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216.380 Critical access hospitals -- Designation by secretary -- Licensure -- Required and authorized services -- Staffing requirements -- Medicaid reimbursement.

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216.380 Critical access hospitals -- Designation by secretary -- Licensure -- Required and authorized services -- Staffing requirements -- Medicaid <br>reimbursement. (1) The licensure category of critical access hospital is hereby created for existing licensed acute-care hospitals which qualify under this section for that status. (2) It shall be unlawful to operate or maintain a critical access hospital without first obtaining a license from the Cabinet for Health and Family Services. An acute-care <br>hospital converting to a critical access hospital shall not require a certificate of <br>need. A certificate of need shall not be required for services provided on a <br>contractual basis in a critical access hospital. A certificate of need shall not be <br>required for an existing critical access hospital to increase its acute-care bed <br>capacity to twenty-five (25) beds. (3) Except as provided in subsection (4) of this section, only a hospital licensed as a general acute-care hospital may be relicensed as a critical access hospital if: <br>(a) The hospital is located in a county in a rural area that is: 1. Located more than a thirty-five (35) mile drive, or, where the terrain is <br>mountainous or only secondary roads are available, located more than a <br>fifteen (15) mile drive, from another acute-care hospital or critical access <br>hospital; or 2. Certified by the secretary as a necessary provider of health care services <br>to area residents; (b) For the purposes of paragraph (a) of this subsection, a hospital shall be considered to be located in a rural area if the hospital is not in a county which <br>is part of a standard metropolitan statistical area, the hospital is located in a <br>rural census tract of a metropolitan statistical area as determined under the <br>most recent modification of the Goldsmith Modification, or is designated by <br>the state as a rural provider. The secretary shall designate a hospital as a rural <br>provider if the hospital is not located in a county which has the largest county <br>population of a standard metropolitan statistical area; (c) Except as provided in paragraph (d) of this subsection, the hospital provides not more than twenty-five (25) acute care inpatient beds for providing acute <br>inpatient care for a period that does not exceed, as determined on an annual, <br>average basis, ninety-six (96) hours; (d) If the hospital is operating swing beds under which the hospital's inpatient hospital facilities are used for the provision of extended care services, the <br>hospital may be designated as a critical access hospital so long as the total <br>number of beds that may be used at any time for furnishing of either extended <br>care services or acute inpatient services does not exceed twenty-five (25) beds. <br>For the purposes of this section, any bed of a unit of the hospital that is <br>licensed as a nursing facility at the time the hospital applies to the state for <br>designation as a critical care access hospital shall not be counted. (4) The secretary for health and family services may designate a facility as a critical access hospital if the facility: (a) Was a hospital that ceased operations on or after ten (10) years prior to April 21, 2000; or (b) Was a hospital that was converted to a licensed primary care center, rural health clinic, ambulatory health center, or other type of licensed health clinic <br>or health center and, as of the effective date of that conversion, meets the <br>criteria for licensure as a critical access hospital under this subsection or <br>subsection (3) of this section. (5) A critical access hospital shall provide the following services: (a) Twenty-four (24) hour emergency-room care that the secretary determines is necessary for insuring access to emergency care services in each area served <br>by a critical access hospital; and (b) Basic laboratory, radiologic, pharmacy, and dietary services. These services may be provided on a part-time, off-site contractual basis. (6) A critical access hospital may provide the following services: (a) Swing beds or a distinct unit of the hospital which is a nursing facility in accordance with KRS Chapter 216B and subject to approval under certificate <br>of need; (b) Surgery; <br>(c) Normal obstetrics; <br>(d) Primary care; <br>(e) Adult day health care; <br>(f) Respite care; <br>(g) Rehabilitative and therapeutic services including, but not limited to, physical therapy, respiratory therapy, occupational therapy, speech pathology, and <br>audiology, which may be provided on an off-site contractual basis; (h) Ambulatory care; <br>(i) Home health services which may be established upon obtaining a certificate of need; and (j) Mobile diagnostic services with equipment not exceeding the major medical equipment cost threshold pursuant to KRS Chapter 216B and for which there <br>are no review criteria in the State Health Plan. (7) In addition to the services that may be provided under subsection (6) of this section, a critical access hospital may establish the following units in accordance with <br>applicable Medicare regulations and subject to certificate of need approval: <br>(a) A psychiatric unit that is a distinct part of the hospital, with a maximum of ten (10) beds; and (b) A rehabilitation unit that is a distinct part of the hospital, with a maximum of ten (10) beds notwithstanding any other bed limit contained in law or <br>regulation. (8) Psychiatric unit and rehabilitation unit beds operated under subsection (7) of this section shall not be counted in determining the number of beds or the average length of stay of a critical access hospital for purposes of applying the bed and <br>average length of stay limitations under paragraph (c) of subsection (3) of this <br>section. (9) The following staffing plan shall apply to a critical access hospital: (a) The hospital shall meet staffing requirements as would apply under section 1861(e) of Title XVIII of the Federal Social Security Act to a hospital located <br>in a rural area except that: <br>1. The hospital need not meet hospital standards relating to the number of <br>hours during a day, or days during a week, in which the hospital shall be <br>open and fully staffed, except insofar as the facility is required to make <br>available emergency services and nursing services available on a twenty-<br>four (24) hour basis; and 2. The hospital need not otherwise staff the facility except when an <br>inpatient is present; and (b) Physician assistants and nurse practitioners may provide inpatient care within the limits of their statutory scope of practice and with oversight by a physician <br>who is not required to be on-site at the hospital. (10) A critical access hospital shall have a quality assessment and performance improvement program and procedures for review of utilization of services. (11) A critical access hospital shall have written contracts assuring the following linkages: <br>(a) Secondary and tertiary hospital referral services which shall provide for the transfer of a patient to the appropriate level of care and the transfer of patients <br>to the critical access hospital for recuperative care; (b) Ambulance services; <br>(c) Home health services; and <br>(d) Nursing facility services if not provided on-site. (12) If the critical access hospital is part of a rural health network, the hospital shall have the following: <br>(a) An agreement for patient referral and transfer, development, and use of communications systems including telemetry and electronic sharing of patient <br>data, and emergency and nonemergency transportation; and (b) An agreement for credentialing and quality assurance with a network hospital, peer review organization, or other appropriate and qualified entity identified in <br>the state rural health plan. (13) The Cabinet for Health and Family Services and any insurer or managed care program for Medicaid recipients that contracts with the Department for Medicaid <br>Services for the receipt of Federal Social Security Act Title XIX funds shall provide <br>for reimbursement of services provided to Medicaid recipients in a critical access <br>hospital at rates that are at least equal to those established by the Federal Health <br>Care Financing Administration or Centers for Medicare and Medicaid Services for <br>Medicare reimbursement to a critical access hospital. (14) The Cabinet for Health and Family Services shall promulgate administrative regulations pursuant to KRS Chapter 13A necessary to implement this section. Effective: June 20, 2005 <br>History: Amended 2005 Ky. Acts ch. 99, sec. 57, effective June 20, 2005. -- Amended 2004 Ky. Acts ch. 56, sec. 1, effective April 2, 2004. -- Amended 2000 Ky. Acts <br>ch. 439, sec. 1, effective April 21, 2000. -- Amended 1998 Ky. Acts ch. 426, <br>sec. 425, effective July 15, 1998; and ch. 559, sec. 3, effective July 15, 1998. -- <br>Amended 1996 Ky. Acts ch. 299, sec. 3, effective July 15, 1996. -- Created 1992 Ky. <br>Acts ch. 61, sec. 3, effective March 16, 1992. Legislative Research Commission Note (7/15/98). This section was amended by 1998 Ky. Acts chs. 426 and 559. Where these Acts are not in conflict, they have been <br>codified together. Where a conflict exists, Acts ch. 559, which is a nonrevisory Act, <br>prevails under KRS 7.136(3).