(a) Critical Access Hospital Requirements. - (i) Each Critical Access Hospital shall comply with criteria set forth in Social Security Act Section 1820. [ 42 U.S.C. 1395i-4 ](c). This document is available at the website http://www.ssa.gov/OP_Home/ssact/title18/1820.htm.
- (ii) Key Criteria for designation include:
- (A) A facility shall be currently participating Medicare hospital, a hospital that ceased operation on or after November 29, 1989, or a health care clinic or health center that ceased operation as a hospital before being downsized to a health clinic or health center.
- (B) A facility located more than 35-mile drive from any other hospital (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) or Critical Access Hospital unless designated by the Department of Health, prior to January 1, 2006 to be a necessary provider.
- (C) The facility 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 Critical Access Hospital (consistent with the Wyoming Trauma Plan).
- (D) The facility provides not more than twenty five (25) acute care inpatient beds or in the case of a Critical Access Hospital with a swing bed agreement, swing beds.
- (E) The facility 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:
- (I) Transfer to a hospital is precluded because of inclement weather or other emergency conditions, or;
- (II) A peer review organization or equivalent entity, upon request, waives the 96-hour restriction on a case-by-case basis;
- (F) The facility meets such staffing requirements as would apply to a hospital located in a rural area, except that:
- (I) 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;
- (G) 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
- (H) 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.
- (I) Documentation of agreements for the following services with one or more hospitals for;
- (I) Patient referral and transfer;
- (II) Development and use of communications systems including telemetry systems and systems for electronic sharing of patient data;
- (III) Provision of emergency and non-emergency transportation; and
- (IV) 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 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 two (2) of 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 hospital 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 Critical Access Hospital designation. This does not apply to closed facilities.
- (v) The Director, Department of Health, must designate the facility as a Critical Access Hospital before state licensure or federal (Medicare) certification can be pursued.