KRS 216.380: Critical access hospitals -- Designation by secretary -- Licensure --

Required and authorized services -- Staffing requirements -- Medicaid

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

hospital converting to a critical access hospital shall not require a certificate of

need. A certificate of need shall not be required for services provided on a

contractual basis in a critical access hospital. A certificate of need shall not be

required for an e xisting critical access hospital to increase its acute -care bed

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:

(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

mountainous or only secondary roads are available, located more than a

fifteen (15) mile drive, from another acute-care hospital or critical access

hospital; or

2. Certified by the secretary as a necessary provider of health care services

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

is part of a standard metropolitan statistical area, the hospital is located in a

rural census tract of a metropolitan statistical area as determined under the

most recent modification of the Golds mith Modification, or is designated by

the state as a rural provider. The secretary shall designate a hospital as a rural

provider if the hospital is not located in a county which has the largest county

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

inpatient care for a period that does not exceed, as determined on an annual,

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

hospital may be designated as a critical access hospital so long as the tot al

number of beds that may be used at any time for furnishing of either extended

care services or acute inpatient services does not exceed twenty-five (25) beds.

For the purposes of this section, any bed of a unit of the hospital that is

licensed as a nurs ing facility at the time the hospital applies to the state for

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 ambulatory health center or

other type of licensed health clinic or health center and, as of the effective date

of that conversion, meets the criteria for licensure as a critical access hospital

under this subsection or 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

by a critical access hospital; and

(b) Basic laboratory, radiologic, pharmacy, and dietary services. The se 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

of need;

(b) Surgery;

(c) Normal obstetrics;

(d) Primary care;

(e) Adult day health care;

(f) Respite care;

(g) Rehabilitative and therapeutic services including, but not limited to, physical

therapy, respiratory ther apy, occupational therapy, speech pathology, and

audiology, which may be provided on an off-site contractual basis;

(h) Ambulatory care;

(i) Home health services which may be established upon obtaining a certificate of

need; and

(j) Mobile diagnostic servi ces with equipment not exceeding the major medical

equipment cost threshold pursuant to KRS Chapter 216B and for which there

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

applicable Medicare regulations and subject to certificate of need approval:

(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

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

average length of stay limitations under paragraph (c) of subsection (3) of this

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

in a rural area except that:

1. The hospital need not meet hospital standards relating to the number of

hours during a day, or days during a week, in which the hospital shall be

open and fully staffed, except insofar as the facility is required to make

available emergency services and nursing services available on a twenty-

four (24) hour basis; and

2. The hospital need not otherwise staff the facility except when an

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

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:

(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

to the critical access hospital for recuperative care;

(b) Ambulance services;

(c) Home health services; and

(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:

(a) An agreement for patient referral and transfer, development, and use of

communications systems including telemetry and electronic sharing of patie nt

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

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

Services for the receipt of Federal Social Security Act Title XIX funds shall provide

for reimbursement of services provided to Medicaid recipients in a critical access

hospital at rates that are at least equal to those established by the Federal Health

Care Financing Administration or Centers for Medicare and Medicaid Services for

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.