1. (1) Classifications of Licenses. Each REH shall be licensed pursuant to the regulations adopted herein. All licenses are granted for the calendar year and shall expire on December 31 unless renewed by the owner for the succeeding year.
   
   (a) Unrestricted License. An unrestricted license may be granted by the Board after it has determined that the REH is willing and capable of maintaining compliance with these rules.

   1. (b) Probational License. At its discretion, the Board may grant a probational license when it determines that both of the following conditions exist:

      1. 1. The REH has engaged in one or more deficient practices which are serious in nature, chronic in nature, or which the REH has failed to correct; and
      2. 2. The REH's current governing authority has demonstrated the capability and willingness to correct cited problems and to maintain compliance.
   2. 
      (c) A probational license shall be granted for a specific period which may be extended but which shall in no case exceed 1 year.

2. (2) Application.

   1. 
      (a) Application. An applicant for initial licensure as an REH shall provide all information on the application form prescribed by the Department, including all information required by law, these rules, and the policies and procedures of the Department, and shall submit such additional information as shall be required by the Department in its discretion to demonstrate that the applicant has the ability and the willingness to comply with these rules.

      1. 1. Each application shall include a detailed transition plan that lists the specific services that the REH will retain, modify, add, and/or discontinue upon conversion and a description of the services that it intends to furnish on an outpatient basis as an REH. The transition plan shall also address the REH's functional plans for utilizing spaces formerly designated for inpatient beds.
      2. 2. Each application shall be signed by a person authorized to bind the applicant to the representations in the application and any supporting documentation.
   2. (b) Fee. An initial license application, an application for license renewal, or an application for a change in ownership, shall be accompanied by the application fee specified in §22-21-24, Code of Ala. 1975. An application for a name change is not subject to a license application fee. An application fee is non-refundable. Any application fee submitted in the incorrect amount shall nevertheless be deposited. If the fee submitted is too large, a refund for the difference shall be processed using the Department's usual procedures. If the fee submitted is too small, the applicant shall be notified and the application shall not be considered until the difference is received. Any application submitted without any fee shall be returned to the applicant. If an incomplete application is submitted, the application fee shall be deposited, and the applicant shall be notified in writing of the defects in the application. If the applicant fails to submit all required additional information within 10 working days of the date of the notice, the application shall be denied. The Department may in its discretion extend the deadline for submitting additional information. Denial of an application as incomplete shall not prejudice the applicant from submitting a new application, accompanied by the requisite fee, at a future date.
      
      (c) Name of Facility. Every REH shall have a unique name, which shall include the words "Rural Emergency Hospital." No REH shall change its name without first applying for a change of name approval nor shall it change its name until such approval is granted. The Department may in its discretion deny an initial REH application or an application for a change of name if the Department determines that the proposed name is misleading to the public or that the name is overly similar to the name of an already licensed REH. Separately licensed REHs owned by the same governing authority may have names that are similar to one another and distinguished from one another in some other manner, such as a geographic description. If an initial REH application is denied under this rule provision, the applicant shall be provided a reasonable period of time to submit a revised application with a different name.
      
      (d) How to Obtain Applications. Information on how to obtain applications and where to submit applications can be found on the Department's website at http://www.adph.org.
      

3. (3) Licensing.

   1. (a) License. If an applicant submits a timely and complete application accompanied by the appropriate license fee and any supporting documentation that may be required by the Department, and if the Department is satisfied on the basis of the application that the applicant is willing and capable of compliance with these rules, and if granting such a license would not violate any other state or federal law or regulation, then the Department, as agent for the Board, may grant a license to the applicant. All licenses granted shall expire at midnight on December 31 of the year in which the license is granted. The Department, as agent for the Board, may deny a license. A license shall only be valid at the licensed premises and for the business entity licensed. It is a condition of licensure that the licensee shall continuously occupy the licensed premises and keep its ED open to the public 24 hours a day, 7 days a week. If an REH fails to remain open and fully staffed as required for 30 consecutive days, its license shall become void. If a licensee abandons the licensed premises, the license shall immediately become void. Before a facility which has closed may be relicensed, a new license application is required.
   2. (b) License Renewal. Licenses may be renewed by the applicant as a matter of course upon submission of a completed renewal application and payment of the required fee. When the Department has served written notice on an REH of its intent to revoke or downgrade the license, a renewal application shall be filed but does not affect the proposed adverse licensure action.
   3. (c) License Certificate. A license certificate shall be issued by the Department to every successful initial licensure applicant and to every successful renewal applicant. It shall set forth the name and physical address of the REH, the name of the governing authority, the type of hospital, and the expiration date of the license.
   4. (d) Change of Ownership. An REH license is not transferable. A change of ownership may only occur between hospitals duly licensed in Alabama by the Board. In the event that the legal ownership of the right to occupy an REH's premises is transferred to an individual or entity other than the licensee, the REH's license shall become void and continued operation of the REH shall be unlawful pursuant to §22-21-22, Code of Ala. 1975, and subject to penalties as provided in §22-21-33, Code of Ala. 1975, unless an application for a change of ownership has been submitted to and approved by the Department prior to the transfer of legal ownership. An application for change of ownership shall be submitted on the form prescribed by the Department, shall be accompanied by the requisite application fee set forth in §22-21-24, Code of Ala. 1975, and shall be subject to the same requirements and considerations as are set forth above for initial license applications. An application for a change of ownership shall be submitted and signed by the prospective new licensee, or its agent, and also either signed by the current licensee or its agent, or accompanied by a court order demonstrating that the current licensee has been dispossessed of the legal right to occupy the premises and that the prospective new licensee has been awarded the legal right to occupy the premises. Upon approval of a change of ownership, the Department shall notify the current licensee and the new license applicant and shall issue a license certificate to the new licensee.
   5. (e) Change of Name. An REH may apply for a change of name by submitting a completed application on a form prescribed by the Department. There is no application fee for a change of name application. Upon approval of a change of name, the Department shall notify the licensee and shall issue a revised license certificate to the licensee, which may be predicated on the return of the old license certificate.
   6. (f) Relocation. An REH license is valid only at the premises stated on the most recent license application or renewal application, and recited as a physical address on the current REH license certificate. Prior to physically relocating an REH, plans and specifications shall be submitted for review and approval to the Department in accordance with the Board's Rules for Submission of Plans and Specifications for Health Care Facilities, Chapter 420-5-22, Ala. Admin. Code. The REH shall submit a relocation application to the Department on a form prescribed by the Department. On relocation, the REH must maintain rural status or continue to be located in an area that has been designated or reclassified as rural in accordance with CMS regulations. Upon approval of a change of address, the Department shall notify the licensee and shall issue a revised license certificate to the licensee, which may be predicated on the return of the old license certificate.

   7. (g) Denial and Revocation of a License.

      1. 1. The Board may deny a license to any applicant or revoke the license to operate an REH on grounds of insufficient evidence of the willingness or ability to comply with §§22-21-20 through 22-21-34, Code of Ala. 1975, or these rules, including the reasons justifying denial or revocation of a license as set out in the Board's Rules for Hospitals, Chapter 420-5-7, Ala. Admin. Code.
      2. 2. Hearing procedures concerning the denial or revocation of a license shall be governed by the provisions of the Alabama Administrative Procedure Act, §41-22-1, et seq., Code of Ala. 1975, and the Board's Rules for Hearing of Contested Cases, Chapter 420-l-3, Ala. Admin. Code.
4. (4) Failure to Renew a License. Any licensee who fails to renew a license on or before the close of business on the last business day in December shall be assessed a late fee equal to the amount of the original license fee. A license may only be renewed with the payment of a late fee before the close of business on the last business day in January of any calendar year. A license which has not been renewed by the end of January has expired and shall be void.

5. (5) Compliance with federal, state, and local laws. The REH shall be in compliance with all applicable federal, state, and local laws.

   1. (a) Licensing of Staff. Staff of the facility shall be currently licensed, certified, or registered in accordance with applicable laws.
   2. (b) Compliance with Other Laws. The REH shall comply with laws relating to fire and life safety, sanitation, communicable and reportable diseases, Certificate of Need review and approval, reporting of health care acquired infections, adverse event reporting, and other relevant health and safety requirements. If an REH utilizes the services of a clinical laboratory located outside the state of Alabama, the REH shall ensure that, in connection with any work performed for the REH, the laboratory complies with the requirements for the reporting of notifiable diseases to the Department, as set forth in state law and the rules of the Board.
      
      
6. (6) An REH shall promptly notify the Department in writing when there is any change in its accrediting organization or deemed status.

Author: Dana H. Billingsley

Statutory Authority: Code of Ala. 1975, §§22-21-20, et seq.

History: New Rule: Published August 31, 2023; effective October 15, 2023.