902 KAR 20:008. License procedures and fee schedule

      Section 1. Definitions. (1) "Adverse action" means action taken by the Cabinet for Health and Family Services, Office of Inspector General to deny, suspend, or revoke a health facility's license to operate.

      (2) "Cabinet" is defined by KRS 216B.015(6).

      (3) "Deemed hospital" means a hospital that has had its accreditation accepted by the Office of Inspector General pursuant to KRS 216B.185(1) as evidence that the hospital demonstrates compliance with the licensure requirements of KRS Chapter 216B.

      (4) "Inspector General" means the Inspector General or designee.

      (5) "Variance" means the written approval of the Inspector General authorizing a health care facility to depart from a required facility specification, upon meeting the conditions established in Sections 4 and 5 of this administrative regulation.

 

      Section 2. Licenses. (1) A license required by KRS 216B.105(1) shall be conspicuously posted in a public area of the facility.

      (2) An applicant for licensure as a health facility or service shall complete and submit to the Office of the Inspector General the appropriate application for licensure as follows:

      (a) Application for License to Operate a Health Facility or Service;

      (b) Application for License to Operate a Chemical Dependency Treatment Service, Group Home, Psychiatric Residential Treatment Facility, or Residential Hospice Facility;

      (c) Application for License to Operate a Hospital;

      (d) Application for License to Operate a Home Health Agency, Non-residential Hospice, or Private Duty Nursing Agency;

      (e) Application for License to Operate a Renal Dialysis Facility, Mobile Health Service, Special Health Clinic, or Specialized Medical Technological Service;

      (f) Application for License to Operate a Long Term Care Facility; or

      (g) Application for License to Operate a Family Care Home.

      (3) An applicant for an initial license shall, as a condition precedent to licensure be in compliance with each administrative regulation applicable to the license requested, which shall be determined through an on-site inspection of the health facility.

      (4) Licensure inspections.

      (a) Except for a health facility subject to KRS 216.530, a licensure inspection may be unannounced.

      (b)1. A representative of the Office of Inspector General shall have access to the health facility pursuant to KRS 216B.042(2).

      2. An applicant for licensure or a current licensee shall not deny access to a representative of the Office of Inspector General, after proper identification, to make an inspection for determining compliance with the requirements of each applicable administrative regulation for which the facility is licensed under 902 KAR Chapter 20 or 906 KAR Chapter 1.

      3.a. Denial of access, including any effort to delay, interfere with, or obstruct an effort by a representative of the Office of Inspector General to enter the facility, or deny access to records relevant to the inspection, unless deemed confidential by 42 U.S.C. 299b-22(a), shall result in disciplinary action, including denial, revocation, modification, or suspension of the facility’s license.

      b. Denial, revocation, modification, or suspension of a facility’s license shall be subject to appeal pursuant to KRS 216B.105.

      (c) An inspection of a health facility or service licensed under 902 KAR Chapter 20 or 906 KAR Chapter 1 shall comply as follows:

      1. The inspection shall be made at any time during the licensee’s hours of operation;

      2. The inspection shall be limited to ensure compliance with the standards set forth in 902 KAR Chapter 20, 906 KAR Chapter 1, KRS Chapter 216, or KRS Chapter 216B; and

      3. The inspection of a health facility or service based on a complaint or a follow-up visit shall not limit the scope of the inspection to the basis of the complaint or the implementation of a plan of correction.

      (5) Violations.

      (a) The Office of Inspector General shall notify the health facility in writing of a regulatory violation identified during an inspection.

      (b) The health facility shall submit to the Office of Inspector General, within ten (10) days of the notice, a written plan for the correction of the regulatory violation.

      1. The plan shall be signed by the facility's administrator, the licensee, or a person designated by the licensee and shall specify:

      a. The date by which the violation shall be corrected;

      b. The specific measures utilized to correct the violation; and

      c. The specific measures utilized to ensure the violation will not recur.

      2. The Office of Inspector General shall review the plan and notify the facility in writing of the decision to:

      a. Accept the plan;

      b. Not accept the plan; or

      c. Deny, suspend, or revoke the license for a substantial regulatory violation in accordance with KRS 216B.105(2).

      3. The notice specified in subparagraph 2b of this paragraph shall:

      a. State the specific reasons the plan is unacceptable; and

      b. Require an amended plan of correction within ten (10) days of receipt of the notice.

      4. The Office of Inspector General shall review the amended plan of correction and notify the facility in writing of the decision to:

      a. Accept the plan;

      b. Deny, suspend, or revoke the license for a substantial regulatory violation in accordance with KRS 216B.105(2); or

      c. Require the facility to submit an acceptable plan of correction.

      5. A facility that fails to submit an acceptable amended plan of correction may be notified that the license will be denied, suspended, or revoked in accordance with KRS 216B.105(2).

      (6) A license shall:

      (a) Expire one (1) year from the date of issuance, unless otherwise expressly provided in the license certificate; and

      (b) Be renewed if the licensee:

      1. Submits a completed licensure application;

      2. Pays the prescribed fee;

      3. Has no pending adverse action and

      4. Unless exempted, has responded to requests from the cabinet for:

      a. Annual utilization surveys; and

      b. Requests for information regarding health services provided.

      (7) Except for a Level I psychiatric residential treatment facility licensed pursuant to the exception established in 902 KAR 20:320, Section 3(2), more than one (1) license shall not be issued or renewed for a particular licensure category at a specific location.

      (8) A new licensure application shall be filed within thirty (30) calendar days of the effective date of a change of ownership. A change of ownership for a license shall be deemed to occur if more than twenty-five (25) percent of an existing facility or capital stock or voting rights of a corporation is purchased, leased, or otherwise acquired by one (1) person from another.

      (9) The licensee shall fully disclose to the cabinet the name, mailing address, email address, and phone number, or a change in the name, mailing address, email address, or phone number of:

      (a) Each person having an ownership interest of twenty-five (25) percent or more in the facility; and

      (b)1. Each officer or director of the corporation, if a facility is organized as a corporation; or

      2. Each partner, if a facility is organized as a partnership.

      (10) An unannounced inspection shall be conducted:

      (a) In response to a credible, relevant complaint or allegation; and

      (b) According to procedures established in subsection (4) of this section.

      (11) A licensee that does not have a pending adverse action, but fails to submit a completed licensure application annually shall cease operating the health facility unless:

      (a) The items required under subsection (6)(b) of this section have been tendered; and

      (b) The Office of Inspector General has provided the facility with a notice granting temporary authority to operate pending submission of the application.

 

      Section 3. Fee Schedule. (1)(a) Fees for review of plans and specifications for construction or renovation of health facilities shall be as follows:

License Type	Rate
(a) Hospitals plans and specifications review	$.10 per sq. ft.
(initial through final)	$200 minimum
(b) All other health facilities plans and specifications review	$.10 per sq. ft.
(initial through final)	$200 minimum

      (b) A request for review of plans and specifications shall be submitted on the Program Review Fee – Worksheet Health Facility Identification form, accompanied by payment described in paragraph (a) of this subsection.

      (2) Initial and Annual fees. The initial and annual licensure fee for health facilities and services shall be as follows:

License Type	Rate
(a) Freestanding birth center	$500
(b) Alzheimer's nursing home	For Alzheimer’s nursing facilities with 50 beds or less, $750 + $25 per bed; For Alzheimer’s nursing facilities with 51 or more beds, $1,000 + $25 per bed
(c) Ambulatory surgical center	$750
(d) Chemical dependency treatment service	$1,000 + $25 per bed
(e) Community mental health center	$1,500
(f) Day health care	$170
(g) Family care home	$42
(h) Group home for individuals with an intellectual or developmental disability	$100
(i) Health maintenance organization	$12 per 100 patients
(j) Home health agency	$500
(k) Hospice	$500
(l) Hospital
1. Deemed hospital	For deemed hospitals with 25 beds or less, $750 + $25 per bed; For deemed hospitals with 26 or more beds, $1,000 + $25 per bed
2. Non-deemed hospital	For non-deemed hospitals with 25 beds or less, $750 + $25 per bed; For non-deemed hospitals with 26 or more beds, $1,000 + $25 per bed
(m) Intermediate care facility	For intermediate care facilities with 50 beds or less, $750 + $25 per bed; For intermediate care facilities with 51 or more beds, $1,000 + $25 per bed
(n) ICF/IID facility	For ICFs/IID with 50 beds or less, $750 + $25 per bed; For ICFs/IID with 51 or more beds, $1,000 + $25 per bed
(o) Network	$500
(p) Nursing facility	For nursing facilities with 50 beds or less, $750 + $25 per bed; For nursing facilities with 51 or more beds, $1,000 + $25 per bed
(q) Nursing home	For nursing homes with 50 beds or less, $750 + $25 per bed; For nursing homes with 51 or more beds, $1,000 + $25 per bed
(r) Ambulatory care clinic	$500
(s) Personal care home	$100 + $5 per bed
(t) Primary care center	$500 + $50 per extension
(u) Psychiatric hospital
1. Deemed hospital	For deemed psychiatric hospitals with 25 beds or less, $750 + $25 per bed; For deemed psychiatric hospitals with 26 or more beds, $1,000 + $25 per bed
2. Non-deemed hospital	For non-deemed psychiatric hospitals with 25 beds or less, $750 + $25 per bed; For non-deemed psychiatric hospitals with 26 or more beds, $1,000 + $25 per bed
(v) Psychiatric residential treatment facility	$500
(w) Rehabilitation agency	$300
(x) Renal dialysis facility	$350 per station
(y) Rural health clinic	$500
(z)Special health clinic	$500
(aa) Specialized medical technology service	$500
(bb) Mobile health service	$500
(cc) Comprehensive physical rehabilitation hospital
1. Deemed hospital	For deemed hospitals with 25 beds or less, $750 + $25 per bed; For deemed hospitals with 26 or more beds, $1,000 + $25 per bed
2. Non-deemed	For non-deemed hospitals with 25 beds or less, $750 + $25 per bed; For non-deemed hospitals with 26 or more beds, $1,000 + $25 per bed
(dd) Critical access hospital	$750 + $25 per bed
(ee) Private duty nursing agency	$500
(ff) Residential hospice facility	$500
(gg) Prescribed Pediatric Extended Care Facility	$500
(hh) Outpatient health care center	$500

      (3) Change in status of a licensed health facility.

      (a) Name change or change of facility administrator. If a health facility changes the name of the facility as set forth on its license or the facility administrator changes, the licensee shall notify the Office of Inspector General of the facility’s new name or new administrator within ten (10) calendar days of the effective date of the name change or administrator change.

      (b) Change of location.

      1. If a health facility or one (1) of its extensions or satellites changes location and certificate of need approval is not required prior to relocation, the licensee shall notify the Office of Inspector General of the new location within ten (10) calendar days of the effective date of the change.

      2. The Office of Inspector General shall conduct an on-site inspection for a change of location if the facility is one (1) of the following levels of care:

      a. Freestanding birth center;

      b. Alzheimer’s nursing home;

      c. Ambulatory surgical center;

      d. Chemical dependency treatment service;

      e. Group home;

      f. Non-deemed hospital;

      g. Intermediate care facility;

      h. Intermediate care facility for individuals with an intellectual or developmental disability (ICF/IID);

      i. Nursing facility;

      j. Nursing home;

      k. Personal care home;

      l. Psychiatric residential treatment facility;

      m. Renal dialysis facility;

      n. Residential hospice facility; or

      o. Outpatient health care clinic.

 

      Section 4. Existing Facilities With Waivers. (1) The Inspector General shall deem an existing health care facility to be in compliance with a facility specification requirement, even though the facility does not meet fully the applicable requirement, if:

      (a) The Inspector General has previously granted, to the facility, a waiver for the requirement;

      (b) The facility is licensed by the cabinet;

      (c) The facility is in good standing as of the effective date of this administrative regulation; and

      (d) The waived requirement does not adversely affect the health, safety, or welfare of a resident or patient.

      (2) If the Inspector General determines that the waived requirement has adversely affected patient or resident health, safety or welfare, then:

      (a) The Inspector General shall notify the facility by certified mail of the findings and the need to comply with the applicable administrative regulations; and

      (b) The health facility shall submit a written plan to ensure compliance, pursuant to Section 2(5)(b) of this administrative regulation.

 

      Section 5. Variances. (1) The Inspector General may grant a health care facility a variance from a facility specification requirement if the facility establishes that the variance will:

      (a) Improve the health, safety, or welfare of a resident or patient; or

      (b) Promote the same degree of health, safety, or welfare of a resident or patient as would prevail without the variance.

      (2) A facility shall submit a request for a variance, in writing, to the Office of Inspector General. The request shall include:

      (a) All pertinent information about the facility;

      (b) The specific provision of the administrative regulation affected;

      (c) The specific reason for the request; and

      (d) Evidence in support of the request.

      (3) The Inspector General shall review and approve or deny the request for variance. The Inspector General may request additional information from the facility as is necessary to render a decision. A variance may be granted with or without a stipulation or restriction.

      (4) The Inspector General shall revoke a variance previously granted if the Inspector General determines the variance has not:

      (a) Improved the health, safety, or welfare of a patient or resident; or

      (b) Promoted the same degree of health, safety, or welfare of a patient or resident that would prevail without the variance.

      1. The Inspector General shall notify the health facility, by certified mail, of a decision to revoke a variance and the need to comply with the applicable regulatory requirement.

      2. The health facility shall submit a written plan to ensure compliance, pursuant to Section 2(5)(b) of this administrative regulation.

 

      Section 6. Variance Hearings. (1)(a) A health care facility dissatisfied with a decision to deny, modify, or revoke a variance or a request for a variance may file a written request for a hearing with the Secretary of the Cabinet for Health and Family Services.

      (b) The request shall be received by the secretary within twenty (20) days of the date the health care facility receives notice of the decision to deny, modify, or revoke the variance or request for a variance.

      (2) An administrative hearing shall be conducted in accordance with KRS Chapter 13B.

 

      Section 7. Adverse Action Procedures. (1) A facility that has received a preliminary order to close or other notice of adverse action:

      (a) Shall receive a duplicate license from the Office of Inspector General indicating that the facility has adverse action pending;

      (b) Shall post the duplicate license in place of the original license;

      (c) Shall be subject to periodic inspections by the inspecting agency to investigate complaints and ensure patient safety; and

      (d) May continue to operate under duplicate license pending completion of the adverse action process, if patients and residents are not subjected to risk of death or serious harm.

      (2) Until all appeals pursuant to KRS 216B.105 of the pending adverse action have been exhausted, the facility shall not have its:

      (a) License renewed; or

      (b) Duplicate license replaced.

 

      Section 8. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) Form OIG 001, "Application for License to Operate a Health Facility or Service", June 2014;

      (b) Form OIG 002, "Application for License to Operate a Chemical Dependency Treatment Service, Group Home, Psychiatric Residential Treatment Facility, or Residential Hospice Facility", June 2014;

      (c) Form OIG 003, "Application for License to Operate a Hospital", June 2014;

      (d) Form OIG 004, "Application for License to Operate a Home Health Agency, Non-Residential Hospice, or Private Duty Nursing Agency", June 2014;

      (e) Form OIG 005, "Application for License to Operate a Renal Dialysis Facility, Mobile Health Service, Special Health Clinic, or Specialized Medical Technology Service", June 2014;

      (f) Form OIG 006, "Application for License to Operate a Long Term Care Facility", June 2014;

      (g) Form OIG 007, "Application for License to Operate a Family Care Home", June 2014; and

      (h) Form OIG PR-1, "Program Review Fee – Worksheet Health Facility Identification Form", June 2014.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Office of the Inspector General, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (8 Ky.R. 218; Am. 493; eff. 2-1-1982; 9 Ky.R. 61; eff. 8-11-1982; 745; eff. 1-6-1983; 1055; eff. 4-6-1983; 1325; eff. 7-6-1983; 11 Ky.R. 465; Am. 730; eff. 12-11-1984; 13 Ky.R. 1131; eff. 2-10-1987; 14 Ky.R. 1870; 2031; eff. 4-14-1988; 17 Ky.R. 133; eff. 9-13-1990; 3536; eff. 7-17-1991; 23 Ky.R. 3624; 4135; eff. 6-16-1997; 24 Ky.R. 1786; 2378; eff. 5-18-1998; 27 Ky.R. 3166; 28 Ky.R. 90; eff. 7-16-2001; 29 Ky.R. 1896; 2471; eff. 4-11-2003; 30 Ky.R. 434; 868; eff. 10-15-2003; 41 Ky.R. 194; 809; eff. 12-17-2014.)

Notation

      RELATES TO: KRS 216.2925, 216.530, 216B.010, 216B.015, 216B.040, 216B.042, 216B.045-216B.055, 216B.075, 216B.105-216B.131, 216B.185, 216B.990

      STATUTORY AUTHORITY: KRS 216.530, 216B.042(1)(a)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 requires the Cabinet for Health and Family Services to promulgate administrative regulations necessary for the proper administration of the licensure function and establish reasonable application fees for licenses. This administrative regulation establishes the fee schedule and requirements for obtaining a license to operate a health facility and establishes the procedure for obtaining a variance.