42 CFR § 485.538 - Condition of participation: Agreements.

---
identifier: "/us/cfr/t42/s485.538"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 485.538 - Condition of participation: Agreements."
title_number: 42
title_name: "Public Health"
section_number: "485.538"
section_name: "Condition of participation: Agreements."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "G"
subchapter_name: "STANDARDS AND CERTIFICATION"
part_number: "485"
part_name: "CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302 and 1395(hh)."
regulatory_source: "48 FR 56293, Dec. 15, 1982, unless otherwise noted. Redesignated at 50 FR 33034, Aug. 16, 1985."
cfr_part: "485"
---


# 485.538 Condition of participation: Agreements.

The REH must have in effect an agreement with at least one certified hospital that is a level I or level II trauma center for the referral and transfer of patients requiring emergency medical care beyond the capabilities of the REH that is—

(a) Licensed as a hospital in a state that provides for the licensing of hospitals under state or applicable local law or approved by the agency of such state or locality responsible for licensing hospitals, as meeting standards established for licensing established by the agency of the state; and

(b) Licensed or designated by the state or local government authority as level I or level II trauma center or is verified by the American College of Surgeons as a level I or level II trauma center.