Kentucky. Revised Statutes.

 

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CHAPTER 15 DEPARTMENT OF LAW

 

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15.241 Attorney General's duty with respect to violations by abortion facilities.

The Attorney General, upon certification by the secretary of the Cabinet for Health and

Family Services, shall seek injunctive relief in a course of proper jurisdiction to prevent

violations of the provisions of KRS Chapter 216B regarding abortion facilities or the

administrative regulations promulgated in furtherance thereof in cases where other

administrative penalties and legal sanctions imposed have failed to prevent or cause a

discontinuance of the violation.

 

 

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CHAPTER 18A STATE PERSONNEL

 

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18A.225 Health and dental care insurance coverage -- Emergency during calendar

year 2001 -- Requirements of prospective carriers -- Analysis of carrier

coverage data -- Agency's termination of participation -- Provision of amount

of employer contribution -- Lapse of excess flexible spending account funds --

Appeal of formulary change -- Retiree's participation -- Mail order drug

option coverage -- Hearing aid coverage for minors -- Access to certain services

in contiguous counties -- Study of bid variation -- Regional rating bid scenario.

(1) (a) The term "health maintenance organization" for the purposes of this section

means a health maintenance organization as defined in KRS 304.38-030 or as

a nonprofit hospital, medical-surgical, dental, and health service corporation,

which has been licensed by the Kentucky Health Facilities and Health

Services Certificate of Need and Licensure Board or its successor agency and

issued a certificate of authority by the Office of Insurance as a health

maintenance organization or as a nonprofit hospital, medical-surgical, dental,

and health service corporation and which is qualified under the requirements

of the United States Department of Health, Education and Welfare except as

provided in subsection (2) of this section; and

(b) The term "employee" for purposes of this section means:

1. Any person, including an elected public official, who is regularly

employed by any department, office, board, agency, or branch of state

government; or by a public postsecondary educational institution; or by

any city, urban-county, charter county, county, or consolidated local

government, whose legislative body has opted to participate in the statesponsored

health insurance program pursuant to KRS 79.080; and who

is either a contributing member to any one (1) of the retirement systems

administered by the state, including but not limited to the Kentucky

Retirement Systems, Kentucky Teachers' Retirement System, the

Legislators' Retirement Plan, or the Judicial Retirement Plan; or is

receiving a contractual contribution from the state toward a retirement

plan; or, in the case of a public postsecondary education institution, is an

individual participating in an optional retirement plan authorized by

KRS 161.567;

2. Any certified or classified employee of a local board of education;

3. Any person who is a present or future recipient of a retirement

allowance from the Kentucky Retirement Systems, Kentucky Teachers'

Retirement System, the Legislators' Retirement Plan, the Judicial

Retirement Plan, or the Kentucky Community and Technical College

System's optional retirement plan authorized by KRS 161.567, except

that a person who is receiving a retirement allowance and who is age

sixty-five (65) or older shall not be included, with the exception of

persons covered under KRS 61.702(4)(c), unless he or she is actively

employed pursuant to subparagraph 1. of this paragraph; and

4. Any eligible dependents and beneficiaries of participating employees

and retirees who are entitled to participate in the state-sponsored health

insurance program.

(2) (a) The secretary of the Finance and Administration Cabinet, upon the

recommendation of the secretary of the Personnel Cabinet, shall procure, in

compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090,

from one (1) or more health insurance companies or from one (1) or more

health maintenance organizations authorized to do business in this state, a

policy or policies of group health care coverage, that may include but not be

limited to health maintenance organization (HMO), preferred provider

organization (PPO), point of service (POS), and exclusive provider

organization (EPO) benefit plans encompassing all or any class or classes of

employees. With the exception of employers governed by the provisions of

KRS Chapters 16, 18A, and 151B, all employers of any class of employees or

former employees shall enter into a contract with the Personnel Cabinet prior

to including that group in the state health insurance group. The contracts shall

include but not be limited to designating the entity responsible for filing any

federal forms, adoption of policies required for proper plan administration,

acceptance of the contractual provisions with health insurance carriers or

third-party administrators, and adoption of the payment and reimbursement

methods necessary for efficient administration of the health insurance

program. Health insurance coverage provided to state employees under this

section shall, at a minimum, contain the same benefits as provided under

Kentucky Kare Standard as of January 1, 1994, and shall include a mail-order

drug option as provided in subsection (14) of this section. All employees and

other persons for whom the health care coverage is provided or made

available shall annually be given an option to elect health care coverage

through a self-funded plan offered by the Commonwealth or, if a self-funded

plan is not available, from a list of coverage options determined by the

competitive bid process under the provisions of KRS 45A.080, 45A.085, and

45A.090 and made available during annual open enrollment.

 

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(11) Notwithstanding any other provision of law to the contrary, the policy or policies

provided to employees pursuant to this section shall not provide coverage for

obtaining or performing an abortion, nor shall any state funds be used for the

purpose of obtaining or performing an abortion on behalf of employees or their

dependents.

 

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CHAPTER 156 DEPARTMENT OF EDUCATION

 

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156.497 Interagency Task Force on Family Resource Centers and Youth Services

Centers -- Formulation of five-year plan -- Implementation.

(1) There is created an Interagency Task Force on Family Resource Centers and Youth

Services Centers which shall consist of twenty-one (21) members appointed by the

Governor. The twenty-one (21) members appointed shall include one (1)

representative from each of the following agencies or groups, except the

Department of Education which shall include three (3) representatives and parents

which shall have three (3) representatives:

(a) Department of Education;

(b) Department for Employment Services of the Cabinet for Workforce

Development;

(c) Department for Health Services of the Cabinet for Human Resources;

(d) Department for Mental Health and Mental Retardation Services of the Cabinet

for Human Resources;

(e) Department for Social Services of the Cabinet for Human Resources;

(f) Department for Social Insurance of the Cabinet for Human Resources;

(g) Justice Cabinet;

(h) Governor's Office;

(i) Office of the Secretary, Cabinet for Workforce Development;

(j) Parents;

(k) Teachers;

(l) Local school administrators;

(m) Local school boards;

(n) Local community mental health-mental retardation programs;

(o) Local health departments;

(p) Local community action agencies; and

(q) A family resource and youth services coordinator.

(2) The task force shall be appointed and begin to meet immediately upon July 13,

1990, to formulate a five (5) year implementation plan establishing family resource

and youth services centers designed to meet the needs of children and their families.

By July 1, 1995, the implementation plan shall be revised to include two (2)

additional years, 1996 and 1997. The centers shall provide services which will

enhance students' abilities to succeed in school. If resources are limited, students

and families who are the most economically disadvantaged shall receive priority

status for receiving services. The secretary of the Cabinet for Human Resources

shall call the first meeting, at which time the task force by majority vote shall elect a

task force chair to serve a one (1) year term. A new chair shall be elected annually

thereafter, and the chair may succeed himself. The Cabinet for Human Resources

shall provide adequate staff to assist in the development and implementation of the

task force's plan.

(3) The plan developed by the task force shall include an effort to implement a network

of family resource centers across the Commonwealth. The centers shall be located

in or near each elementary school in the Commonwealth in which twenty percent

(20%) or more of the student body are eligible for free or reduced price school

meals. The plan developed for the centers by the task force shall promote

identification and coordination of existing resources and shall include, but not be

limited to, the following components for each site:

(a) Full-time preschool child care for children two (2) and three (3) years of age;

(b) After school child care for children ages four (4) through twelve (12), with the

child care being full-time during the summer and on other days when school is

not in session;

(c) Families in training, which shall consist of an integrated approach to home

visits, group meetings, and monitoring child development for new and

expectant parents;

(d) Parent and child education (PACE) as described in KRS 158.360 or similar

program;

(e) Support and training for child day care providers; and

(f) Health services or referral to health services, or both.

(4) The plan developed by the task force shall include a schedule to implement a

network of youth services centers across the Commonwealth. The centers shall be

located in or near each school, except elementary schools, serving youth over

twelve (12) years of age and in which twenty percent (20%) or more of the student

body are eligible for free or reduced price school meals. The plan developed for the

centers by the task force shall promote identification and coordination of existing

resources and include, but not be limited to, the following components for each site:

(a) Referrals to health and social services;

(b) Employment counseling, training, and placement;

(c) Summer and part-time job development;

(d) Drug and alcohol abuse counseling; and

(e) Family crisis and mental health counseling.

(5) The task force shall complete its implementation plan for the program prior to

January 1, 1991, and local school districts shall develop initial plans for their family

resource centers and youth services centers by June 30, 1991. By June 30, 1992,

family resource centers and youth services centers shall be established in or adjacent

to at least one-fourth (1/4) of the eligible schools, with expansion by one-fourth

(1/4) by June 30 of each year thereafter or until the centers have been established in

or adjacent to all eligible schools.

(6) A grant program is established to provide financial assistance to eligible school

districts establishing family resource centers and youth services centers. The

Cabinet for Human Resources shall award the grants pursuant to KRS 156.4977. A

school district shall not operate a family resource center or a youth services center

which provides abortion counseling or makes referrals to a health care facility for

purposes of seeking an abortion.

(7) Funding provided to the Cabinet for Families and Children for the grant program

and agency administrative costs shall include an increase that is equal to or greater

than the general fund growth factor provided in agency budget instructions.

(8) The task force shall continue to monitor the family resource centers and the youth

services centers, review grant applications, and otherwise monitor the

implementation of the plan until December 31, 1997, at which time the task force

shall cease to exist. During its existence, the task force shall report at least annually

to the secretary of the Cabinet for Human Resourceformance of

their duties authorized by the task force. The expenses shall be paid out of the

appropriation for the task force.

 

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CHAPTER 205 PUBLIC ASSISTANCE AND MEDICAL ASSISTANCE

 

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205.560 Scope of care to be designated by administrative regulations --

Reimbursements mandated or prohibited -- Assessment of health care provider

credentials.

(1) The scope of medical care for which the Cabinet for Health and Family Services

undertakes to pay shall be designated and limited by regulations promulgated by the

cabinet, pursuant to the provisions in this section. Within the limitations of any

appropriation therefor, the provision of complete upper and lower dentures to

recipients of Medical Assistance Program benefits who have their teeth removed by

a dentist resulting in the total absence of teeth shall be a mandatory class in the

scope of medical care. Payment to a dentist of any Medical Assistance Program

benefits for complete upper and lower dentures shall only be provided on the

condition of a preauthorized agreement between an authorized representative of the

Medical Assistance Program and the dentist prior to the removal of the teeth. The

selection of another class or other classes of medical care shall be recommended by

the council to the secretary for health and family services after taking into

consideration, among other things, the amount of federal and state funds available,

the most essential needs of recipients, and the meeting of such need on a basis

insuring the greatest amount of medical care as defined in KRS 205.510 consonant

with the funds available, including, but not limited to, the following categories,

except where the aid is for the purpose of obtaining an abortion:

(a) Hospital care, including drugs, and medical supplies and services during any

period of actual hospitalization;

(b) Nursing-home care, including medical supplies and services, and drugs during

confinement therein on prescription of a physician, dentist, or podiatrist;

(c) Drugs, nursing care, medical supplies, and services during the time when a

recipient is not in a hospital but is under treatment and on the prescription of a

physician, dentist, or podiatrist. For purposes of this paragraph, drugs shall

include those amino acid modified preparations and low-protein modified

food products for the treatment of the following inherited metabolic diseases,

if the amino acid modified preparations or low-protein modified food products

are prescribed for therapeutic treatment and are administered under the

direction of a physician, and are limited to the following conditions:

1. Phenylketonuria;

2. Hyperphenylalaninemia;

3. Tyrosinemia (types I, II, and III);

4. Maple syrup urine disease;

5. A-ketoacid dehydrogenase deficiency;

6. Isovaleryl-CoA dehydrogenase deficiency;

7. 3-methylcrotonyl-CoA carboxylase deficiency;

8. 3-methylglutaconyl-CoA hydratase deficiency;

9. 3-hydroxy-3-methylglutaryl-CoA lyase deficiency (HMG-CoA lyase

deficiency);

10. B-ketothiolase deficiency;

11. Homocystinuria;

12. Glutaric aciduria (types I and II);

13. Lysinuric protein intolerance;

14. Non-ketotic hyperglycinemia;

15. Propionic acidemia;

16. Gyrate atrophy;

17. Hyperornithinemia/hyperammonemia/homocitrullinuria syndrome;

18. Carbamoyl phosphate synthetase deficiency;

19. Ornithine carbamoyl transferase deficiency;

20. Citrullinemia;

21. Arginosuccinic aciduria;

22. Methylmalonic acidemia; and

23. Argininemia;

(d) Physician, podiatric, and dental services;

(e) Optometric services for all age groups shall be limited to prescription services,

services to frames and lenses, and diagnostic services provided by an

optometrist, to the extent the optometrist is licensed to perform the services

and to the extent the services are covered in the ophthalmologist portion of the

physician's program. Eyeglasses shall be provided only to children under age

twenty-one (21);

(f) Drugs on the prescription of a physician used to prevent the rejection of

transplanted organs if the patient is indigent;

(g) Nonprofit neighborhood health organizations or clinics where some or all of

the medical services are provided by licensed registered nurses or by advanced

medical students presently enrolled in a medical school accredited by the

Association of American Medical Colleges and where the students or licensed

registered nurses are under the direct supervision of a licensed physician who

rotates his services in this supervisory capacity between two (2) or more of the

nonprofit neighborhood health organizations or clinics specified in this

paragraph;

(h) Services provided by health-care delivery networks as defined in KRS

216.900; and

(i) Services provided by midlevel health-care practitioners as defined in KRS

216.900.

 

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CHAPTER 212 LOCAL HEALTH PROGRAMS

 

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212.275 Distribution of nonscheduled legend drugs at health department by

advanced registered nurse practitioner or registered nurse -- Written policy --

Record of prescription drugs -- Responsibility for inventory -- Pharmacist --

Dispensing medication or device prescribed for purpose of causing abortion.

(1) The governing board for each local, district, and independent health department

shall have a written policy concerning the distribution of nonscheduled legend drugs

at the health department by an advanced registered nurse practitioner or a registered

nurse. In a health department, an advanced registered nurse practitioner or a

registered nurse may distribute nonscheduled legend drugs from a list that has been

prepared by the commissioner of the Department for Public Health. Nothing in this

section shall be construed to limit advanced registered nurse practitioners from

dispensing nonscheduled drug samples under KRS 314.011. Each prescription drug

distributed or dispensed at the health department shall be recorded in the patient

record. The director of each health department shall be responsible for keeping track

of the inventory of stock medications and accounting for the medications dispensed

or distributed.

(2) Only a health department board having within its membership a pharmacist holding

a valid license issued pursuant to KRS 315.030 shall be authorized to permit

advanced registered nurse practitioners or registered nurses to dispense

nonscheduled legend drugs according to the written policy of the board. If a health

department is unable to recruit a licensed pharmacist to serve on the board, the

board shall document consultation with a pharmacist licensed pursuant to KRS

315.030 in the public health practice of the health department.

(3) No health department shall dispense any medication or device prescribed for the

purpose of causing an abortion as defined in KRS 311.720(1).

 

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CHAPTER 216B LICENSURE AND REGULATION OF HEALTH FACILITIES AND SERVICES

 

 

216B.015 Definitions for chapter.

Except as otherwise provided, for purposes of this chapter, the following definitions shall

apply:

(1) "Abortion facility" means any place in which an abortion is performed;

 

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216B.020 Certificate of need -- Exemptions -- Requirements for issuance of

certificate of need.

(1) The provisions of this chapter that relate to the issuance of a certificate of need shall

not apply to abortion facilities as defined in KRS 216B.015; any hospital which

does not charge its patients for hospital services and does not seek or accept

Medicare, Medicaid, or other financial support from the federal government or any

state government; assisted living residences; family care homes; state veterans'

nursing homes; services provided on a contractual basis in a rural primary-care

hospital as provided under KRS 216.380; community mental health centers for

services as defined in KRS Chapter 210; primary care centers; rural health clinics;

private duty nursing services licensed as nursing pools; group homes; end stage

renal disease dialysis facilities, freestanding or hospital based; swing beds; special

clinics, including, but not limited to, wellness, weight loss, family planning,

disability determination, speech and hearing, counseling, pulmonary care, and other

clinics which only provide diagnostic services with equipment not exceeding the

major medical equipment cost threshold and for which there are no review criteria

in the state health plan; nonclinically-related expenditures; nursing home beds that

shall be exclusively limited to on-campus residents of a certified continuing care

retirement community; the relocation of hospital administrative or outpatient

services into medical office buildings which are on or contiguous to the premises of

the hospital; residential hospice facilities established by licensed hospice programs;

or the following health services provided on site in an existing health facility when

the cost is less than six hundred thousand dollars ($600,000) and the services are in

place by December 30, 1991: psychiatric care where chemical dependency services

are provided, level one (1) and level two (2) of neonatal care, cardiac

catheterization, and open heart surgery where cardiac catheterization services are in

place as of July 15, 1990. The provisions of this section shall not apply to nursing

homes, personal care homes, intermediate care facilities, and family care homes; or

nonconforming ambulance services as defined by administrative regulation. These

listed facilities or services shall be subject to licensure, when applicable.

(2) Nothing in this chapter shall be construed to authorize the licensure, supervision,

regulation, or control in any manner of:

(a) Private offices and clinics of physicians, dentists, and other practitioners of

the healing arts, except any physician's office that meets the criteria set forth

in KRS 216B.015(4);

(b) Office buildings built by or on behalf of a health facility for the exclusive use

of physicians, dentists, and other practitioners of the healing arts; unless the

physician's office meets the criteria set forth in KRS 216B.015(4), or unless

the physician's office is also an abortion facility as defined in KRS 216B.015,

except no capital expenditure or expenses relating to any such building shall

be chargeable to or reimbursable as a cost for providing inpatient services

offered by a health facility;

(c) Dispensaries and first-aid stations located within business or industrial

establishments maintained solely for the use of employees, if the facility does

not contain inpatient or resident beds for patients or employees who generally

remain in the facility for more than twenty-four (24) hours;

(d) Establishments, such as motels, hotels, and boarding houses, which provide

domiciliary and auxiliary commercial services, but do not provide any health

related services and boarding houses which are operated by persons

contracting with the United States Veterans Administration for boarding

services;

(e) The remedial care or treatment of residents or patients in any home or

institution conducted only for those who rely solely upon treatment by prayer

or spiritual means in accordance with the creed or tenets of any recognized

church or religious denomination and recognized by that church or

denomination; and

(f) On-duty police and fire department personnel assisting in emergency

situations by providing first aid or transportation when regular emergency

units licensed to provide first aid or transportation are unable to arrive at the

scene of an emergency situation within a reasonable time.

(3) An existing facility licensed as skilled nursing, intermediate care, or nursing home

shall notify the cabinet of its intent to change to a nursing facility as defined in

Public Law 100-203. A certificate of need shall not be required for conversion of

skilled nursing, intermediate care, or nursing home to the nursing facility licensure

category.

(4) Notwithstanding any other provision of law to the contrary, dual-license acute care

beds licensed as of December 31, 1995, and those with a licensure application filed

and in process prior to February 10, 1996, may be converted to nursing facility beds

by December 31, 1996, without applying for a certificate of need. Any dual-license

acute care beds not converted to nursing facility beds by December 31, 1996, shall,

as of January 1, 1997, be converted to licensed acute care beds.

(5) Notwithstanding any other provision of law to the contrary, no dual-license acute

care beds or acute care nursing home beds that have been converted to nursing

facility beds pursuant to the provisions of subsection (3) of this section may be

certified as Medicaid eligible after December 31, 1995, without the written

authorization of the secretary.

(6) Notwithstanding any other provision of law to the contrary, total dual-license acute

care beds shall be limited to those licensed as of December 31, 1995, and those with

a licensure application filed and in process prior to February 10, 1996. No acute

care hospital may obtain a new dual license for acute care beds unless the hospital

had a licensure application filed and in process prior to February 10, 1996.

(7) Ambulance services owned and operated by a city government, which propose to

provide services in coterminous cities outside of the ambulance service's designated

geographic service area, shall not be required to obtain a certificate of need if the

governing body of the city in which the ambulance services are to be provided

enters into an agreement with the ambulance service to provide services in the city.

(8) Notwithstanding any other provision of law, a continuing care retirement

community's nursing home beds shall not be certified as Medicaid eligible unless a

certificate of need has been issued authorizing applications for Medicaid

certification. The provisions of subsection (3) of this section notwithstanding, a

continuing care retirement community shall not change the level of care licensure

status of its beds without first obtaining a certificate of need.

 

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216B.042 Licenses -- Authority to enter upon premises -- Authority for

administrative regulations.

(1) The cabinet shall:

(a) Establish by promulgation of administrative regulation under KRS Chapter

13A reasonable application fees for licenses and promulgate other

administrative regulations necessary for the proper administration of the

licensure function;

(b) Issue, deny, revoke, modify, or suspend licenses or provisional licenses in

accordance with the provisions of this chapter;

(c) Establish licensure standards and procedures to ensure safe, adequate, and

efficient abortion facilities, health facilities and health services. These

regulations, under KRS Chapter 13A, shall include, but need not be limited to:

1. Patient care standards and safety standards, minimum operating

standards, minimum standards for training, required licenses for medical

staff personnel, and minimum standards for maintaining patient records;

2. Licensure application and renewal procedures; and

3. Classification of health facilities and health services according to type,

size, range of services, and level of care; and

(d) Compile in a single document, maintain, and make available to abortion

facilities and the public during regular business hours, all licensure standards

and procedures promulgated under KRS Chapter 13A related to abortion

facilities.

(2) The cabinet may authorize its agents or representatives to enter upon the premises

of any health care facility for the purpose of inspection, and under the conditions set

forth in administrative regulations promulgated under KRS Chapter 13A by the

cabinet.

(3) The cabinet may revoke licenses or certificates of need for specific health facilities

or health services or lign:none'>regulations.

(1) The cabinet shall, no later than September 1, 1998, and subject to the provisions of

KRS Chapter 13A, promulgate administrative regulations providing licensure

standards and procedures for abortion facilities. The cabinet shall begin enforcing

the administrative regulations on March 1, 1999.

(2) Any person operating an abortion facility for which a license is required under this

chapter may apply for the license prior to March 1, 1999.

(3) Each abortion facility shall report monthly to the cabinet the information required

by the cabinet by administrative regulation for each abortion performed in the

facility.

(4) Licensed acute-care hospitals shall be exempt from the provisions of this section,

except for any reporting requirements issued by the cabinet.

 

216B.0435 Requirement of written agreements between abortion facility and acute care

hospital and ambulance service.

(1) Each abortion facility shall enter into a written agreement with a licensed acute-care

hospital capable of treating patients with unforeseen complications related to an

abortion facility procedure by which agreement the hospital agrees to accept and

treat these patients.

(2) If unforeseen complications arise prior to or during an abortion facility procedure,

the patient shall be transferred to the licensed acute-care hospital with which the

abortion facility has a written agreement as provided under subsection (1) of this

section or to the hospital selected by the patient, if the patient so chooses.

(3) Each abortion facility shall enter into a written agreement with a licensed local

ambulance service for the transport of any emergency patient within the scope of

subsection (1) of this section to the licensed acute-care hospital.

(4) The written agreements of an abortion facility with an acute-care hospital and with a

local ambulance service shall be filed by the abortion facility with the cabinet.

 

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216B.400 Emergency care -- Examination services for victims of sexual offenses --

Examination expenses paid by Crime Victims' Compensation Board.

(1) Where a person has been determined to be in need of emergency care by any person

with admitting authority, no such person shall be denied admission by reason only

of his inability to pay for services to be rendered by the hospital.

(2) Every hospital of this state which offers emergency services shall provide that a

physician or a sexual assault nurse examiner, who shall be a registered nurse

licensed in the Commonwealth and credentialed by the Kentucky Board of Nursing

as provided under KRS 314.142, is available on call twenty-four (24) hours each

day for the examinations of persons reported to any law enforcement agency to be

victims of sexual offenses as defined by KRS 510.010 to 510.140, 530.020,

530.064, and 531.310.

(3) An examination provided in accordance with this section of a victim of a sexual

offense may be performed in a sexual assault examination facility as defined in

KRS 216B.015. An examination under this section shall apply only to an

examination of a victim.

(4) The physician or sexual assault nurse examiner, acting under a statewide medical

protocol which shall be developed by the chief medical examiner, and promulgated

by the secretary of justice pursuant to KRS Chapter 13A shall, upon the request of

any peace officer or prosecuting attorney, and with the consent of the reported

victim, or upon the request of the reported victim, examine such person for the

purpose of gathering physical evidence. This examination shall include but not be

limited to:

(a) Basic treatment and evidence gathering services; and

(b) Laboratory tests, as appropriate.

(5) Each reported victim shall be informed of available services for treatment of

venereal disease, pregnancy, and other medical and psychiatric problems. Pregnancy

counseling shall not include abortion counseling or referral information.

(6) Each reported victim shall be informed of available crisis intervention or other

mental health services provided by regional rape crisis centers providing services to

victims of sexual assault.

(7) Notwithstanding any other provision of law, a minor may consent to examination

under this section. This consent is not subject to disaffirmance because of minority,

and consent of the parents or guardians of the minor is not required for the

examination.

(8) (a) The examinations provided in accordance with this section shall be paid for by

the Crime Victims' Compensation Board at a rate to be determined by the

administrative regulation promulgated by the board after consultation with the

Sexual Assault Response Team Advisory Committee as defined in KRS

403.707.

(b) Upon receipt of a completed original claim form supplied by the board and

itemized billing for a forensic sexual assault examination, the board shall

reimburse the hospital or sexual assault examination facility, and the

physician or sexual assault nurse examiner as provided in administrative

regulations promulgated by the board pursuant to KRS Chapter 13A.

Reimbursement shall be made to an out-of-state nurse who is credentialed in

the other state to provide sexual assault examinations, an out-of-state hospital,

or an out-of-state physician if the sexual assault occurred in Kentucky.

(c) Independent investigation by the Crime Victims' Compensation Board shall

not be required for payment of claims under this section; however, the board

may require additional documentation or proof that the forensic medical

examination was performed.

(9) No charge shall be made to the victim for sexual assault examinations by the

hospital, the sexual assault examination facility, the physician, the sexual assault

nurse examiner, the victim's insurance carrier, or the Commonwealth.

 

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216B.990 Penalties.

(1) Any person who, in willful violation of this chapter, operates a health facility or

abortion facility without first obtaining a license or continues to operate a health

facility or abortion facility after a final decision suspending or revoking a license

shall be fined not less than five hundred dollars ($500) nor more than ten thousand

dollars ($10,000) for each violation.

(2) Any person who, in willful violation of this chapter, acquires major medical

equipment, establishes a health facility, or obligates a capital expenditure without

first obtaining a certificate of need, or after the applicable certificate of need has

been withdrawn, shall be fined one percent (1%) of the capital expenditure involved

but not less than five hundred dollars ($500) for each violation.

(3) Any hospital acting by or through its agents or employees which violates any

provision of KRS 216B.400 shall be punished by a fine of not less than one hundred

dollars ($100) nor more than five hundred dollars ($500).

(4) Any hospital acting by or through its agents or employees which violates any

provision of KRS 311.241 to 311.245 shall be punished by a fine of not less than

one hundred dollars ($100) nor more than five hundred dollars ($500).

(5) Any hospital violating the provisions of KRS 311.241 may be denied a license to

operate under the provisions of this chapter.

(6) Any health facility which willfully violates KRS 216B.250 shall be fined one

hundred dollars ($100) per day for failure to post required notices and one hundred

dollars ($100) per instance for willfully failing to provide an itemized statement

within the required time frames.

(7) In addition to the civil penalties established under KRS 216B.306(1) and (4), any

person who advertises, solicits boarders, or operates a boarding home without first

obtaining a registration as required by KRS 216B.305 and any person who aids or

abets the operation of a boarding home that is not registered shall be imprisoned for

no more than twelve (12) months.

(8) Any person or entity establishing, managing, or operating an abortion facility or

conducting the business of an abortion facility which otherwise violates any

provision of this chapter or any administrative regulation promulgated thereunder

regarding abortion facilities shall be subject to revocation or suspension of the

license of the abortion facility. In addition, any violation of any provision of this

chapter regarding abortion facilities or any administrative regulation related thereto

by intent, fraud, deceit, unlawful design, willful and deliberate misrepresentation, or

by careless, negligent, or incautious disregard for the statute or administrative

regulation, either by persons acting individually or in concert with others, shall

constitute a violation and shall be punishable by a fine not to exceed one thousand

dollars ($1,000) for each offense. Each day of continuing violation shall be

considered a separate offense. The venue for prosecution of the violation shall be in

any county of the state in which the violation, or any portion thereof, occurred.

(9) Any hospital acting by or through its agents or employees that violates any

provision of KRS 216B.150 shall be punished by a fine of not less than one hundred

dollars ($100) nor more than five hundred dollars ($500) for each violation.

 

* * *

 

CHAPTER 304 INSURANCE CODE

 

* * *

 

304.5-160 Health insurance and health care contracts not to cover elective

abortions except by optional rider.

(1) No health insurance contracts, plans or policies delivered or issued for delivery in

the state shall provide coverage for elective abortions except by an optional rider for

which there must be paid an additional premium. For purposes of this section, an

"elective abortion" means an abortion for any reason other than to preserve the life

of the female upon whom the abortion is performed.

(2) This section shall be applicable to all contracts, plans or policies of:

(a) All health insurers subject to Subtitle 17 of KRS Chapter 304; and

(b) All group and blanket health insurers subject to Subtitle 18 of KRS Chapter

304; and

(c) All nonprofit hospital, medical, surgical, dental and health service

corporations subject to Subtitle 32 of KRS Chapter 304; and

(d) All health maintenance organizations subject to Subtitle 38 of KRS Chapter

304; and

(e) Any provision of medical, hospital, surgical and funeral benefits and of

coverage against accidental death or injury, when such benefits or coverage

are incidental to or part of other insurance described in KRS 304.5-070(1);

and

(f) All employers who provide health insurance for employees on a self-insured

basis.

 

* * *

 

304.32-310 Benefits.

(1) A converted policy issued pursuant to the conversion privilege provided in KRS

304.32-300 providing hospital or surgical expense insurance shall provide on an

expense incurred basis, the following minimum benefits:

(a) Hospital room and board benefits of twenty-five dollars ($25) per day, for a

minimum duration of seventy (70) days for any one period of hospital

confinement as defined in the converted policy.

(b) Miscellaneous hospital expense benefits for any one (1) period of hospital

confinement in a minimum amount up to twenty (20) times the hospital room

and board daily benefit provided under the converted policy.

(c) Surgical operation expense benefits according to a relative value schedule, or

a minimum of two hundred fifty dollars ($250).

(d) The option to continue any existing benefits on account of pregnancy,

childbirth, or miscarriage.

(2) The relative values in the surgical schedule shall be consistent with the schedule of

operations generally offered by the insurer under group or individual health

insurance policies. In the event that the insurer and the employer agree upon one

(1) or more additional plans of benefits to be available for converted policies, the

applicant for the converted policy may, at his option, elect such a plan in lieu of a

converted policy providing the benefits of paragraphs (a), (b), and (c) of subsection

(1) of this section. In no event shall the benefits be less than the minimums set forth

in subsection (1) of this section.

(3) In no event need the insurer provide under the converted policy:

(a) Benefits on account of abortion or complications thereof,

(b) The benefits of paragraphs (a) and (b) of subsection (1) of this section, unless

the group policy from which conversion is made provided hospital expense

insurance benefits, or

(c) The benefits of paragraph (c) of subsection (1) of this section, unless the

group policy provided surgical expense insurance benefits. Furthermore, the

converted policy may contain any exclusion, reduction, or limitation contained

in the group policy and any exclusion, reduction, or limitation customarily

used in individual policies issued by the insurer. With respect to any person

who was covered by the group policy, the period specified in the time limit on

certain defenses of the incontestable provision of the converted policy shall

commence with the date the insurance on such person or member became

effective under the group policy.

(4) The converted policy may provide that any hospital, surgical, or medical expense

benefits otherwise payable thereunder with respect to any person covered

thereunder may be reduced by the amount of any such benefits payable under the

group policy for the same loss with respect to such person after termination of such

person's coverage thereunder. The insurer shall not be entitled to use deterioration

of health as the basis for refusing to renew a converted policy. The converted policy

may provide for termination of coverage thereunder on any person when he is or

could be covered by Medicare (Title XVIII of the United States Social Security Act

as added by the Social Security Amendments of 1965 or as later amended or

superseded).

(5) A converted policy may include a provision whereby the insurer may request

information in advance of any premium due date of such policy of any person

covered thereunder as to whether:

(a) He is covered for similar benefits by another hospital, surgical, or medical

expense insurance policy or hospital or medical service subscriber contract or

medical practice or other prepayment plan or by any other plan or program; or

(b) Similar benefits are provided for, or available to, such person pursuant to, or

in accordance with the requirements of, any statute.

If any such person is so covered or such statutory benefits are provided or available,

and such person fails to furnish the insurer the details of such coverage within

thirty-one (31) days after the date of such request, the benefits payable under the

converted policy may be based on the hospital or surgical or medical expenses

actually incurred after excluding expenses to the extent of the amount of benefits

provided or available therefor from any of the sources referred to in paragraphs (a)

and (b) of this subsection. A converted policy may contain any provisions permitted

herein and may also include any other provisions not expressly prohibited by law;

and any provision required to be permitted herein may be made a part of any such

policy by means of an endorsement or rider.

 

* * *

 

CHAPTER 311 PHYSICIANS, OSTEOPATHS, PODIATRISTS, AND RELATED MEDICAL PRACTITIONERS

 

* * *

 

311.595 Denial, probation, suspension, or revocation of licenses and permits. [These provisions have been held to be unconstitutional and unenforceable]

If the power has not been transferred by statute to some other board, commission, or

agency of this state, the board may deny an application or reregistration for a license;

place a licensee on probation for a period not to exceed five (5) years; suspend a license

for a period not to exceed five (5) years; limit or restrict a license for an indefinite period;

or revoke any license heretofore or hereafter issued by the board, upon proof that the

licensee has:

 

* * *

 

(3) Committed, procured, or aided in the procurement of an unlawful abortion,

including a partial-birth abortion;

 

* * *

 

311.710 Legislative findings.

The General Assembly of the Commonwealth of Kentucky hereby finds and declares:

(1) That it is in the interest of the people of the Commonwealth of Kentucky that every

precaution be taken to insure the protection of every viable unborn child being

aborted, and every precaution be taken to provide life-supportive procedures to

insure the unborn child its continued life after its abortion; and

(2) That currently, in the Commonwealth, there is inadequate legislation to protect the

life, health and welfare of pregnant women and unborn human life; and

(3) That it is in the interest of the people of the Commonwealth of Kentucky to

maintain accurate statistical data to aid in providing proper maternal health

regulations.

(4) It is the intention of the General Assembly of the Commonwealth of Kentucky to

assure the integrity and autonomy of a woman's decision whether to submit to an

abortion or to carry her child to term, to protect the rights and interests of a minor

incompetent woman and her parents in the context of abortion, to further the

Commonwealth's compelling interest in protecting the formal integrity of the

marital relation and the procreative rights and interests of the husband, and to

provide for the development of statistical data. The General Assembly finds as fact

that the rights and interests furthered by this chapter are not secure in the context in

which abortion is presently performed.

(5) It is the present intention of the General Assembly to protect the valid and

compelling interests of the Commonwealth and its inhabitants without unduly

burdening a woman's constitutional privacy rights as delineated by the courts. If,

however, the United States Constitution is amended or relevant judicial decisions

are reversed or modified, the declared policy of this Commonwealth to recognize

and to protect the lives of all human beings regardless of their degree of biological

development shall be fully restored.

 

311.715 Use of public funds for abortion or in-vitro fertilization prohibited -- Use

of public medical facilities for in-vitro fertilization permitted -- "Public funds"

defined. [These provisions have been held to be unenforceable with respect to abortion.]

No public funds shall be used for the purpose of obtaining an abortion or paying for the

performance of an abortion. Public medical facilities may be used for the purpose of

conducting research into or the performance of in-vitro fertilization as long as such

procedures do not result in the intentional destruction of a human embryo. For purposes

of this section, "public funds" means any money of the Commonwealth of Kentucky, any

department, agency or instrumentality thereof, or any money of any county, city, agency

or instrumentality thereof or any money of any other political subdivision of the

Commonwealth, agency or instrumentality thereof. Nothing in this section shall be

deemed to deprive a woman of all appropriate medical care necessary to prevent her

physical death. Nothing in this section shall be construed to allow public funds to pay for

in-vitro fertilization procedures performed on any individual patient.

 

311.720 Definitions for KRS 311.710 to 311.820 and other laws.

As used in KRS 311.710 to 311.820, and laws of the Commonwealth unless the context

otherwise requires:

(1) "Abortion" shall mean the use of any means whatsoever to terminate the pregnancy

of a woman known to be pregnant with intent to cause fetal death;

(2) "Hospital" shall mean those institutions licensed in the Commonwealth of Kentucky

pursuant to the provisions of KRS Chapter 216;

(3) "Consent" as used in KRS 311.710 to 311.820 with reference to those who must

give their consent shall mean an informed consent expressed by a written agreement

to submit to an abortion on a written form of consent to be promulgated by the

secretary for health and family services;

(4) "Cabinet" shall mean the Cabinet for Health and Family Services of the

Commonwealth of Kentucky;

(5) "Fetus" shall mean a human being from fertilization until birth;

(6) "Human being" shall mean any member of the species homo sapiens from

fertilization until death;

(7) "Partial-birth abortion" shall mean an abortion in which the physician performing

the abortion partially vaginally delivers a living fetus before killing the fetus and

completing the delivery; [This provisions has been held to be unconstitutional and unenforceable]

(8) "Vaginally delivers a living fetus before killing the fetus" shall mean deliberately

and intentionally delivers into the vagina a living fetus, or a substantial portion

thereof, for the purpose of performing a procedure the physician knows will kill the

fetus, and kills the fetus;

(9) "Physician" shall mean any person licensed to practice medicine in the

Commonwealth or osteopathy pursuant to the provisions of this chapter;

(10) "Viability" shall mean that stage of human development when the life of the unborn

child may be continued by natural or life-supportive systems outside the womb of

the mother;

(11) "Accepted medical procedures" shall mean procedures of the type performed in the

manner and in a facility with equipment sufficient to meet the standards of medical

care which physicians engaged in the same or similar lines of work, would

ordinarily exercise and devote to the benefit of their patients;

(12) "Medical emergency" means any condition which, on the basis of the physician's

good faith clinical judgment, so complicates the medical condition of a pregnant

female as to necessitate the immediate abortion of her pregnancy to avert her death

or for which a delay will create serious risk of substantial and irreversible

impairment of a major bodily function;

(13) "Medical necessity" means a medical condition of a pregnant woman that, in the

reasonable judgment of the physician who is attending the woman, so complicates

the pregnancy that it necessitates the immediate performance or inducement of an

abortion; and

(14) "Probable gestational age of the embryo or fetus" means the gestational age that, in

the judgment of a physician, is, with reasonable probability, the gestational age of

the embryo or fetus at the time that the abortion is planned to be performed.

 

311.723 When physician may perform abortion -- Guidelines.

(1) No abortion shall be performed except by a physician after either:

(a) He determines that, in his best clinical judgment, the abortion is necessary; or

(b) He receives what he reasonably believes to be a written statement signed by

another physician, hereinafter called the "referring physician," certifying that

in the referring physician's best clinical judgment the abortion is necessary,

and, in addition, he receives a copy of the report form required by KRS

213.055.

(2) No abortion shall be performed except in compliance with regulations which the

cabinet shall issue to assure that:

(a) Before the abortion is performed, the pregnant woman shall have a private

medical consultation either with the physician who is to perform the abortion

or with the referring physician in a place, at a time and of a duration

reasonably sufficient to enable the physician to determine whether, based

upon his best clinical judgment, the abortion is necessary;

(b) The physician who is to perform the abortion or the referring physician will

describe the basis for his best clinical judgment that the abortion is necessary

on a form prescribed by the cabinet as required by KRS 213.055; and

(c) Paragraph (a) of this subsection shall not apply when, in the medical judgment

of the attending physician based on the particular facts of the case before him,

there exists a medical emergency. In such a case, the physician shall describe

the basis of his medical judgment that an emergency exists on a form

prescribed by the cabinet as required by KRS 213.055.

(3) Notwithstanding any statute to the contrary, nothing in this chapter shall be

construed as prohibiting a physician from prescribing or a woman from using birth

control methods or devices, including, but not limited to, intrauterine devices, oral

contraceptives, or any other birth control method or device.

 

311.725 Requirement of voluntary and informed written consent for abortion --

Cabinet's duty to produce and make available informational materials --

Abortions in medical emergencies. [The provisions of this section that require in-person receipt of state-mandated information and materials are unenforceable by court order].

(1) No abortion shall be performed or induced except with the voluntary and informed

written consent of the woman upon whom the abortion is to be performed or

induced. Except in the case of a medical emergency, consent to an abortion is

voluntary and informed if and only if:

(a) At least twenty-four (24) hours prior to the abortion, a physician, licensed

nurse, physician assistant, or social worker to whom the responsibility has

been delegated by the physician has verbally informed the woman of all of the

following:

1. The nature and purpose of the particular abortion procedure or treatment

to be performed and of those medical risks and alternatives to the

procedure or treatment that a reasonable patient would consider material

to the decision of whether or not to undergo the abortion;

2. The probable gestational age of the embryo or fetus at the time the

abortion is to be performed; and

3. The medical risks associated with the pregnant woman carrying her

pregnancy to term;

(b) At least twenty-four (24) hours prior to the abortion, in an individual, private

setting, a physician, licensed nurse, physician assistant, or social worker to

whom the responsibility has been delegated by the physician has informed the

pregnant woman that:

1. The cabinet publishes the printed materials described in paragraphs (a)

and (b) of subsection (2) of this section and that she has a right to review

the printed materials and that copies will be provided to her by the

physician, licensed nurse, physician assistant, or social worker free of

charge if she chooses to review the printed materials;

2. Medical assistance benefits may be available for prenatal care,

childbirth, and neonatal care, and that more detailed information on the

availability of such assistance is contained in the printed materials

published by the cabinet; and

3. The father of the fetus is liable to assist in the support of her child, even

in instances where he has offered to pay for the abortion;

(c) At least twenty-four (24) hours prior to the abortion, a copy of the printed

materials has been provided to the pregnant woman if she chooses to view

these materials;

(d) The pregnant woman certifies in writing, prior to the performance or

inducement of the abortion:

1. That she has received the information required to be provided under

paragraphs (a), (b), and (c) of this subsection; and

2. That she consents to the particular abortion voluntarily and knowingly,

and she is not under the influence of any drug of abuse or alcohol; and

(e) Prior to the performance or inducement of the abortion, the physician who is

scheduled to perform or induce the abortion or the physician's agent receives a

copy of the pregnant woman's signed statement, on a form which may be

provided by the physician, on which she consents to the abortion and that

includes the certification required by paragraph (d) of this subsection.

(2) By January 1, 1999, the cabinet shall cause to be published in English in a typeface

not less than 12 point type the following materials:

(a) Materials that inform the pregnant woman about public and private agencies

and services that are available to assist her through her pregnancy, upon

childbirth, and while her child is dependent, including, but not limited to,

adoption agencies. The materials shall include a comprehensive list of the

available agencies and a description of the services offered by the agencies

and the telephone numbers and addresses of the agencies, and inform the

pregnant woman about available medical assistance benefits for prenatal care,

childbirth, and neonatal care and about the support obligations of the father of

a child who is born alive. The cabinet shall ensure that the materials are

comprehensive and do not directly or indirectly promote, exclude, or

discourage the use of any agency or service described in this section; and

(b) Materials that inform the pregnant woman of the probable anatomical and

physiological characteristics of the zygote, blastocyte, embryo, or fetus at two

(2) week gestational increments for the first sixteen (16) weeks of her

pregnancy and at four (4) week gestational increments from the seventeenth

week of her pregnancy to full term, including any relevant information

regarding the time at which the fetus possibly would be viable. The materials

shall use language that is understandable by the average person who is not

medically trained, shall be objective and nonjudgmental, and shall include

only accurate scientific information about the zygote, blastocyte, embryo, or

fetus at the various gestational increments. The materials shall include, for

each of the two (2) of four (4) week increments specified in this paragraph, a

pictorial or photographic depiction of the zygote, blastocyte, embryo, or fetus.

The materials shall also include, in a conspicuous manner, a scale or other

explanation that is understandable by the average person and that can be used

to determine the actual size of the zygote, blastocyte, embryo, or fetus at a

particular gestational increment as contrasted with the depicted size of the

zygote, blastocyte, embryo, or fetus at that gestational increment.

(3) Upon submission of a request to the cabinet by any person, hospital, physician, or

medical facility for one (1) or more copies of the materials published in accordance

with subsection (2) of this section, the cabinet shall make the requested number of

copies of the materials available to the person, hospital, physician, or medical

facility that requested the copies.

(4) If a medical emergency or medical necessity compels the performance or

inducement of an abortion, the physician who will perform or induce the abortion,

prior to its performance or inducement if possible, shall inform the pregnant woman

of the medical indications supporting the physician's judgment that an immediate

abortion is necessary. Any physician who performs or induces an abortion without

the prior satisfaction of the conditions specified in subsection (1) of this section

because of a medical emergency or medical necessity shall enter the reasons for the

conclusion that a medical emergency exists in the medical record of the pregnant

woman.

(5) If the conditions specified in subsection (1) of this section are satisfied, consent to

an abortion shall be presumed to be valid and effective.

(6) The failure of a physician to satisfy the conditions of subsection (1) of this section

prior to performing or inducing an abortion upon a pregnant woman may be the

basis of disciplinary action pursuant to KRS 311.595.

(7) The cabinet shall charge a fee for each copy of the materials distributed in

accordance with subsections (1) and (3) of this section. The fee shall be sufficient to

cover the cost of the administration of the materials published in accordance with

subsection (2) of this section, including the cost of preparation and distribution of

materials.

 

311.726 Repealed, 1998.

 

311.729 Repealed, 1998.

 

311.730 Repealed, 1982.

 

311.732 Performance of abortion upon a minor -- Definitions -- Consent

requirement -- Petition in District or Circuit Court -- Medical emergencies.

(1) For purposes of this section the following definitions shall apply:

(a) "Minor" means any person under the age of eighteen (18);

(b) "Emancipated minor" means any minor who is or has been married or has by

court order or otherwise been freed from the care, custody, and control of her

parents; and

(c) "Abortion" means the use of any instrument, medicine, drug, or any other

substance or device with intent to terminate the pregnancy of a woman known

to be pregnant with intent other than to increase the probability of a live birth,

to preserve the life or health of the child after live birth, or to remove a dead

fetus.

(2) No person shall perform an abortion upon a minor unless:

(a) The attending physician or his agent secured the informed written consent of

the minor and one (1) parent or legal guardian;

(b) The minor is emancipated and the attending physician or his agent has

received the informed written consent of the minor; or

(c) The minor elects to petition any Circuit or District Court of the

Commonwealth pursuant to subsection (3) of this section and obtain an order

pursuant to subsection (4) of this section granting consent to the abortion and

the attending physician or his agent has received the informed written consent

of the minor.

(3) Every minor shall have the right to petition any Circuit or District Court of the

Commonwealth for an order granting the right to self-consent to an abortion

pursuant to the following procedures:

(a) The minor or her next friend may prepare and file a petition setting forth the

request of the minor for an order of consent to an abortion;

(b) The court shall insure that the minor prepares or her next friend is given

assistance in preparing and filing the petition and shall insure that the minor's

identity is kept anonymous;

(c) The minor may participate in proceedings in the court on her own behalf or

through her next friend and the court shall appoint a guardian ad litem for her.

The court shall advise her that she has a right to court-appointed counsel and

shall provide her with such counsel upon her request;

(d) All proceedings under this section shall be anonymous and shall be given

preference over other matters to insure that the court may reach a decision

promptly, but in no case shall the court fail to rule within seventy-two (72)

hours of the time of application, provided that the seventy-two (72) hour

limitation may be extended at the request of the minor; and

(e) The court shall hold a hearing on the merits of the petition before reaching a

decision. The court shall hear evidence at the hearing relating to the emotional

development, maturity, intellect, and understanding of the minor; the nature,

possible consequences, and alternatives to the abortion; and any other

evidence that the court may find useful in determining whether the minor

should be granted majority rights for the purpose of consenting to the abortion

or whether the abortion is in the best interest of the minor.

(4) The court shall enter a written order, making specific factual findings and legal

conclusions supporting its decision as follows:

(a) Granting the petition for an abortion if the court finds that the minor is mature

and well informed enough to make the abortion decision on her own;

(b) Granting consent to the abortion if the court finds that the performance of the

abortion would be in the minor's best interest; or

(c) Deny the petition, if the court finds that the minor is immature and that

performance of the abortion would not be in the minor's best interest.

(5) Any minor shall have the right of anonymous and expedited appeal to the Court of

Appeals, and that court shall give precedence over other pending matters.

(6) No fees shall be required of any minor who declares she has no sufficient funds to

pursue the procedures provided by this section.

(7) The Supreme Court is respectfully requested to promulgate any rules and

regulations it feels are necessary to ensure that proceedings under this section are

handled in an expeditious and anonymous manner.

(8) The requirements of subsections (2), (3), and (4) of this section shall not apply

when, in the best medical judgment of the physician based on the facts of the case

before him, a medical emergency exists that so complicates the pregnancy as to

require an immediate abortion. A physician who does not comply with subsection

(2), (3), or (4) of this section due to the utilization of this exception shall certify in

writing the medical indications upon which his judgment was based.

(9) A report indicating the basis for any medical judgment that warrants failure to

obtain consent pursuant to this section shall be filed with the Cabinet for Health and

Family Services on a form supplied by the cabinet. This report shall be confidential.

(10) Failure to obtain consent pursuant to the requirements of this section is prima facie

evidence of failure to obtain informed consent and of interference with family

relations in appropriate civil actions. The law of this state shall not be construed to

preclude the award of exemplary damages in any appropriate civil action relevant to

violations of this section. Nothing in this section shall be construed to limit the

common-law rights of parents.

 

311.733 Severability.

If any provision, word, phrase, or clause of KRS 311.732 or the application thereof to any

person or circumstance shall be held invalid, such invalidity shall not affect the

provisions, words, phrases, clauses, or application of KRS 311.732 which can be given

effect without the invalid provision, word, phrase, clause, or application and to this end,

the provisions, words, phrases, and clauses of KRS 311.732 are declared to be severable.

 

311.735 Notice to spouse -- Exceptions -- Civil remedies. [These provisions have been held to be unconstitutional and unenforceable.]

(1) Prior to performing an abortion, the physician who is to perform the abortion or his

agent shall notify, if reasonably possible, the spouse of the woman upon whom the

abortion is to be performed. If it is not reasonably possible to notify the spouse prior

to the abortion, the physician or his agent shall do so, if reasonably possible, within

thirty (30) days of the abortion.

(2) (a) The requirements of this section shall not apply if, before the abortion is

performed, either party to a marriage has filed a petition for dissolution of

marriage which has been served on the respondent;

(b) The requirements of this section shall not apply when, in the medical

judgment of the attending physician based on the particular facts of the case

before him, there exists a medical emergency. In such a case, the physician

shall describe the basis of his medical judgment that such an emergency exists

on a form prescribed by the cabinet as required by KRS 213.055, and the

physician or his agent shall notify, if reasonably possible, the spouse of the

woman upon whom the abortion was performed, within thirty (30) days of the

abortion.

(3) Failure to notify a spouse as required by this section is prima facie evidence of

interference with family relations in appropriate civil actions. The law of this

Commonwealth shall not be construed to preclude the award of punitive damages or

damages for emotional distress, even if unaccompanied by physical complications

in any civil action brought pursuant to violations of this section. Nothing in this

section shall be construed to limit the common law rights of a husband.

 

311.740 Repealed, 1982.

 

311.750 Performance by other than licensed physician prohibited.

Subject to the provisions of KRS 311.760(1), no person other than a licensed physician

shall perform an abortion.

 

311.760 Minimum standards for performance of abortion.

An abortion may be performed in this state only under the following circumstances:

(1) During the first trimester of pregnancy by a woman upon herself upon the advice of

a licensed physician or by a licensed physician.

(2) After the first trimester of pregnancy, except in cases of emergency to protect the

life or health of the pregnant woman, where an abortion is permitted under other

provisions of KRS 311.710 to 311.820, by a duly licensed physician in a hospital

duly licensed by the Kentucky Health Facilities and Health Services Certificate of

Need and Licensure Board.

 

311.765 Prohibition against partial-birth abortion. [This provision has been held to be unconstitutional and unenforceable]

No physician shall perform a partial-birth abortion.

 

311.770 Restriction on use of saline method.

After the first trimester no person shall perform the form of abortion known as the saline

method of abortion.

 

311.780 Prohibition of abortion after viability -- Exceptions.

No abortion shall be performed or prescribed knowingly after the unborn child may

reasonably be expected to have reached viability, except when necessary to preserve the

life or health of the woman. In those instances where an abortion is performed under this

section, the person performing the abortion shall take all reasonable steps in keeping with

reasonable medical practices to preserve the life and health of the child, including but not

limited to KRS 311.760(2).

 

311.790 Issuance of birth and death certificates for live-born child after attempted

abortion.

Any child which is live born after an induced termination of pregnancy shall be fully

recognized as a human person under the law and a birth certificate shall be issued

certifying the birth of the live-born person even though the person may die thereafter. In

the event death does ensue, a death certificate shall be issued. Both the birth and death

certificates shall be issued as required by KRS 213.046, 213.051, and 213.076.

 

311.800 Abortions in publicly owned hospital or health care facility prohibited --

Exception -- Injunction to enforce compliance -- Abortions in private hospital

or health care facility -- Unlawful discriminatory practices.

(1) No publicly owned hospital or other publicly owned health care facility shall

perform or permit the performance of abortions, except to save the life of the

pregnant woman.

(2) In the event that a publicly owned hospital or publicly owned health facility is

performing or about to perform an abortion in violation of subsection (1) of this

section, and law enforcement authorities in the county have failed or refused to take

action to stop such a practice, any resident of the county in which the hospital or

health facility is located, may apply to the Circuit Court of that county for an

injunction or other court process to require compliance with subsection (1) of this

section.

(3) No private hospital or private health care facility shall be required to, or held liable

for refusal to, perform or permit the performance of abortion contrary to its stated

ethical policy.

(4) No physician, nurse staff member or employee of a public or private hospital or

employee of a public or private health care facility, who shall state in writing to

such hospital or health care facility his objection to performing, participating in, or

cooperating in, abortion on moral, religious or professional grounds, be required to,

or held liable for refusal to, perform, participate in, or cooperate in such abortion.

(5) It shall be an unlawful discriminatory practice for the following:

(a) Any person to impose penalties or take disciplinary action against, or to deny

or limit public funds, licenses, certifications, degrees, or other approvals or

documents of qualification to, any hospital or other health care facility due to

the refusal of such hospital or health care facility to perform or permit to be

performed, participate in, or cooperate in, abortion by reason of objection

thereto on moral, religious or professional grounds, or because of any

statement or other manifestation of attitude by such hospital or health care

facility with respect to abortion; or,

(b) Any person to impose penalties or take disciplinary action against, or to deny

or limit public funds, licenses, certifications, degrees, or other approvals or

documents of qualification to any physician, nurse or staff member or

employee of any hospital or health care facility, due to the willingness or

refusal of such physician, nurse or staff member or employee to perform or

participate in abortion by reason of objection thereto on moral, religious or

professional grounds, or because of any statement or other manifestation of

attitude by such physician, nurse or staff member or employee with respect to

abortion; or,

(c) Any public or private agency, institution or person, including a medical,

nursing or other school, to deny admission to, impose any burdens in terms of

conditions of employment upon, or otherwise discriminate against any

applicant for admission thereto or any physician, nurse, staff member, student

or employee thereof, on account of the willingness or refusal of such

applicant, physician, nurse, staff member, student or employee to perform or

participate in abortion or sterilization by reason of objection thereto on moral,

religious or professional grounds, or because of any statement or other

manifestation of attitude by such person with respect to abortion or

sterilization if that health care facility is not operated exclusively for the

purposes of performing abortions or sterilizations.

 

311.810 Discrimination for refusal to submit to abortion prohibited.

No woman may be denied governmental assistance or be otherwise discriminated against

or otherwise subjected to coercion in any way for accepting or refusing to accept or

submit to an abortion, which she may do or not do for any reason without explanation.

 

311.820 Abortion referral or counseling agency not to charge fee -- Penalty.

(1) As used in this section, an abortion referral or counseling agency is any person,

group, or organization, whether funded publicly or privately, that provides advice or

help to persons in obtaining abortions.

(2) No abortion referral or counseling agency shall charge or accept any fee, kickback,

or compensation of any nature from a physician, hospital, clinic or other medical

facility for referring a person thereto for an abortion.

 

311.830 Severability.

If any section of this chapter or any part of any section shall be invalid or

unconstitutional, the declaration of such invalidity shall not affect the validity of the

remaining portions thereof.

 

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311.990 Penalties.

(1) Any person who violates KRS 311.250 shall be guilty of a violation.

(2) Any college or professor thereof violating the provisions of KRS 311.300 to

311.350 shall be civilly liable on his bond for a sum not less than one hundred

dollars ($100) nor more than one thousand dollars ($1,000) for each violation,

which may be recovered by an action in the name of the Commonwealth.

(3) Any person who presents to the county clerk for the purpose of registration any

license which has been fraudulently obtained, or obtains any license under KRS

311.380 to 311.510 by false or fraudulent statement or representation, or practices

podiatry under a false or assumed name or falsely impersonates another practitioner

or former practitioner of a like or different name, or aids and abets any person in the

practice of podiatry within the state without conforming to the requirements of KRS

311.380 to 311.510, or otherwise violates or neglects to comply with any of the

provisions of KRS 311.380 to 311.510, shall be guilty of a Class A misdemeanor.

Each case of practicing podiatry in violation of the provisions of KRS 311.380 to

311.510 shall be considered a separate offense.

(4) Each first violation of KRS 311.560 is a Class A misdemeanor. Each subsequent

violation of KRS 311.560 shall constitute a Class D felony.

(5) Each violation of KRS 311.590 shall constitute a Class D felony. Conviction under

this subsection of a holder of a license or permit shall result automatically in

permanent revocation of such license or permit.

(6) Conviction of willfully resisting, preventing, impeding, obstructing, threatening, or

interfering with the board or any of its members, or of any officer, agent, inspector,

or investigator of the board or the Cabinet for Health and Family Services, in the

administration of any of the provisions of KRS 311.550 to 311.620 shall be a Class

A misdemeanor.

(7) Each violation of subsection (1) of KRS 311.375 shall, for the first offense, be a

Class B misdemeanor, and, for each subsequent offense shall be a Class A

misdemeanor.

(8) Each violation of subsection (2) of KRS 311.375 shall, for the first offense, be a

violation, and, for each subsequent offense, be a Class B misdemeanor.

(9) Each day of violation of either subsection of KRS 311.375 shall constitute a

separate offense.

(10) (a) Any person who intentionally or knowingly performs an abortion contrary to

the requirements of KRS 311.723(1) shall be guilty of a Class D felony; and

(b) Any person who intentionally, knowingly, or recklessly violates the

requirements of KRS 311.723(2) shall be guilty of a Class A misdemeanor.

(11) (a) 1. Any physician who performs a partial-birth abortion in violation of KRS

311.765 shall be guilty of a Class D felony. However, a physician shall

not be guilty of the criminal offense if the partial-birth abortion was

necessary to save the life of the mother whose life was endangered by a

physical disorder, illness, or injury.

2. A physician may seek a hearing before the State Board of Medical

Licensure on whether the physician's conduct was necessary to save the

life of the mother whose life was endangered by a physical disorder,

illness, or injury. The board's findings, decided by majority vote of a

quorum, shall be admissible at the trial of the physician. The board shall

promulgate administrative regulations to carry out the provisions of this

subparagraph.

3. Upon a motion of the physician, the court shall delay the beginning of

the trial for not more than thirty (30) days to permit the hearing, referred

to in subparagraph 2. of this paragraph, to occur.

(b) Any person other than a physician who performs a partial-birth abortion shall

not be prosecuted under this subsection but shall be prosecuted under

provisions of law which prohibit any person other than a physician from

performing any abortion.

(c) No penalty shall be assessed against the woman upon whom the partial-birth

abortion is performed or attempted to be performed. [These provisions (11) have been held to be unconstitutional and unenforceable]

(12) Any person who intentionally performs an abortion with knowledge that, or with

reckless disregard as to whether, the person upon whom the abortion is to be

performed is an unemancipated minor, and who intentionally or knowingly fails to

conform to any requirement of KRS 311.732 is guilty of a Class A misdemeanor.

(13) Any person who negligently releases information or documents which are

confidential under KRS 311.732 is guilty of a Class B misdemeanor.

(14) Any person who performs an abortion upon a married woman either with

knowledge or in reckless disregard of whether KRS 311.735 applies to her and who

intentionally, knowingly, or recklessly fails to conform to the requirements of KRS

311.735 shall be guilty of a Class D felony.

(15) Any person convicted of violating KRS 311.750 shall be guilty of a Class B felony.

(16) Any person who violates KRS 311.760(2) shall be guilty of a Class D felony.

(17) Any person who violates KRS 311.770 or 311.780 shall be guilty of a Class D

felony.

(18) A person convicted of violating KRS 311.780 shall be guilty of a Class C felony.

(19) Any person who violates KRS 311.810 shall be guilty of a Class A misdemeanor.

(20) Any professional medical association or society, licensed physician, or hospital or

hospital medical staff who shall have violated the provisions of KRS 311.606 shall

be guilty of a Class B misdemeanor.

(21) Any administrator, officer, or employee of a publicly owned hospital or publicly

owned health care facility who performs or permits the performance of abortions in

violation of KRS 311.800(1) shall be guilty of a Class A misdemeanor.

(22) Any person who violates KRS 311.914 shall be guilty of a violation.

(23) Any person who violates the provisions of KRS 311.820 shall be guilty of a Class A

misdemeanor.

(24) (a) Any person who fails to test organs, skin, or other human tissue which is to be

transplanted, or violates the confidentiality provisions required by KRS

311.281, shall be guilty of a Class A misdemeanor;

(b) Any person who has human immunodeficiency virus infection, who knows he

is infected with human immunodeficiency virus, and who has been informed

that he may communicate the infection by donating organs, skin, or other

human tissue who donates organs, skin, or other human tissue shall be guilty

of a Class D felony.

(25) Any person who sells or makes a charge for any transplantable organ shall be guilty

of a Class D felony.

(26) Any person who offers remuneration for any transplantable organ for use in

transplantation into himself shall be fined not less than five thousand dollars

($5,000) nor more than fifty thousand dollars ($50,000).

(27) Any person brokering the sale or transfer of any transplantable organ shall be guilty

of a Class C felony.

(28) Any person charging a fee associated with the transplantation of a transplantable

organ in excess of the direct and indirect costs of procuring, distributing, or

transplanting the transplantable organ shall be fined not less than fifty thousand

dollars ($50,000) nor more than five hundred thousand dollars ($500,000).

(29) Any hospital performing transplantable organ transplants which knowingly fails to

report the possible sale, purchase, or brokering of a transplantable organ shall be

fined not less than ten thousand dollars ($10,000) or more than fifty thousand

dollars ($50,000).

 

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CHAPTER 387 GUARDIANS -- CONSERVATORS -- CURATORS OF CONVICTS

 

* * *

 

387.660 Specific powers and duties of guardian.

A guardian of a disabled person shall have the following powers and duties, except as

modified by order of the court:

(1) To take custody of the ward and to establish his place of abode within the state,

except that, if at any time a guardian places a ward in a licensed residential facility

for developmentally disabled persons, the guardian shall, within thirty (30) days of

such placement, file with the court notice of the placement, stating with specificity

the reasons for such placement, and an interdisciplinary evaluation report detailing

the social, psychological, medical or other considerations on which such placement

is predicated, a description of the treatment or habilitation programs which will

benefit the ward as a result of such placement, and a determination that such

placement will provide appropriate treatment in the least restrictive available

treatment and residential program. For purposes of this subsection, the

interdisciplinary evaluation report may be one performed within two (2) months

prior to the placement for purposes of determining whether such placement is

necessary and appropriate, or may be an evaluation and assessment provided by the

residential facility immediately after placement. Notice to the court shall not be

required where the ward is transferred from one licensed residential facility to

another.

(2) To make provision for the ward's care, comfort, and maintenance and arrange for

such educational, social, vocational, and rehabilitation services as are appropriate

and as will assist the ward in the development of maximum self-reliance and

independence.

(3) To give any necessary consent or approval to enable the ward to receive medical or

other professional care, counsel, treatment or service, except that a guardian may

not consent on behalf of a ward to an abortion, sterilization, psychosurgery, removal

of a bodily organ, or amputation of a limb unless the procedure is first approved by

order of the court or is necessary, in an emergency situation, to preserve the life or

prevent serious impairment of the physical health of the ward.

(4) To act with respect to the ward in a manner which limits the deprivation of civil

rights and restricts his personal freedom only to the extent necessary to provide

needed care and services to him.

(5) To expend sums from the financial resources of the ward reasonable and necessary

to carry out the powers and duties assigned to him by the court and, unless a

separate conservator has been appointed, to manage the financial resources of this

ward.

If a separate limited conservator or conservator has been appointed for the ward, the

expenditure of funds by the limited guardian shall be consistent with the duties assigned

to and procedures and policies established by such limited conservator or conservator.

Conflicts arising between a limited guardian and a limited conservator or conservator

regarding the expenditure of funds which are unable to be otherwise resolved shall be

submitted to the court for resolution.

 

* * *

 

CHAPTER 605 ADMINISTRATIVE MATTERS [Unified Juvenile Code]

 

* * *

 

605.110 Medical care, educational programs for committed children -- Kentucky

Educational Collaborative for State Agency Children -- Personnel --

Financing.

(1) Unless provided otherwise, when any child committed to or in the custody of the

Department of Juvenile Justice or the cabinet requires medical or surgical care or

treatment, the Department of Juvenile Justice or the cabinet may provide the same

or arrange for the furnishing thereof by other public or private agencies, and may

give consent to the medical or surgical treatment. For this purpose, the services and

facilities of local health officers and departments shall be made available, at a cost

not to exceed the Medicaid reimbursement rate, to the Department of Juvenile

Justice or the cabinet, and as far as practicable, any publicly owned hospital shall

provide hospitalization without charge for any such child who is a resident of the

political subdivision by which the hospital is owned or operated. This section does

not authorize nor shall permission be granted for abortion or sterilization.

 

* * *

  

610.310 Medical treatment for child.

(1) When the mental or physical health of any child before the juvenile court requires it,

the court may order the child to be placed in a public or private hospital or

institution for examination, evaluation, treatment, or care by a health officer,

comprehensive care center, children's clinic, or any reputable physician or

psychologist who will conduct the examination. The cabinet and the Department of

Juvenile Justice may furnish services under agreements with the individual juvenile

courts. For this purpose, any county judge/executive or chief executive officer of an

urban-county or charter county government may enter into a contract on behalf of

his or her county with the cabinet or the Department of Juvenile Justice for the

furnishings of these services.

(2) The court may order or consent to necessary medical treatment, including surgical

procedures, except for the purpose of abortion, electroshock therapy or

psychosurgery as provided in KRS Chapter 645, or sterilization, after a hearing

conducted to determine the necessity of such treatment or procedure. In making the

order, the court may take into consideration the religious beliefs and practices of the

child and his parents or guardian. Reasonable notice, taking into account any

emergency circumstances, shall be provided to the parents, guardian or person

exercising custodial control or supervision of the child to enable them to attend the

hearing.

 

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-------------------------------------------------------------

 

Kentucky Administrative Regulations.

 

* * *

902 KAR 20:360. Abortion facilities.

RELATES TO: KRS 213.101, 216B.010-216B.130, 216B.990, 311.710-311.830, 314.011(8), 314.042(8)

STATUTORY AUTHORITY: KRS 216B.0431

NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.0431 requires that the Cabinet for Health Services regulate abortion facilities. This administrative regulation establishes the licensure requirements for abortion facilities.

Section 1. Definitions. (1) "Abortion" is defined in KRS 311.720(1).

(2) "Abortion facility" is defined in KRS 216B.015.

(3) "Cabinet" means the Cabinet for Health Services.

(4) "Volunteer" means a person who is not an employee of the abortion facility and who has direct patient health care responsibilities performed within the abortion facility, and excludes escort services.

Section 2. Licenses. (1) A license to operate an abortion facility shall not be required for a health facility licensed to perform the services regulated by 902 KAR 20:016 or 902 KAR 20:106. That health facility shall:

(a) Comply with the requirements of its respective licensure category and provide written notice of its intent to perform abortions to the Office of Inspector General, Division of Licensing and Regulation, 275 East Main Street, Frankfort, Kentucky 40621;

(b) Comply with the reporting requirements of KRS 216B.0431; and

(c) Be exempt from any other licensure requirements of this administrative regulation.

(2) The license required by KRS 216B.0431 shall be conspicuously posted in a public area of the facility.

(3) An applicant for licensure shall file with the Office of the Inspector General, Division of Licensing and Regulation, 275 East Main Street, Frankfort, Kentucky 40621, an application for license to operate an abortion facility.

(4) An applicant for a license shall, as a condition precedent to licensure or relicensure, be in compliance with the applicable administrative regulations relating to an abortion facility:

(a) Compliance with licensure administrative regulations shall be ascertained through an on-site inspection of the facility. A licensure inspection may be unannounced.

(b) A representative of the inspecting agency shall have access to the facility during the hours that the facility operates.

(c) A regulatory violation identified during an inspection shall be transmitted in writing to the facility by the inspecting agency.

(d) The facility shall submit a written plan for the elimination or correction of the regulatory violation to the inspecting agency within ten (10) days.

1. The plan shall specify the date by which each violation shall be corrected.

2. Following a review of the plan, the inspecting agency shall notify the facility in writing of the acceptability of the plan.

3. If a portion or all of the plan is unacceptable:

a. The inspecting agency shall specify the reasons for the unacceptability; and

b. The facility shall modify or amend the plan and resubmit it to the inspecting agency within ten (10) days.

(5) A licensee shall, as a condition of licensure or relicensure, be in compliance with the reporting requirements of KRS 213.101.

(6) An unannounced inspection shall be conducted:

(a) On a complaint allegation; and

(b) Utilizing the procedures established in subsection (3) of this section.

(7) A license shall remain in effect for one (1) year from the date of issuance unless otherwise expressly provided in the license certificate.

(8) A license shall be renewed upon payment of the prescribed fee and compliance with the licensure administrative regulations.

(9) Each license to operate shall be issued for the person or persons and premises named in the application.

(10) A new application shall be filed in the event of change of ownership.

(a) Upon the filing of a new application for a license because of change of ownership, the new license shall be automatically issued for the remainder of the current licensure period.

(b) An additional fee shall not be charged for the remainder of the licensure period.

Section 3. Fee Schedule. (1) Annual fees. The annual licensure fee (including a renewal) for abortion facilities shall be $155 for each licensed facility.

(2) Fees shall be paid by check made payable to Kentucky State Treasurer and sent to Cabinet for Health Services, Division of Licensing and Regulation, 275 East Main Street, 4E-A, Frankfort, Kentucky 40621.

Section 4. Appeals. (1) Notice of the denial, suspension, or revocation of a license shall be made pursuant to the provisions of KRS Chapter 13B.

(2) A licensee may appeal the denial, suspension, or revocation of his license to the Secretary of the Cabinet for Health Services, 275 East Main Street, Frankfort, Kentucky 40621.

(3) A hearing on the denial, suspension, or revocation of a license shall be conducted pursuant to the provisions of KRS Chapter 13B.

Section 5. Administration and Operation. (1) Licensee.

(a) The licensee shall be legally responsible for the abortion facility and for compliance with federal, state and local laws and regulations pertaining to the operation of the abortion facility.

(b) The licensee shall establish written policies for the administration and operation of the abortion facility.

(c) The licensee shall establish lines of authority and designate the person who shall be principally responsible for the daily operation of the abortion facility.

(2) Policies.

(a) Administrative policies. The abortion facility shall have written administrative policies covering all aspects of the operation, including:

1. A description of organizational structure, staffing and allocation of responsibility and accountability;

2. A description of referral linkages with inpatient facilities and other providers;

3. Policies and procedures for the guidance and control of personnel performances;

4. A description of services included in the program;

5. A description of the administrative and patient care records and reports;

6. Procedures to be followed in the storage, handling and administration of drugs and biologicals; and

7. A policy to specify the provision of emergency medical services.

8. Procedures to be followed in obtaining the voluntary and informed written consent of the pregnant woman, as required by KRS 311.725.

(b) Patient rights policies. The abortion facility shall adopt written policies regarding the rights and responsibilities of patients. These patients' rights policies shall assure that each patient:

1. Is informed of these rights and of a procedure for handling patient grievances.

2. Is informed of services available at the abortion facility and of related charges including any charges not covered under third-party payor arrangements.

3. Is informed of her medical condition, unless medically contraindicated (as documented in her medical record), and is afforded the opportunity to participate in the planning of her medical treatment and to refuse to participate in experimental research.

4. Is encouraged and assisted to understand and exercise her patient rights; to this end she may voice grievances and recommend changes in policies and services. Upon the patient's request the grievances and recommendations will be conveyed within a reasonable time to an appropriate decision making level within the organization which has authority to take corrective action.

5. Is assured confidential treatment of her records and is afforded the opportunity to approve or refuse their release to any individual not involved in her care except as required by Kentucky law or third-party payment contract.

6. Is treated with consideration, respect, and full recognition of her dignity and individuality, including privacy in treatment and in the care of her personal health needs.

(3) Personnel.

(a) A facility shall have a staff that is adequately trained and capable of providing appropriate service and supervision to the patients.

1. The licensee shall obtain written applications for employment from all employees. The licensee shall obtain and verify informa2) months, then the two (2) step procedure (one (1) PPD test with negative result followed one (1) to three (3) weeks later by another PPD test) is required to establish a reliable baseline. If employees or volunteers have complete documentation of a negative PPD during the preceding twelve (12) months (may be a single PPD or a two-(2) step PPD), then a single PPD is acceptable to establish the baseline for current employment.

a. A person with negative tuberculin skin tests who has direct contact with patients shall have an annual tuberculin skin test.

b. An initial or routine chest x-ray shall not be required for an employee or volunteer with negative tuberculin test results who is asymptomatic.

c. Personnel with a positive reaction to the skin test shall have no patient contact until certified noncontagious by a physician.

d. A chest x-ray shall be required to determine whether TB disease is present for an employee or volunteer:

(i) With reactions of 10mm and over to the preemployment tuberculin test;

(ii) Who has previously documented positive reactions;

(iii) With newly converted skin tests; and

(iv) With symptoms suggestive of TB (e.g., cough, weight loss, night sweats, fever, etc.)

e. If TB disease is diagnosed, appropriate treatment shall be given and patient contacts examined.

f. Personnel who are known or suspected to have TB shall be required to be evaluated by a physician and shall not be allowed to return to work until they have been certified noncontagious by the physician.

g. Preventive treatment of personnel with new positive reactions is essential, and shall be considered for all infected employees or volunteers who have patient contact, unless specifically contraindicated.

(i) An employee or volunteer who completes treatment, either for disease or infection, may be exempt from further routine chest radiographic screening unless he has symptoms of TB.

(ii) Positive reactors who are unable or unwilling to take preventive treatment shall not receive an annual chest x-ray. These individuals shall be informed of their lifelong risk of developing and transmitting TB to individuals in the institution and in the community. They shall be informed of symptoms which suggest the onset of TB, and the procedure to follow should such symptoms develop.

h. Postexposure skin tests shall be provided for tuberculin negative employees or volunteers within twelve (12) weeks after termination of contact for any suspected exposure to a documented case of pulmonary TB.

i. A person shall be designated in writing at each facility to coordinate TB screening of personnel and any other TB control activities.

3. All professional and allied health professional staff members shall be currently certified with American Red Cross or American Heart Association to perform cardiopulmonary resuscitation and capable of recognizing symptoms of distress.

4. No employee or volunteer of the facility while afflicted with any infected wounds, boils, sores, or an acute respiratory infection, or any other contagious disease or illness, shall work in any capacity in which there is a likelihood of such person transmitting disease to other individuals.

5. Each facility shall have and execute a written orientation program to familiarize each new staff member with the facility and its policies and procedures, to include fire safety and other safety measures, medical emergencies, and infection control.

6. In-service training programs shall be planned and provided for all employees and volunteers to ensure and maintain their understanding of their duties and responsibilities. Records shall be maintained to reflect program content and individual attendance. The following training shall be provided at least annually:

a. Infection control, to include as a minimum, universal precautions against blood-borne diseases, general sanitation, personal hygiene such as hand washing, use of masks and gloves, and instruction to staff if there is a likelihood of transmitting a disease to patients or other staff members;

b. Fire protection, to include evacuating patients, proper use of fire extinguishers, and procedures for reporting fires;

c. Confidentiality of patient information and records, and protecting patient rights; and

d. Licensing regulations.

7. Job descriptions.

a. Written job descriptions that adequately describe the duties of every position shall be maintained.

b. Each job description shall include: position title, authority, specific responsibilities and minimum qualifications.

c. Job descriptions shall be reviewed at least annually, kept current and given to each employee and volunteer when assigned to the position and when revised.

8. A personnel file shall be maintained for each employee and for each volunteer. The records shall be completely and accurately documented, readily available, and systematically organized to facilitate the compilation and retrieval of information. The file shall contain a current job description that reflects the individual's responsibilities and work assignments, and documentation of the person's orientation, in-service education, appropriate licensure, if applicable, and TB skin testing.

(b) Clinical staff.

1. Physicians, nurses, and allied health professionals shall constitute the clinical staff.

2. The clinical staff shall meet at least quarterly to review and analyze their clinical experiences; minutes shall be maintained of such meetings.

3. Physicians.

a. Abortions shall be performed only by a physician who is licensed to practice medicine in Kentucky and who is properly qualified by training and experience to perform pregnancy termination procedures.

b. A physician shall remain on the premises until all patients are discharged.

(c) Nursing.

1. Nursing care shall be under the supervision of a registered nurse currently licensed in Kentucky.

2. A registered nurse shall be on duty to provide or supervise all nursing care of patients in preparation, during the termination procedure, the recovery period and until all patients leave the facility.

3. Licensed practical nurses, working under appropriate supervision and direction of a registered nurse, may be employed as components of the nursing staff.

(d) Allied health professionals, working under appropriate direction and supervision, may be employed to work only within areas where their competency has been established.

Section 6. Patient Care. Abortion facilities shall not serve patients whose needs exceed the resources or capabilities of the facility. The facility shall formulate and adhere to written patient care policies and procedures designed to ensure professional and safe care for patients, to include:

(1) Admission criteria;

(2) Physician and nurse responsibilities for the services offered;

(3) Specific details regarding the preoperative procedures performed, to include history and physical examination, including verification of pregnancy, estimation of gestational age, identification of any preexisting conditions or complications;

(4) The actual abortion procedure, to include the use of:

(a) IVs;

(b) Fluids;

(c) Analgesia/anesthesia. General anesthesia shall be administered only by personnel acting within the limits of their statutory scope of practice; and

(d) Tissue examination and disposal.

(5) Postprocedure care and recovery room procedures to include emergency care;

(6) Provisions for the education of patient, family and others, as appropriate in pre- and postprocedure care;

(7) Plans for follow-up patient care after discharge from the facility;

(8) Management and appropriate referral of high-risk conditions;

(9) Transfer of patients who, during the course of pregnancy termination are determined to need care beyond that of the facility; and

(10) Infection control and sanitation procedures to include duties and responsibilities of the infection control committee that shall include the development and implementation of specific patient care and administrative policies aimed at investigating, controlling and preventing infections in the facility.

Section 7. Pharmaceutical Services. Pharmaceutical services shall be provided in accordance with accepted professional practice and federal, state and local laws.

(1) Emergency drugs:

(a) Emergency kit or emergency drugs: Each facility shall maintain an emergency kit or stock supply of drugs and medicines for use in treating the emergency needs of patients. This kit or medicine shall be stored in such a manner as to prohibit its access by unauthorized personnel. A listing of contents by drawer or shelf shall be placed on the cabinet or emergency cart to allow quick retrieval. Contents shall correspond with the inventory list. Drugs and equipment shall be available within the facility to treat, as a minimum, the following conditions:

1. Cardiac arrest;

2. Seizure;

3. Asthmatic attack;

4. Allergic reaction;

5. Narcotic toxicity;

6. Hypovolemic shock;

7. Vasovagal shock.

(b) Drug Reference Sources. Each facility shall maintain reference sources for identifying and describing drugs and medicines.

(2) Administering drugs and medicines. Drugs and medicines shall not be administered to individual patients or to anyone within or outside the facility except by those authorized by law under orders of a physician or other ordering personnel acting within the limits of their statutory scope of practice. Such orders shall be in writing and signed personally by the physician or other personnel who prescribes the drug or medicine.

(3) Medicine storage. Medicines and drugs maintained in the facility for daily administration shall not be expired and shall be properly stored and safeguarded in enclosures of sufficient size that are not accessible to unauthorized persons. Refrigerators used for storage of medications shall maintain an appropriate temperature as determined by the requirements established on the label of medications. A thermometer accurate to three (3) degrees Fahrenheit shall be maintained in these refrigerators. Only authorized personnel shall have access to storage enclosures. Controlled substances and ethyl alcohol, if stocked, shall be stored under double locks and in accordance with applicable state and federal laws.

(4) Medicine preparation area. Medicines and drugs shall be prepared for administration in an area that contains a counter and a sink. This area shall be located in such a manner as to prevent contamination of medicines being prepared for administration.

(5) Records. Records shall be kept of all stock supplies of controlled substances giving an accounting of all items received or administered.

(6) Poisonous substances. All poisonous substances shall be plainly labeled and kept in a cabinet or closet separate from medicines and drugs to be prepared for administration.

Section 8. Laboratory Services. (1) Laboratory services shall be provided on site or through arrangement with a laboratory certified to provide the required procedures under 42 CFR 493.

(a) Facilities for collecting specimens shall be available on site.

(b) If laboratory services are provided on site they shall be directed by a person who qualifies as a director under KRS 333.090 and 42 CFR part 493 and shall be performed in compliance with KRS Chapter 333 and 42 CFR 493 standards.

(2) Prior to the procedure, laboratory tests shall include a recognized urine pregnancy test unless the physician identifies fetal heart beats or fetal movements on physical examination. If positive, the following additional tests are required:

(a) Urinalysis including albumin and glucose examination;

(b) Hematocrit or hemoglobin; and

(c) Determination of Rh factor with appropriate medical intervention.

(3) Aspirated tissues shall be examined to verify that villi or fetal parts are present; if villi or fetal parts cannot be identified with certainty, the tissue specimen shall be sent for further pathologic examination and the patient alerted to the possibility of an ectopic pregnancy.

(4) A written report of each laboratory test and examination shall be a part of the patient's record.

(5) If a patient is bleeding profusely and a transfusion of red blood cells is necessary, she shall be administered fluids and transported immediately to an acute care hospital.

(6) All laboratory supplies shall be monitored for expiration dates, if applicable.

Section 9. Medical Waste Disposal. (1) Sharp wastes.

(a) Sharp wastes, including needles, scalpels, razors, or other sharp instruments used for patient care procedures, shall be segregated from other wastes and placed in puncture resistant containers immediately after use.

(b) Needles shall not be purposely bent or broken, or otherwise manipulated by hand as a means of disposal, except as permitted by Centers for Disease Control and Occupational Safety and Health Administration guidelines.

(c) The containers of sharp wastes shall either be incinerated on or off site, or be rendered nonhazardous.

(2) Disposable waste.

(a) All disposable waste shall be placed in suitable bags or closed containers so as to prevent leakage or spillage, and shall be handled, stored, and disposed of in such a way as to minimize direct exposure of personnel to waste materials.

(b) The abortion facility shall establish specific written policies regarding handling and disposal of all wastes.

(c) Pathological waste, such as tissues, organs, body parts, and bodily fluids, shall be incinerated.

(d) The following wastes shall be disposed of by incineration, or be autoclaved before disposal, or be carefully poured down a drain connected to sanitary sewer: blood, blood specimens, used blood tubes, or blood products.

(e) Any wastes conveyed to a sanitary sewer shall comply with applicable federal, state, and local pretreatment administrative regulations.

(f) Any incinerator used for the disposal of waste shall be in compliance with 401 KAR 59:023 or 401 KAR 61:013.

Section 10. Emergency Care. (1) An abortion facility shall enter into written agreements with a licensed acute-care hospital and a local ambulance service for the transport and treatment of patients when hospitalization becomes necessary, as required by KRS 216B.0435.

(2) These written agreements shall be filed with the cabinet.

Section 11. Equipment and Supplies. There shall be appropriate equipment and supplies maintained for the patients to include:

(1) A bed or recliner suitable for recovery;

(2) Oxygen with flow meters and masks or equivalent;

(3) Mechanical suction;

(4) Resuscitation equipment to include resuscitation bags and oral airways;

(5) Emergency medications, intravenous fluids, and related supplies and equipment;

(6) A clock with a sweep second hand;

(7) Sterile suturing equipment and supplies;

(8) Adjustable examination light;

(9) Containers for soiled linen and waste materials with covers;

(10) Refrigerator; and

(11) Appropriate equipment for the administering of general anesthesia, if applicable.

Section 12. Consultation. Arrangements shall be made for consultation or referral services to be available as needed.

Section 13. Quality Improvement. (1) The facility shall establish and implement a written plan for a quality improvement program for patient care. The plan shall specify the individual responsible for coordinating the quality improvement program and shall provide for ongoing monitoring of staff and patient care services.

(2) There shall be an ongoing process for monitoring and evaluating patient care services, staffing, infection prevention and control, housekeeping, sanitation, safety, maintenance of physical plant and equipment, patient care statistics, and discharge planning services.

(3) Evaluation of patient care throughout the facility shall be criteria-based, so that certain actions are taken or triggered when specific quantified, predetermined levels of outcomes or potential problems are identified.

(4) The quality improvement process shall incorporate quarterly review of a minimum of five (5) percent of medical records of patients undergoing procedures during a given quarter, but not less than five (5) records shall be reviewed.

(5) The quality improvement process shall include evaluation by patients of care and services provided by the facility. If the families of patients are involved in the care and services provided by the facility, the quality improvement process shall include a means for obtaining input from families of patients.

(6) The administrator shall review the findings of the quality improvement program to ensure that effective corrective actions have been taken, including as a minimum, policy revisions, procedural changes, educational activities, and follow-up on recommendations, or that additional actions are no longer indicated or needed.

(7) The quality improvement program shall identify and establish indicators of quality care, specific to the facility, that shall be monitored and evaluated.

(8) The results of the quality improvement program shall be submitted to the licensee for review at least annually and shall include at least the deficiencies found and recommendations for corrections or improvements. Deficiencies that jeopardize patient safety shall be reported immediately in writing to the licensee.

Section 14. Medical Records. (1) Medical records shall be maintained for all patients examined or treated in the abortion facility. The records shall be completely and accurately documented, readily available, and systematically organized to facilitate the compilation and retrieval of information. All information shall be centralized in the patient's medical record. All entries shall be legibly written or typed, dated and signed.

(a) The record shall include the following information:

1. A face sheet with patient identification data, to include: name, address, telephone number, Social Security number, date of birth, and name, address and telephone number of person to be notified in the event of an emergency;

2. Signed consent for the procedure;

3. Date of initial examination;

4. Date of abortion;

5. Referring and attending physicians' names and phone numbers, if applicable;

6. Complete medical history to include medications currently being taken;

7. Physical examination, to the extent necessary to determine the health status of the patient, within fifteen (15) days of the procedure, including detail of findings of pelvic examination and estimated gestational age, according to the first day of the last menstrual period;

8. Results of diagnostic tests and examinations, e.g., x-ray, electrocardiography, clinical laboratory, pathology, consultations, ultrasound;

9. Preoperative diagnosis;

10. Counselor's notes if applicable;

11. Physician's orders;

12. Complete record of abortion procedure to include:

a. Vital signs, i.e., temperature, pulse, respiration, and blood pressure, prior to and following the procedure;

b. Name of procedure performed;

c. Anesthetic agent utilized;

d. Name of attending physician performing the procedure;

e. Names of clinical assistants in attendance, to include other physicians, physician's assistants, anesthetists, nurses, or specially-trained technicians;

f. Signature of physician performing the procedure.

13. Nurses' notes;

14. Progress notes to include a postanesthesia note if general anesthesia is utilized;

15. Attending physician's description of gross appearance of tissue removed;

16. Final diagnosis;

17. Condition on discharge;

18. Post-op orders and follow-up care; and

19. Documented verification that the woman has received information and was offered printed materials as required by KRS 311.725.

(b) The attending physician shall complete and sign the medical record within seventy-two (72) hours following discharge.

(2) Confidentiality of all patient records shall be maintained at all times.

(3) Transfer of records. The abortion facility shall establish systematic procedures to assist in continuity of care where the patient moves to another source of care, and shall, upon proper release, transfer medical records or an abstract thereof when requested.

(4) Retention of records. After patient's death or discharge the complete medical record shall be placed in an inactive file and retained for five (5) years or, in case of a minor, three (3) years after the patient reaches the age of majority under state law, whichever is the longest.

Section 15. Infection Control. (1) There shall be an infection control program developed to prevent, identify, and control infections.

(2) Written policies and procedures pertaining to the operation of the infection control program shall be established, reviewed at least annually, and revised as necessary.

(3) A practical system shall be developed for reporting, evaluating, and maintaining records of infections among residents and personnel.

(4) The system shall include assignment of responsibility for the ongoing collection and analysis of data, as well as for the implementation of required follow-up actions.

(5) Corrective actions shall be taken on the basis of records and reports of infections and infection potentials among patients and personnel and shall be documented.

(6) All new employees shall be instructed in the importance of infection control and personal hygiene and in their responsibility in the infection control program.

(7) The facility shall document that in-service education in infection prevention and control is provided to all services and program components.

(8) Adequate space shall be provided for storage, maintenance and distribution of sterile supplies and equipment.

(9) Sterile supplies and equipment shall not be mixed with unsterile supplies, and shall be stored in dust-proof and moisture-free units. They shall be properly labeled.

(10) Sterilizing equipment of appropriate type shall be available and of adequate capacity to properly sterilize instruments and materials. The sterilizing equipment shall have approved control and safety features.

Section 16. Linen and Laundry. (1) An adequate supply of clean linen or disposable materials shall be maintained in order to ensure change of linen on procedure tables between patients.

(2) Provisions for proper laundering of linen and washable goods shall be made. Soiled and clean linen shall be handled and stored separately. Storage shall be in covered containers.

(3) A sufficient supply of cloth or disposable towels shall be available so that a fresh towel can be used after each hand washing. Towels shall not be shared.

Section 17. Housekeeping. (1) General.

(a) A facility shall be kept neat, clean and free from odors;

(b) Accumulated waste material shall be removed daily or more often if necessary;

(c) There shall be frequent cleaning of floors, walls, ceilings, woodwork and windows;

(d) The premises shall be kept free from rodent and insect infestation; and

(e) Bath and toilet facilities shall be maintained in a clean and sanitary condition at all times.

(2) Cleaning materials and supplies shall be stored in a safe manner. All harmful agents shall be locked in a closet or cabinet used for this purpose only.

Section 18. Refuse and Waste Disposal. (1) All garbage and waste shall be collected, stored and disposed of in a manner designed to prevent the transmission of disease.

(a) Containers shall be washed and sanitized before being returned to work areas; and

(b) Disposable type containers shall not be reused.

(2) Containers for garbage and refuse shall be covered and stored outside and placed on an approved platform to prevent overturning by animals, the entrance of flies or the creation of a nuisance. All solid waste shall be disposed of at sufficient frequencies in a manner so as not to create a rodent, insect or other vermin problem.

(3) Immediately after emptying, containers for garbage shall be cleaned.

(4) All medical waste shall be managed in accordance with Section 9 of this administrative regulation.

Section 19. Outside Areas. All outside areas, grounds and adjacent buildings shall be kept free of rubbish, grass, and weeds that may serve as a fire hazard or as a haven for insects, rodents and other pests. Outside stairs, walkways, ramps and porches shall be maintained free from accumulations of water, ice, snow and other impediments.

Section 20. Disaster Preparedness. (1) All staff shall be knowledgeable of a written plan and procedure for meeting potential disasters and emergencies such as fires or severe weather. The plan shall be posted. Staff shall be trained in properly reporting a fire, extinguishing a small fire, and in evacuation from the building. Fire drills shall be practiced in accordance with state fire administrative regulations.

(2) All fire protection and alarm systems and other fire fighting equipment shall be inspected and tested at least once each year, and more often if necessary to maintain them in serviceable condition.

Section 21. Facility Specifications. (1) An abortion facility shall provide a functionally safe and sanitary environment for patients, personnel, and the public.

(2) An abortion facility shall include space for the following functions:

(a) Reception and waiting;

(b) Administrative activities such as patient admission, record storage, and business affairs;

(c) Patient dressing and storage of personal items;

(d) Preoperative evaluation, including physical examination, laboratory testing, and preparation for anesthesia;

(e) Performance of surgical procedures;

(f) Preparation and sterilization of instruments;

(g) Storage of equipment, drugs, and fluids;

(h) Postanesthetic recovery; and

(i) Janitorial and utility support.

Section 22. Injunctive Relief. The Office of Inspector General shall refer instances where administrative penalties and legal sanctions have failed to prevent or cause a discontinuance of a violation of KRS Chapter 216B to the secretary of the cabinet for action in accordance with KRS 15.241.

Section 23. Incorporation by Reference. (1) The Application for License to Operate an Abortion Facility, L&R 240 (7/98), is incorporated by reference.

(2) This material may be inspected, copied or obtained at the Office of Inspector General, Division of Licensing and Regulation, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (25 Ky.R. 1293; Am. 2168; 2388; eff. 3-17-99.)

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