Appendix E:

Certificate of Transfer

Certification of necessity for transfer is a requirement for reimbursement by the Centers for Medicare and Medicaid Services. The CMS definition of medical necessity is as follows:
“Medical necessity is established when the patient’s condition is such that use of any other method of transportation is contraindicated. In any case, in which some means of transportation other than an ambulance could be utilized without endangering the individual’s health, whether or not such other transportation is actually available, no payment may be made for ambulance service.”

It is possible (but not likely) that a patient may require transfer and not meet the CMS definition of medical necessity.

The Centers for Medicare and Medicaid Services has issued regulations pertaining to the enforcement of this law. Regulations go into much greater detail than the statute. Proposed rules published in 1988 can be found in the Federal Register, June 16, 1988 (53FR22513). Interim final rules can be found in the Federal Register, June 22, 1994 (59FR32086). The authority supporting the statute is the taxing and spending clause of the Constitution. In essence, Congress has the right to demand certain services from vendors receiving Federal tax dollars. In the EMTALA statute, obligations are tied to hospitals’ participation in Medicare. In fact, a hospital could relieve itself of EMTALA obligations by dropping out of the Medicare program, although this certainly would not be financially beneficial for the hospital.