1. (a) Time calculation. For the purposes of determining eligibility of a facility to qualify as a rural emergency hospital, as defined in 20 CAR § 41-102, the time calculation for determining the average length of stay shall be as follows:

   1. (1) Begins with the registration, check-in, or triage of the patient, whichever occurs first, and ends with the discharge of the patient from the rural emergency hospital; and

   2. (2) The discharge occurs:

      1. (A) When the physician or other appropriate clinician has signed the discharge order; or
      2. (B) At the time the outpatient service is completed and documented in the medical record.

2. (b) Eligibility. The following facilities enrolled and certified to participate in Medicare as of December 27, 2020, are eligible to be licensed as a rural emergency hospital:

   1. (1) Critical access hospital;
   2. (2) A hospital with no more than fifty (50) beds located in a county in a rural area (referred to as a rural hospital) as defined by the Centers for Medicare & Medicaid Services;
   3. (3) A hospital with no more than fifty (50) beds that was treated as being located in a rural area (referred to as a rural hospital) as defined by the Centers for Medicare & Medicaid Services; or

   4. (4) Facilities that were:

      1. (A) Enrolled as a critical access hospital or rural hospital with no more than fifty (50) beds as of December 27, 2020; and
      2. (B) Subsequently closed after that date.

3. (c) Action plan. The critical access hospital or rural hospital must provide the Department of Health with the facility’s action plan for conversion to a rural emergency hospital, including details regarding:

   1. (1) Staffing provisions and the number and type of qualified staff for the provision of rural emergency hospital services;

   2. (2) Detailed transition plan that lists the following:

      1. (A) Specific services the facility will retain;
      2. (B) Specific services the facility will modify;
      3. (C) Specific services the facility will add;
      4. (D) Specific services the facility will discontinue; and
      5. (E) Description of services the facility intends to furnish on an outpatient basis;
   3. (3) New or revised policies/procedures specific to a rural emergency hospital; and
   4. (4) Plan for use and upkeep of unused portions of the building.

4. (d) The rural emergency hospital:

   1. (1) Must not provide acute care inpatient services unless the rural emergency hospital provides either post-hospital extended care services furnished as a unit in a distinct part of the rural emergency hospital that is licensed as a skilled nursing facility or behavioral health services furnished as a unit in a distinct part of the rural emergency hospital in accordance with the Arkansas Health and Opportunity for Me Act of 2021, Arkansas Code § 23-61-1001 et seq.;
   2. (2) Must not exceed an annual per-patient stay of twenty-four (24) hours;
   3. (3) Must have a transfer agreement in place with a Level I or Level II trauma center;

   4. (4) Must have a clinician, doctor of medicine, doctor of osteopathy, physician assistant, nurse practitioner, or clinical nurse specialist with training or experience in emergency care:

      1. (A) At all times;
      2. (B) Immediately available by phone or radio contact; and
      3. (C) Available onsite within thirty (30) minutes;

   5. (5) Must maintain staffed emergency department, including twenty-four (24) hours a day, seven (7) days a week, by an individual or individuals:

      1. (A) Competent in the skills needed to address emergency care; and
      2. (B) Able to receive patients and activate the appropriate medical resources to meet the care needed by the patient; and
   6. (6) Must attest to meeting the required sections listed in subsection (f) of this section.
5. (e) The rural emergency hospital may own and operate an entity that provides licensed ambulance services under the Rules for Emergency Medical Services, 20 CAR pt. 81.

6. (f) Rural emergency hospitals shall conform to the following sections of this part:

   1. (1) SECTION 1: AUTHORITY;
   2. (2) 20 CAR § 41-101, purpose;
   3. (3) 20 CAR § 41-102, definitions;
   4. (4) 20 CAR § 41-103, licensure and codes;
   5. (5) 20 CAR § 41-104, governing body;
   6. (6) 20 CAR § 41-105, medical staff;
   7. (7) 20 CAR § 41-106, general administration;
   8. (8) 20 CAR § 41-107, personnel administration;
   9. (9) 20 CAR § 41-108, administration reports;
   10. (10) 20 CAR § 41-109, patient identification;
   11. (11) 20 CAR § 41-110, patient care service;
   12. (12) 20 CAR § 41-111, medications;
   13. (13) 20 CAR § 41-112, restraints;
   14. (14) 20 CAR § 41-113, Health Information Services;
   15. (15) 20 CAR § 41-114, medical record requirements for outpatient services, emergency room, observation services, and psychiatric records;
   16. (16) 20 CAR § 41-115, pharmacy;
   17. (17) 20 CAR § 41-116, food and nutrition services;
   18. (18) 20 CAR § 41-117, infection prevention and control;
   19. (19) 20 CAR § 41-118, laboratory;
   20. (20) 20 CAR § 41-119, radiological services;

   21. (21)

       1. (A) 20 CAR § 41-125, specialized services — surgical services.
       2. (B) Applicable if services provided;

   22. (22)

       1. (A) 20 CAR § 41-126, specialized services — postanesthesia care unit.
       2. (B) Applicable if services provided;

   23. (23)

       1. (A) 20 CAR § 41-127, specialized services — ambulatory surgery services.
       2. (B) Applicable if services provided;

   24. (24)

       1. (A) 20 CAR § 41-128, specialized services — anesthesia services.
       2. (B) Applicable if services provided;
   25. (25) 20 CAR § 41-133, specialized services — central sterilization and supply;

   26. (26)

       1. (A) 20 CAR § 41-134, specialized services — respiratory care.
       2. (B) Applicable if services provided;
   27. (27) 20 CAR § 41-135, specialized service — emergency services;
   28. (28) 20 CAR § 41-145, physical environment;
   29. (29) 20 CAR § 41-146, physical facilities;
   30. (30) 20 CAR § 41-147, physical facilities — patient accommodations — adult medical, surgical — communicable or pulmonary disease;
   31. (31) 20 CAR § 41-152, physical facilities — surgical facilities;
   32. (32) 20 CAR § 41-154, physical facilities — emergency suite;
   33. (33) 20 CAR § 41-155, physical facilities — imaging suite;
   34. (34) 20 CAR § 41-156, physical facilities — nuclear medicine;
   35. (35) 20 CAR § 41-158, physical facilities — laboratory services;
   36. (36) 20 CAR § 41-160, physical facilities — morgue and necropsy;
   37. (37) 20 CAR § 41-161, physical facilities — pharmacy;
   38. (38) 20 CAR § 41-162, physical facilities — dietary facilities;
   39. (39) 20 CAR § 41-163, physical facilities — administration and public areas;
   40. (40) 20 CAR § 41-164, physical facilities — health information unit;
   41. (41) 20 CAR § 41-165, physical facilities — central medical and surgical supply department;
   42. (42) 20 CAR § 41-166, physical facilities — central supply and receiving;
   43. (43) 20 CAR § 41-167, physical facilities — linen services;
   44. (44) 20 CAR § 41-168, physical facilities — cleaning and sanitizing carts, employee facilities, and environmental closets;
   45. (45) 20 CAR § 41-169, physical facilities — engineering service and equipment areas;
   46. (46) 20 CAR § 41-170, physical facilities — waste processing services;
   47. (47) 20 CAR § 41-171, physical facilities — details and finishes;
   48. (48) 20 CAR § 41-172, physical facilities — construction, including fire-resistive requirements;
   49. (49) 20 CAR § 41-173, physical facilities — mechanical requirements;
   50. (50) 20 CAR § 41-174, physical facilities — plumbing and other piping systems;
   51. (51) 20 CAR § 41-175, physical facilities — electrical standards; and
   52. (52) 20 CAR § 41-177, physical facilities — helicopter landing area.

7. (g) Reclassification to a critical access hospital or general hospital.

   1. (1) If a rural emergency hospital licensed by the department elects under this part to reclassify as a critical access hospital or a general hospital in full service with no limits on the number of beds available or the length of stay, the hospital shall:

      1. (A) Provide notice to the department of its intention for reclassification; and
      2. (B) Be surveyed using the Life Safety Code under which the hospital previously held when the hospital entered into the rural emergency hospital program.
   2. (2) The hospital shall be able to show that it has continued to be licensed and complied consistently with the Life Safety Code as a rural emergency hospital.

Codification Notes: “SECTION 1: AUTHORITY” referenced in subdivision (f)(1) of this section was placed into a codification note at the beginning of this part.