CABINET FOR HEALTH AND

FAMILY SERVICES

Office of Health Policy

(As Amended at ARRS,

November 10, 2015)

 

      900 KAR 6:055. Certificate of need forms.

 

      RELATES TO: KRS 216B.015[216B.010-216B.130,

216B.330-216B.339, 216B.455, 216B.990]

      STATUTORY AUTHORITY: KRS[194A.030,

194A.050,] 216B.040(2)(a)1[, 216B.330]

      NECESSITY, FUNCTION, AND CONFORMITY: KRS

216B.040(2)(a)1 requires the Cabinet for Health and Family Services to

administer Kentucky's Certificate of Need Program and to promulgate

administrative regulations as necessary for the program. This administrative

regulation establishes the forms necessary for the orderly administration of

the Certificate of Need Program.

 

      Section 1. Definitions. (1)

"Administrative escalation" means an approval from the cabinet to

increase the capital expenditure authorized on a previously issued certificate

of need.

      (2) "Cabinet" is defined by KRS

216B.015(6)[(5)].

 

      Section 2. Forms. (1) OHP - Form 1, Letter

of Intent, shall be filed by an applicant[all applicants] for a certificate

of need pursuant to the requirements established in 900 KAR 6:065.

      (2) OHP - Form 2A, Certificate of Need

Application, shall be filed by an applicant[applicants] for a certificate

of need unless the application is for[other than] ground

ambulance services,[providers or] change of location,

replacement,[or] cost escalation, or acquisition.

      (3) OHP - Form 2B, Certificate of Need

Application For Ground Ambulance Service, shall be filed by an applicant[applicants]

for a certificate of need for a ground ambulance service[providers].

      (4) OHP - Form 2C, Certificate of Need

Application For Change of Location, Replacement, Cost Escalation, or

Acquisition, shall be filed by an applicant[applicants] for a certificate

of need for change of location, replacement, cost escalation, or

acquisition.

      (5) OHP - Form 3, Notice of Appearance,

shall be filed by a person who wishes[persons that wish] to

appear at a hearing.

      (6) OHP - Form 4, Witness List, shall be

filed by a person who elects [persons that elect] to call a

witness[witnesses] at a hearing.

      (7) OHP - Form 5, Exhibit List, shall be

filed by a person who elects[persons that elect] to introduce

evidence at a hearing.

      (8) OHP - Form 6, Cost Escalation Form,

shall be filed by a facility[facilities] that elects[elect]

to request an administrative escalation.

      (9) OHP - Form 7, Request for Advisory

Opinion, shall be filed by anyone electing to request an advisory opinion.

      (10) OHP - Form 8, Certificate of Need Six

Month Progress Report, shall be filed by a holder of a certificate of need

whose project is not fully implemented.

      (11) OHP - Form 9, Notice of Intent to

Acquire a Health Facility or Health Service, shall be submitted by a person

proposing to acquire an existing licensed health facility or service.

      (12) OHP - Form 10A, Notice of Addition

or Establishment of a Health Service or Equipment, shall be filed by any health

facility that[which] adds equipment or makes an

addition to a health service for which there are review criteria in the State

Health Plan but for which a certificate of need is not required.

      (13) OHP – Form 10B, Notice of

Termination or Reduction of a Health Service or Reduction of Bed Capacity,

shall be filed by a health facility that[which]

reduces or terminates a health service[,] or reduces bed capacity.

      (14) OHP - Form 11, Application for

Certificate of Compliance for a Continuing Care Retirement Community (CCRC),

shall be filed by a facility to obtain a certificate of compliance as a

continuing care retirement community.

 

      Section 3. Incorporation by Reference.

(1) The following material is incorporated by reference:

      (a) "OHP - Form 1, Letter of

Intent", 05/2009;

      (b) "OHP - Form 2A, Certificate of

Need Application", 07/2015 [05/2009];

      (c) "OHP - Form 2B, Certificate of

Need Application For Ground Ambulance Service[Providers]",

05/2009;

      (d) "OHP - Form 2C, Certificate of

Need Application For Change of Location, Replacement, Cost Escalation, or

Acquisition ", 05/2009;

      (e) "OHP - Form 3, Notice of

Appearance", 10/2015[05/2009];

      (f) "OHP - Form 4, Witness

List", 10/2015[05/2009];

      (g) "OHP - Form 5, Exhibit

List", 10/2015[05/2009];

      (h) "OHP - Form 6, Cost Escalation

Form", 05/2009;

      (i) "OHP - Form 7, Request for

Advisory Opinion", 05/2009;

      (j) "OHP - Form 8, Certificate of

Need Six Month Progress Report", 07/2015[05/2009];

      (k) "OHP - Form 9, Notice of Intent

to Acquire a Health Facility or Health Service", 07/2015[05/2009];

      (l) "OHP - Form 10A, Notice of

Addition or Establishment of a Health Service or Equipment", 05/2009;

      (m) "OHP - Form 10B, Notice of

Termination or Reduction of a Health Service or Reduction of Bed

Capacity", 07/2015[05/2009]; and

      (n) "OHP - Form 11, Application for

Certificate of Compliance for a Continuing Care Retirement Community

(CCRC)", 05/2009.

      (2) This material may be inspected,

copied, or obtained, subject to applicable copyright law, at the Cabinet for

Health and Family Services, Office of Health Policy, 275 East Main Street 4WE,

Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

 

ERIC FRIEDLANDER, Acting Executive Director

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: October 8, 2015

      FILED WITH LRC: October 14, 2015 at 1

p.m.

      CONTACT PERSON: Tricia Orme, Office of

Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40601, phone 502-564-7905,

fax 502-564-7573, email tricia.orme@ky.gov.