CHAPTER 53 SENATE BILL No. 425
      An Act concerning hospitals; critical access hospitals and rural health networks; amending
      K.S.A. 65-468, 65-470, 65-471, 65-473 and 65-474 and K.S.A. 1997 Supp. 65-425 and
      repealing the existing sections.

Be it enacted by the Legislature of the State of Kansas:

Section 1. K.S.A. 1997 Supp. 65-425 is hereby amended to read as
follows: 65-425. As used in this act:

(a) ``General hospital'' means an establishment with an organized
medical staff of physicians; with permanent facilities that include inpatient
beds; and with medical services, including physician services, and contin-
uous registered professional nursing services for not less than 24 hours
of every day, to provide diagnosis and treatment for patients who have a
variety of medical conditions.

(b) ``Special hospital'' means an establishment with an organized
medical staff of physicians; with permanent facilities that include inpatient
beds; and with medical services, including physician services, and contin-
uous registered professional nursing services for not less than 24 hours
of every day, to provide diagnosis and treatment for patients who have
specified medical conditions.

(c) ``Person'' means any individual, firm, partnership, corporation,
company, association, or joint-stock association, and the legal successor
thereof.

(d) ``Governmental unit'' means the state, or any county, municipality,
or other political subdivision thereof; or any department, division, board
or other agency of any of the foregoing.

(e) ``Licensing agency'' means the department of health and environ-
ment.

(f) ``Ambulatory surgical center'' means an establishment with an or-
ganized medical staff of one or more physicians; with permanent facilities
that are equipped and operated primarily for the purpose of performing
surgical procedures; with continuous physician services during surgical
procedures and until the patient has recovered from the obvious effects
of anesthetic and at all other times with physician services available when-
ever a patient is in the facility; with continuous registered professional
nursing services whenever a patient is in the facility; and which does not
provide services or other accommodations for patient to stay more than
24 hours. Before discharge from an ambulatory surgical center, each pa-
tient shall be evaluated by a physician for proper anesthesia recovery.
Nothing in this section shall be construed to require the office of a phy-
sician or physicians to be licensed under this act as an ambulatory surgical
center.

(g) ``Recuperation center'' means an establishment with an organized
medical staff of physicians; with permanent facilities that include inpatient
beds; and with medical services, including physician services, and contin-
uous registered professional nursing services for not less than 24 hours
of every day, to provide treatment for patients who require inpatient care
but are not in an acute phase of illness, who currently require primary
convalescent or restorative services, and who have a variety of medical
conditions.

(h) ``Medical care facility'' means a hospital, ambulatory surgical cen-
ter or recuperation center, but shall not include a hospice which is cer-
tified to participate in the medicare program under 42 code of federal
regulations, chapter IV, section 418.1 et seq. and amendments thereto
and which provides services only to hospice patients.

(i) ``Rural primary care Critical access hospital'' shall have the mean-
ing ascribed to such term under K.S.A. 65-468 and amendments thereto.

(j) ``Hospital'' means ``general hospital,'' ``rural primary care critical
access hospital,'' or ``special hospital.''

(k) ``Physician'' means a person licensed to practice medicine and
surgery in this state.

Sec. 2. K.S.A. 65-468 is hereby amended to read as follows: 65-468.
As used in K.S.A. 65-468 to 65-474, inclusive, and amendments thereto:

(a) ``Health care provider'' means any person licensed or otherwise
authorized by law to provide health care services in this state or a pro-
fessional corporation organized pursuant to the professional corporation
law of Kansas by persons who are authorized by law to form such cor-
poration and who are health care providers as defined by this subsection,
or an officer, employee or agent thereof, acting in the course and scope
of employment or agency.

(b) ``Essential access community hospital'' means a hospital which has
been designated as an essential access community hospital by the licens-
ing agency and which has entered into a written agreement with at least
one rural primary care hospital to form a rural health network. The writ-
ten agreement must include provisions for the essential access community
hospital to accept patients transferred from participating rural primary
care hospitals and to provide emergency and medical support services to
rural primary care hospitals participating in the essential access commu-
nity hospital rural health network.

(c) ``Member'' means any hospital, emergency medical service, local
health department, home health agency, adult care home, medical clinic,
mental health center or clinic or nonemergency transportation system.

(d) (c) ``Mid-level practitioner'' means a physician's assistant or ad-
vanced registered nurse practitioner who has entered into a written pro-
tocol with a rural health network physician.

(e) (d) ``Physician'' means a person licensed to practice medicine and
surgery.

(f) (e) ``Rural health network'' means an alliance of members includ-
ing at least one rural primary care critical access hospital and at least one
essential access community other hospital or supporting hospital which
has developed a comprehensive plan submitted to and approved by the
secretary of health and environment regarding patient referral and trans-
fer; the provision of emergency and nonemergency transportation among
members; the development of a network-wide emergency services plan;
and the development of a plan for sharing patient information and serv-
ices between hospital members concerning medical staff credentialing,
risk management, quality assurance and peer review.

(g) ``Rural primary care hospital'' means a member of a rural health
network, located within 75 miles of the network's essential access com-
munity hospital or supporting hospital unless an exception is granted by
the licensing agency pursuant to rules and regulations; with a staff which
includes one or more physicians and may include one or more mid-level
practitioners; with permanent facilities that include inpatient beds to
serve not more than an average of six acute patients requiring treatment
not to exceed 72 hours each unless an exception is granted for either
requirement by the licensing agency pursuant to rules and regulations;
and with 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. Emergency serv-
ices must be provided as specified in a comprehensive plan developed in
conjunction with the hospital's rural health network. All treatment pro-
vided by mid-level practitioners must be pursuant to written protocols
established between the mid-level practitioners and network physicians,
after consultation with network physicians, or in an emergency. Network
physicians must approve all patient admissions by the mid-level practi-
tioner within 24 hours; review patient records, which review may be
off-site, and document such review in the patient record within 48 hours
of treatment provided by the mid-level practitioner; and consult with the
mid-level practitioner and document such consultation in the patient rec-
ord on site at the hospital at least weekly.

(f) ``Critical access hospital'' means a member of a rural health net-
work which makes available twenty-four hour emergency care services;
provides not more than 15 acute care inpatient beds for providing inpa-
tient care for a period not to exceed 96 hours (unless a longer period is
required because transfer to a hospital is precluded because of inclement
weather or other emergency conditions), except that a peer review organ-
ization or equivalent entity, on request, may waive the ninety-six hour
restriction on a case-by-case basis; provides inpatient extended care serv-
ices (if there is in effect an approved swing-bed agreement) so long as the
combined total of extended care and acute care beds does not exceed 25
beds; and provides nursing services under the direction of a licensed pro-
fessional 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. The critical access hospital may
provide inpatient services by a physician's assistant, nurse practitioner or
a clinical nurse specialist subject to the oversight of a physician who need
not be present in the facility.

(h) ``Supporting hospital'' means a hospital other than a rural primary
care hospital or an essential access community (g) ``Hospital'' means a
hospital other than a critical access hospital which has entered into a
written agreement with at least one rural primary care critical access
hospital to form a rural health network and to provide medical or admin-
istrative supporting services within the limit of the supporting hospital's
capabilities.

Sec. 3. K.S.A. 65-470 is hereby amended to read as follows: 65-470.
(a) Any hospital is authorized to seek licensure as a rural primary care
critical access hospital and to accept and secure any benefits of federal
aid. A rural primary care critical access hospital shall participate in or
affiliate with a rural health network and may execute contracts, upon such
conditions and terms as is deemed appropriate by the governing body,
for the integration of health services or to further any portion of a com-
prehensive plan for a rural health network.

(b) Any hospital is authorized to seek designation as an essential ac-
cess community hospital and to accept and secure any benefits of federal
aid. An essential access community hospital shall participate in or affiliate
with a rural health network and may execute contracts, upon such con-
ditions and terms as is deemed appropriate by the governing body, for
the integration of health services or to further any portion of a compre-
hensive plan for a rural health network.

Sec. 4. K.S.A. 65-471 is hereby amended to read as follows: 65-471.
(a) Upon such conditions and terms as is deemed appropriate by the
governing body of any member of a rural health network, a member of a
rural health network or the rural health network may enter into agree-
ments with any other person or entity to perform any service, including
but not limited to services for provision of primary risk management and
peer review services.

(b) Any rural primary care critical access hospital, essential access
community hospital or rural health network may employ any health care
provider to provide patient care or other services and may employ such
other persons as necessary to carry out the function of the rural health
network. The contract may allow for the health care provider or a member
of the rural health network to seek direct compensation from the patient,
the patient's representative or a third party payor for the services per-
formed by the health care provider.

Sec. 5. K.S.A. 65-473 is hereby amended to read as follows: 65-473.
The secretary of health and environment may adopt rules and regulations
setting minimum standards for the establishment and operation of rural
health networks, including the licensure of rural primary critical access
hospitals and the designation of essential access community hospitals.

Sec. 6. K.S.A. 65-474 is hereby amended to read as follows: 65-474.
Each individual and group policy of accident and sickness insurance, each
contract issued by health maintenance organizations, and all coverage
maintained by an entity authorized under K.S.A. 40-2222 and amend-
ments thereto or by a municipal group funded pool authorized under
K.S.A. 12-2618 and amendments thereto shall provide benefits for serv-
ices when performed by an essential access community hospital, a rural
primary care critical access hospital or a supporting hospital if such serv-
ices would be covered under such policies or contracts if performed by a
general hospital.

Sec. 7. K.S.A. 65-468, 65-470, 65-471, 65-473 and 65-474 and K.S.A.
1997 Supp. 65-425 are hereby repealed.

Sec. 8. This act shall take effect and be in force from and after its
publication in the statute book.

Approved April 2, 1998

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