AN ACT relating to ambulatory surgical centers.

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AN ACT relating to ambulatory surgical centers. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 216B.020 is amended to read as follows: 3
(1) (a) The provisions of this chapter that relate to the issuance of a certificate of 4
need shall not apply to: 5
1. Abortion facilities as defined in KRS 216B.015; 6
2. Any hospital that[which] does not charge its patients for hospital 7
services and does not seek or accept Medicare, Medicaid, or other 8
financial support from the federal government or any state government; 9
3. Assisted living residences; 10
4. Family care homes; 11
5. State veterans' nursing homes; 12
6. Services provided on a contractual basis in a rural primary -care hospital 13
as provided under KRS 216.380; 14
7. Community mental health centers for services as defined in KRS 15
Chapter 210; 16
8. Primary care centers; 17
9. Rural health clinics; 18
10. Private duty nursing services operating as health care services agencies 19
as defined in KRS 216.718; 20
11. Group homes; 21
12. Licensed residential crisis stabilization units; 22
13. Licensed free -standing residential substance use disorder trea tment 23
programs with sixteen (16) or fewer beds, but not including Levels I and 24
II psychiatric residential treatment facilities or licensed psychiatric 25
inpatient beds; 26
14. Outpatient behavioral health treatment, but not including partial 27
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hospitalization programs; 1
15. End stage renal disease dialysis facilities, freestanding or hospital based; 2
16. Swing beds; 3
17. Special clinics, including but not limited to wellness, weight loss, family 4
planning, disability determination, speech and hearing, counseling, 5
pulmonary care, and other clinics that[which] only provide diagnostic 6
services with equipment not exceeding the major medical equipment 7
cost threshold and for which there are no review criteria in the state 8
health plan; 9
18. Nonclinically related expenditures; 10
19. Nursing home beds that shall be exclusively limited to on -campus 11
residents of a certified continuing care retirement community; 12
20. Home health services provided by a continuing care retirement 13
community to its on-campus residents; 14
21. The relocation o f hospital administrative or outpatient services into 15
medical office buildings that[which] are on or contiguous to the 16
premises of the hospital; 17
22. The relocation of acute care beds that[which] occur among acute care 18
hospitals under common ownership and that[which] are located in the 19
same area development district so long as there is no substantial change 20
in services and the relocation does not result in the establishment of a 21
new service at the receiving hospital for which a certificate of need is 22
required; 23
23. The redistribution of beds by licensure classification within an acute 24
care hospital so long as the redistribution does not increase the total 25
licensed bed capacity of the hospital; 26
24. Residential hospice facilities established by licensed hospice programs; 27
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25. Freestanding birthing centers as defined in KRS 216B.198; 1
26. Ambulatory surgical centers that are ophthalmology or endoscopy 2
surgical centers: 3
a. Limited to providing ophthalmic surgery or endoscopic 4
procedures; and 5
b. One hundred percent (100%) owned by an ophthalmologist or a 6
physician who practices at the ambulatory surgical center, or an 7
ophthalmologist group or physician group whose members 8
practice at the ambulatory surgical center; 9
27. The following health services provided on site in an existing health 10
facility when the cost is less than six hundred thousand dollars 11
($600,000) and the services are in place by December 30, 1991: 12
a. Psychiatric care where chemical dependency services are 13
provided;[, ] 14
b. Level I[one (1)] and Level II[level two (2)] of neonatal care; and[, 15
] 16
c. Cardiac catheterization [,] and open heart surgery where cardiac 17
catheterization services are in place as of July 15, 1990; or 18
28. Ambulance services operating in accordance with subsection (6), (7), or 19
(8) of this section. 20
(b) The[These listed] facilities or services listed in paragraph (a) of this 21
subsection shall be subject to licensure, when applicable. 22
(2) Nothing in this chapter shall be construed to authorize the licensure, supervision, 23
regulation, or control in any manner of: 24
(a) Private offices and clinics of physicians, dentists, and other practitioners of 25
the healing arts, except any physician's office that meets the criteria set forth 26
in KRS 216B.015(5) or that meets the definition of an ambulatory surgical 27
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center as set out in KRS 216B.015; 1
(b) Office buildings built by or on behalf of a health facility for the exclusive use 2
of physicians, dentists, an d other practitioners of the healing arts; unless the 3
physician's office meets the criteria set forth in KRS 216B.015(5), or unless 4
the physician's office is also an abortion facility as defined in KRS 216B.015, 5
except no capital expenditure or expenses re lating to any such building shall 6
be chargeable to or reimbursable as a cost for providing inpatient services 7
offered by a health facility; 8
(c) Outpatient health facilities or health services that: 9
1. Do not provide services or hold patients in the facilit y after midnight; 10
and 11
2. Are exempt from certificate of need and licensure under subsection (3) 12
of this section; 13
(d) Dispensaries and first -aid stations located within business or industrial 14
establishments maintained solely for the use of employees, if the facility does 15
not contain inpatient or resident beds for patients or employees who generally 16
remain in the facility for more than twenty-four (24) hours; 17
(e) Establishments[,] such as motels, hotels, and boarding houses [,] that[which] 18
provide domiciliary and auxiliary commercial services [,] but do not provide 19
any health related services and boarding houses that[which] are operated by 20
persons contracting with the United States Department of Veterans Affairs for 21
boarding services; 22
(f) The remedial care or tr eatment of residents or patients in any home or 23
institution conducted only for those who rely solely upon treatment by prayer 24
or spiritual means in accordance with the creed or tenets of any recognized 25
church or religious denomination and recognized by tha t church or 26
denomination; and 27
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(g) On-duty police and fire department personnel assisting in emergency 1
situations by providing first aid or transportation when regular emergency 2
units licensed to provide first aid or transportation are unable to arrive at t he 3
scene of an emergency situation within a reasonable time. 4
(3) The following outpatient categories of care shall be exempt from certificate of need 5
and licensure[ on July 14, 2018]: 6
(a) Primary care centers; 7
(b) Special health clinics, unless the clinic provides pain management services 8
and is located off the campus of the hospital that has majority ownership 9
interest; 10
(c) Specialized medical technology services, unless providing a State Health Plan 11
service; 12
(d) Retail-based health clinics and ambulatory care clinics that provide 13
nonemergency, noninvasive treatment of patients; 14
(e) Ambulatory care clinics treating minor illnesses and injuries; 15
(f) Mobile health services, unless providing a service in the State Health Plan; 16
(g) Rehabilitation agencies; 17
(h) Rural health clinics; and 18
(i) Off-campus, hospital-acquired physician practices. 19
(4) The exemptions established by subsections (2) and (3) of this section shall not 20
apply to the following categories of care: 21
(a) An ambulatory surgical center as defined in[by] KRS 216B.015[(4)]; 22
(b) A health facility or health service that provides one (1) of the following types 23
of services: 24
1. Cardiac catheterization; 25
2. Megavoltage radiation therapy; 26
3. Adult day health care; 27
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4. Behavioral health services; 1
5. Chronic renal dialysis; or 2
6. Emergency services above the level of treatment for minor illnesses or 3
injuries; 4
(c) A pain management facility as defined by KRS 218A.175[(1)]; 5
(d) An abortion facility that requires licensure pursuant to KRS 216B.0431; or 6
(e) A health facility or health service that requests an expenditure that exceeds the 7
major medical expenditure minimum. 8
(5) An existing facility licensed as an intermediate care or nursing home shall notify 9
the cabinet of its intent to change to a nursing facility as defined in Pub. L. 10
No.[Public Law] 100-203. A certificate of need shall not be required for conversion 11
of an intermediate care or nursing home to the nursing facility licensure category. 12
(6) Ambulance services own ed and operated by a city government [,] that[which] 13
propose to provide services in coterminous cities outside of the ambulance service's 14
designated geographic service area [,] shall not be required to obtain a certificate of 15
need if the governing body of th e city in which the ambulance services are to be 16
provided enters into an agreement with the ambulance service to provide services in 17
the city. 18
(7) Ambulance services owned by a hospital shall not be required to obtain a certificate 19
of need for the sole pur pose of providing non -emergency and emergency transport 20
services originating from its hospital. 21
(8) (a) As used in this subsection, "emergency ambulance transport services" means 22
the transportation of an individual that has an emergency medical condition 23
with acute symptoms of sufficient severity that the absence of immediate 24
medical attention could reasonably be expected to place the individual's health 25
in serious jeopardy or result in the serious impairment or dysfunction of the 26
individual's bodily organs. 27
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(b) A city or county government that has conducted a public hearing for the 1
purposes of demonstrating that an imperative need exists in the city or county 2
to provide emergency ambulance transport services within its jurisdictional 3
boundaries shall not be required to obtain a certificate of need for the city or 4
county to: 5
1. Directly provide emergency ambulance transport services as defined in 6
this subsection within the city's or county's jurisdictional boundaries; or 7
2. Enter into a contract with a hospit al or hospitals within its jurisdiction, 8
or within an adjoining county if there are no hospitals located within the 9
county, for the provision of emergency ambulance transport services as 10
defined in this subsection within the city's or county's jurisdiction al 11
boundaries. 12
(c) Any license obtained under KRS Chapter 311A by a city or county for the 13
provision of ambulance services operating under a certificate of need 14
exclusion pursuant to this subsection shall be held exclusively by the city or 15
county government and shall not be transferrable to any other entity. 16
(d) Prior to obtaining the written agreement of a city, an ambulance service 17
operating under a county government certificate of need exclusion pursuant to 18
this subsection shall not provide emergency amb ulance transport services 19
within the boundaries of any city that: 20
1. Possesses a certificate of need to provide emergency ambulance 21
services; 22
2. Has an agency or department thereof that holds a certificate of need to 23
provide emergency ambulance services; or 24
3. Is providing emergency ambulance transport services within its 25
jurisdictional boundaries pursuant to this subsection. 26
(9) (a) Except where a certificate of need is not required pursuant to subsection (6), 27
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(7), or (8) of this section, the cabinet shall grant nonsubstantive review for a 1
certificate of need proposal to establish an ambulance service that is owned by 2
a: 3
1. City government; 4
2. County government; or 5
3. Hospital, in accordance with paragraph (b) of this subsection. 6
(b) A notice shall be sent by the cabinet to all cities and counties that a certificate 7
of need proposal to establish an ambulance service has been submitted by a 8
hospital. The legislative bodi es of the cities and counties affected by the 9
hospital's certificate of need proposal shall provide a response to the cabinet 10
within thirty (30) days of receiving the notice. The failure of a city or county 11
legislative body to respond to the notice shall b e deemed to be support for the 12
proposal. 13
(c) An ambulance service established under this subsection shall not be 14
transferred to another entity that does not meet the requirements of paragraph 15
(a) of this subsection without first obtaining a substantive certificate of need. 16
(10) Notwithstanding any other provision of law, a continuing care retirement 17
community's nursing home beds shall not be certified as Medicaid eligible unless a 18
certificate of need has been issued authorizing applications for Medicaid 19
certification. The provisions of subsection (5) of this section notwithstanding, a 20
continuing care retirement community shall not change the level of care licensure 21
status of its beds without first obtaining a certificate of need. 22
(11) An ambulance service es tablished under subsection (9) of this section shall not be 23
transferred to an entity that does not qualify under subsection (9) of this section 24
without first obtaining a substantive certificate of need. 25
Section 2. KRS 216B.061 is amended to read as follows: 26
(1) Unless otherwise provided in this chapter, a[no] person shall not do any of the 27
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following without first obtaining a certificate of need: 1
(a) Establish a health facility; 2
(b) Obligate a capital expenditure which exceeds the capital expenditure 3
minimum; 4
(c) Make a substantial change in the bed capacity of a health facility; 5
(d) Make a substantial change in a health service; 6
(e) Make a substantial change in a project; 7
(f) Acquire major medical equipment; 8
(g) Alter a geographical area or alter a specific location which has been 9
designated on a certificate of need or license; or 10
(h) Transfer an approved certificate of need for the establishment of a new health 11
facility or the replacement of a licensed facility. 12
(2) A[No] person shall not separate portions of a single project into components in 13
order to evade any expenditure minimum established[set forth] in this chapter. For 14
purposes of this chapter, the acquisition of one (1) or more items of functionally 15
related diagnostic or therapeutic equipment shall be considered as one (1) project. 16
(3) A[No] person shall not have ex parte contact with the final -decision-making 17
authority engaged in certificate of need activities regarding a certificate of 18
need[certificate-of-need] application from the commencement of the review cycle 19
to the final decision. If an ex parte contact occurs, it shall be promptly made a part 20
of the record. 21
(4) A[No] person shall not obligate a capital expenditure in excess of the amount 22
authorized by an existing certificate of need unless the person has received an 23
administrative escalation from the cabinet in accordance with an administrative 24
regulation promulgated by the cabinet in accordance with KRS Chapter 13A [as 25
prescribed by regulation]. 26
(5) A[No] person shall not proceed to obligate a capital expenditure under an approved 27
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certificate of need if there has been a substantial change in the project. 1
(6) A certificate of need shall be issued for a specific location and, when applicable, for 2
a designated geographical area. 3
(7) A[No] person shall not establish an ambulatory surgical center as defined in KRS 4
216B.015 without obtaining a certificate of need. An ambulatory surgical center 5
shall require a [certificate of need and ] license, and a certificate of need except as 6
exempted[notwithstanding any exemption contained] in KRS 216B.020. 7
(8) Nothing in this chapter shall be interpreted to require any ambulatory surgical 8
center licensed as of July 12, 2012, to obtain a certificate of need to continue 9
operations and exercise all of the rights of a licensed health care facility, regardless 10
of whether it obtained a certificate of need before being licensed. 11