Statutes, codes, and regulations
West Virginia Administrative Code
Agency 64 - HealthTitle 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES
Series 64-12 - Hospital Licensure
Section 64-12-16 - Critical Access Hospital

W. Va. Code R. § 64-12-16

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Current through Register Vol. XLI, No. 50, December 13, 2024
Section 64-12-16 - Critical Access Hospital
16.1. Critical Access Hospital Designation.
16.1.1. A critical access hospital is designated as such by the Office of Community and Rural Health and approved by the Centers for Medicare and Medicaid Services.
16.1.2. Upon designation as a Critical Access Hospital, the hospital shall remain subject to the provisions of Critical Access Hospital rules and public health law and rules applicable to hospitals, including those parts pertaining to certificates of need and other operating certificates. This shall also apply to the proposed revocation, suspension, limitation, or decertification of a Critical Access Hospital designation.
16.2. Scope of Services.
16.2.1. Critical Access Hospital shall provide initial diagnostic services, a limited range of therapeutic services, resuscitation, and stabilization services, and shall have the ability to arrange transport to other more appropriate facilities for patients in need of services not offered at the Critical Access Hospitals.
16.2.2. A Critical Access Hospital shall provide a minimum set of core services to meet patient needs including:
16.2.2.a. Emergency services provided by a licensed West Virginia physician or an experienced and trained midlevel practitioner who can handle urgent and emergency care services, within his or her scope of practice, and in compliance with 42 C.F.R. § 485.618. In the event services are provided by a clinician other than a Doctor of Medicine or a Doctor of Osteopathy, this clinician must be supervised by a Doctor of Medicine or Osteopathy who is available by telephone or radio contact 24 hours a day and be available on site within 30 minutes from initial contact;
16.2.2.b. Inpatient acute care and ambulatory services;
16.2.2.c. Laboratory services;
16.2.2.d. Imaging services; and
16.2.2.e. Pharmacy services.
16.2.3. When a Critical Access Hospital does not require a physician to be on site, it must ensure that patients in need of emergency care arriving at the facility are provided with emergency medical treatment within the capabilities of the facility.
16.3. Licensure.

A Critical Access Hospital shall meet all hospital licensure standards for the state of West Virginia, cited in section 1 through 14 of this rule in addition to the following requirements:

16.3.1. A licensed professional registered nurse, nurse practitioner, physician's assistant, or physician shall provide 24-hour on-site care when the Critical Access Hospital renders inpatient services;
16.3.2. Authorized admissions to a Critical Access Hospital may include only patients that, by the judgment of the admitting practitioner, are determined to have medical needs that can be managed and resolved within the 96-hour period estimated for inpatient services pursuant to 42 C.F.R. § 485.620. The Critical Access Hospital shall transfer patients presenting with conditions that are beyond the clinical capabilities of the Critical Access Hospital to a hospital that has available appropriate services.
16.4. Quality Improvement.
16.4.1. The governing authority shall require the establishment and maintenance of a written quality assurance program which integrates the review activities of all Critical Access Hospital services to enhance the quality of patient care. In meeting the hospital quality assessment under section 15 of this rule, this program shall be designed to focus on the continuum of care that concentrates on improving the outcomes of care to patients from all services provided at the facility.
16.4.2. At a minimum the quality improvement program shall include, but not be limited to, the following:
16.4.2.a. Access and availability of care;
16.4.2.b. Variations from generally accepted standards of care;
16.4.2.c. Unanticipated transfers to a more intensive facility;
16.4.2.d. Cases that exceed the 96-hour length of stay for the Critical Access Hospital;
16.4.2.e. Nosocomial infections and other infection control issues;
16.4.2.f. Complaints, grievances, or risk management findings;
16.4.2.g. Evaluation of diagnostic and therapeutic services provided;
16.4.2.h. Medication errors and other incidents or occurrences; and
16.4.2.i. Adverse drug reactions.
16.5. Medical Staff.
16.5.1. The medical staff shall develop a system in which network medical and professional staff participates and collaborates to provide consultation, assistance with medical emergencies, and patient referrals.
16.5.2. The Critical Access Hospital shall ensure that physicians are present for sufficient period of time, as defined by the hospital's governing body, to provide the necessary and appropriate medical direction, medical care services, consultation, and supervision of hospital health care staff in accordance with patient needs.
16.5.3. When the Critical Access Hospital does not require a physician to be onsite, the medical staff shall ensure that at least one Doctor of Medicine or Osteopathy is available by radio or telephone on a 24 hour a day basis, and is available on-site within 30 minutes of patient need 24 hours a day.

W. Va. Code R. § 64-12-16