[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR485.618]



[Page 619-621]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 485_CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS--Table of 

 

 Subpart F_Conditions of Participation: Critical Access Hospitals (CAHs)

 

Sec.  485.618  Condition of participation: Emergency services.



    The CAH provides emergency care necessary to meet the needs of its 

inpatients and outpatients.

    (a) Standard: Availability. Emergency services are available on a 

24-hours a day basis.

    (b) Standard: Equipment, supplies, and medication. Equipment, 

supplies, and medication used in treating emergency cases are kept at 

the CAH and are readily available for treating emergency cases. The 

items available must include the following:

    (1) Drugs and biologicals commonly used in life-saving procedures, 

including analgesics, local anesthetics, antibiotics, anticonvulsants, 

antidotes and emetics, serums and toxoids, antiarrythmics, cardiac 

glycosides, antihypertensives, diuretics, and electrolytes and 

replacement solutions.

    (2) Equipment and supplies commonly used in life-saving procedures, 

including airways, endotracheal tubes, ambu bag/valve/mask, oxygen, 

tourniquets, immobilization devices, nasogastric



[[Page 620]]



tubes, splints, IV therapy supplies, suction machine, defibrillator, 

cardiac monitor, chest tubes, and indwelling urinary catheters.

    (c) Standard: Blood and blood products. The facility provides, 

either directly or under arrangements, the following:

    (1) Services for the procurement, safekeeping, and transfusion of 

blood, including the availability of blood products needed for 

emergencies on a 24-hours a day basis.

    (2) Blood storage facilities that meet the requirements of 42 CFR 

part 493, subpart K, and are under the control and supervision of a 

pathologist or other qualified doctor of medicine or osteopathy. If 

blood banking services are provided under an arrangement, the 

arrangement is approved by the facility's medical staff and by the 

persons directly responsible for the operation of the facility.

    (d) Standard: Personnel. (1) Except as specified in paragraph (d)(2) 

of this section, there must be a doctor of medicine or osteopathy, a 

physician assistant, a nurse practitioner, or a clinical nurse 

specialist, with training or experience in emergency care on call and 

immediately available by telephone or radio contact, and available 

onsite within the following timeframes:

    (i) Within 30 minutes, on a 24-hour a day basis, if the CAH is 

located in an area other than an area described in paragraph (d)(1)(ii) 

of this section; or

    (ii) Within 60 minutes, on a 24-hour a day basis, if all of the 

following requirements are met:

    (A) The CAH is located in an area designated as a frontier area 

(that is, an area with fewer than six residents per square mile based on 

the latest population data published by the Bureau of the Census) or in 

an area that meets the criteria for a remote location adopted by the 

State in its rural health care plan, and approved by CMS, under section 

1820(b) of the Act.

    (B) The State has determined, under criteria in its rural health 

care plan, that allowing an emergency response time longer than 30 

minutes is the only feasible method of providing emergency care to 

residents of the area served by the CAH.

    (C) The State maintains documentation showing that the response time 

of up to 60 minutes at a particular CAH it designates is justified 

because other available alternatives would increase the time needed to 

stabilize a patient in an emergency.

    (2) A registered nurse satisfies the personnel requirement specified 

in paragraph (d)(1) of this section for a temporary period if--

    (i) The CAH has no greater than 10 beds;

    (ii) The CAH is located in an area designated as a frontier area or 

remote location as described in paragraph (d)(1)(ii)(A) of this section;

    (iii) The State in which the CAH is located submits a letter to CMS 

signed by the Governor, following consultation on the issue of using RNs 

on a temporary basis as part of their State rural healthcare plan with 

the State Boards of Medicine and Nursing, and in accordance with State 

law, requesting that a registered nurse with training and experience in 

emergency care be included in the list of personnel specified in 

paragraph (d)(1) of this section. The letter from the Governor must 

attest that he or she has consulted with State Boards of Medicine and 

Nursing about issues related to access to and the quality of emergency 

services in the States. The letter from the Governor must also describe 

the circumstances and duration of the temporary request to include the 

registered nurses on the list of personnel specified in paragraph (d)(1) 

of this section;

    (iv) Once a Governor submits a letter, as specified in paragraph 

(d)(2)(iii) of this section, a CAH must submit documentation to the 

State survey agency demonstrating that it has been unable, due to the 

shortage of such personnel in the area, to provide adequate coverage as 

specified in this paragraph (d).

    (3) The request, as specified in paragraph(d)(2)(iii) of this 

section, and the withdrawal of the request, may be submitted to us at 

any time, and are effective upon submission.

    (e) Standard: Coordination with emergency response systems. The CAH 

must, in coordination with emergency response systems in the area, 

establish procedures under which a doctor of medicine or osteopathy is 

immediately



[[Page 621]]



available by telephone or radio contact on a 24-hours a day basis to 

receive emergency calls, provide information on treatment of emergency 

patients, and refer patients to the CAH or other appropriate locations 

for treatment.



[58 FR 30671, May 26, 1993, as amended at 62 FR 46037, Aug. 29, 1997; 64 

FR 41544, July 30, 1999; 67 FR 80041, Dec. 31, 2002; 69 FR 49271, Aug. 

11, 2004]