices, payment methodology, and amounts as prescribed under joint regulations issued by the Secretary and by the Secretaries of Defense and Transportation, in implementation of sections 1079 and 1086 of title 10, United States Code."

Effective Date.- The amendments made by subsection (a) shall apply to agreements entered into our renewed on or after the date of the enactment of this Act, but shall apply only to inpatient hospital services provided pursuant to admissions to hospitals occurring on or after January 1, 1987.

Reference to Study Required.- For a study of the use by Champus of the Medicare prospective payment system, see section 634 of the Department of Defense Authorization Act, 1985 ( Public Law 98-525), the deadline for which is extended under section 2002 of this Act.

Report.- The Secretary of Health and Human Services shall report to Congress periodically on the number of hospitals that have terminated or failed to renew an agreement under section 1866 of the Social Security Act as a result of the additional conditions imposed under the amendments made by subsection(a).

Miss. Code. tit. 15, pt. 12, subpt. 31, ch. 10, app 15-12-31-10-7

Miss. Code Ann.§ 41-59-5
Adopted 12/23/2020