UNOFFICIAL COPY 23 RS BR 1326 Page 1 of 20 XXXX 2/7/2023 11:16 AM Jacketed AN ACT relating to freestanding birthing centers. 1 Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2 SECTION 1. A NEW SECTION OF KRS CHAPTER 216B IS CREATED TO 3 READ AS FOLLOWS: 4 (1) As used in this section, "freestanding birthing center" means any health facility, 5 place, or institution which is not a hospital, is not in a hospital or a private 6 residence, and is established to provide care for labor, delivery, the immediate 7 postpartum period, and the newborn immediately following delivery. 8 (2) The cabinet shall promulgate updated administrative regulations establishing 9 licensure standards for freestanding birthing centers by December 1, 2023. The 10 administrative regulations shall: 11 (a) Require accreditation by the Commission for the Accreditation of Birth 12 Centers; 13 (b) Be consistent with the American Association of Birth Centers (AABC) 14 Standards for Birth Centers; 15 (c) Consistent with the requirements of paragraphs (a) and (b) of this 16 subsection, require plans for transfer and safe transport to a hospital when 17 such transfer and transport are needed, including to facilities providing 18 maternal and neonatal intensive care when such care is indicated; and 19 (d) Not prohibit a hospital from owning or operating a freestanding birthing 20 center that complies with the requirements of this section. 21 (3) A certificate of need shall not be required to establish and license a freestanding 22 birthing center. 23 (4) Nothing in this section is intended to expand or limit liability of a health care 24 provider or a freestanding birthing center. In the event of an action for injury or 25 death due to any act or omission of a health care provider rendering services at a 26 freestanding birthing center where an injured patient is transferred to any other 27 UNOFFICIAL COPY 23 RS BR 1326 Page 2 of 20 XXXX 2/7/2023 11:16 AM Jacketed licensed health care provider or licensed health care facility, the liability of the 1 subsequent licensed health care provider or licensed health care facility shall be 2 limited to their own negligent acts and omissions that violate their standards of 3 care according to existing law, unless the subsequent licensed health care 4 provider or licensed health care facility owns, operates, or provides care at the 5 freestanding birthing center, and under those circumstances the licensed health 6 care provider or licensed health care facility shall be liable for acts or omissions 7 that violate their standards of care and that occur at a freestanding birthing 8 center that the licensed health care provider or licensed health care facility owns 9 or operates. 10 Section 2. KRS 216B.020 is amended to read as follows: 11 (1) The provisions of this chapter that relate to the issuance of a certificate of need shall 12 not apply to abortion facilities as defined in KRS 216B.015; any hospital which 13 does not charge its patients for hospital services and does not seek or accept 14 Medicare, Medicaid, or other financial support from the federal government or any 15 state government; assisted living residences; family care homes; state veterans' 16 nursing homes; services provided on a contractual basis in a rural primary-care 17 hospital as provided under KRS 216.380; community mental health centers for 18 services as defined in KRS Chapter 210; primary care centers; rural health clinics; 19 private duty nursing services operating as health care services agencies as defined 20 in KRS 216.718; group homes; licensed residential crisis stabilization units; 21 licensed free-standing residential substance use disorder treatment programs with 22 sixteen (16) or fewer beds, but not including Levels I and II psychiatric residential 23 treatment facilities or licensed psychiatric inpatient beds; outpatient behavioral 24 health treatment, but not including partial hospitalization programs; end stage renal 25 disease dialysis facilities, freestanding or hospital based; swing beds; special 26 clinics, including but not limited to wellness, weight loss, family planning, 27 UNOFFICIAL COPY 23 RS BR 1326 Page 3 of 20 XXXX 2/7/2023 11:16 AM Jacketed disability determination, speech and hearing, counseling, pulmonary care, and other 1 clinics which only provide diagnostic services with equipment not exceeding the 2 major medical equipment cost threshold and for which there are no review criteria 3 in the state health plan; nonclinically related expenditures; nursing home beds that 4 shall be exclusively limited to on-campus residents of a certified continuing care 5 retirement community; home health services provided by a continuing care 6 retirement community to its on-campus residents; the relocation of hospital 7 administrative or outpatient services into medical office buildings which are on or 8 contiguous to the premises of the hospital; the relocation of acute care beds which 9 occur among acute care hospitals under common ownership and which are located 10 in the same area development district so long as there is no substantial change in 11 services and the relocation does not result in the establishment of a new service at 12 the receiving hospital for which a certificate of need is required; the redistribution 13 of beds by licensure classification within an acute care hospital so long as the 14 redistribution does not increase the total licensed bed capacity of the hospital; 15 residential hospice facilities established by licensed hospice programs; freestanding 16 birthing centers as defined in Section 1 of this Act; the following health services 17 provided on site in an existing health facility when the cost is less than six hundred 18 thousand dollars ($600,000) and the services are in place by December 30, 1991: 19 psychiatric care where chemical dependency services are provided, level one (1) 20 and level two (2) of neonatal care, cardiac catheterization, and open heart surgery 21 where cardiac catheterization services are in place as of July 15, 1990; or 22 ambulance services operating in accordance with subsection (6), (7), or (8) of this 23 section. These listed facilities or services shall be subject to licensure, when 24 applicable. 25 (2) Nothing in this chapter shall be construed to authorize the licensure, supervision, 26 regulation, or control in any manner of: 27 UNOFFICIAL COPY 23 RS BR 1326 Page 4 of 20 XXXX 2/7/2023 11:16 AM Jacketed (a) Private offices and clinics of physicians, dentists, and other practitioners of 1 the healing arts, except any physician's office that meets the criteria set forth 2 in KRS 216B.015(5) or that meets the definition of an ambulatory surgical 3 center as set out in KRS 216B.015; 4 (b) Office buildings built by or on behalf of a health facility for the exclusive use 5 of physicians, dentists, and other practitioners of the healing arts; unless the 6 physician's office meets the criteria set forth in KRS 216B.015(5), or unless 7 the physician's office is also an abortion facility as defined in KRS 216B.015, 8 except no capital expenditure or expenses relating to any such building shall 9 be chargeable to or reimbursable as a cost for providing inpatient services 10 offered by a health facility; 11 (c) Outpatient health facilities or health services that: 12 1. Do not provide services or hold patients in the facility after midnight; 13 and 14 2. Are exempt from certificate of need and licensure under subsection (3) 15 of this section; 16 (d) Dispensaries and first-aid stations located within business or industrial 17 establishments maintained solely for the use of employees, if the facility does 18 not contain inpatient or resident beds for patients or employees who generally 19 remain in the facility for more than twenty-four (24) hours; 20 (e) Establishments, such as motels, hotels, and boarding houses, which provide 21 domiciliary and auxiliary commercial services, but do not provide any health 22 related services and boarding houses which are operated by persons 23 contracting with the United States Department of Veterans Affairs for 24 boarding services; 25 (f) The remedial care or treatment of residents or patients in any home or 26 institution conducted only for those who rely solely upon treatment by prayer 27 UNOFFICIAL COPY 23 RS BR 1326 Page 5 of 20 XXXX 2/7/2023 11:16 AM Jacketed or spiritual means in accordance with the creed or tenets of any recognized 1 church or religious denomination and recognized by that church or 2 denomination; and 3 (g) On-duty police and fire department personnel assisting in emergency 4 situations by providing first aid or transportation when regular emergency 5 units licensed to provide first aid or transportation are unable to arrive at the 6 scene of an emergency situation within a reasonable time. 7 (3) The following outpatient categories of care shall be exempt from certificate of need 8 and licensure on July 14, 2018: 9 (a) Primary care centers; 10 (b) Special health clinics, unless the clinic provides pain management services 11 and is located off the campus of the hospital that has majority ownership 12 interest; 13 (c) Specialized medical technology services, unless providing a State Health Plan 14 service; 15 (d) Retail-based health clinics and ambulatory care clinics that provide 16 nonemergency, noninvasive treatment of patients; 17 (e) Ambulatory care clinics treating minor illnesses and injuries; 18 (f) Mobile health services, unless providing a service in the State Health Plan; 19 (g) Rehabilitation agencies; 20 (h) Rural health clinics; and 21 (i) Off-campus, hospital-acquired physician practices. 22 (4) The exemptions established by subsections (2) and (3) of this section shall not 23 apply to the following categories of care: 24 (a) An ambulatory surgical center as defined by KRS 216B.015(4); 25 (b) A health facility or health service that provides one (1) of the following types 26 of services: 27 UNOFFICIAL COPY 23 RS BR 1326 Page 6 of 20 XXXX 2/7/2023 11:16 AM Jacketed 1. Cardiac catheterization; 1 2. Megavoltage radiation therapy; 2 3. Adult day health care; 3 4. Behavioral health services; 4 5. Chronic renal dialysis;[ 5 6. Birthing services;] or 6 6.[7.] Emergency services above the level of treatment for minor illnesses or 7 injuries; 8 (c) A pain management facility as defined by KRS 218A.175(1); 9 (d) An abortion facility that requires licensure pursuant to KRS 216B.0431; or 10 (e) A health facility or health service that requests an expenditure that exceeds the 11 major medical expenditure minimum. 12 (5) An existing facility licensed as an intermediate care or nursing home shall notify 13 the cabinet of its intent to change to a nursing facility as defined in Public Law 100-14 203. A certificate of need shall not be required for conversion of an intermediate 15 care or nursing home to the nursing facility licensure category. 16 (6) Ambulance services owned and operated by a city government, which propose to 17 provide services in coterminous cities outside of the ambulance service's designated 18 geographic service area, shall not be required to obtain a certificate of need if the 19 governing body of the city in which the ambulance services are to be provided 20 enters into an agreement with the ambulance service to provide services in the city. 21 (7) Ambulance services owned by a hospital shall not be required to obtain a certificate 22 of need for the sole purpose of providing non-emergency and emergency transport 23 services originating from its hospital. 24 (8) (a) As used in this subsection, "emergency ambulance transport services" means 25 the transportation of an individual that has an emergency medical condition 26 with acute symptoms of sufficient severity that the absence of immediate 27 UNOFFICIAL COPY 23 RS BR 1326 Page 7 of 20 XXXX 2/7/2023 11:16 AM Jacketed medical attention could reasonably be expected to place the individual's health 1 in serious jeopardy or result in the serious impairment or dysfunction of the 2 individual's bodily organs. 3 (b) A city or county government that has conducted a public hearing for the 4 purposes of demonstrating that an imperative need exists in the city or county 5 to provide emergency ambulance transport services within its jurisdictional 6 boundaries shall not be required to obtain a certificate of need for the city or 7 county to: 8 1. Directly provide emergency ambulance transport services as defined in 9 this subsection within the city's or county's jurisdictional boundaries; or 10 2. Enter into a contract with a hospital or hospitals within its jurisdiction, 11 or within an adjoining county if there are no hospitals located within the 12 county, for the provision of emergency ambulance transport services as 13 defined in this subsection within the city's or county's jurisdictional 14 boundaries. 15 (c) Any license obtained under KRS Chapter 311A by a city or county for the 16 provision of ambulance services operating under a certificate of need 17 exclusion pursuant to this subsection shall be held exclusively by the city or 18 county government and shall not be transferrable to any other entity. 19 (d) Prior to obtaining the written agreement of a city, an ambulance service 20 operating under a county government certificate of need exclusion pursuant to 21 this subsection shall not provide emergency ambulance transport services 22 within the boundaries of any city that: 23 1. Possesses a certificate of need to provide emergency ambulance 24 services; 25 2. Has an agency or department thereof that holds a certificate of need to 26 provide emergency ambulance services; or 27 UNOFFICIAL COPY 23 RS BR 1326 Page 8 of 20 XXXX 2/7/2023 11:16 AM Jacketed 3. Is providing emergency ambulance transport services within its 1 jurisdictional boundaries pursuant to this subsection. 2 (9) (a) Except where a certificate of need is not required pursuant to subsection (6), 3 (7), or (8) of this section, the cabinet shall grant nonsubstantive review for a 4 certificate of need proposal to establish an ambulance service that is owned by 5 a: 6 1. City government; 7 2. County government; or 8 3. Hospital, in accordance with paragraph (b) of this subsection. 9 (b) A notice shall be sent by the cabinet to all cities and counties that a certificate 10 of need proposal to establish an ambulance service has been submitted by a 11 hospital. The legislative bodies of the cities and counties affected by the 12 hospital's certificate of need proposal shall provide a response to the cabinet 13 within thirty (30) days of receiving the notice. The failure of a city or county 14 legislative body to respond to the notice shall be deemed to be support for the 15 proposal. 16 (c) An ambulance service established under this subsection shall not be 17 transferred to another entity that does not meet the requirements of paragraph 18 (a) of this subsection without first obtaining a substantive certificate of need. 19 (10) Notwithstanding any other provision of law, a continuing care retirement 20 community's nursing home beds shall not be certified as Medicaid eligible unless a 21 certificate of need has been issued authorizing applications for Medicaid 22 certification. The provisions of subsection (5) of this section notwithstanding, a 23 continuing care retirement community shall not change the level of care licensure 24 status of its beds without first obtaining a certificate of need. 25 (11) An ambulance service established under subsection (9) of this section shall not be 26 transferred to an entity that does not qualify under subsection (9) of this section 27 UNOFFICIAL COPY 23 RS BR 1326 Page 9 of 20 XXXX 2/7/2023 11:16 AM Jacketed without first obtaining a substantive certificate of need. 1 (12) (a) The provisions of subsections (7), (8), and (9) of this section shall expire on 2 July 1, 2026. 3 (b) All actions taken by cities, counties, and hospitals, exemptions from obtaining 4 a certificate of need, and any certificate of need granted under subsections (7), 5 (8), and (9) of this section prior to July 1, 2026, shall remain in effect on and 6 after July 1, 2026. 7 Section 3. KRS 196.173 is amended to read as follows: 8 (1) Except as provided in subsection (2) of this section, an inmate housed in a jail, 9 penitentiary, or local or state correctional or detention facility, residential center, or 10 reentry center who is known to be pregnant shall be restrained solely with 11 handcuffs in front of her body unless further restraint is required to protect herself 12 or others. 13 (2) (a) Except in an extraordinary circumstance, no inmate who is known to be 14 pregnant shall be restrained during labor, during transport to a medical facility 15 or freestanding birthing center for delivery, or during postpartum recovery. 16 (b) As used in this subsection, "extraordinary circumstance" means that 17 reasonable grounds exist to believe the inmate presents an immediate and 18 credible: 19 1. Serious threat of hurting herself, staff, or others; or 20 2. Risk of escape that cannot be reasonably minimized through any method 21 other than restraints. 22 Section 4. KRS 211.647 is amended to read as follows: 23 (1) The office, on receipt of an auditory screening report of an infant from a hospital or 24 freestanding[alternative] birthing center in accordance with KRS 216.2970 shall 25 review each auditory screening report that indicates a potential hearing loss. The 26 office shall contact the parents to schedule follow-up evaluations or make a referral 27 UNOFFICIAL COPY 23 RS BR 1326 Page 10 of 20 XXXX 2/7/2023 11:16 AM Jacketed for evaluations within three (3) business days. 1 (2) The office shall secure information missing from birth certificates or hospital 2 referral reports which is relevant to identifying infants with a hearing loss. 3 (3) The office shall establish standards for infant audiological assessment and 4 diagnostic centers based on accepted national standards, including but not limited to 5 the "Guidelines for the Audiologic Assessment of Children From Birth to 5 Years 6 of Age" as published by the American Speech-Language-Hearing Association 7 (ASHA) and the "Year 2007 Position Statement: Principles and Guidelines for 8 Early Hearing Detection and Intervention Programs" as published by the Joint 9 Committee on Infant Hearing (JCIH). The office may promulgate administrative 10 regulations in accordance with KRS Chapter 13A to establish the standards for the 11 centers. 12 (4) The office shall maintain a list of approved infant audiological assessment and 13 diagnostic centers that meet the standards established by the office. An audiological 14 assessment and diagnostic center included on the list shall meet the standards 15 established by the office. An approved center may voluntarily choose not to be 16 included on the list. 17 (5) An approved audiology assessment and diagnostic center shall agree to provide 18 requested data to the office for each infant evaluated and on any newly identified 19 children ages birth to three (3) years with a permanent childhood hearing loss 20 within forty-eight (48) hours and make a referral to the Kentucky Early Intervention 21 System point of entry in the service area of the child's residence for services under 22 KRS 200.664. A center shall submit documentation to the office of a referral made 23 to the Kentucky Early Intervention System. A referral received by the Kentucky 24 Early Intervention System from a center shall be considered a referral from the 25 office. 26 (6) If the audiological evaluation performed by the office contains evidence of a 27 UNOFFICIAL COPY 23 RS BR 1326 Page 11 of 20 XXXX 2/7/2023 11:16 AM Jacketed hearing loss, within forty-eight (48) hours the office shall: 1 (a) Contact the attending physician and parents and provide information to the 2 parents in an accessible format as supplied by the Kentucky Commission on 3 the Deaf and Hard of Hearing; and 4 (b) Make a referral to the Kentucky Early Intervention System point of entry in 5 the service area of the child's residence for services under KRS 200.664. 6 (7) The office shall forward a report of an audiological evaluation that indicates a 7 hearing loss, with no information that personally identifies the child, to: 8 (a) The Kentucky Commission on the Deaf and Hard of Hearing for census 9 purposes; and 10 (b) The Kentucky Birth Surveillance Registry for information purposes. 11 (8) Cumulative demographic data of identified infants with a hearing loss shall be made 12 available to agencies and organizations including but not limited to the Cabinet for 13 Health and Family Services and the Early Childhood Advisory Council, requesting 14 the information for planning purposes. 15 Section 5. KRS 211.660 is amended to read as follows: 16 (1) The Department for Public Health shall establish and maintain a Kentucky birth 17 surveillance registry that will provide a system for the collection of information 18 concerning birth defects, stillbirths, and high-risk conditions. The system may cover 19 all or part of the Commonwealth. 20 (2) In establishing the system, the department may review vital statistics records, and 21 shall also consider expanding the current list of congenital anomalies and high-risk 22 conditions as reported on birth certificates. 23 (3) (a) The department may require general acute-care hospitals licensed under KRS 24 Chapter 216B to maintain a list of all inpatients and voluntarily to maintain a 25 list of all outpatients up to the age of five (5) years with a primary diagnosis 26 of a congenital anomaly or high-risk condition as defined by the department 27 UNOFFICIAL COPY 23 RS BR 1326 Page 12 of 20 XXXX 2/7/2023 11:16 AM Jacketed upon the recommendation of the appointed advisory committee. Hospital 1 participation regarding its outpatients shall be voluntary and subject to the 2 discretion of each hospital. 3 (b) The department may require medical laboratories licensed under KRS Chapter 4 333 to maintain medical records for all persons up to the age of five (5) years 5 with a primary diagnosis of or a laboratory test result indicating congenital 6 anomaly or high-risk condition as defined by the department upon the 7 recommendation of the appointed advisory committee. 8 (4) Each licensed freestanding[free-standing] birthing center, general acute-care 9 hospital licensed under KRS Chapter 216B, and medical laboratory licensed under 10 KRS Chapter 333 shall grant, if required or otherwise participating voluntarily 11 under the provisions of subsection (3) of this section, to any Kentucky Birth 12 Surveillance Registry personnel or his or her designee, upon presentation of proper 13 identification, access to the medical records of any patient meeting the criteria in 14 subsection (3) of this section. If the department's agent determines that copying of 15 the medical records is necessary, associated costs shall be borne by the Department 16 for Public Health at the rate pursuant to KRS 422.317. 17 (5) No liability of any kind, character, damages, or other relief shall arise or be 18 enforced against any licensed freestanding[free-standing] birthing center, general 19 acute-care hospital, or medical laboratory by reason of having provided the 20 information or material to the Kentucky Birth Surveillance Registry. 21 (6) The Department for Public Health may implement the provisions of KRS 211.651 22 to 211.670 through the promulgation of administrative regulations in accordance 23 with the provisions of KRS Chapter 13A. 24 Section 6. KRS 213.046 is amended to read as follows: 25 (1) A certificate of birth for each live birth which occurs in the Commonwealth shall be 26 filed with the state registrar within five (5) working days after such birth and shall 27 UNOFFICIAL COPY 23 RS BR 1326 Page 13 of 20 XXXX 2/7/2023 11:16 AM Jacketed be registered if it has been completed and filed in accordance with this section and 1 applicable administrative regulations. No certificate shall be held to be complete 2 and correct that does not supply all items of information called for in this section 3 and in KRS 213.051, or satisfactorily account for their omission except as provided 4 in KRS 199.570(3). If a certificate of birth is incomplete, the local registrar shall 5 immediately notify the responsible person and require that person to supply the 6 missing items, if that information can be obtained. 7 (2) When a birth occurs in an institution or en route thereto, the person in charge of the 8 institution or that person's designated representative, shall obtain the personal data, 9 prepare the certificate, secure the signatures required, and file the certificate as 10 directed in subsection (1) of this section or as otherwise directed by the state 11 registrar within the required five (5) working days. The physician or other person in 12 attendance shall provide the medical information required for the certificate and 13 certify to the fact of birth within five (5) working days after the birth. If the 14 physician or other person in attendance does not certify to the fact of birth within 15 the five (5) working day period, the person in charge of the institution shall 16 complete and sign the certificate. 17 (3) When a birth occurs in a hospital or en route thereto to a woman who is unmarried, 18 the person in charge of the hospital or that person's designated representative shall 19 immediately before or after the birth of a child, except when the mother or the 20 alleged father is a minor: 21 (a) Meet with the mother prior to the release from the hospital; 22 (b) Attempt to ascertain whether the father of the child is available in the hospital, 23 and, if so, to meet with him, if possible; 24 (c) Provide written materials and oral, audio, or video materials about paternity; 25 (d) Provide the unmarried mother, and, if possible, the father, with the voluntary 26 paternity form necessary to voluntarily establish paternity; 27 UNOFFICIAL COPY 23 RS BR 1326 Page 14 of 20 XXXX 2/7/2023 11:16 AM Jacketed (e) Provide a written and an oral, audio, or video description of the rights and 1 responsibilities, the alternatives to, and the legal consequences of 2 acknowledging paternity; 3 (f) Provide written materials and information concerning genetic paternity 4 testing; 5 (g) Provide an opportunity to speak by telephone or in person with staff who are 6 trained to clarify information and answer questions about paternity 7 establishment; 8 (h) If the parents wish to acknowledge paternity, require the voluntary 9 acknowledgment of paternity obtained through the hospital-based program be 10 signed by both parents and be authenticated by a notary public; 11 (i) Upon both the mother's and father's request, help the mother and father in 12 completing the affidavit of paternity form; 13 (j) Upon both the mother's and father's request, transmit the affidavit of paternity 14 to the state registrar; and 15 (k) In the event that the mother or the alleged father is a minor, information set 16 forth in this section shall be provided in accordance with Civil Rule 17.03 of 17 the Kentucky Rules of Civil Procedure. 18 If the mother or the alleged father is a minor, the paternity determination shall be 19 conducted pursuant to KRS Chapter 406. 20 (4) The voluntary acknowledgment of paternity and declaration of paternity forms 21 designated by the Vital Statistics Branch shall be the only documents having the 22 same weight and authority as a judgment of paternity. 23 (5) The Cabinet for Health and Family Services shall: 24 (a) Provide to all freestanding birthing centers and public and private birthing 25 hospitals in the state written materials in accessible formats and audio or 26 video materials concerning paternity establishment forms necessary to 27 UNOFFICIAL COPY 23 RS BR 1326 Page 15 of 20 XXXX 2/7/2023 11:16 AM Jacketed voluntarily acknowledge paternity; 1 (b) Provide copies of a written description in accessible formats and an audio or 2 video description of the rights and responsibilities of acknowledging 3 paternity; and 4 (c) Provide staff training, guidance, and written instructions regarding voluntary 5 acknowledgment of paternity as necessary to operate the hospital-based 6 program. 7 (6) When a birth occurs outside an institution, verification of the birth shall be in 8 accordance with the requirements of the state registrar and a birth certificate shall 9 be prepared and filed by one (1) of the following in the indicated order of priority: 10 (a) The physician in attendance at or immediately after the birth; or, in the 11 absence of such a person, 12 (b) A midwife or any other person in attendance at or immediately after the birth; 13 or, in the absence of such a person, 14 (c) The father, the mother, or in the absence of the father and the inability of the 15 mother, the person in charge of the premises where the birth occurred or of 16 the institution to which the child was admitted following the birth. 17 (7) No physician, midwife, or other attendant shall refuse to sign or delay the filing of a 18 birth certificate. 19 (8) If a birth occurs on a moving conveyance within the United States and the child is 20 first removed from the conveyance in the Commonwealth, the birth shall be 21 registered in the Commonwealth, and the place where the child is first removed 22 shall be considered the place of birth. If a birth occurs on a moving conveyance 23 while in international waters or air space or in a foreign country or its air space and 24 the child is first removed from the conveyance in the Commonwealth, the birth 25 shall be registered in the Commonwealth, but the certificate shall show the actual 26 place of birth insofar as can be determined. 27 UNOFFICIAL COPY 23 RS BR 1326 Page 16 of 20 XXXX 2/7/2023 11:16 AM Jacketed (9) The following provisions shall apply if the mother was married at the time of either 1 conception or birth or anytime between conception and birth: 2 (a) If there is no dispute as to paternity, the name of the husband shall be entered 3 on the certificate as the father of the child. The surname of the child shall be 4 any name chosen by the parents; however, if the parents are separated or 5 divorced at the time of the child's birth, the choice of surname rests with the 6 parent who has legal custody following birth. 7 (b) If the mother claims that the father of the child is not her husband and the 8 husband agrees to such a claim and the putative father agrees to the statement, 9 a three (3) way affidavit of paternity may be signed by the respective parties 10 and duly notarized. The state registrar of vital statistics shall enter the name of 11 a nonhusband on the birth certificate as the father and the surname of the child 12 shall be any name chosen by the mother. 13 (c) If a question of paternity determination arises which is not resolved under 14 paragraph (b) of this subsection, it shall be settled by the District Court. 15 (10) The following provisions shall apply if the mother was not married at the time of 16 either conception or birth or between conception and birth or the marital 17 relationship between the mother and her husband has been interrupted for more than 18 ten (10) months prior to the birth of the child: 19 (a) The name of the father shall not be entered on the certificate of birth. The 20 state registrar shall upon acknowledgment of paternity by the father and with 21 consent of the mother pursuant to KRS 213.121, enter the father's name on the 22 certificate. The surname of the child shall be any name chosen by the mother 23 and father. If there is no agreement, the child's surname shall be determined 24 by the parent with legal custody of the child. 25 (b) If an affidavit of paternity has been properly completed and the certificate of 26 birth has been filed accordingly, any further modification of the birth 27 UNOFFICIAL COPY 23 RS BR 1326 Page 17 of 20 XXXX 2/7/2023 11:16 AM Jacketed certificate regarding the paternity of the child shall require an order from the 1 District Court. 2 (c) In any case in which paternity of a child is determined by a court order, the 3 name of the father and surname of the child shall be entered on the certificate 4 of birth in accordance with the finding and order of the court. 5 (d) In all other cases, the surname of the child shall be any name chosen by the 6 mother. 7 (11) If the father is not named on the certificate of birth, no other information about the 8 father shall be entered on the certificate. In all cases, the maiden name of the 9 gestational mother shall be entered on the certificate. 10 (12) Any child whose surname was restricted prior to July 13, 1990, shall be entitled to 11 apply to the state registrar for an amendment of a birth certificate showing as the 12 surname of the child, any surname chosen by the mother or parents as provided 13 under this section. 14 (13) The birth certificate of a child born as a result of artificial insemination shall be 15 completed in accordance with the provisions of this section. 16 (14) Each birth certificate filed under this section shall include all Social Security 17 numbers that have been issued to the parents of the child. 18 (15) Either of the parents of the child, or other informant, shall attest to the accuracy of 19 the personal data entered on the certificate in time to permit the filing of the 20 certificate within ten (10) days prescribed in subsection (1) of this section. 21 (16) When a birth certificate is filed for any birth that occurred outside an institution, the 22 Cabinet for Health and Family Services shall forward information regarding the 23 need for an auditory screening for an infant and a list of options available for 24 obtaining an auditory screening for an infant. The list shall include the Office for 25 Children with Special Health Care Needs, local health departments as established in 26 KRS Chapter 212, hospitals offering obstetric services, freestanding[alternative] 27 UNOFFICIAL COPY 23 RS BR 1326 Page 18 of 20 XXXX 2/7/2023 11:16 AM Jacketed birthing centers required to provide an auditory screening under KRS 216.2970, 1 audiological assessment and diagnostic centers approved by the Office for Children 2 with Special Health Care Needs in accordance with KRS 211.647 and licensed 3 audiologists, and shall specify the hearing methods approved by the Office for 4 Children with Special Health Care Needs in accordance with KRS 216.2970. 5 Section 7. KRS 216.2920 is amended to read as follows: 6 As used in KRS 216.2920 to 216.2929, unless the context requires otherwise: 7 (1) "Ambulatory facility" means an outpatient facility, including an ambulatory 8 surgical facility, freestanding birthing[birth] center, freestanding or mobile 9 technology unit, or an urgent treatment center, that is not part of a hospital and that 10 provides one (1) or more ambulatory procedures to patients not requiring 11 hospitalization; 12 (2) "Cabinet" means the Cabinet for Health and Family Services; 13 (3) "Charge" means all amounts billed by a hospital or ambulatory facility, including 14 charges for all ancillary and support services or procedures, prior to any adjustment 15 for bad debts, charity contractual allowances, administrative or courtesy discounts, 16 or similar deductions from revenue. However, if necessary to achieve comparability 17 of information between providers, charges for the professional services of hospital-18 based or ambulatory-facility-based physicians shall be excluded from the 19 calculation of charge; 20 (4) "Facility" means any hospital, health care service, or other health care facility, 21 whether operated for profit or not; 22 (5) "Health-care provider" or "provider" means any pharmacist as defined pursuant to 23 KRS Chapter 315, and any of the following independent practicing practitioners: 24 (a) Physicians, osteopaths, and podiatrists licensed pursuant to KRS Chapter 311; 25 (b) Chiropractors licensed pursuant to KRS Chapter 312; 26 (c) Dentists licensed pursuant to KRS Chapter 313; 27 UNOFFICIAL COPY 23 RS BR 1326 Page 19 of 20 XXXX 2/7/2023 11:16 AM Jacketed (d) Optometrists licensed pursuant to KRS Chapter 320; 1 (e) Physician assistants regulated pursuant to KRS Chapter 311; 2 (f) Nurse practitioners licensed pursuant to KRS Chapter 314; and 3 (g) Other health-care practitioners as determined by the Cabinet for Health and 4 Family Services by administrative regulation promulgated pursuant to KRS 5 Chapter 13A; 6 (6) "Hospital" means a facility licensed pursuant to KRS Chapter 216B as either an 7 acute-care hospital, psychiatric hospital, rehabilitation hospital, or chemical 8 dependency treatment facility; 9 (7) "Procedures" means those surgical, medical, radiological, diagnostic, or therapeutic 10 procedures performed by a provider, as periodically determined by the cabinet in 11 administrative regulations promulgated pursuant to KRS Chapter 13A as those for 12 which reports to the cabinet shall be required. "Procedures" also includes 13 procedures that are provided in hospitals or other ambulatory facilities, or those that 14 require the use of special equipment, including fluoroscopic equipment, computer 15 tomographic scanners, magnetic resonance imagers, mammography, ultrasound 16 equipment, or any other new technology as periodically determined by the cabinet; 17 (8) "Quality" means the extent to which a provider renders care that obtains for patients 18 optimal health outcomes; and 19 (9) "Secretary" means the secretary of the Cabinet for Health and Family Services. 20 Section 8. KRS 216.2970 is amended to read as follows: 21 (1) As a condition of licensure or relicensure, all hospitals offering obstetric services 22 and freestanding[alternative] birthing centers with at least forty (40) births per year 23 shall provide an auditory screening for all infants using one (1) of the methods 24 approved by the Office for Children with Special Health Care Needs by 25 administrative regulation promulgated in accordance with KRS Chapter 13A. 26 (2) An auditory screening report that indicates a finding of potential hearing loss shall 27 UNOFFICIAL COPY 23 RS BR 1326 Page 20 of 20 XXXX 2/7/2023 11:16 AM Jacketed be forwarded by the hospital or freestanding[alternative] birthing center within 1 twenty-four (24) hours of receipt to the: 2 (a) Attending physician or health care provider; 3 (b) Parents; 4 (c) Office for Children with Special Health Care Needs for evaluation or referral 5 for further evaluation in accordance with KRS 211.647; and 6 (d) Audiological assessment and diagnostic center approved by the office if a 7 follow-up assessment has been scheduled prior to the infant's discharge from 8 the hospital. 9 (3) An auditory screening report that does not indicate a potential hearing loss shall be 10 forwarded within one (1) week to the Office for Children with Special Health Care 11 Needs with no information that personally identifies the child. 12 Section 9. This Act shall be known as the Mary Carol Akers Birth Centers Act. 13