Section 124.40. Requirements for a critical access hospital.

 

(1)   Operation as a hospital. A critical access hospital shall comply with all provisions of this chapter, except as provided in this section.

(2)   Bed complement.

(a) A critical access hospital shall maintain no more than a total of 25 beds to be used exclusively for acute inpatient care.

(b) If the critical access hospital has an agreement established under 42 USC 1395tt governing the hospital's maintenance of swing beds, the critical access hospital may maintain not more than 25 inpatient beds to be used interchangeably for acute care or swing-bed services.

(c) A critical access hospital may have up to 4 additional permanently-placed 24-hour observation beds.

(3)   Limits on acute inpatient stays. A critical access hospital shall provide inpatient care for periods not to exceed an annual average of 96 hours per patient. The hospital shall record each patient's stay and any longer inpatient stay because transfer to a network or other hospital is precluded due to inclement weather or other emergency conditions.

(4)   Emergency care services.

(a) A critical access hospital shall make emergency services available on a 24-hour-a-day-basis and in accordance with the rural health plan.

(b) Emergency services shall be provided by a practitioner with training or experience in emergency care who is on call and immediately available by telephone or radio contact, and available on-site within 30 minutes on a 24-hour-a-day basis. In this paragraph, "practitioner" means a physician, a nurse practitioner or a physician assistant.

(5)   Staffing.

(a) General. A critical access hospital shall comply with the provisions of subchs. III and IV only when the facility has one or more patients receiving care in the facility. When the facility does not have any inpatients, the facility need not comply with the federal conditions of participation of a hospital under medicare relating to the number of hours during a day, or days during a week, in which the facility must be open, and with the provisions of subchs. III and IV relating to staffing requirements, except that the facility is required to make available emergency care services pursuant to sub. (4) and shall have registered nurses available on a 24-hour basis as required by s. DHS 124.13 (1) (a) .

(b) Inpatient care services. Inpatient care under sub. (3) 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.

(c) Special services. A critical access hospital may make available any services provided by staff under ss. DHS 124.15 , 124.16 , 124.17 , 124.18 , 124.19 , 124.20 , 124.21 , 124.22 , 124.23 or 124.25 on a part-time, off-site basis under arrangements as specified in 42 USC 1395x (e).

(6)   Referral agreement. A critical access hospital shall have a written agreement with one or more network hospitals which shall address all of the following:

(a) Transfer and referral of patients from the critical access hospital.

(b) Development and use of communication systems.

(c) Provision of emergency and non-emergency transportation.

(d) Credentialing of professional staff and quality assurance.

Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517 , eff. 2-1-99; CR 03-042 : am. (2) (b) and (3), cr. (2) (c) Register September 2003 No. 573 , eff. 10-1-03; CR 04-040 : am. (2) (a) and (b) Register November 2004 No. 587 , eff. 12-1-04.