This regulation requires nursing facilities participating in Medicare and Medicaid to maintain a written transfer agreement with one or more approved hospitals, ensuring timely transfer of residents when medically appropriate and exchange of necessary medical information between providers. Facilities that cannot secure such an agreement must demonstrate good faith efforts to do so by exhausting all reasonable means with sufficiently close hospitals. The transfer agreement must support safe, orderly transfers and include information required under §483.15(c)(2)(iii), including consideration of less restrictive care settings. Surveyors may cite deficiencies for absence of a written agreement, inadequate agreement terms, or failure to document good faith efforts.
View official sourceF843 (Rev. 229; Issued: 04-25-25; Effective: 04-25-25; Implementation: 04-28-25) §483.70(i) Transfer agreement. §483.70(i)(1) In accordance with section 1861(l) of the Act, the facility (other than a nursing facility which is located in a State on an Indian reservation) must have in effect a written transfer agreement with one or more hospitals approved for participation under the Medicare and Medicaid programs that reasonably assures that— (i) Residents will be transferred from the facility to the hospital, and ensured of timely admission to the hospital when transfer is medically appropriate as determined by the attending physician or, in an emergency situation, by another practitioner in accordance with facility policy and consistent with State law; and (ii) Medical and other information needed for care and treatment of residents and, when the transferring facility deems it appropriate, for determining whether such residents can receive appropriate services or receive services in a less restrictive setting than either the facility or the hospital, or reintegrated into the community will be exchanged between the providers, including but not limited to the information required under §483.15(c)(2)(iii). §483.70(i)(2) The facility is considered to have a transfer agreement in effect if the facility has attempted in good faith to enter into an agreement with a hospital sufficiently close to the facility to make transfer feasible. GUIDANCE §483.70(i) A facility must demonstrate its good faith effort to secure a transfer agreement with a hospital. If a hospital that the facility reached out to refuses to accept a transfer agreement, determine if the facility reached out to any other hospitals. A good faith effort is considered to have been made if the nursing home has exhausted all reasonable means and taken every necessary and appropriate step to enter into an agreement with a hospital sufficiently close to the facility to make the transfer of residents safe and orderly. Also refer to §483.15 - Admission, transfer and discharge rights. Information in the transfer agreement should support the requirements in §483.15(c)(7), F627 and the facility’s efforts to ensure safe and orderly transfers. In addition, the agreement should include the information in §483.15(c)(2)(iii), (F628), and consider other information that may be necessary for the safe and orderly transfer of the resident, and care and treatment of the resident at the receiving setting. KEY ELEMENTS OF NONCOMPLIANCE To cite deficient practice at F843, the surveyor’s investigation will generally show that the facility failed to do any one of the following: • Have a written transfer agreement in effect with one or more hospitals approved for participation in Medicare/Medicaid programs; or • Ensure the transfer agreement(s) reasonably assured: o Residents will be transferred for timely admission to the hospital when medically appropriate; or o Medical or other information will be exchanged between the facility and the hospital: Including, but not limited to the information required under §483.15(c)(2)(iii); or Information needed for resident care/treatment; or To determine whether the resident can be cared for in a less restrictive setting than either the facility or the hospital; or • Attempt good faith efforts to enter into an agreement with a hospital sufficiently close to the facility to make the transfer safely and orderly.