SESSION OF 2025
SUPPLEMENTAL NOTE ON SENATE BILL NO. 82
As Amended by House Committee on Health
and Human Services
Brief*
SB 82, as amended, would add provisions that would
become part of and supplemental to the Rural Emergency
Hospital Act (Act). The bill would authorize the Secretary for
Aging and Disability Services (Secretary), upon application by
a rural emergency hospital (REH) and compliance with
certain requirements, to grant a physical environment waiver
(waiver) for existing nursing facilities to a REH to provide
skilled nursing facility care.
The bill would be in effect upon publication in the
Kansas Register.
Requirements for Waiver
The bill would authorize the Secretary, after application
by a REH, to grant a waiver to the REH to transition a
maximum of 10 swing beds to skilled nursing facility beds if
the REH met the following requirements:
●Licensed as a REH under the Act;
●Licensed as a hospital immediately prior to
licensure as a REH; and
●During licensure as a hospital, the REH provided
skilled nursing facility services or critical access
hospital swing bed services to patients for a
____________________
*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
https://klrd.gov/ minimum of one year without an immediate
jeopardy finding.
Definitions
The bill would define the following terms per existing
statutes:
●“Critical access hospital” would mean a member of
a rural health network that:
○Makes available 24-hour emergency care
services;
○Provides not more than 25 acute care
inpatient beds or, in the case of a facility with
an approved swing-bed agreement, a
combined total of extended care and acute
care beds that does not exceed 25 beds;
○Provides acute inpatient care for a period that
does not exceed, on an annual average basis,
96 hours per patient; and
○Provides nursing services under the direction
of a licensed professional nurse and
continuous licensed professional nursing
services for not less than 24 hours of every
day when any bed is occupied or the facility is
open to provide services for patients unless
an exemption is granted by the licensing
agency pursuant to rules and regulations.
The critical access hospital may provide:
○Any services otherwise required to be
provided by a full-time, on-site dietician,
pharmacist, laboratory technician, medical
technologist, and radiological technologist on
a part-time, off-site basis under written
agreements or arrangements with one or
more providers or suppliers recognized under
Medicare; and
2- 82 ○Inpatient services by a physician assistant,
advanced practice registered nurse, or a
clinical nurse specialist subject to the
oversight of a physician who need not be
present in the facility.
In addition to the facility’s 25 acute beds or swing
beds, or both, the critical access hospital may have
a psychiatric unit or a rehabilitation unit, or both.
Each unit shall not exceed 10 beds and neither unit
shall count toward the 25-bed limit or be subject to
the average 96-hour length of stay restriction [KSA
65-468]; and
●“Hospital” would mean a general hospital, critical
access hospital, or special hospital [KSA 65-425].
Background
The bill was introduced by the Senate Committee on
Public Health and Welfare at the request of Senator Owens
on behalf of the Kansas Hospital Association.
[Note: A companion bill, HB 2249, has been introduced
in the House.]
Senate Committee on Public Health and Welfare
At the Senate Committee meeting, proponent testimony
was provided by representatives of the Kansas Hospital
Association, LeadingAge Kansas, and Mercy Hospital, Inc.
The conferees generally stated the bill is needed to authorize
the Kansas Department for Aging and Disability Services
(KDADS) to grant a waiver for existing nursing facilities to a
REH with skilled nursing units operating under hospital
licensure. Without a waiver, a REH would have to meet the
physical environment standards of a new skilled nursing
facility to continue operating its skilled nursing unit, which
would be cost prohibitive for many older hospital buildings.
3- 82 The conferees stated allowing such a waiver would help
prevent the closure of needed beds in long-term care units of
hospitals and retain a valuable service to the community. The
Mercy Hospital representative provided details regarding the
financial impact the denial of a waiver had on the hospital that
resulted in the closure of its long-term care unit to avoid
jeopardizing its REH designation. The Mercy Hospital
representative noted the closure directly impacted care for its
numerous long-term care residents.
Neutral testimony was provided by a representative of
KDADS who stated the agency is aware of only one REH that
would meet the criteria to request the waiver. The
representative stated the waiver would allow REHs to
transition up to 10 beds from swing beds to skilled nursing
facility beds. The representative noted enactment of the bill
would have no fiscal effect on the agency unless the Centers
for Medicare and Medicaid Services (CMS) allows REHs to
be certified for Medicare or Medicaid services (Title 18 and
Title 19 of the Social Security Act, respectively).
No other testimony was provided.
House Committee on Health and Human Services
In the House Committee hearing, proponent testimony
was provided by representatives of Kansas Hospital
Association and LeadingAge Kansas, who generally stated
that the bill would address issues that have arisen with
hospitals transitioning to the REH model and maintaining
access to care in rural areas.
Neutral testimony was provided by a representative of
KDADS, similar to that provided to the Senate Committee.
Written-only neutral testimony was provided by a
representative of the Kansas Department of Health and
Environment.
4- 82 No other testimony was provided.
The House Committee amended the bill to change the
effective date to upon publication in the Kansas Register.
Fiscal Information
According to the fiscal note prepared by the Division of
Budget on the bill, as introduced, KDADS indicates that
enactment of the bill would have a negligible fiscal effect on
the agency. KDADS is aware of only one REH that meets the
criteria to request the physical environment waiver. The bill
would have no impact on providers unless the CMS would
allow for this newly created entity to be certified for Title 18
and Title 19 services. The bill could increase Medicare or
Medicaid payments for these ten skilled nursing facility beds.
KDADS has not had regulatory oversight over this facility and
does not have information on the utilization of the long-term
beds in the facility before the transition to REH. Granting the
waiver from the physical environment standards for a facility
that meets the requirements of the bill would allow the
provider to continue providing long-term care services as it
did before the transition from a Critical Access Hospital to a
REH.
Rural Emergency Hospital Act; rural emergency hospital; critical access hospital;
skilled nursing facility beds; swing beds; physical environment waiver; Secretary for
Aging and Disability Services
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