CMS SOM App. W, Tag C-2408

(i) A participating hospital may not delay providing an appropriate medical screening

examination required under paragraph (a) of this section or further medical

examination and treatment required under paragraph (d)(1) of this section in order to

inquire about the individual's method of payment or insurance status.

(ii)A participating hospital may not seek, or direct an individual to seek, authorization

from the individual's insurance company for screening or stabilization services to be

furnished by a hospital, physician, or nonphysician practitioner to an individual until

after the hospital has provided the appropriate medical screening examination required

under paragraph (a) of this section, and initiated any further medical examination and

treatment that may be required to stabilize the emergency medical condition under

paragraph (d)(1) of this section.

(iii) An emergency physician or nonphysician practitioner is not precluded from

contacting the individual's physician at any time to seek advice regarding the

individual's medical history and needs that may be relevant to the medical treatment

and screening of the patient, as long as this consultation does not inappropriately delay

services required under paragraph (a) or paragraphs (d)(1) and (d)(2) of this section.

Hospitals may follow reasonable registration processes for individuals for whom

examination or treatment is required by this section, including asking whether an

individual is insured and, if so, what that insurance is, as long as that inquiry does not

delay screening or treatment. Reasonable registration processes may not unduly

discourage individuals from remaining for further evaluation.

A hospital meets the requirements of paragraph (d)(1)(ii) of this section with respect to

an individual if the hospital offers to transfer the individual to another medical facility

in accordance with paragraph (e) of this section and informs the individual (or a

person acting on his or her behalf) of the risks and benefits to the individual of the

transfer, but the individual (or a person acting on the individual's behalf) does not

consent to the transfer. The hospital must take all reasonable steps to secure the

individual's written informed refusal (or that of a person acting on his or her behalf).

The written document must indicate the person has been informed of the risks and

benefits of the transfer and state the reasons for the individual's refusal. The medical

record must contain a description of the proposed transfer that was refused by or on

behalf of the individual.