216B.020 Certificate of need -- Exemptions -- Categories of care not exempted -- Requirements for issuance of certificate of need

216B.020 Certificate of need -- Exemptions -- Categories of care not exempted --

Requirements for issuance of certificate of need.

(1) The provisions of this chapter that relate to the issuance of a certificate of need shall

not apply to abortion facilities as defined in KRS 216B.015; any hospital which

does not charge its patients for hospital services and does not seek or accept

Medicare, Medicaid, or other financial support from the federal government or any

state government; assisted living residences; family care homes; state veterans'

nursing homes; services provided on a contractual basis in a rural primary-care

hospital as provided under KRS 216.380; community mental health centers for

services as defined in KRS Chapter 210; primary care centers; rural health clinics;

private duty nursing services operating as health care services agencies as defined

in KRS 216.718; group homes; licensed residential crisis stabilization units;

licensed free-standing residential substance use disorder treatment programs with

sixteen (16) or fewer beds, but not including Levels I and II psychiatric residential

treatment facilities or licensed psychiatric inpatient beds; outpatient behavioral

health treatment, but not including partial hospitalization programs; end stage renal

disease dialysis facilities, freestanding or hospital based; swing beds; special

clinics, including but not limited to wellness, weight loss, family planning,

disability determination, speech and hearing, counseling, pulmonary care, and other

clinics which only provide diagnostic services with equipment not exceeding the

major medical equipment cost threshold and for which there are no review criteria

in the state health plan; nonclinically related expenditures; nursing home beds that

shall be exclusively limited to on-campus residents of a certified continuing care

retirement community; home health services provided by a continuing care

retirement community to its on-campus residents; the relocation of hospital

administrative or outpatient services into medical office buildings which are on or

contiguous to the premises of the hospital; the relocation of acute care beds which

occur among acute care hospitals under common ownership and which are located

in the same area development district so long as there is no substantial change in

services and the relocation does not result in the establishment of a new service at

the receiving hospital for which a certificate of need is required; the redistribution

of beds by licensure classification within an acute care hospital so long as the

redistribution does not increase the total licensed bed capacity of the hospital;

residential hospice facilities established by licensed hospice programs; freestanding

birthing centers as defined in KRS 216B.198; the following health services

provided on site in an existing health facility when the cost is less than six hundred

thousand dollars ($600,000) and the services are in place by December 30, 1991:

psychiatric care where chemical dependency services are provided, level one (1)

and level two (2) of neonatal care, cardiac catheterization, and open heart surgery

where cardiac catheterization services are in place as of July 15, 1990; or

ambulance services operating in accordance with subsection (6), (7), or (8) of this

section. These listed facilities or services shall be subject to licensure, when

applicable.

(2) Nothing in this chapter shall be construed to authorize the licensure, supervision,

regulation, or control in any manner of:

(a) Private offices and clinics of physicians, dentists, and other practitioners of

the healing arts, except any physician's office that meets the criteria set forth

in KRS 216B.015(5) or that meets the definition of an ambulatory surgical

center as set out in KRS 216B.015;

ing in this chapter shall be construed to authorize the licensure, supervision,

regulation, or control in any manner of:

(a) Private offices and clinics of physicians, dentists, and other practitioners of

the healing arts, except any physician's office that meets the criteria set forth

in KRS 216B.015(5) or that meets the definition of an ambulatory surgical

center as set out in KRS 216B.015;

(b) Office buildings built by or on behalf of a health facility for the exclusive use

of physicians, dentists, and other practitioners of the healing arts; unless the

physician's office meets the criteria set forth in KRS 216B.015(5), or unless

the physician's office is also an abortion facility as defined in KRS 216B.015,

except no capital expenditure or expenses relating to any such building shall

be chargeable to or reimbursable as a cost for providing inpatient services

offered by a health facility;

(c) Outpatient health facilities or health services that:

1. Do not provide services or hold patients in the facility after midnight;

and

2. Are exempt from certificate of need and licensure under subsection (3)

of this section;

(d) Dispensaries and first-aid stations located within business or industrial

establishments maintained solely for the use of employees, if the facility does

not contain inpatient or resident beds for patients or employees who generally

remain in the facility for more than twenty-four (24) hours;

(e) Establishments, such as motels, hotels, and boarding houses, which provide

domiciliary and auxiliary commercial services, but do not provide any health

related services and boarding houses which are operated by persons

contracting with the United States Department of Veterans Affairs for

boarding services;

(f) The remedial care or treatment of residents or patients in any home or

institution conducted only for those who rely solely upon treatment by prayer

or spiritual means in accordance with the creed or tenets of any recognized

church or religious denomination and recognized by that church or

denomination; and

(g) On-duty police and fire department personnel assisting in emergency

situations by providing first aid or transportation when regular emergency

units licensed to provide first aid or transportation are unable to arrive at the

scene of an emergency situation within a reasonable time.

(3) The following outpatient categories of care shall be exempt from certificate of need

and licensure on July 14, 2018:

(a) Primary care centers;

(b) Special health clinics, unless the clinic provides pain management services

and is located off the campus of the hospital that has majority ownership

interest;

(c) Specialized medical technology services, unless providing a State Health Plan

service;

(d) Retail-based health clinics and ambulatory care clinics that provide

nonemergency, noninvasive treatment of patients;

(e) Ambulatory care clinics treating minor illnesses and injuries;

(f) Mobile health services, unless providing a service in the State Health Plan;

(g) Rehabilitation agencies;

(h) Rural health clinics; and

(i) Off-campus, hospital-acquired physician practices.

(4) The exemptions established by subsections (2) and (3) of this section shall not

apply to the following categories of care:

(a) An ambulatory surgical center as defined by KRS 216B.015(4);

(b) A health facility or health service that provides one (1) of the following types

of services:

1. Cardiac catheterization;

2. Megavoltage radiation therapy;

3. Adult day health care;

4. Behavioral health services;

5. Chronic renal dialysis; or

6. Emergency services above the level of treatment for minor illnesses or

injuries;

(c) A pain management facility as defined by KRS 218A.175(1);

(d) An abortion facility that requires licensure pursuant to KRS 216B.0431; or

pes

of services:

1. Cardiac catheterization;

2. Megavoltage radiation therapy;

3. Adult day health care;

4. Behavioral health services;

5. Chronic renal dialysis; or

6. Emergency services above the level of treatment for minor illnesses or

injuries;

(c) A pain management facility as defined by KRS 218A.175(1);

(d) An abortion facility that requires licensure pursuant to KRS 216B.0431; or

(e) A health facility or health service that requests an expenditure that exceeds the

major medical expenditure minimum.

(5) An existing facility licensed as an intermediate care or nursing home shall notify

the cabinet of its intent to change to a nursing facility as defined in Public Law 100-

203. A certificate of need shall not be required for conversion of an intermediate

care or nursing home to the nursing facility licensure category.

(6) Ambulance services owned and operated by a city government, which propose to

provide services in coterminous cities outside of the ambulance service's designated

geographic service area, shall not be required to obtain a certificate of need if the

governing body of the city in which the ambulance services are to be provided

enters into an agreement with the ambulance service to provide services in the city.

(7) Ambulance services owned by a hospital shall not be required to obtain a certificate

of need for the sole purpose of providing non-emergency and emergency transport

services originating from its hospital.

(8) (a) As used in this subsection, "emergency ambulance transport services" means

the transportation of an individual that has an emergency medical condition

with acute symptoms of sufficient severity that the absence of immediate

medical attention could reasonably be expected to place the individual's health

in serious jeopardy or result in the serious impairment or dysfunction of the

individual's bodily organs.

(b) A city or county government that has conducted a public hearing for the

purposes of demonstrating that an imperative need exists in the city or county

to provide emergency ambulance transport services within its jurisdictional

boundaries shall not be required to obtain a certificate of need for the city or

county to:

1. Directly provide emergency ambulance transport services as defined in

this subsection within the city's or county's jurisdictional boundaries; or

2. Enter into a contract with a hospital or hospitals within its jurisdiction,

or within an adjoining county if there are no hospitals located within the

county, for the provision of emergency ambulance transport services as

defined in this subsection within the city's or county's jurisdictional

boundaries.

(c) Any license obtained under KRS Chapter 311A by a city or county for the

provision of ambulance services operating under a certificate of need

exclusion pursuant to this subsection shall be held exclusively by the city or

county government and shall not be transferrable to any other entity.

(d) Prior to obtaining the written agreement of a city, an ambulance service

operating under a county government certificate of need exclusion pursuant to

this subsection shall not provide emergency ambulance transport services

within the boundaries of any city that:

1. Possesses a certificate of need to provide emergency ambulance

services;

2. Has an agency or department thereof that holds a certificate of need to

provide emergency ambulance services; or

3. Is providing emergency ambulance transport services within its

jurisdictional boundaries pursuant to this subsection.

(9) (a) Except where a certificate of need is not required pursuant to subsection (6),

(7), or (8) of this section, the cabinet shall grant nonsubstantive review for a

certificate of need proposal to establish an ambulance service that is owned by

a:

1. City government;

2. County government; or

3. Hospital, in accordance with paragraph (b) of this subsection.

es pursuant to this subsection.

(9) (a) Except where a certificate of need is not required pursuant to subsection (6),

(7), or (8) of this section, the cabinet shall grant nonsubstantive review for a

certificate of need proposal to establish an ambulance service that is owned by

a:

1. City government;

2. County government; or

3. Hospital, in accordance with paragraph (b) of this subsection.

(b) A notice shall be sent by the cabinet to all cities and counties that a certificate

of need proposal to establish an ambulance service has been submitted by a

hospital. The legislative bodies of the cities and counties affected by the

hospital's certificate of need proposal shall provide a response to the cabinet

within thirty (30) days of receiving the notice. The failure of a city or county

legislative body to respond to the notice shall be deemed to be support for the

proposal.

(c) An ambulance service established under this subsection shall not be

transferred to another entity that does not meet the requirements of paragraph

(a) of this subsection without first obtaining a substantive certificate of need.

(10) Notwithstanding any other provision of law, a continuing care retirement

community's nursing home beds shall not be certified as Medicaid eligible unless a

certificate of need has been issued authorizing applications for Medicaid

certification. The provisions of subsection (5) of this section notwithstanding, a

continuing care retirement community shall not change the level of care licensure

status of its beds without first obtaining a certificate of need.

(11) An ambulance service established under subsection (9) of this section shall not be

transferred to an entity that does not qualify under subsection (9) of this section

without first obtaining a substantive certificate of need.