Part 407 - Primary Care Hospitals - Minimum Standards

Effective Date: 
Wednesday, June 12, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, sections 2803 and 2957

Section 407.1 - Definitions

Section 407.1 Definitions.

(a) "Primary care hospital (PCH)" shall mean a general hospital serving a rural area which:

(1) complies with the provisions of this Part and the provisions of Part 405 of this Title to the extent required by this Part;

(2) provides all services required by section 407.3 of this Part in a manner that safely and effectively meets patient needs;

(3) may provide one or more additional optional services authorized by section 407.14 of this Part in accordance with patient needs, the hospital's ability to meet these needs safely and effectively and the Commissioner's approval to provide such services;

(4) may participate in a rural health network as defined in subdivision (c) of this section;

(5) has a formal affiliation with a general hospital that complies with all provisions of Part 405 of this Title; and

(6) is located in a rural area, defined as any county with less than two hundred thousand persons or any town which has a population of less than two hundred persons per square mile, or if approved by the Commissioner, any town which has a population of less than two hundred fifty persons per square mile.

(b) Critical Access Hospital (CAH) shall mean a PCH serving a rural area which:

(1) is designated by the federal government as an RPCH pursuant to the requirements of 42 CFR section 485.606; and

(2) complies with provisions of this Part that relate to PCHs as well as those applying only to be CAHs. (c) Rural health network shall mean an affiliation of health care providers serving a rural area, pursuant to a contract, joint or cooperative agreement, or organized pursuant to the not-for-profit corporation law and approved pursuant to subdivision 14 of section 2801-a of the Public Health Law, which provides or arranges for the provision of health care services pursuant to a network plan to residents of a rural area or the provision of administrative or management services among such health care providers.
(d) Network plan shall mean a written plan prepared by a rural health network or rural providers planning to form a rural health network, with the involvement of consumers, describing the steps to be taken by such network and its participating providers to respond to the health care needs of the rural area, improve access to and the quality of care for residents of the community, promote the coordination of resources among providers and reduce duplication of services while achieving cost and other operational efficiencies.

(e) Medical control shall have the meaning set forth in subdivision 15 of section 3001 of the Public Health Law and includes advice and direction provided by or under the direction of a physician to certified first responders, emergency medical technicians or advanced emergency medical technicians who are providing medical care at the scene of an emergency or in route to a health care facility. For the purposes of this Part, medical control shall also involve the implementation of network emergency medical service plans developed in conjunction with the Regional Emergency Medical Advisory Committee(s) (REMACs) responsible for the hospital's
(f) Professional shall mean a person practicing medicine as defined in Article 131 of Title 8 of the State Education Law, and may also mean other licensed and currently registered health care practitioners appointed by the governing body, in accordance with State law. The governing body shall determine which categories of health care practitioners are eligible candidates for appointment to the medical staff. The eligible categories may include qualified staff such as registered physician's assistants, registered specialists' assistants, registered professional nurses - nurse practitioners or clinical nurse specialists.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.2 - Designation of PCHs and CAHs

407.2 Designation of PCHs and CAHs.

(a) PCHs and CAHs shall be designated by the Commissioner of Health to operate as a primary care hospital pursuant to guidelines developed by the commissioner and the provisions of Part 710 of this Title. The decision to submit an application for designation as either a PCH or a CAH shall be at the discretion of the hospital seeking designation. The guidelines for designation may be obtained from the commissioner, and shall be published in the New York State Register.

(b) At the time of application to become either a PCH or a CAH, a facility shall be licensed as a general hospital, shall have a Medicare/Medicaid participation agreement in effect and shall be in substantial compliance with all other applicable state and federal requirements.

(c) Hospitals seeking designation as a CAH pursuant to this section, shall, in addition to complying with the provisions of this Part, comply with the following requirements of 42 CFR section 485.620.

(1) except as permitted for CAHs having Federal swing-bed agreements, the CAH maintains no more than 15 inpatient beds; and

(2) the CAH discharges or transfers each patient within 96 hours after admission, unless transfer to a hospital is precluded because of inclement weather or other emergency conditions.

(d) At the time of application PCHs may provide swing-bed services in accordance with Part 406 of this Title or seek approval to provide swing-bed services following designation as a PCH. CAHs shall comply with the following additional conditions pursuant to 42 CFR section 485.645 regarding swing-bed services:

(1) Federal swing-bed approval must not have been terminated within the two (2) years prior to the facility's application for CAH status; and

(2) a facility that, at the timie it applied for designation as a CAH, had in effect a swing-bed agreement for post-hospital skilled nursing facility care may continue to use its inpatient facilities for the provision of post-hosital SNF care, so long as the total number of beds that are used at any time for the furnishing of such services does not exceed 25 beds and the number of beds used at anytime for acute care inpatient services does not exceed 15 beds.
(e) Upon designation, PCHs and CAHs shall remain subject to the provisions of this Part and all other pertinent requirements of this Title and of the Public Health Law applicable to general hospitals, including those pertaining to operating certificates which shall also apply to the proposed revocation, suspension, limitation or annulment of a PCH or CAH designation.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.3 - Scope of service

407.3 Scope of service.

(a) PCHs and CAHs 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 PCH/CAH.

(b) A PCH/CAH shall provide a minimum set of core services to meet patient needs, including:

(1) primary care: inpatient and ambulatory services;

(2) inpatient non-surgical clinical services;

(3) emergency services sufficient to handle a range of urgent and limited emergent care needs;

(4) laboratory services;

(5) imaging services; and

(6) pharmacy services.

(c) PCHs and CAHs may provide, subject to the approval of the Commissioner, one or more of the optional services listed in section 407.14.

(d) PCHs and CAHs shall: (1) participate in the development and implementation of an emergency medical services plan that is suitable to meet the needs of the rural area in which the hospital is located. If the PCH or CAH is a member of a rural health network. such plan shall be a component of the network plan. The emergency medical services plan shall be developed in conjunction with the existing local EMS system and service delivery providers. In the event that the PCH or CAH is a member of a rural health network, the plan shall reflect the agreement of all appropriate providers in the network;

(2) install and maintain a radio operated or dedicated phone line (call box) outside the PCH/CAH to provide continuous contact with medical control and appropriate providers of advice and/or emergency transport for patients that may arrive after hours;

(3) develop written policies and protocols for medical control. Such protocols shall be developed in conjunction with appropriate area or network providers, entities providing medical control services, be consistent with area and regional EMS protocols and be approved by the area Regional Emergency Medical Advisory Committee (REMAC);

(4) educate the community about the role of the hospital in meeting community health and health related needs including, but not limited to:

(i) the types of services provided at the hospital and, if applicable, within the network;

(ii) the hours of operation, which shall be posted publicly in the rural area served by the hospital and made available to the designated medical control facility for the area in which the hospital operates; and

(iii) changes in hours of operation, which shall be publicly posted and implemented only after a reasonable notification period to insure the rural area has had ample warning of the changes; and

(5) support and participate in any communication system that may be available for the area served by the PCH/CAH and the general hospital(s) with which it has a formal affiliation pursuant to section 407.1 of this Part. Such communication system may include but shall not be limited to electronic sharing of patient data, telemetry, and medical records as well as cellular and other radio transmission devices for providing immediate communication links with medical control, back-up services and transport systems; (6) CAH shall have the following additional agreements: (i) patient referral and transfer with its supporting hospital(s); (ii) the provision of emergency and non-emergency transportation between the CAH and its supporting hospital(s) pursuant to the provisions of section 407.12 of this Part; and (iii) credentialing and quality assurance activities with the CAH's support hospital(s) pursuant to the provisions of section 407.6 of this Part. (e) PCHs and CAHs shall comply with construction standards contained in Article 2 Subchapter C (Medical Facility Construction) of this Title.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.4 - Governing body

407.4 Governing body.

(a) The entity or person established as operator of the PCH/CAH shall be legally responsible for the quality of patient care services; for the conduct and obligations of the hospital as an institution and for ensuring compliance with all federal, state and local laws. The operator's governing body, which shall mean the governing authority as defined in subdivision (a) of section 600.9 of this Title, shall operate in accordance with the provisions of section 405.2 of this Title except as provided for below. In addition, the governing body shall:

(1) ensure that all officers, directors, trustees, partners, or sole proprietors participate in orientation and continuing education programs addressing the mission, role and responsibilities of the hospital, the local EMS system and if appropriate, the network of which the PCH/CAH is a member in meeting the health care needs of patients and the community;

(2) adopt by-laws which reflect the role, purpose and responsibilities (3) establish and maintain a coordinated program, in conjunction with an affiliated full service hospital and other area providers as appropriate, which integrates the operational review activities of all hospital services for the purpose of enhancing the quality of patient care and identifying and preventing potential malpractice issues;

(4) sets policies that assure that a doctor of medicine or osteopathy and/or a registered physician's assistant under the general supervision of a physician or a nurse practitioner collaborating with a physician, is on duty at all times during regularly scheduled hours of operation of emergency care services, and other services at times determined appropriate by the governing body of the hospital and specified by hospital policies and procedures; and

(5) sets policies that ensure that a doctor of medicine or osteopathy is on call at all times.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.5 - Administrative requirements

407.5 Administrative requirements.

(a) PCH and CAH administration. PCHs and CAHs shall comply with the requirements of section 405.3 of this Title regarding administration.

(b) Admission/discharge/transfer.

(1) General.

(i) The administrative and medical/professional staff shall develop for approval by the governing body written admission and discharge policies designed to protect the health and safety of patients, and shall not assign or delegate the functions of admission and discharge to any referral agency.

(ii) The priority use of inpatient beds in the hospital shall be for short stay acute cases that can be discharged or transferred within a limited period of time. A PCH or CAH certified to provide swing-bed services shall ensure the timely availability of acute care beds at all times.

(iii) Long term cases shall be assigned to the swing-bed capacity of the hospital.

(2) Admissions.

(i) Each patient shall be advised of his or her rights pursuant to section 407.7 of this Part and, as appropriate, the criteria for Medicaid eligibility.

(ii) No person shall be denied admission to the hospital because of race, creed, national origin, sex, disability (subject to the capacity of the hospital to provide necessary treatment), sexual orientation or source of payment.

(iii) Except in emergencies, patients shall be admitted only upon referral and under the care of a licensed and currently registered practitioner who has been granted admitting privileges by the governing body. The patient's condition and provisional diagnosis shall be established on admission by the patient's admitting practitioner and shall be noted in the patient's medical record.

(iv) Except in emergencies and under exceptional circumstances (i.e., weather, availability of transport, equipment or staff), a hospital shall admit as patients only those persons who require the type of medical services authorized by the hospital's operating certificate and specified in the hospital's written admission and discharge policies.

(a) Authorized admissions to CAHs shall involve only patients that, by the judgement of the admitting practitioner, are determined to have medical needs that can be managed and resolved within the 96 hour time period allowed for inpatient services pursuant to 42 CFR section 485.620 as expressly set forth in subdivision (c) of section 407.2 of this Part. Patients presenting with conditions that have the reasonable potential for requiring a greater amount of time to resolve shall be transferred to a more appropriate full service hospital.

(b) Authorized admissions criteria for PCHs shall be developed locally based on the service and resource capabilities of the PCH, its supporting full service hospital(s) and, if appropriate, any network in which it operates. Expected length of stay necessary to meet a patient's medical needs shall not be used as a criterion for admission to PCHs.

(v) PCHs and CAHs shall comply with the provisions of paragraphs (6) through (14) of subdivision (b) of section 405.9 of this Title.

(3) Sexual offense evidence. PCHs and CAHs shall comply with the provision of subdivision (c) of section 405.9 of this Title regarding the maintenance of sexual offense evidence.

(4) Child abuse and maltreatment. PCHs and CAHs shall comply with the provisions of subdivision (d) of section 405.9 of this Title with respect to identification, assessment, reporting and management of cases of suspected child abuse and maltreatment.

(5) Domestic violence. PCHs and CAHs shall comply with the provisions of section 405.9(e) of this Title with regard to the
identification, assessment, treatment and appropriate referral of cases of suspected or confirmed domestic violence.

(6) Discharge/transfer. Hospitals shall comply with the provisions of paragraph (1) of subdivision (i) of section 405.9 of this Title concerning discharge/transfer. In addition, PCHs and CAHs shall comply with the following:

(i) in carrying out discharge planning requirements, PCHs and CAHs that are members of a rural health network may include as the discharge planning coordinator a member of the network utilization review committee who has appropriate training and experience to perform such duties;

(ii) ensure that discharge planning staff have available current information regarding home care programs, institutional health care providers, and other support services, including their scope of services, admission and discharge policies and payment criteria;

(iii) each removal, transfer or discharge shall be carried out in accordance with written PCH/CAH policy, and if the facilitity is a member of a rural health network, network policy. Such policies shall specify referral arrangements and transfer protocols outlining the duties and responsibilities involved in determining the necessity of a transfer and for personnel involved in the transfer and shall be set forth in written agreements between the PCH/CAH and appropriate receiving hospital(s); and
(iv) each patient being removed or discharged shall be provided with information and/or assistance as required for linking the patient with a community based primary care provider.

(c) Incident reporting. PCHs/CAHs shall comply with the provisions of section 405.8 of this Title regarding incident reporting.

(d) Medical records. PCHs/CAHs shall comply with the provisions of section 405.10 of this Title regarding medical records.

(e) Request for consent to an anatomical gift. PCHs/CAHs shall comply with the provisions of section 405.25 of this Title regarding requests for consent to an anatomical gift.

(f) Utilization review. PCHs/CAHs shall comply with the provisions of section 405.26 of this Title regarding utilization review.

(g) Information policy and other reporting requirements. PCHs/CAHs shall comply with the provision of sections 86-1.2, 86-1.3 and 400.18 of this Title regarding information policy and other reporting requirements.

Effective Date: 
Wednesday, June 12, 2019
Doc Status: 
Complete

Section 407.6 - Quality assurance and utilization review

407.6 Quality assurance and utilization review.

(a) The governing body shall require the establishment and maintenance of a written coordinated quality assurance program which integrates the review activities of all PCH/CAH services to enhance the quality of patient care. This program shall be designed to identify and prevent potential malpractice issues, shall incorporate the minimum standards for a quality assurance program delineated in Section 405.6 of this Title and shall require at least quarterly quality assurance reports to be submitted to the governing body. For purposes of this Part, the quality assurance program may be developed and implemented for all services in accordance with the ongoing quality assurance program of the affiliated full service hospital.

(b) Where a PCH/CAH is a member of a rural health network and there is a network-wide quality assurance program and/or health information system, the PCH/CAH shall coordinate its assessment and improvement activities with such program or system.

(c) The PCH's/CAH's quality assurance program shall support a care delivery continuum and may utilize a performance measurement system for the analysis of care provided which includes, but need not be limited to:

(1) a permanent patient record; and

(2) an indicator measurement system for analysis of undesired outcomes related to:

(i) access to and availability of care;

(ii) variations from generally accepted standards of professional practice; and

(iii) if the PCH/CAH is a member of a rural health network, any departures within the network from established medical/professional standards delineated in paragraph (1) of subdivision (a) of section 405.4 of this Title, and generally accepted practice guidelines.

(d) In addition to implementing the activities required by the quality assurance provisions of this Part and subdivision (b) of section 405.6 of this Title, the PCH/CAH shall:

(1) review admissions made under exceptional circumstances;

(2) review cases involving an unanticipated transfer to a more service intensive facility;

(3) review cases involving a readmission within two days of discharge; and

(4) review cases that exceed a length of stay determined by the governing body to be in excess of what is appropriate for the PCH/CAH.

(e) A PCH's/CAH's utilization review program shall provide for prospective, concurrent and retrospective review processes.

(1) The prospective review process shall be locally developed by clinicians from the PCH/CAH and from the facility or facilities providing hospital support services to the network within which the PCH/CAH operates, and shall be based upon the service capabilities of those facilities.

(2) The concurrent review process shall provide for a review of patients admitted to the PCH/CAH under exceptional circumstances (i.e., emergency or other life threatening situations, weather, availability of transport, equipment or staff prohibits transfer to a more appropriate facility) and patients whose service needs have changed after admission and may exceed the service capacity or capabilities of the PCH/CAH.

(3) The retrospective review process shall include case level assessments for patients as set forth in subdivision (b) of section 405.6 of this Title and subdivision (d) of this section and, in cases involving the transfer or referral of a patient to another facility, shall involve a facility level assessment.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.7 - Patients' rights

407.7 Patients' rights. PCHs/CAHs shall comply with the provisions of section 405.7 of this Title with regard to patients' rights. However, for PCHs/CAHs that participate in a rural health network, requirements for skilled interpreters and personnel skilled in communicating with vision and hearing impaired individuals may be met through effective communication within the network including telephone, radio or electronic communications.
 

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.8 - Medical/professional staff

407.8 Medical/professional staff.

(a) The Medical/Professional staff of the PCH/CAH shall consist of at least one doctor of medicine or osteopathy and may also include licensed dentists and other qualified personnel as defined in subsection (g) of section 407.1 of this Part and as determined to be appropriate by the governing body to provide approved services in accordance with their respective qualifications and patient needs.

(b) For purposes of this section, the term "medical staff", as used in section 405.4 of this Title, may refer to the medical/professional staff of a PCH/CAH.

(c) For the conduct of its medical/professional staff, PCHs/CAHs shall comply with the provisions of section 405.4 of this Title. In addition to such requirements, PCHs/CAHs shall:

(1) ensure that members of the emergency medical/professional staff have successfully completed the necessary course work and training for basic cardiac life support or advanced cardiac life support, have received their credentialing from the hospital and are available on-site at all times during posted hours of operation;

(2) ensure that a system is in place to provide for the ongoing oversight and direction by a physician of all professional staff in accordance with applicable practice acts and regulations;

(3) if the hospital is a member or a rural health network, develop a system in which network medical/professional staff participate and collaborate to provide consultation, assistance with medical emergencies, and patient referrals; and

(4) ensure that at least one doctor of medicine or osteopathy is available by radio or phone, and one is on standby as a backup for consultation and patient referral assistance, on a 24 hour a day basis except that CAHs shall ensure that physicians are present for sufficient periods of time to provide the necessary and appropriate medical direction, medical care services, consultation, and supervision of hospital health care staff in accordance with patient needs.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.9 - Nursing services

407.9 Nursing services. The PCH/CAH shall have an organized nursing service with a written plan of administrative authority which delineates responsibilities for patient care.

(a) Organization. The director of the nursing service shall be a licensed registered nurse with appropriate education and experience. He or she shall be responsible for the operation of the service, credentialling of nursing staff and the determination of the types, numbers, and mix of nursing personnel and support staff necessary to provide nursing care for all patients admitted to the hospital.

(b) Staffing and delivery of care. The nursing service shall have adequate numbers of licensed registered nurses, licensed practical nurses and other personnel to provide nursing care to all patients as needed. There shall be supervisory and staff personnel for each department or nursing unit to ensure the immediate availability within 20 minutes of a registered nurse for bedside care of any patient.

(1) The PCH shall be capable of providing 24-hour a day nursing care furnished or supervised by a registered nurse and shall have a licensed practical nurse or registered nurse on duty at all times, except for PCHs that have in effect a 24-hour a day nursing waiver granted by the federal government.

(2) CAHs shall not be required to provide nursing staff when there are no inpatients in the CAH.

(3) PCHs shall comply with the provisions of paragraph (3) of subdivision (a) through paragraph (2) of subdivision (e) of section 405.5 of this Title.
 

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.10 - Primary care related inpatient and outpatient services

407.10 Primary care related inpatient and outpatient services.

(a) Definition. Primary care related inpatient and outpatient services are those non-critical or special care services that are provided to patients on a short term inpatient or outpatient basis to protect and promote the health and well being of the patients. Such services shall be provided to inpatients who are in need of clinical preventive services and/or the continuous management of non-critical medical conditions and to members of the community on an outpatient basis.

(b) General provisions. Primary care related inpatient and outpatient services shall be organized to meet the needs of patients and provided to patients requiring such care on a short term basis. PCH/CAH primary care services shall be provided through medical and professional staff and support services appropriate to the scope of services offered and consistent with the primary health care needs of the patients.

(c) Organization and direction. Primary care related inpatient services shall be directed by a physician member of the medical/professional staff, who shall be responsible for the administrative and clinical aspects of all such inpatient care services. The director shall have received specialized training in and have demonstrated competence in the organization and delivery of, primary care services, and may also be responsible for the administrative and clinical aspects of all outpatient primary care services.

(1) The provision of all primary care related inpatient and outpatient services shall be in accordance with generally accepted standards of medical practice and other licensed health care practitioner standards of practice.

(2) The PCH shall ensure that written policies and procedures are developed for the provision of all inpatient and outpatient primary care services, and implemented by the medical and professional staff.

(3) Such policies shall set forth procedures for ensuring that all patients are provided with information necessary for their selection of or referral to community based primary care providers, and for the ongoing management of a patient's primary health care needs.

(d) If the PCH/CAH has an organized outpatient service, the service shall be operated in accordance with the provisions of subdivisions (a) through (c) of section 405.20 of this Title and organized in a manner that supports and augments other primary care services available in the rural area being served by the PCH/CAH.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.11 - Clinical and ancillary support services

407.11 Clinical and ancillary support services.

(a) Introduction. Required clinical and ancillary support services shall include diagnostic radiology, clinical laboratory, pharmaceutical, food and dietetic and social services. The PCH shall provide or have available such services as are necessary to meet the needs of the patients and the medical staff. Such services shall meet professionally approved standards for safety and personnel qualifications.

(b) Organization and direction.

(1) Diagnostic radiology services shall be directed by a radiologist who satisfies the requirements of subparagraph (i) of paragraph (4) of subdivision (a) of section 405.15 of this Title.

(2) Clinical laboratory services shall be supervised by an individual who satisfies the requirements of paragraph (1) of subdivision (c) of section 405.16 of this Title.

(3) Pharmacy services shall be directed by a registered pharmacist who satisfies the requirements of section 405.17 of this Title.

(4) Food, dietetic and social services shall be directed by individuals who are qualified by experience or training to manage and direct such services.

(c) Operation and service delivery.

(1) Diagnostic radiology. The hospital shall maintain or have available diagnostic radiologic services, defined for the purposes of this subdivision as imaging services utilizing diagnostic radiation equipment. In addition, the hospital shall meet the standards of Part 16 of the State Sanitary Code.

(i) Service delivery shall comply with the provisions of paragraphs (1) through (5) of subdivision (a) of section 405.15 of this Title.

(ii) Diagnostic imaging through the use of ultrasound devices, if provided, shall be under the supervision of the director of diagnostic radiologic services.

(2) Laboratory services shall be provided in accordance with the provisions of subdivisions (a) through (c) of section 405.16 of this Title.

(3) Pharmaceutical services.

(i) Pharmaceutical services shall be provided in accordance with the provision of section 405.17 of this Title.

(a) PCHs/CAHs shall provide or arrange for such services through a pharmacy that is registered and operated in accordance with Article 137 of the New York State Education Law and is directed by a registered pharmacist trained in the specialized functions of hospital pharmacy.

(b) For services provided off site, the PCH/CAH shall ensure the 24 hour a day availability of pharmaceuticals necessary to meet patient needs on a timely basis.

(ii) The service shall maintain, on site, a sufficient supply of drugs and biologicals, including electrolytes, fluid volume replacement solutions and other fluid supplements to meet patient needs.

(4) Food and dietetic services shall comply with the provisions of section 405.23 of this Title.

(5) Social services shall comply with the provisions of section 405.28 of this Title.
 

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.12 - Emergency services

407.12 Emergency services.

(a) General requirements for emergency services.

(1) Written protocols for the provision of emergency services by a PCH/CAH shall be developed for the area served by the PCH/CAH; they shall take into consideration the service capabilities of the PCH/CAH, the general hospital(s) with which it has a formal affiliation pursuant to section 407.1 of this Part, and other area providers, as appropriate.

(2) PCHs/CAHs shall participate in a system which assures the availability of emergency medical services on a 24-hour a day basis within a service area-wide emergency medical services system. A PCH/CAH shall maintain an instantaneous communications link with its affiliated general hospital(s) and other appropriate providers of emergency medical services, medical backup and consultation, and medical control.

(3) At a minimum, PCHs/CAHs shall maintain an adequate supply of emergency equipment, supplies, and medication readily available for treating emergency cases. The items available shall include, but need not be limited to:

(i) drugs and biologicals commonly used in life-saving procedures such as analgesics, local anesthetics, antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids, antiarrhythmics, cardiac glycosides, antihypertensives, diuretics, and oral and IV electrolytes and replacement solutions (adult and pediatric); and

(ii) equipment and supplies commonly used in lifesaving and life support procedures including but not limited to airway control and ventilation devices in adult and pediatric sizes, portable (transport) mechanical ventilators, endotracheal tubes, bag/valve/mask, oxygen, tourniquets, immobilization devices, nasogastric tubes, splints, IV therapy supplies, suction machine, defibrillator, cardiac monitor, chest tubes, and indwelling urinary catheters.

(4) Emergency services shall be coordinated with appropriate area providers including ambulance providers serving the pre-hospital delivery system of the PCH's/CAH's service area.

(5) PCHs/CAHs shall establish comprehensive written procedures for screening and assessing patients to determine the most appropriate on-site treatment, for identifying cases beyond the facility's capability to treat which require safe transfer to a more appropriate facility, and for arranging such transfers.

(6) PCHs/CAHs shall maintain, or coordinate with the general hospital(s) with which it has a formal affiliation pursuant to section 407.1 of this Part, or, if a member of a rural health network, through the network, an emergency transportation system with advanced life support capability available on a 24-hour a day on call basis to provide timely inter-facility transport.

(7) PCHs/CAHs, in cooperation with other area emergency medical service providers, shall develop written procedures to allow appropriately trained PCH/CAH personnel to provide patient care on ambulances in potentially life-threatening situations where such assistance is required; and

(8) PCHs that do not provide 24-hour a day on-site emergency services shall:

(i) ensure that patients in need of emergency care arriving at the facility during non-operating hours are provided with information necessary to contact hospital personnel responsible for arranging for providing emergency care; and

(ii) ensure that EMS/ambulance personnel transporting patients are able, during operating and non-operating hours, to contact hospital personnel responsible for arranging for providing emergency care to facilitate appropriate and timely patient disposition.

(b) PCHs/CAHs shall comply with the provisions of subdivisions (b) through (e) of section 405.19 of this Title with regard to the provision of emergency services.

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.13 - Environmental health and infection control

407.13 Environmental health and infection control.
(a) PCHs/CAHs shall comply with the provisions of section 405.24 of this Title with regard to assuring a safe and suitable environment for patients.
(b) PCHs/CAHs shall comply with the provision of section 405.11 of this Title with regard to infection control requirements.
 

Effective Date: 
Wednesday, March 25, 1998
Doc Status: 
Complete

Section 407.14 - Optional services

407.14 Optional services. A Primary Care Hospital (PCH) may offer additional special services, for which it is able to provide appropriate technical and human resources, in order to respond to community need or to assure quality in the delivery of services. Optional services may include but are not limited to ambulatory surgery, inpatient surgery under anesthesia, full range laboratory services, full range imaging services, radiation oncology and nuclear medicine, full range pharmacy services, physical medicine and rehabilitation services, respiratory care services, perinatal services, mental health services, blood bank/transfusion services, or special care services. Such services may only be provided if approved by the Commissioner of Health pursuant to sections 407.2 (a) and 407.3 (c) of this Part and the applicable provisions of Part 710 of this Title.

Effective Date: 
Wednesday, September 14, 2005
Doc Status: 
Complete