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AN ACT relating to certificates of need. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
ď˘Section 1. KRS 216B.020 is amended to read as follows: 3
(1) The provisions of this chapter that relate to the issuance of a certificate of need shall 4
not apply to abortion facilities as defined in KRS 216B.015; any hospital which 5
does not charge its patients for hospital services and does not seek or accept 6
Medicare, Medicaid, or other financial support from the federal government or any 7
state government; assisted living residences; family care homes; state veterans' 8
nursing homes; services provided on a contractual basis in a rural primary-care 9
hospital as provided under KRS 216.380; community mental health centers for 10
services as defined in KRS Chapter 210; primary care centers; rural health clinics; 11
private duty nursing services operating as health care services agencies as defined 12
in KRS 216.718; group homes; licensed residential crisis stabilization units; 13
licensed free-standing residential substance use disorder treatment programs with 14
sixteen (16) or fewer beds, but not including Levels I and II psychiatric residential 15
treatment facilities or licensed psychiatric inpatient beds; outpatient behavioral 16
health treatment, but not including partial hospitalization programs; end stage renal 17
disease dialysis facilities, freestanding or hospital based; swing beds; special 18
clinics, including but not limited to wellness, weight loss, family planning, 19
disability determination, speech and hearing, counseling, pulmonary care, and other 20
clinics which only provide diagnostic services with equipment not exceeding the 21
major medical equipment cost threshold and for which there are no review criteria 22
in the state health plan; nonclinically related expenditures; nursing home beds that 23
shall be exclusively limited to on-campus residents of a certified continuing care 24
retirement community; home health services provided by a continuing care 25
retirement community to its on-campus residents; the relocation of hospital 26
administrative or outpatient services into medical office buildings which are on or 27 UNOFFICIAL COPY 23 RS BR 903
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contiguous to the premises of the hospital; the relocation of acute care beds which 1
occur among acute care hospitals under common ownership and which are located 2
in the same area development district so long as there is no substantial change in 3
services and the relocation does not result in the establishment of a new service at 4
the receiving hospital for which a certificate of need is required; the redistribution 5
of beds by licensure classification within an acute care hospital so long as the 6
redistribution does not increase the total licensed bed capacity of the hospital; 7
residential hospice facilities established by licensed hospice programs; the 8
following health services provided on site in an existing health facility when the 9
cost is less than six hundred thousand dollars ($600,000) and the services are in 10
place by December 30, 1991: psychiatric care where chemical dependency services 11
are provided, level one (1) and level two (2) of neonatal care, cardiac 12
catheterization, and open heart surgery where cardiac catheterization services are in 13
place as of July 15, 1990; or ambulance services operating in accordance with 14
subsection (6), (7), or (8) of this section. These listed facilities or services shall be 15
subject to licensure, when applicable. 16
(2) Nothing in this chapter shall be construed to authorize the licensure, supervision, 17
regulation, or control in any manner of: 18
(a) Private offices and clinics of physicians, dentists, and other practitioners of 19
the healing arts, except any physician's office that meets the criteria set forth 20
in KRS 216B.015(5) or that meets the definition of an ambulatory surgical 21
center as set out in KRS 216B.015; 22
(b) Office buildings built by or on behalf of a health facility for the exclusive use 23
of physicians, dentists, and other practitioners of the healing arts; unless the 24
physician's office meets the criteria set forth in KRS 216B.015(5), or unless 25
the physician's office is also an abortion facility as defined in KRS 216B.015, 26
except no capital expenditure or expenses relating to any such building shall 27 UNOFFICIAL COPY 23 RS BR 903
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be chargeable to or reimbursable as a cost for providing inpatient services 1
offered by a health facility; 2
(c) Outpatient health facilities or health services that: 3
1. Do not provide services or hold patients in the facility after midnight; 4
and 5
2. Are exempt from certificate of need and licensure under subsection (3) 6
of this section; 7
(d) Dispensaries and first-aid stations located within business or industrial 8
establishments maintained solely for the use of employees, if the facility does 9
not contain inpatient or resident beds for patients or employees who generally 10
remain in the facility for more than twenty-four (24) hours; 11
(e) Establishments, such as motels, hotels, and boarding houses, which provide 12
domiciliary and auxiliary commercial services, but do not provide any health 13
related services and boarding houses which are operated by persons 14
contracting with the United States Department of Veterans Affairs for 15
boarding services; 16
(f) The remedial care or treatment of residents or patients in any home or 17
institution conducted only for those who rely solely upon treatment by prayer 18
or spiritual means in accordance with the creed or tenets of any recognized 19
church or religious denomination and recognized by that church or 20
denomination; and 21
(g) On-duty police and fire department personnel assisting in emergency 22
situations by providing first aid or transportation when regular emergency 23
units licensed to provide first aid or transportation are unable to arrive at the 24
scene of an emergency situation within a reasonable time. 25
(3) The following outpatient categories of care shall be exempt from certificate of need 26
and licensure on July 14, 2018: 27 UNOFFICIAL COPY 23 RS BR 903
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(a) Primary care centers; 1
(b) Special health clinics, unless the clinic provides pain management services 2
and is located off the campus of the hospital that has majority ownership 3
interest; 4
(c) Specialized medical technology services, unless providing a State Health Plan 5
service; 6
(d) Retail-based health clinics and ambulatory care clinics that provide 7
nonemergency, noninvasive treatment of patients; 8
(e) Ambulatory care clinics treating minor illnesses and injuries; 9
(f) Mobile health services, unless providing a service in the State Health Plan; 10
(g) Rehabilitation agencies; 11
(h) Rural health clinics; and 12
(i) Off-campus, hospital-acquired physician practices. 13
(4) The exemptions established by subsections (2) and (3) of this section shall not 14
apply to the following categories of care: 15
(a) An ambulatory surgical center as defined by KRS 216B.015(4); 16
(b) A health facility or health service that provides one (1) of the following types 17
of services: 18
1. Cardiac catheterization; 19
2. Megavoltage radiation therapy; 20
3. Adult day health care; 21
4. Behavioral health services; 22
5. Chronic renal dialysis; 23
6. Birthing services; or 24
7. Emergency services above the level of treatment for minor illnesses or 25
injuries; 26
(c) A pain management facility as defined by KRS 218A.175(1); 27 UNOFFICIAL COPY 23 RS BR 903
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(d) An abortion facility that requires licensure pursuant to KRS 216B.0431; or 1
(e) A health facility or health service that requests an expenditure that exceeds the 2
major medical expenditure minimum. 3
(5) An existing facility licensed as an intermediate care or nursing home shall notify 4
the cabinet of its intent to change to a nursing facility as defined in Public Law 100-5
203. A certificate of need shall not be required for conversion of an intermediate 6
care or nursing home to the nursing facility licensure category. 7
(6) Ambulance services owned and operated by a city government, which propose to 8
provide services in coterminous cities outside of the ambulance service's designated 9
geographic service area, shall not be required to obtain a certificate of need if the 10
governing body of the city in which the ambulance services are to be provided 11
enters into an agreement with the ambulance service to provide services in the city. 12
(7) Ambulance services owned by a hospital shall not be required to obtain a certificate 13
of need for the sole purpose of providing non-emergency and emergency transport 14
services originating from its hospital. 15
(8) (a) As used in this subsection, "emergency ambulance transport services" means 16
the transportation of an individual that has an emergency medical condition 17
with acute symptoms of sufficient severity that the absence of immediate 18
medical attention could reasonably be expected to place the individual's health 19
in serious jeopardy or result in the serious impairment or dysfunction of the 20
individual's bodily organs. 21
(b) A city or county government that has conducted a public hearing for the 22
purposes of demonstrating that an imperative need exists in the city or county 23
to provide emergency ambulance transport services within its jurisdictional 24
boundaries shall not be required to obtain a certificate of need for the city or 25
county to: 26
1. Directly provide emergency ambulance transport services as defined in 27 UNOFFICIAL COPY 23 RS BR 903
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this subsection within the city's or county's jurisdictional boundaries; or 1
2. Enter into a contract with a hospital or hospitals within its jurisdiction, 2
or within an adjoining county if there are no hospitals located within the 3
county, for the provision of emergency ambulance transport services as 4
defined in this subsection within the city's or county's jurisdictional 5
boundaries. 6
(c) Any license obtained under KRS Chapter 311A by a city or county for the 7
provision of ambulance services operating under a certificate of need 8
exclusion pursuant to this subsection shall be held exclusively by the city or 9
county government and shall not be transferrable to any other entity. 10
(d) Prior to obtaining the written agreement of a city, an ambulance service 11
operating under a county government certificate of need exclusion pursuant to 12
this subsection shall not provide emergency ambulance transport services 13
within the boundaries of any city that: 14
1. Possesses a certificate of need to provide emergency ambulance 15
services; 16
2. Has an agency or department thereof that holds a certificate of need to 17
provide emergency ambulance services; or 18
3. Is providing emergency ambulance transport services within its 19
jurisdictional boundaries pursuant to this subsection. 20
(9) (a) Except where a certificate of need is not required pursuant to subsection (6), 21
(7), or (8) of this section, the cabinet shall grant nonsubstantive review for a 22
certificate of need proposal to establish an ambulance service that is owned by 23
a: 24
1. City government; 25
2. County government; or 26
3. Hospital, in accordance with paragraph (b) of this subsection. 27 UNOFFICIAL COPY 23 RS BR 903
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(b) A notice shall be sent by the cabinet to all cities and counties that a certificate 1
of need proposal to establish an ambulance service has been submitted by a 2
hospital. The legislative bodies of the cities and counties affected by the 3
hospital's certificate of need proposal shall provide a response to the cabinet 4
within thirty (30) days of receiving the notice. The failure of a city or county 5
legislative body to respond to the notice shall be deemed to be support for the 6
proposal. 7
(c) An ambulance service established under this subsection shall not be 8
transferred to another entity that does not meet the requirements of paragraph 9
(a) of this subsection without first obtaining a substantive certificate of need. 10
(10) Notwithstanding any other provision of law, a continuing care retirement 11
community's nursing home beds shall not be certified as Medicaid eligible unless a 12
certificate of need has been issued authorizing applications for Medicaid 13
certification. The provisions of subsection (5) of this section notwithstanding, a 14
continuing care retirement community shall not change the level of care licensure 15
status of its beds without first obtaining a certificate of need. 16
(11) An ambulance service established under subsection (9) of this section shall not be 17
transferred to an entity that does not qualify under subsection (9) of this section 18
without first obtaining a substantive certificate of need. 19
(12) (a) The provisions of subsections (7), (8), and (9) of this section shall expire on 20
July 1, 2026. 21
(b) All actions taken by cities, counties, and hospitals, exemptions from obtaining 22
a certificate of need, and any certificate of need granted under subsections (7), 23
(8), and (9) of this section prior to July 1, 2026, shall remain in effect on and 24
after July 1, 2026. 25
(13) A certificate of need shall not be required to establish any health service in any 26
group of three (3) contiguous counties if each county borders another state and 27 UNOFFICIAL COPY 23 RS BR 903
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each county has a population of ninety thousand (90,000) or more according to 1
the most recent federal decennial census. 2