California § 1317.4a

§ 1317.4a.

(a) (1) Notwithstanding subdivision (j) of Section 1317.1, a patient may be transferred for admission to a psychiatric unit within a general acute care hospital, as defined in subdivision (a) of Section 1250, or an acute psychiatric hospital, as defined in subdivision (b) of Section 1250, for care and treatment that is solely necessary to relieve or eliminate a psychiatric emergency medical condition, as defined in subdivision (k) of Section 1317.1, provided that, in the opinion of the treating provider, the patient’s psychiatric emergency medical condition is such that, within reasonable medical probability, no material deterioration of the patient’s psychiatric emergency medical condition is likely to result from, or occur during, a transfer of the patient. (2) A provider shall notify the patient’s health care service plan, or the health plan’s contracting medical provider of the need for the transfer if identification of the plan is obtained pursuant to paragraph (1) of subdivision (b). (b) A hospital that transfers a patient pursuant to subdivision (a) shall do both of the following: (1) Seek to obtain the name and contact information of the patient’s health care service plan. The hospital shall document its attempt to ascertain this information in the patient’s medical record. The hospital’s attempt to ascertain the information shall include requesting the patient’s health care service plan member card, asking the patient, the patient’s family member, or other person accompanying the patient if they can identify the patient’s health care service plan, or using other means known to the hospital to accurately identify the patient’s health care service plan. (2) Notify the patient’s health care service plan or the health plan’s contracting medical provider of the transfer, provided that the identification of the plan was obtained pursuant to paragraph (1). The hospital shall provide the plan or its contracting medical provider with the name of the patient, the patient’s member identification number, if known, the location and contact information, including a telephone number, for the location where the patient will be admitted, and the preliminary diagnosis. (c) (1) A hospital shall make the notification described in paragraph (2) of subdivision (b) by either following the instructions on the patient’s health care service plan member card or by using the contact information provided by the patient’s health care service plan. A health care service plan shall provide all noncontracting hospitals in the state to which one of its members would be transferred pursuant to paragraph (1) of subdivision (b) with specific contact information needed to make the contact required by this section. The contact information provided to hospitals shall be updated as necessary, but no less than once a year. (2) A hospital making the transfer pursuant to subdivision (a) shall not be required to make more than one telephone call to the health care service plan, or its contracting medical provider, provided that in all cases the health care service plan, or its contracting medical provider, shall be able to reach a representative of the provider upon returning the call, should the plan, or its contracting medical provider, need to call back. The representative of the hospital who makes the telephone call may be, but is not required to be, a physician and surgeon. (d) If a transfer made pursuant to subdivision (a) is made to a facility that does not have a contract with the patient’s health care service plan, the plan may subsequently require and make provision for the transfer of the patient receiving services pursuant to this section and subdivision (a) of Section 1317.1 from the noncontracting facility to a psychiatric unit within a general acute care hospital, as defined in subdivision (a) of Section 1250, or an acute psychiatric hospital, as defined in subdivision (b) of Section 1250, that has a contract with the plan or its delegated payer, provided that in the opinion of the treating provider the patient’s psychiatric emergency medical condition is such that, within reasonable medical probability, no material deterioration of the patient’s psychiatric emergency medical condition is likely to result from, or occur during, the transfer of the patient. (e) Upon admission, the hospital to which the patient was transferred shall notify the health care service plan of the transfer, provided that the facility has the name and contact information of the patient’s health care service plan. The facility shall not be required to make more than one telephone call to the health care service plan, or its contracting medical provider, provided that in all cases the health care service plan, or its contracting medical provider, shall be able to reach a representative of the facility upon returning the call, should the plan, or its contracting medical provider, need to call back. The representative of the facility who makes the telephone call may be, but is not required to be, a physician and surgeon. (f) A provider is not required to seek prior authorization to provide emergency services and care, as defined in paragraph (2) of subdivision (a) of Section 1317.1, or to make a transfer pursuant to subdivision (a) for a patient who has a psychiatric emergency medical condition, as defined in subdivision (k) of Section 1317.1, that is not otherwise required by law.