Wyo. Code R. 048-0050-3
Rural Health, Office of
Chapter 3: Designation of Critical Access Hospitals
Effective Date: 09/21/2000 to 11/04/2004
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0050.3.09212000
Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Office of Rural Health at W.S. §9-2-117 et seq. and the Wyoming Administrative Procedures Act at W.S. §16-3-101 et seq.
Section 2. Purpose. These rules have been adopted to provide the application process and criteria for a health care facility to become designated as Critical Access Hospital.
Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.
Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and visa versa. Throughout these rules gender pronouns are used interchangeably. The drafters have attempted to utilize each gender pronoun in equal numbers, in random distribution. Words in each gender shall include individuals of the other gender.
For the purpose of these rules, the following shall apply:
(a) 'Acute Care Hospital' means an institution licensed in accordance with the Wyoming Department of Health's adopted Rules and Regulations for Licensure of Hospitals.
(b) 'Certification' means a health care provider or supplier of services meets the federal conditions to participate in the Medicare and/or Medicaid programs.
(c) 'Critical Access Hospital' means a hospital which makes available twenty-four (24) hour emergency care; provides for not more than fifteen (15) acute care inpatient beds; provides inpatient care for a period that does not exceed, as determined on an annual, average basis, ninety-six (96) hours per patient, unless a longer period is required because transfer to another hospital is precluded because of inclement weather or emergency conditions, or a peer review organization or equivalent entity, upon request, waives the ninety-six (96) hour restriction on a case-by-case basis. An exception to the fifteen (15) bed requirement is made for swing bed hospitals, which are allowed to have up to twenty-five (25) inpatient beds that can be used interchangeably for acute or Skilled Nursing Facility (SNF) level of care, provided that not more than fifteen (15) beds are used at any one time for acute care.
(d) 'Designation' means an official finding and recognition by the Director, Department of Health, that a health care facility meets Wyoming State Rural Health Care Plan criteria to be a Critical Access Hospital.
(e) 'Governing Body' means the individual(s), group, or corporation that is legally responsible for the Critical Access Hospital.
(f) 'Health Care Facility' means an acute care hospital, health clinic or health center that was licensed by the State and has been closed for no more than ten (10) years.
(g) 'Rural Health Care Plan' means the document used by the Department of Health as a basis for improving primary health care services in rural Wyoming communities.
(a) Applications for Critical Access Hospital designation can be obtained by contacting: Wyoming Department of Health, Office of Rural Health, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, (307) 777-6918 Phone, (307) 777-7127 Fax.
(b) The Office of Rural Health will, within ten (10) working days from receipt of the application request, mail the application form plus other pertinent material to the applicant.
(c) The applicant will have up to sixty (60) days to complete and submit an application form to the Office of Rural Health. The applicant can request permission to extend the time period for completion of the application.
(d) The Office of Rural Health must declare an application complete or incomplete within ten (10) working days after receipt of the application. Once the application has been declared complete, the Office of Rural Health will have twenty (20) days to draft preliminary findings and recommendations for consideration by the Director, Department of Health.
(e) The Director, Department of Health will have twenty (20) days to review the findings and recommendations offered by the Office of Rural Health and provide written notice of designation or denial of designation to the applicant. The Director must designate the applicant as a Critical Access Hospital before the applicant can petition for Medicare certification.
(i) To review a decision of the Department, a provider may request a hearing by submitting a written request within thirty (30) days of the date of receipt of the notice of adverse action to the Director, Department of Health.
(ii) Hearings requested under the terms of these rules shall be held in accordance with the provisions of the Wyoming Administrative Procedure Act.
Note: The above process outlines only minimum requirements for designating facilities as Critical Access Hospitals. It is recommended that each health care facility develop a clearly defined strategy which includes additional factors such as: Governing board education and involvement, financial feasibility study, health care facility and medical staff education, community education and awareness, and a study of potential networking relationships.
(i) Critical Access Hospital requirements is an acute care hospital, health clinic or health center that is located in a rural area, more than a 35-mile drive from a hospital or another CAH, 15 miles on secondary or mountainous roads, or is certified by the State as being a necessary provider of health care services to residents in the area (Wyoming's criteria for certifying necessary providers are described below).
(ii) Makes available 24-hour emergency medical services that the State determines are necessary for ensuring access to emergency care services in each area served by a CAH (consistent with the Wyoming Trauma Plan).
(iii) Provides not more than 15 acute care inpatient beds.
(iv) Provides inpatient care for a period that does not exceed, as determined on an annual, average basis, ninety-six (96) hours per patient, unless a longer period is required because:
(A) Transfer to a hospital is precluded because of inclement weather or other emergency conditions, or;
(B) A peer review organization or equivalent entity, upon request, waives the 96-hour restriction on a case-by-case basis;
(C) Meets such staffing requirements as would apply to a hospital located in a rural area, except that:
(D) The facility need not meet hospital standards relating to the number of hours during a day, or days during a week, in which it must be open and fully staffed, except as required to make available emergency medical care services as described above and must have nursing services available on a 24-hour basis, but need not otherwise staff the facility except when an inpatient is present;
(E) The facility may provide the services of a dietitian, pharmacist, laboratory technician, medical technologist, and/or radiological technologist on a part-time, off site basis; and
(F) The inpatient care described may be provided by a Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist subject to the oversight of a physician who need not be present in the facility.
(v) Documentation of agreements for the following services with one or more hospitals for;
(vi) Patient referral and transfer;
(vii) Development and use of communications systems including telemetry systems and systems for electronic sharing of patient data;
(viii) Provision of emergency and non-emergency transportation; and
(ix) Documentation of agreement with respect to credentialing and quality assurance with one or more hospitals or a peer review organization or equivalent entity.
(b) Necessary Provider Requirements.
The following criteria will be used to certify a health care facility as being a necessary provider of health care services to residents in an area. The facility will be designated as a necessary provider of health care services if it meets the following criteria:
(i) The facility is located in an area that meets the criteria for designation as a Health Professional Shortage Area (HPSA) as defined by 42 Code of Federal Regulations, Chapter 1, Part 5, or Medically Underserved Area (MUA) as defined by Public Law 99-280, Federal Register, October 15, 1976, Pages 45718-45723.
(ii) The facility has been designated a Sole Community Provider as defined by the Department of Health’s Rural Health Care Plan.
(iii) The facility was licensed by the State as a health care facility and has been closed for no more than ten (10) years.
(iv) The board has determined that the ongoing operation of the facility is in danger of financial insolvency and has passed a board resolution allowing the facility to apply for a CAH designation. This does not apply to closed health care facilities.
(v) The Director, Department of Health, must designate the health care facility as a Critical Access Hospital before state licensure or federal (Medicare) certification can be pursued.
Section 7. State Licensure. Rules and Regulations for the Licensure of Critical Access Hospitals can be obtained for a nominal fee by contacting: Wyoming Department of Health, Office of Health Quality, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, (307) 777-7123 Phone, (307) 777-7127 Fax.
Section 8. Federal Certification. Federal (Medicare) certification standards for Critical Access Hospitals can be obtained for a nominal fee by contacting: Wyoming Department of Health, Office of Health Quality, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, (307) 777-7123 Phone, (307) 777-7127 Fax.