Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
216B.010,
216B.015,
216B.020,
216B.040,
216B.095,
216B.990,
311.271
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
216B.040(2)(a) 1 requires
the Cabinet for Health and Family Services to administer Kentucky's Certificate
of Need Program and to promulgate administrative regulations as necessary for
the program. This administrative regulation establishes the requirements for
physician exemption criteria necessary for the orderly administration of the
Certificate of Need Program.
Section
1. Definitions.
(1) "Ambulatory
surgical center" is defined by
KRS
216B.015(4).
(2) "Entity" means any legally recognized
business entity in which an individual or group may practice its profession
including a professional limited liability company, professional service
corporation, partnership, or sole proprietor.
(3) "Evaluation and Management codes" means
those codes recognized by the American Medical Association as procedures
involving evaluation of patients and management of patient care in the Current
Procedural Terminology© references.
(4) "Office" or "clinic" means the physical
location at which health care services are provided by a physician, dentist,
advanced practice registered nurse, licensed clinical social worker,
speech-language pathologist, occupational therapist, physical therapist,
psychologist, or other practitioner of the healing arts.
(5) "Owner" means a person as defined by
KRS
216B.015(22) who is applying
for the Certificate of Need and will become the licensee of the proposed health
service or facility.
(6) "Practice"
means the individual, entity, or group that proposes to provide health care
services and shall include the owners and operators of an office or
clinic.
(7) "Practitioner of the
healing arts" means a person licensed by the appropriate state agency to
practice a healing art as defined by
KRS
311.271(2)(a).
(8) "Primarily" means a simple majority or
something that occurs at least fifty-one (51) percent of the time.
Section 2. Physician non-exemption
due to operation of an ambulatory surgical center. An office or clinic that is
operating an ambulatory surgical center pursuant to
KRS
216B.095(7) shall not be
exempt from the Certificate of Need requirements.
Section 3. Physician Exemption from
Certificate of Need.
(1)
(a) An office or clinic that would otherwise
be required to obtain a Certificate of Need shall be exempt from Certificate of
Need pursuant to
KRS
216B.020(2) if:
1. The practice claiming the exemption is 100
percent owned in an organizational form recognized by the Commonwealth as one
(1) in which the listed professions can be practiced by the individual
physician, dentist, advanced practice registered nurse, licensed clinical
social worker, speech-language pathologist, occupational therapist, physical
therapist, psychologist, or other practitioner of the healing arts or group of
physicians, dentists, advanced practice registered nurses, licensed clinical
social workers, speech-language pathologists, occupational therapists, physical
therapists, psychologists, or other practitioners of the healing arts
(hereinafter collectively referred to as "physician") claiming the
exemption;
2.The practice claiming
the exemption primarily provides physician services (e.g., evaluation and
management codes) rather than services or equipment covered by the State Health
Plan;
3. Services or equipment
covered by the State Health Plan that are offered or provided at the office or
clinic shall be primarily provided to patients whose medical conditions are
being treated or managed by the practice;
4. A physician or physicians licensed to
practice and practicing in Kentucky within the practice and claiming the
exemption have overall responsibility for directing and coordinating the care
and management of services provided to patients;
5. Patients are treated on an outpatient
basis and are not maintained overnight on the premises of the office or
clinic;
6. Services or equipment
covered by the State Health Plan that are offered or provided at the office or
clinic are related to the professional services offered to patients of the
practice claiming the exemption; and
7. Major medical equipment in excess of the
limits set forth in
900 KAR
6:030 is not being utilized without a Certificate of
Need or other statutory or regulatory exemption.
(b) This section shall not limit or prohibit
the continued operation of an office or clinic that was established and in
operation prior to January 31, 2006, and operating pursuant to and in
accordance with the following:
1. Provisions
of a Certificate of Need advisory opinion issued by the Office of Health Policy
specifically with respect to that office or clinic;
2. Provisions of an Attorney General opinion
issued specifically with respect to that office or clinic; or
3. An order issued with respect to that
office or clinic by a court of competent jurisdiction in the Commonwealth of
Kentucky.
(2)
A practice owned entirely by a radiologist or group of radiologists shall
demonstrate the following:
(a) Compliance with
subsection (1)(a)1., 4., 5., and 6. of this section;
(b) The radiologists shall regularly perform
physician services (e.g., test interpretations) at the location where the
diagnostic tests are performed, including interpretations by or through
teleradiology; and
(c) The billing
patterns of the practice indicate that the practice is not primarily a testing
facility and that it was organized to provide the professional services of
radiology.
(3) A
hospital-acquired private practice or an outpatient clinic under the same
ownership and administrative and financial control as a Kentucky-licensed
hospital shall demonstrate that:
(a) The
practice or clinic does not:
1. Provide pain
management services at an off-campus clinic in which the majority of patients
of the practitioners at the facility are provided treatment for pain that
includes the use of controlled substances;
2. Provide any services or equipment covered
by the State Health Plan; or
3.
Provide outpatient surgical services; and
(b) The physician or physicians and other
practitioners of the healing arts providing care and treatment to patients of
the office or clinic are:
1. Licensed to
practice in Kentucky; and
2.
Employed by the:
a. Hospital; or
b. Entity with ownership and control of both
the hospital and office or clinic.
STATUTORY AUTHORITY:
KRS
194A.030,
194A.050,
216B.040(2)(a)
1