SESSION OF 2021
SUPPLEMENTAL NOTE ON SENATE SUBSTITUTE FOR
HOUSE BILL NO. 2208
As Recommended by Senate Committee on
Public Health and Welfare

Brief*
Senate Sub. for HB 2208 would enact the Rural
Emergency Hospital Act (Act) and create a category of
licensure to enable certain Kansas hospitals to receive
federal health care reimbursement as rural emergency
hospitals. The bill would require benefits coverage for
services provided by rural emergency hospitals if covered
when performed by a general hospital or critical access
hospital. The bill would define applicable terms, including
“rural emergency hospital” in the Act, and reference the
definition in the Kansas Medical Facilities Survey and
Construction Act. The bill would also establish certification for
certified community behavioral health clinics (CCBHCs) and
prescribe the powers, duties, and functions of the Kansas
Department for Aging and Disability Services (KDADS) with
regard to CCBHCs. The bill would also authorize a licensed
out-of-state physician with a telemedicine waiver issued by
the State Board of Healing Arts (BOHA) to practice
telemedicine in Kansas. The bill would also amend the
disciplinary authority of the Behavioral Sciences Regulatory
Board (BSRB) and modify licensure and temporary permit
requirements of professional counselors, social workers,
marriage and family therapists, addiction counselors,
psychologists, and master’s level psychologists.
The bill would also make technical amendments.

____________________
*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
http://www.kslegislature.org
Rural Emergency Hospital Act (New Sections 1-8)
The bill would establish eligibility and application
requirements for licensure as a rural emergency hospital and
require the Secretary of Health and Environment (Secretary)
to adopt rules and regulations establishing minimum
standards for the establishment and operations of rural
emergency hospitals in accordance with the Act. Further, the
bill would require the Secretary, in formulating rules and
regulations under the Kansas Medical Facilities Survey and
Construction Act, to give due consideration to the
requirements for receipt of federal reimbursement for the
particular type of medical care facility.
Definitions (Sections 3 and Section 9 [Amending the Kansas
Medical Facilities Survey and Construction Act])
The bill would define multiple terms, including the
following:
● “Rural emergency hospital” would mean an
establishment that:
○ Meets the eligibility requirements described in
Section 4;
○ Provides rural emergency hospital services;
○ Provides rural emergency hospital services in
the facility 24 hours per day by maintaining an
emergency medical department that is staffed
24 hours per day, 7 days per week, with a
physician, nurse practitioner, clinical nurse
specialist, or physician assistant;
○ Has a transfer agreement with a level I or
level II trauma center; and
○ Meets such other requirements as the Kansas
Department of Health and Environment
(KDHE) finds necessary in the interest of the
health and safety of individuals who are

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 provided rural emergency hospital services
and to implement state licensure that satisfies
requirements for reimbursement by federal
health care programs as a rural emergency
hospital.
● “Rural emergency services” would mean the
following services, provided by a rural emergency
hospital, that do not require in excess of an annual
per-patient average of 24 hours in such rural
emergency hospital:
○ Emergency department services and
observation care; and
○ At the election of the rural emergency
hospital, for services provided on an
outpatient basis, other medical and health
services as specified in regulations adopted
by the U.S. Secretary of Health and Human
Services and authorized by KDHE.
State Policy (New Section 2)
The bill would outline how the Kansas Legislature seeks
to address the provision and regulation of a structured and
integrated system of health care services. The bill would
declare the State’s policy is to create a category of licensure
to enable certain hospitals to receive federal health care
reimbursement as rural emergency hospitals, and the
implementation of the Act facilitates such policy.
Eligibility for Licensure (New Section 4)
The bill would provide that a facility would be eligible to
apply for a rural emergency hospital license, if such a facility,
as of December 27, 2020, was a:
● Licensed critical access hospital;

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 ● General hospital with not more than 50 licensed
beds located in a county in a rural area as defined
in Section 1886(d)(2)(D) of the federal Social
Security Act; or
● General hospital with not more than 50 licensed
beds that is deemed as being located in a rural
area pursuant to Section 1886(d)(8)(E) of the
Social Security Act.
The bill would require a facility applying for licensure as
a rural emergency hospital to include the following with the
licensure application:
● An action plan for initiating rural emergency
hospital services, including a detailed transition
plan listing the specific services the facility will
retain, modify, add, and discontinue;
● A description of services the facility intends to
provide on an outpatient basis; and
● Such other information as required by rules and
regulations adopted by KDHE.
The bill would outline additional prohibitions and
requirements for rural emergency hospital licensure as
follows:
● Inpatient beds would be prohibited, except a
distinct unit that is part of the hospital and licensed
as a skilled nursing facility could provide post-
hospital extended care services;
● A rural emergency hospital would be allowed to
own and operate an entity that provides ambulance
services; and
● A licensed general hospital or critical access
hospital that applies for and receives licensure as a

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 rural emergency hospital and elects to operate as a
rural emergency hospital would retain its original
license as a general hospital or critical access
hospital. The original license would remain inactive
while the rural emergency hospital license is in
effect.
Authority to Enter into Contracts for Federal Reimbursement
(New Section 5)
The bill would authorize all rural emergency hospitals,
including city, county, hospital district, or other governmental
or quasi-governmental hospitals to enter into any contracts
required to be eligible for federal reimbursement as a rural
emergency hospital.
Protections Provided (New Section 6)
In addition to the limited liability protections provided in
KSA 65-4909 when acting in good faith and without malice,
the bill would provide that entities engaging in activities and
entering into contracts required to meet the requirements for
licensure as a rural emergency hospital, and officers, agents,
representatives, employees, and directors of such entities,
would be considered to be acting pursuant to clearly
expressed state policy as established in the Act under the
supervision of the State. Such entities would not be subject to
state or federal antitrust laws while acting in this manner.
Rules and Regulations Authority (New Section 7)
The bill would require the Secretary to adopt rules and
regulations establishing minimum standards for the
establishment, operation, and licensure of rural emergency
hospitals in accordance with the Act.


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Required Service Coverage (New Section 8)
The bill would require benefits for services performed by
a rural emergency hospital to be covered if such services
would be covered under the following policies, contracts, or
coverage, if performed by a general hospital:
● Each individual and group policy of accident and
sickness insurance;
● Each contract issued by a health maintenance
organization; and
● All coverage maintained by an entity authorized
under KSA 40-2222 (those entities providing
coverage in Kansas for medical, surgical,
chiropractic, physical therapy, speech pathology,
audiology, professional mental health, dental,
hospital, or optometric expenses, whether such
coverage is by direct payment, reimbursement, or
otherwise, that are presumed to be subject to the
jurisdiction of the Commissioner of Insurance,
unless the entities fall under the listed exemptions)
or by a municipal group-funded pool authorized
under KSA 12-2618.
Kansas Medical Facilities Survey and Construction Act
(Sections 11 and 12)
The bill would define “rural emergency hospital” in
Section 11 by referencing the definition in Section 2 of the bill.
Rules and Regulations (Section 12)
The bill would amend the Kansas Medical Facilities
Survey and Construction Act by adding that, in formulating
rules and regulations with respect to different types of
medical care facilities to be licensed under such act, KDHE
would be required to give due consideration to the
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requirements for the receipt of medical reimbursement for the
type of medical facility. The bill would also provide that a rural
emergency hospital would be deemed to satisfy the rules and
regulations requirements for a hospital consisting of more
than one establishment if such rural emergency hospital
meets its licensing requirements established by the licensing
agency.

KDADS Responsibilities for CCBHC Certification (New
Section 9)
The bill would require KDADS to establish a process to
certify CCBHCs.
The bill would require KDADS to certify as a CCBHC
any community mental health center (CMHC) licensed by
KDADS that provides the following services: crisis services;
screening, assessment, and diagnosis, including risk
assessment; person-centered treatment planning; outpatient
mental health and substance use services; primary care
screening and monitoring of key indicators of health risks;
targeted case management; psychiatric rehabilitation
services; peer support and family supports; medication-
assisted treatment; assertive community treatment; and
community-based mental health care for military service
members and veterans.
KDHE Responsibilities
The bill would require KDHE to establish a prospective
payment system (PPS) under the Kansas Medical Assistance
Program to fund CCBHCs. Daily or monthly rate payments
would be allowed in the PPS.


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KDADS Rules and Regulation Authority
The bill would authorize KDADS to adopt rules and
regulations as necessary to implement and administer
provisions related to CCBHCs.
Implementation Schedule
The bill would establish a staggered implementation
schedule for CCBHC certification and require KDADS,
subject to certification applications, to certify:
● Six facilities currently receiving grants to operate as
CCBHCs by no later than May 1, 2022;
● Three additional facilities by no later than July 1,
2022;
● Nine additional facilities by no later than July 1,
2023; and
● Eight additional facilities by no later than July 1,
2024.
The bill would authorize KDADS to certify CCBHCs,
including portions of the specified facility numbers, in
advance of the above-cited deadlines.

Out-of-state Telemedicine Practice (New Section 10)
The bill would authorize a physician holding a license
issued by the applicable licensing agency of another state or
who otherwise meets the requirements of the bill to practice
telemedicine to treat patients located in Kansas if the
physician receives a telemedicine waiver issued by the
BOHA. The bill would require the BOHA to issue the waiver
within 15 days from receipt of a complete application, if the
physician:

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 ● Submits a complete application, which may include
an affidavit from an authorized third party that the
applicant meets the requirements, in a manner
determined by the BOHA, and pays a fee not to
exceed $100; and
● Holds an unrestricted license to practice medicine
and surgery in another state or meets the
qualifications required under Kansas law for a
license to practice medicine and surgery and is not
the subject of any investigation or disciplinary
action by the applicable licensing agency.
The bill would require a physician to practice
telemedicine in accordance with the bill to conduct an
appropriate assessment and evaluation of a patient’s current
condition and document an appropriate medical indication for
any prescription issued.
The bill would not supersede or affect the provisions of
KSA 65-4a10 (Performance of abortions restricted to a
physician licensed to practice medicine in Kansas) or KSA
2020 Supp. 40-2,210 et seq. (Kansas Telemedicine Act).
Rules and Regulations for Telemedicine Waivers
The bill would require any person who receives a
telemedicine waiver to be subject to all rules and regulations
pertaining to the practice of the licensed profession in Kansas
and be considered a licensee for the purposes of the
professional practice acts administered by the BOHA. The bill
would also require any waiver issued to expire on the date
established, unless renewed by the BOHA upon receipt of
payment of an annual renewal fee not to exceed $100 and
evidence that the applicant continues to meet the
qualifications of the bill. The bill would not prohibit a licensing
agency from denying a waiver application if the licensing
body determines granting the application may endanger the
health and safety of the public.

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Out-of-state Authorizations
The bill would authorize:
● A physician holding a license issued by the
applicable licensing agency of another state to
provide, without limitation, consultation through
remote technology to a physician licensed in
Kansas; and
● An applicable health care licensing agency of this
state to adopt procedures consistent with this
section to allow other health care professionals
licensed and regulated by the licensing agency to
practice telemedicine within the profession’s scope
of practice by Kansas law as deemed by the
licensing agency to be consistent with ensuring
patient safety.
Definition of Telemedicine
The bill would define “telemedicine” to mean the delivery
of health care services by a health care provider while the
patient is at a different physical location.

Clinical Professional Counselor Licensure (Section 13)
The bill would amend the licensure requirements to
become a clinical professional counselor to:
● Reduce from 350 to 280 the minimum number of
hours of direct client contact or additional
postgraduate supervised experience as determined
by the BSRB;
● Reduce from 4,000 to 3,000 the minimum number
of hours of supervised professional experience;

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 ● Reduce from 150 to 100 the minimum number of
hours of face-to-face clinical supervision as defined
by the BSRB in rules and regulations;
● Require no less than 50 of the face-to-face clinical
supervision hours to include individual supervision,
although the BSRB could waive:
○ The requirement such supervision be face-to-
face upon finding extenuating circumstances;
and
○ Half of the required hours for an individual
who has a doctoral degree in professional
counseling or a BSRB-approved related field
and who completes half of the required hours
in one or more years of supervised
professional experience;
● Specify a temporary license may be issued after
the applicant pays the temporary license fee; and
● Increase from 6 to 12 the number of months after
issuance a temporary license would expire, absent
extenuating circumstances approved by the BSRB.
Clinical Social Work Licensure (Section 17)
The bill would amend requirements to become a
licensed specialist clinical social worker to:
● Remove the requirement an individual complete
350 hours of direct clinical contact or additional
postgraduate su