CMS SOM App. U, Tag R161

The RNHCI must transfer or refer patients in a timely manner to another facility

(including a medical facility if requested by the beneficiary, or his or her legal

representative) in accordance with §403.730(b)(2)

Interpretive Guidelines: §403.736(b)

The RNCHI must have a process for transferring or referring patients to other facilities,

including medical facilities. The RNHCI’s process should describe how they would

recognize when a patient requires a referral or transfer and also assure appropriate

handling of the transfer, including effectuating the transfer in a timely manner. We note

that a transfer to a medical facility can only occur when the patient (and/or patient’s

representative or healthcare proxy) revokes their Election. RNHCI by nature should not

be making referrals to medical facilities since that implies medical knowledge of a

condition/diagnoses they believe the medical facility can address, which is outside the

scope of a RNHCI. However, the process must include arrangement for appropriate and

timely transport of the patient, as needed. Use of 9-1-1 to obtain transport does not,

however, relieve the RNHCI of its obligation to arrange for the patient’s transfer to an

appropriate facility, including a medical facility if requested, and to provide the

necessary information along with the patient.

In the event the RNCHI must transfer a patient to an acute medical facility, such as a

hospital, the RNCHI must ensure any pertinent information concerning the identification

of the patient’s needs should be transferred with the patient. While RNCHIs by nature

furnish only nonmedical nursing items and services to beneficiaries who choose to rely

solely upon a religious method of healing, CMS would expect that if a patient requires a

transfer to a medical facility, that the RNCHI provide any potentially relevant

information about the patient that could be foreseen as critical to provide continuity of

care for the patient.

In general, a patient transfer to another or a medical facility is only done when a patient

elects to no longer receive care from the RNHCI. The RNHCI would be responsible for

making arrangement to transfer the patient prior to discharge, only when the patient is

no longer seeking to receive care at the RNHCI. In most circumstances, there would not

be a condition for which the RNHCI would have to recognize a need for a patient to be

transferred, other than the patient’s (and/or patient’s representative or healthcare proxy)

election to no longer receive care at that facility. If an RNHCI transfers a patient to a

medical facility, the RNHCI would not opine on medical diagnoses or treatment as

mentioned above. The RNHCI transfer would only indicate what care they provided, but

any description that would constitute a medical term or explanation would not be used.

A RNHCI should not be expected to provide what a medical professional or medical

facility would consider potentially relevant information about a patient that could be

foreseen as critical to provide continuity of care of the patient at a medical facility.

We also note, additional transfer requirements are outlined for RNHCIs at

§403.748(b)(7) under their Emergency Preparedness Program. Within the RNCHI’s

Emergency Program, the facility must have policies and procedures which address the

development of arrangements with other RNHCIs and other providers to receive patients

in the event of limitations or cessation of operations to maintain the continuity of nonmedical services to RNHCI patients. Please refer to Appendix Z, Tag 0025 for additional

guidance.

Survey Procedures:

• Verify transfer or referral policies to determine the following:

o Does the RNHCI demonstrate timely transfers and referrals?

o Are there policies and procedures in place for emergency situations,

transfers, and/or referrals?

• Interview staff to determine how they convey transfers to patients and whether the

RNHCI makes the appropriate transfers or referrals.

• Review a closed record in which a patient was transferred. Does the

discharge/transfer plan indicate the reason and was the transfer consistent with

the standard?