{"data":{"id":"us-ky/krs-216.380","jurisdiction":"us-ky","citation":"KRS 216.380","heading":"Critical access hospitals -- Designation by secretary -- Licensure --","body":"Required and authorized services -- Staffing requirements -- Medicaid\nreimbursement.\n(1) The licensure category of critical access hospital is hereby created for existing\nlicensed acute-care hospitals which qualify under this section for that status.\n(2) It shall be unlawful to operate or maintain a critical access hospital without first\nobtaining a license from the Cabinet for Health and Family Services. An acute -care\nhospital converting to a critical access hospital shall not require a certificate of\nneed. A certificate of need shall not be required for services provided on a\ncontractual basis in a critical access hospital. A certificate of need shall not be\nrequired for an e xisting critical access hospital to increase its acute -care bed\ncapacity to twenty-five (25) beds.\n(3) Except as provided in subsection (4) of this section, only a hospital licensed as a\ngeneral acute-care hospital may be relicensed as a critical access hospital if:\n(a) The hospital is located in a county in a rural area that is:\n1. Located more than a thirty -five (35) mile drive, or, where the terrain is\nmountainous or only secondary roads are available, located more than a\nfifteen (15) mile drive, from another acute-care hospital or critical access\nhospital; or\n2. Certified by the secretary as a necessary provider of health care services\nto area residents;\n(b) For the purposes of paragraph (a) of this subsection, a hospital shall be\nconsidered to be located in a rural area if the hospital is not in a county which\nis part of a standard metropolitan statistical area, the hospital is located in a\nrural census tract of a metropolitan statistical area as determined under the\nmost recent modification of the Golds mith Modification, or is designated by\nthe state as a rural provider. The secretary shall designate a hospital as a rural\nprovider if the hospital is not located in a county which has the largest county\npopulation of a standard metropolitan statistical area;\n(c) Except as provided in paragraph (d) of this subsection, the hospital provides\nnot more than twenty -five (25) acute care inpatient beds for providing acute\ninpatient care for a period that does not exceed, as determined on an annual,\naverage basis, ninety-six (96) hours;\n(d) If the hospital is operating swing beds under which the hospital's inpatient\nhospital facilities are used for the provision of extended care services, the\nhospital may be designated as a critical access hospital so long as the tot al\nnumber of beds that may be used at any time for furnishing of either extended\ncare services or acute inpatient services does not exceed twenty-five (25) beds.\nFor the purposes of this section, any bed of a unit of the hospital that is\nlicensed as a nurs ing facility at the time the hospital applies to the state for\ndesignation as a critical care access hospital shall not be counted.\n(4) The secretary for health and family services may designate a facility as a critical\naccess hospital if the facility:\n(a) Was a hospital that ceased operations on or after ten (10) years prior to April\n21, 2000; or\n(b) Was a hospital that was converted to a licensed ambulatory health center or\nother type of licensed health clinic or health center and, as of the effective date\nof that conversion, meets the criteria for licensure as a critical access hospital\nunder this subsection or subsection (3) of this section.\n(5) A critical access hospital shall provide the following services:\n(a) Twenty-four (24) hour emergency -room care that the secretary determines is\nnecessary for insuring access to emergency care services in each area served\nby a critical access hospital; and\n(b) Basic laboratory, radiologic, pharmacy, and dietary services. The se services\nmay be provided on a part-time, off-site contractual basis.\n(6) A critical access hospital may provide the following services:\n(a) Swing beds or a distinct unit of the hospital which is a nursing facility in\naccordance with KRS Chapter 216B and  subject to approval under certificate\nof need;\n(b) Surgery;\n(c) Normal obstetrics;\n(d) Primary care;\n(e) Adult day health care;\n(f) Respite care;\n(g) Rehabilitative and therapeutic services including, but not limited to, physical\ntherapy, respiratory ther apy, occupational therapy, speech pathology, and\naudiology, which may be provided on an off-site contractual basis;\n(h) Ambulatory care;\n(i) Home health services which may be established upon obtaining a certificate of\nneed; and\n(j) Mobile diagnostic servi ces with equipment not exceeding the major medical\nequipment cost threshold pursuant to KRS Chapter 216B and for which there\nare no review criteria in the State Health Plan.\n(7) In addition to the services that may be provided under subsection (6) of this section,\na critical access hospital may establish the following units in accordance with\napplicable Medicare regulations and subject to certificate of need approval:\n(a) A psychiatric unit that is a distinct part of the hospital, with a maximum of ten\n(10) beds; and\n(b) A rehabilitation unit that is a distinct part of the hospital, with a maximum of\nten (10) beds notwithstanding any other bed limit contained in law or\nregulation.\n(8) Psychiatric unit and rehabilitation unit beds operated under subsection (7 ) of this\nsection shall not be counted in determining the number of beds or the average\nlength of stay of a critical access hospital for purposes of applying the bed and\naverage length of stay limitations under paragraph (c) of subsection (3) of this\nsection.\n(9) The following staffing plan shall apply to a critical access hospital:\n(a) The hospital shall meet staffing requirements as would apply under section\n1861(e) of Title XVIII of the Federal Social Security Act to a hospital located\nin a rural area except that:\n1. The hospital need not meet hospital standards relating to the number of\nhours during a day, or days during a week, in which the hospital shall be\nopen and fully staffed, except insofar as the facility is required to make\navailable emergency services and nursing services available on a twenty-\nfour (24) hour basis; and\n2. The hospital need not otherwise staff the facility except when an\ninpatient is present; and\n(b) Physician assistants and nurse practitioners may provide inpatient care within\nthe limits of their statutory scope of practice and with oversight by a physician\nwho is not required to be on-site at the hospital.\n(10) A critical access hospital shall have a quality assessment and performance\nimprovement program and procedures for review of utilization of services.\n(11) A critical access hospital shall have written contracts assuring the following\nlinkages:\n(a) Secondary and tertiary hospital referral services which shall provide for the\ntransfer of a patient to the appropriate level of care and the transfer of patients\nto the critical access hospital for recuperative care;\n(b) Ambulance services;\n(c) Home health services; and\n(d) Nursing facility services if not provided on-site.\n(12) If the critical access hospital is part of a rural health network, the hospital shall have\nthe following:\n(a) An agreement for patient referral and transfer, development, and use of\ncommunications systems including telemetry and electronic sharing of patie nt\ndata, and emergency and nonemergency transportation; and\n(b) An agreement for credentialing and quality assurance with a network hospital,\npeer review organization, or other appropriate and qualified entity identified in\nthe state rural health plan.\n(13) The Cabinet for Health and Family Services and any insurer or managed care\nprogram for Medicaid recipients that contracts with the Department for Medicaid\nServices for the receipt of Federal Social Security Act Title XIX funds shall provide\nfor reimbursement of services provided to Medicaid recipients in a critical access\nhospital at rates that are at least equal to those established by the Federal Health\nCare Financing Administration or Centers for Medicare and Medicaid Services for\nMedicare reimbursement to a critical access hospital.\n(14) The Cabinet for Health and Family Services shall promulgate administrative\nregulations pursuant to KRS Chapter 13A necessary to implement this section.","path":["KRS Chapter 216"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=47992","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:21Z","sha256":"f374825c0780c625273ae6eac60d02e93b1907bca04d8113b86928b176474368","source_id":"us-ky","stale":false,"prev":"us-ky/krs-216.379","next":"us-ky/krs-216.400"},"notice":"GroundRules: Original legal text. Not legal advice."}