50-5-234. Designation as rural emergency hospital -- requirements -- rulemaking. (1) The department may designate as a rural emergency hospital a facility that operates for the purpose of providing emergency department services, observation care, and outpatient services and in which the annual per patient average length of stay does not exceed 24 hours. The designation is available to a facility that, as of December 27, 2020, was licensed as:

(a) a critical access hospital; or

(b) a hospital with 50 or fewer beds if the hospital is:

(i) located in a county in a rural area as defined in the federal Social Security Act, 42 U.S.C. 1395ww(d)(2)(D); or

(ii) deemed as being located in a rural area pursuant to the federal Social Security Act, 42 U.S.C. 1395ww(d)(8)(E).

(2) A hospital seeking rural emergency hospital designation:

(a) shall maintain a 24-hour emergency department that:

(i) provides emergency and observation care;

(ii) is open 7 days a week; and

(iii) is staffed with a physician, an advanced practice registered nurse certified as a nurse practitioner or clinical nurse specialist, or a physician assistant;

(b) must have:

(i) a transfer agreement in effect with a hospital that is designated by the department pursuant to 50-6-410 as, at a minimum, a regional trauma center; and

(ii) any other transfer agreement necessary for patient care;

(c) shall provide laboratory services; and

(d) shall provide pharmacy services or maintain a drug storage area.

(3) A rural emergency hospital may:

(a) provide outpatient services as allowed by the department by rule, in accordance with federal regulations governing rural emergency hospitals; and

(b) own and operate an entity that provides ambulance services.

(4) A rural emergency hospital may not have inpatient beds unless the hospital has a unit that is a distinct part of the hospital and is licensed as a skilled nursing facility to provide extended posthospital care.

(5) A facility that applies for a rural emergency hospital designation shall include with its application:

(a) an action plan for initiating rural emergency hospital services, including a detailed transition plan that lists the specific services the facility will retain, modify, add, and discontinue;

(b) a description of services that the facility intends to provide on an outpatient basis; and

(c) other information as required by the department by rule.

(6) A hospital or critical access hospital that applies for the designation and elects to operate as a rural emergency hospital may later transition back to its original license as a hospital or critical access hospital.

(7) Before approving an application under this section, the department shall adopt rules necessary to implement this section, including but not limited to:

(a) licensure standards that satisfy the requirement for reimbursement by federal health care programs as a rural emergency hospital;

(b) procedures for applying for and receiving designation as a rural emergency hospital; and

(c) services the facility may provide on an outpatient basis, in accordance with federal regulations governing rural emergency hospital designation.