TITLE 8 SOCIAL
SERVICES
CHAPTER 370 OVERSIGHT
OF LICENSED HEALTHCARE FACILITIES AND COMMUNITY BASED WAIVER PROGRAMS
PART 13 REQUIREMENTS FOR RURAL EMERGENCY
HOSPITALS
8.370.13.1 ISSUING
AGENCY: New Mexico Health Care Authority.
[8.370.13.1 NMAC - N, 7/1/2024]
8.370.13.2 SCOPE: These
requirements apply to private and public hospitals that as of December 27, 2020
was designated as a critical access hospital (CAH) by the centers for medicare and medicaid services (CMS),
or was licensed as a hospital with not more than 50 licensed beds and located
in a county in a rural area as defined in Section 1886(d)(2)(D) or Section 1886
(d)(8)(E) of the federal Social Security Act, and provides rural emergency
hospital (REH) services in the facility 24 hours per day seven days a week by a
physician, nurse practitioner, clinical nurse specialist or physician assistant
with a transfer agreement in effect with a level I or II trauma center, which
does not have an annual average patient length of stay over 24 hours and
satisfies all CMS requirements for reimbursement as a rural emergency hospital (REH).
Facilities that were enrolled as CAHs or
rural hospitals with not more than 50 beds as of December 27, 2020, and then
subsequently closed after that date, would also be eligible to seek REH
designation if they re-enroll in medicare and meet
all the conditions of participation (COP) and requirements for REH.
[8.370.13.2 NMAC - N, 7/1/2024]
8.370.13.3 STATUTORY
AUTHORITY:
The requirements set forth herein are promulgated by the secretary of
the health care authority pursuant to the authority granted under Subsection E
of Section 9-8-6 NMSA 1978, Subsection D of Section 24-1-2, Subsection J of
Section 24-1-3 NMSA, and Section 24-1-5 NMSA of the Public Health Act as
amended, and S.B. 245, 56th Leg., 1st Sess. (N.M.2023). Section
9-8-1 et seq. NMSA 1978 establishes the health care authority (authority) as a
single, unified department to administer laws and exercise functions relating
to health care purchasing and regulation.
[8.370.13.3 NMAC - N, 7/1/2024]
8.370.13.4 DURATION: Permanent.
[8.370.13.4 NMAC - N, 7/1/2024]
8.370.13.5 EFFECTIVE
DATE:
July 1, 2024, unless a later date is cited at the end of a section.
[8.370.13.5 NMAC - N, 7/1/2024]
8.370.13.6 OBJECTIVE: Establish standards
for licensing REHs in order to ensure the provision of
emergency department services, observation care, and additional outpatient
medical and health services, if elected by the REH, that promote equity in
health care for those living in rural communities by facilitating access to needed
services.
[8.370.13.6 NMAC - N, 7/1/2024]
8.370.13.7 DEFINITIONS:
A. Definitions
beginning with “A”:
(1) “Action plan” means the eligible
facility’s plan for conversion to an REH and the initiation of REH specific
services including the provision of emergency department services, observation
care and other medical and health services elected by the REH, submitted to the
authority for recommended approval or denial pursuant to CMS COPs.
(2) “Amended license” means a
change of administrator, name, location, capacity, classification of any units
as listed in these requirements requires a new license:
(a) the application shall be on a form
provided by the licensing authority;
(b) the application shall be accompanied
by the required fee for an amended license; and
(c) the application shall be submitted at
least 10 working days prior to the change.
(3) “Annual license” means a
license issued for a one-year period to a hospital that has met all license
prior to the initial state licensing survey, or when the licensing authority
finds partial compliance with these requirements.
B. Definitions beginning with “B”: [RESERVED]
C. Definitions beginning with “C”: “Critical access hospital” means a
hospital with special characteristics, duly certified as such by centers for medicare and medicaid services
(CMS) and is in compliance with the conditions of participation
for such facilities; such critical access hospitals are deemed as meeting the
intent of these requirements and may be licensed accordingly by the licensing
authority.
D. Definitions beginning
with “D”: [RESERVED]
E. Definitions
beginning with “E”: [RESERVED]
F. Definitions beginning with “F”:
(1) "Facility" means:
(a) was a critical access hospital; or
(b) was a hospital as defined in 42
U.S.C. 1395ww(d)(1)(B) with not more than 50 beds located in a county (or
equivalent unit of local government) in a rural area (as defined in 42 U.S.C.
1395ww(d)(2)(D) or was a hospital as so defined in 42 U.S.C. 1395ww(d)(8)(E)
with not more than 50 beds that was treated as being located
in a rural area.
(2) “Financial interest” means any
equity, security, lease or debt interest in the hospital; financial interest
also includes any equity, security, and lease or debt interest in any real
property used by the hospital or in any entity that receives compensation
arising from the use real property by the hospital.
G. Definitions
beginning with “G”: [RESERVED]
H. Definitions
beginning with “H”: “Hospital” means a facility offering in-patient services, nursing, overnight care
on a 24-hour basis for diagnosing, treating, and providing medical,
psychological or surgical care for three or more separate individuals who have
a physical or mental illness, disease, injury, a rehabilitative condition or
are pregnant; use of the term “hospital” for any facility not duly licensed
according to these requirements is prohibited; any acute care hospital shall
have emergency services, inpatient medical and nursing care for acute illness,
injury, surgery, and obstetrics; any limited services hospital shall have
emergency services, inpatient medical and nursing care for acute illness,
injury and surgery; ancillary services such as pharmacy, clinical laboratory,
radiology, and dietary are required for acute-care or limited service
hospitals.
I. Definitions
beginning with “I”: [RESERVED]
J. Definitions
beginning with “J”: [RESERVED]
K. Definitions beginning with “K”: [RESERVED]
L. Definitions
beginning with “L”:
(1) “Licensee” means the person(s)
who, or organization which, has an ownership, leasehold, or similar interest in
the hospital and in whose name a license has been issued and who is legally
responsible for compliance with these requirements.
(2) “Licensing authority” means the agency within the authority vested
with the authority to enforce these requirements.
M. Definitions
beginning with “M”: [RESERVED]
N. Definitions beginning with “N”: [RESERVED]
O. Definitions beginning with “O”: [RESERVED]
P. Definitions beginning with “P”: [RESERVED]
Q. Definitions beginning with “Q”: [RESERVED]
R. Definitions beginning with “R”:
(1) "Rural emergency hospital"
or "REH" means a facility, as defined above, that:
(a) is enrolled under as defined in 42
U.S.C. 1395cc(j), which relates to the enrollment process for providers of
services and suppliers, submits the additional information described in
paragraph as defined in 42 U.S.C. 1395x(kkk)(4)(A)
related to providing an action plan, describing any outpatient services offered
and the proposed use of the additional facility payment to REHs, for purposes
of such enrollment, and makes the detailed transition plan described in clause
(i) of such paragraph available to the public, in a
form and manner determined appropriate by the U.S. secretary of health & human
services ("secretary");
(b) does not provide any acute care
inpatient services, other than those as defined in 42 U. S. C. 1395x(kkk)(6)(A), related to a skilled nursing facility to
furnish post-hospital extended care services;
(c) has in effect a transfer agreement
with a level I or level II trauma center;
(d) meets:
(i) licensure
requirements as described in 42 U.S.C. 1395x(kkk)(5);
(ii) the requirements of a staffed emergency
department as described in 42 U.S.C. 1395x(kkk)(1)(B);
(iii) such staff training and certification
requirements as the secretary may require;
(iv) conditions of participation applicable
to critical access hospitals, with respect to emergency services under section as
defined in 42 CFR 485.618 (or any successor regulation) and hospital emergency
departments under this subchapter, as determined applicable by the secretary; as
defined in 42 U.S.C. 1395x(kkk).
(e) is an entity that operates for the
purpose of providing emergency department services, observation care, and other
outpatient medical and health services specified by the Secretary in which the
annual per patient average length of stay does not exceed 24 hours. 42 CFR Part
485, 485.502.
(2) "Rural emergency hospital
services" means the following services furnished by a rural emergency
hospital that do not exceed an annual per patient average of 24 hours in such
rural emergency hospital:
(a) emergency department services and
observation care; and
(b) At the election of the rural
emergency hospital, with respect to services furnished on an outpatient basis,
other medical and health services as specified by the secretary through
rulemaking. 42 U.S.C. 1395x (kkk)(1).
S. Definitions
beginning with “S”: “Secretary”
means the secretary of the New Mexico health care authority.
T. Definitions beginning
with “T”: [RESERVED]
U. Definitions beginning with “U”: [RESERVED]
V. Definitions
beginning with “V”: “Variance” means
an act on the part of the licensing authority to refrain from enforcing
compliance with a portion or portions of these requirements for an unspecified period of time where the granting of a variance will not
create a danger to the health, safety, or welfare of patients or staff of a
hospital and is at the sole discretion of the licensing authority.
W. Definitions beginning with “W”: “Waive/waiver” means to refrain from
pressing or enforcing compliance with a portion or portions of these
regulations for a limited period of time where the
granting of a waiver will not create a danger to the health, safety, or welfare
of patients or staff of a facility, and is at the sole discretion of the
licensing authority.
X. Definitions
beginning with “X”: [RESERVED]
Y. Definitions
beginning with “Y”: [RESERVED]
Z. Definitions
beginning with “Z”: [RESERVED]
[8.370.13.7 NMAC - N, 7/1/2024]
8.370.13.8 GENERAL
REQUIREMENTS:
A. Eligibility: The
following facilities that were enrolled and certified to participate in
Medicare as of December 27, 2020 are eligible to be an
REH:
(1) CAHs;
(2) A
subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social
Security Act (the Act) with not more than 50 beds located in a county (or
equivalent unit of local government) in a rural area (as defined in section
1886(d)(2)(D) of the Act) (referred to as rural hospital);
(3) A
subsection (d) hospital (as so defined) with not more than 50 beds that was
treated as being located in a rural area pursuant to
section 1886(d)(8)(E) of the Act (referred to as rural hospital);
(4) Facilities
that were enrolled as CAHs or rural hospitals with not more than 50 beds as of
December 27, 2020 and then subsequently closed after
that date, would also be eligible to seek REH designation if they re-enroll in
Medicare and meet all the COPs and requirements for REHs.
B. Action plan: An action plan must be submitted to the authority
by the applicant facility to initiate REH services. The action plan outlines the facility’s plan
for conversion to an REH and the initiation of REH specific services including
the provision of emergency department services, observation care and other
medical and health services elected by the REH. This should include details regarding staffing
provisions and the number and type of qualified staff for the provision of REH
services, as set forth in the CMS COPs.
(1) The
action plan must include a detailed transition plan that lists the following:
(a) specific
services the facility will retain;
(b) specific
services the facility will modify;
(c) specific
services the facility will add; and
(d) specific
services the facility will discontinue.
(2) The
facility must include a description of services that the facility intends to
furnish on an outpatient basis if elected by the REH.
(3) The
facility must also include information regarding how the facility intends to
use the additional facility payment. This
includes a description of the services that the additional facility payment
would be supporting such as the operation and maintenance of the facility and
furnishing of services (i.e., telehealth services, ambulance services etc.).
(4) Eligible
facilities may submit the action plan and additional information on letterhead
or use the model template available on the CMS website. The submission should be signed by the
facility’s legal representative/administrator.
(5) The
authority will forward the action plan and information along with its
recommendation for approval or denial to the designated CMS location for review
and approval of the action plan components. The CMS location will make a final
determination and notify the MAC once the enrollment package is complete and
has been reviewed and approved.
(6) The
action plan and information must include all the required elements as specified
in Paragraph (1)-(3) of Subsection B of Section 8.370.13.9 NMAC. Missing or incomplete information may delay
the conversion and enrollment process for eligible facilities applying to
become an REH.
(7) In
accordance with section 1861(kkk)(2)(A) of the Act,
action plans will be available to the public and will eventually be posted on
the CMS website.
C. Transfer
Agreement: Pursuant to section 1861(kkk)(2) of the Act and 42 CFR 485.538 Condition of participation:
Agreements, the REH is required to have
a transfer agreement with at least one medicare-certified
hospital that is designated as a level I or level II trauma center. The agreement is intended to ensure an
appropriate referral and transfer process is in place for patients requiring
emergency care and continued care services beyond the capabilities of the REH. In order to document
compliance, a copy of the transfer agreement should be submitted to the authority
along with the action plan.
D. Attestation:
(1) An
REH is required to meet the COPs for rural emergency hospitals set forth at
Subpart E of 42 CFR Part 485 (485.500 - 485.546). Other than the requirement that the REH submit
its agreement with a nearby trauma center, eligible facilities converting to an
REH may self-attest to meeting the REH COPs and will not require an automatic
on-site initial survey as eligible facilities are expected to be in full
compliance with the existing CAH and hospital requirements at the time of the
request for conversion.
(2) Facilities
may submit the attestation for compliance with the REH COPs along with the
action plan and copy of the transfer agreement to the SA. The attestation may be completed on facility letterhead or the model template provided on the CMS website
may be used. The attestation should be
signed by the facility’s legal representative or administrator.
(3) The
authority will review the additional information for completeness and confirm
compliance with any applicable state licensure requirements. Once complete, the authority will forward the
additional information to the CMS location, along with a recommendation for
certification or denial.
(4) The
CMS location is responsible for making the final determination for
certification of the REH. The effective
date will be based upon the date the application package was determined to be
complete and approved by the CMS location for meeting all REH requirements. For facilities that require an on-site initial
survey, the effective date will be based on current CMS policy, which is the
exit day of survey if no deficiencies are cited, or in the alternative, if deficiencies
are noted, the date an acceptable plan of correction was approved (see 42 CFR
489.13).
E. Types of licenses:
(1) “Annual license”: an annual
license is issued for a one-year period to a hospital that has met all
requirements of these requirements.
(2) “Temporary
license”: the licensing authority may, at its sole discretion, issue a temporary
license prior to the initial state survey, or when the licensing authority
finds partial compliance with these requirements. Facilities that were eligible as of December
27, 2020, which subsequently closed and re-enrolled in Medicare would require
an initial on-site survey by the authority. These facilities do not have to submit an
attestation, as required in Subsection D of 8.370.13.9 NMAC, as an on-site
initial survey will be performed to determine the facility is operational and
in compliance with the REH requirements.
(a) a temporary license shall cover a period
of time, not to exceed 120 days, during which the facility must correct
all specified deficiencies;
(b) in accordance with Subsection
D of Section 24-1-5 NMSA 1978, no more than two consecutive temporary licenses
shall be issued.
(3) “Amended
license”: a licensee must apply to
the licensing authority for an amended license when there is any change of
administrator, name, location, capacity, classification of any unit as listed
in these requirements:
(a) the application must be
on a form provided by the licensing authority;
(b) application must be
accompanied by the required fee for an amended license; and
(c) application must be submitted at
least 30 calendar days prior to the change.
[8.370.13.8 NMAC - N, 7/1/2024]
8.370.13.9 LICENSE RENEWAL:
A. The licensee must submit a renewal application on forms provided
by the licensing authority, along with the required fee prior to the expiration
of the current license.
B. Upon receipt of the renewal application and the required
fee prior to expiration of current license, the licensing authority will issue
a new license effective the day following the date of expiration of the current
license if the facility is in substantial compliance with these requirements.
[8.370.13.9 NMAC - N, 7/1/2024]
8.370.13.10 POSTING: The license, or
a copy thereof, shall be conspicuously posted in a location accessible to
public view within the hospital.
[8.370.13.10 NMAC - N, 7/1/2024]
8.370.13.11 NON-TRANSFERABLE
REGISTRATION OF LICENSE: A license shall not be transferred by assignment or otherwise to other
persons or locations. The license shall
be void and must be returned to the licensing authority when any one of the
following situations occur:
A. ownership of the hospital changes;
B. the facility changes location;
C. the licensee of the hospital changes; or
D. the hospital discontinues operation.
[8.370.13.11 NMAC - N, 7/1/2024]
8.370.13.12 EXPIRATION
OF LICENSE: A license will expire at midnight on the day indicated on the license as
the expiration date, unless sooner renewed, suspended, or revoked, or:
A. on the day a facility discontinues operation; or
B. on the day a facility is sold, leased, otherwise changes
ownership or licensee; or
C. on the day a facility changes location.
[8.370.13.12 NMAC - N, 7/1/2024]
8.370.13.13 SUSPENSION
OF LICENSE WITHOUT PRIOR HEARING: In accordance with Subsection H of Section 24-1-5 NMSA 1978, if the
licensing authority determines immediate action is required to protect human
health and safety, the licensing authority may suspend a license. A hearing must be held in accordance with the
regulations governing adjudicatory hearings, New Mexico health care authority, 8.370.2
NMAC.
[8.370.13.13 NMAC
- N, 7/1/2024]
8.370.13.14 GROUNDS FOR
REVOCATION OR SUSPENSION OF LICENSE, DENIAL OF INITIAL OR RENEWAL APPLICATION
FOR LICENSE, OR IMPOSITION OF INTERMEDIATE SANCTIONS OR CIVIL MONETARY
PENALTIES:
A. A
license may be denied, revoked or suspended, or intermediate sanctions or civil
monetary penalties may be imposed after notice and opportunity for a hearing
for any of the following reasons:
(1) failure
to comply with any provisions of these requirements;
(2) failure
to allow survey by authorized representatives of the licensing authority;
(3) permitting
any person while active in the operation of a facility licensed pursuant to
these requirements to be impaired by the use of
prescribed or non-prescribed drugs, including alcohol;
(4) misrepresentation
or falsification of any information provided to the licensing authority;
(5) the
discovery of repeat violations of these requirements during surveys; or
(6) the
failure to provide the required care and services as outlined by these
requirements.
B. for
the purposes of calculating civil monetary penalties, penalty rates will be
applied as set forth in Subparagraph (d) of Paragraph (3) of Subsection B of 8.370.4
NMAC.
[8.370.13.14 NMAC - N, 7/1/2024]
8.370.13.15 HEARING PROCEDURES:
A. An
applicant or licensee subject to an adverse action may request an
administrative appeal.
B. Hearing
procedures for an administrative appeal of an adverse action taken by the
licensing authority against the hospital as outlined in Section 14 and 15 above
will be held in accordance with adjudicatory hearings, New Mexico health care
authority, 8.370.2 NMAC.
C. A
copy of the adjudicatory hearing procedures will be furnished to the hospital
at the time an adverse action is taken against the licensee by the licensing
authority. A copy may be requested at
any time by contacting the licensing authority.
[8.370.13.15 NMAC – N, 7/1/2024]
8.370.13.16 WAIVERS
AND VARIANCES:
A. Applications: All
applications for the grant of a waiver or variance shall be made in writing to
the licensing authority, specifying the following:
(1) the rule, regulation, or code from
which the waiver or variance is requested;
(2) the time period
for which the waiver or variance is requested;
(3) if the request is for a variance, the
specific alternative action which the facility proposes;
(4) the reasons for request; and
(5) an explanation of why the health,
safety, and welfare of the residents or staff are not endangered by the
condition.
B. Requests for a waiver or variance may be made at any
time.
C. The licensing authority may require additional information
from the hospital prior to acting on the request.
(1) Grants and denials. The licensing authority shall grant or deny
each request for waiver or variance in writing.
(a) Notice of a denial shall contain the
reasons for denial.
(b) The decisions to grant, modify, or
deny a request for a waiver or variance is subject to
appeal one time only.
(2) The terms of a requested waiver or variance
may be modified upon agreement between the licensing authority and the
hospital.
D. The licensing authority may impose whatever conditions on
the granting of a waiver or variance it considers necessary.
E. The licensing authority may limit the duration of any
waiver.
[8.370.13.16 NMAC – N, 7/1/2024]
8.370.13.17 Compliance
with existing requirements: An REH shall comply with the following:
A. 42 CFR Part 485, Subpart E (relating
to conditions of participation: Rural
Emergency Hospitals (REHs));
B. In addition to the conditions of
participation at 42 CFR Part 485, Subpart E, the hospital shall comply with 8.370.12
NMAC to the extent it does not conflict with the conditions of participation.
[8.370.13.17 NMAC - N, 7/1/2024]
8.370.13.18 INCORPORATED
AND RELATED CODES: The facilities that are subject to this rule
are also subject to other rules, codes and standards that may, from time to
time, be amended. This includes but not limited to the following:
A. Health facility licensure fees and
procedures, health care authority, 8.370.3 NMAC.
B. Health facility sanctions and civil
monetary penalties, health care authority, 8.370.4 NMAC.
C. Adjudicatory hearings for licensed
facilities, health care authority, 8.370.2 NMAC.
D. Caregiver’s criminal history
screening requirements, 8.370.5 NMAC.
E. Employee abuse registry, 8.370.8 NMAC.
F. Incident reporting, intake
processing and training requirements, 8.370.9 NMAC.
G. New Mexico Administrative Code,
Title 14 Housing and Construction, chapters 5 through 12.
[8.370.13.18 NMAC – N, 7/1/2024]
8.370.13 NMAC History:
[RESERVED]