RULES OF ALABAMA STATE BOARD OF HEALTH ALABAMA
RULESOFALABAMA STATE BOARD OF HEALTHALABAMA DEPARTMENT OF PUBLIC HEALTHCHAPTER 420-5-7HOSPITALSREPEALED AND NEW RULE September 28, 2012AMENDED August 26, 2013STATE OF ALABAMADEPARTMENT OF PUBLIC HEALTHMONTGOMERY, ALABAMA
ALABAMA STATE BOARD OF HEALTH DIVISIONOF LICENSURE AND CERTIFICATIONADMINISTRATIVE CODECHAPTER 420-5-7HOSPITALS TABLE 5-7-.27Appendix AGeneral ProvisionsThe LicenseClassification of HospitalsThe Governing AuthorityPatient RightsPersonnelPhysical EnvironmentPatient TransportMedical StaffQuality Assurance or Quality Assessmentand Performance Improvement (QAPI)ProgramNursing ServicesInfection ControlMedical Record ServicesFood and Dietetic ServicesEmergency ServicesPharmaceutical ServicesSurgical ServicesAnesthesia ServicesRadiologic ServicesLaboratory ServicesNuclear Medicine ServicesRehabilitation ServicesRespiratory Care ServicesOutpatient ServicesDischarge PlanningPsychiatric HospitalsEmergency PreparednessInformation on the Application Processfor Hospitals
420-5-7-.01General Provisions.(1)Legal Authority for Adoption of Rules. Thefollowing rules for hospitals are adopted by the Alabama StateBoard of Health pursuant to §22-21-20, et seq., Code of Ala.1975.(2)Definitions(a)Authorized Bed Capacity means the number of beds ahospital has available for inpatient care. A hospital may byapplication designate its authorized bed capacity, not to exceedits licensed bed capacity. The term, “Authorized Bed Capacity,”shall exclude beds intended for ancillary usage such as laborbeds, recovery room beds and stretchers, and bassinets fornewborn infants. The authorized bed capacity is also the maximumdaily census that a hospital may have admitted in an in-patientcapacity. A hospital shall at all times have in place the actualbeds and all necessary ancillary equipment for individual patientcare equal to the number of its authorized bed capacity. Ahospital’s authorized bed capacity may be the same as itslicensed bed capacity, or it may be some smaller number, but itsauthorized bed capacity may never exceed its licensed bedcapacity.(b)Board or State Board of Health means the AlabamaState Board of Health.(c)Certified Registered Nurse Anesthetist (CRNA)means a registered nurse who meets the requirements and isapproved by the Alabama Board of Nursing to practice as a CRNA.(d)Clinical Psychologist means a person who holds adoctoral degree in psychology and who is currently licensed inAlabama at the independent practice level of psychology tofurnish diagnostic, assessment, preventive, and therapeuticservices directly to individuals.(e)Health.Department means the Alabama Department of Public(f)Governing Authority means owner(s), hospitalassociation, county hospital board, board of directors, board ofgovernors, board of trustees, or any other comparable designationof a body duly organized and constituted for the purpose ofowning, acquiring, constructing, equipping, operating, andmaintaining a hospital, and exercising control over the affairsof said hospital.(g)Hospital means a health institution planned,organized, and maintained for offering to the public, facilitiesand beds for use in the diagnosis and treatment of patients
requiring in-patient medical care, out-patient medical care, orother care performed by or under the supervision of physiciansdue to illness, disease, injury, deformity, abnormality, orpregnancy.(h)License means the legal authority to operate ahospital as defined above, to admit patients, and to offer andprovide care as permitted under these rules. A license may onlybe granted by the Board through the actions of its authorizedagents.(i)License Certificate means a document issued by theDepartment showing that the entity named on the document islicensed as a hospital. A license certificate shall contain thesignature of the State Health Officer and other seals andmarkings designed to demonstrate its authenticity. The licensecertificate shall be posted in a conspicuous place on thehospital premises.(j)Licensed Bed Capacity means the number of beds forwhich the facility has a certificate of need, and has been issueda certificate of licensure by the Department. The term “LicensedBed Capacity” shall exclude beds intended for ancillary usagesuch as labor beds, recovery room beds and stretchers, andbassinets for newborn infants.(k)Licensed Practical Nurse means a person who holdsan active license issued by the Alabama Board of Nursing.(l)Physician means a person currently licensed topractice medicine and/or surgery in Alabama under the provisionscontained in current state statutes.(m)Principal means an individual associated with agoverning authority or a license applicant in any of thefollowing capacities:1.Administrator, or equivalent;2.Chief Executive Officer, or equivalent;3.Owner of a controlling interest in the governingauthority, or, if the governing authority is a subsidiary ofanother business entity, owner of a controlling interest in theparent business entity;4.If no person has a controlling interest in thegoverning authority or in a parent corporation of the governingauthority, then an owner of ten percent or more of the governingauthority or of any business entity of which the governingauthority is a subsidiary.
(n)Registered Nurse means a person who holds anactive license issued by the Alabama Board of Nursing.Authors: W. T. Geary, Jr., M.D., Carter SimsStatutory Authority: Code of Ala. 1975, §§22-21-20, et seq.History: Filed September 1, 1982.Amended: Filed March 20, 1992.Amended: Filed May 20, 1994, effective June 24, 1994.Repealed and New Rule:Filed November 18, 1994; effectiveDecember 23, 1994.Amended: Filed January 19, 1996; effective February 23, 1996.Amended: Filed December 16, 1999; effective January 20, 2000.Repealed and New Rule: Filed August 24, 2012; effectiveSeptember 28, 2012.420-5-7-.02The License.(1)Classifications of Licenses. All licenses aregranted for the calendar year and shall expire on December 31 unlessrenewed by the owner for the succeeding year.(a)Unrestricted License. An unrestricted license maybe granted by the Board after it has determined that the hospital iswilling and capable of maintaining compliance with these rules.(b)Probational License. At its discretion, the Boardmay grant a probational license when it determines that both of thefollowing conditions exist:1.The hospital has engaged in one or more deficientpractices which are serious in nature, chronic in nature, or whichthe hospital has failed to correct.2.The hospital’s current governing authority hasdemonstrated the capability and willingness to correct citedproblems and to maintain compliance.(c)A probational license shall be granted for aspecific period which may be extended but which shall in no caseexceed one year.(2)Application.(a)Application. An applicant for initial licensureshall provide all information on the application form prescribed bythe Department, including all information required by law, theserules, and the policies and procedures of the Department, and shallsubmit such additional information as shall be required by theDepartment in its discretion to demonstrate that the applicant hasthe ability and the willingness to comply with these rules. Eachapplication shall be signed by the applicant, if the applicant is a
natural person, or, if the applicant is not a natural person, shallbe signed by a natural person who is authorized to bind theapplicant to the representations in the application and anysupporting documentation.(b)Fee. An initial license application, an applicationfor license renewal, an application for an increase in the number ofauthorized or licensed beds, or an application for a change inownership, shall be accompanied by the application fee specified in§22-21-24, Code of Ala. 1975. An application for a name change, anapplication for a decrease in authorized or licensed bed capacity,or an application for a relocation is not subject to a licenseapplication fee. An application fee is non-refundable. Anyapplication fee submitted in the incorrect amount shall neverthelessbe deposited. If the fee submitted is too large, a refund for thedifference shall be processed using the Department’s usualprocedures. If the fee submitted is too small, the applicant shallbe notified and the application shall not be considered until thedifference is received. Any application submitted without any feeshall be returned to the applicant. If an incomplete application issubmitted, the application fee shall be deposited, and the applicantshall be notified in writing of the defects in the application. Ifthe applicant fails to submit all required additional informationwithin 10 working days of the date of the notice, the applicationshall be denied. The Department may in its discretion extend thedeadline for submitting additional information. Denial of anapplication as incomplete shall not prejudice the applicant fromsubmitting a new application, accompanied by the requisite fee, at afuture date.(c)Name of Facility. Every hospital shall have aunique name. No hospital shall change its name without firstapplying for a change of name approval nor shall it change its nameuntil such approval is granted. The Department may in itsdiscretion deny an initial hospital application or an applicationfor a change of name if the Department determines that the proposedname is misleading to the public or that the name is overly similarto the name of an already licensed hospital. Separately licensedhospitals owned by the same governing authority may have names thatare similar to one another and distinguished from one another insome other manner, such as a geographic description. No hospitallicensed on the date these rules are adopted shall be required tochange its name as a result of this rule provision. If an initialhospital application is denied under this rule provision, theapplicant shall be provided a reasonable period of time to submit arevised application with a different name.(d)Number of Beds. Each application for license shallspecify the bed capacity the facility seeks to have approved by theDepartment.1.A hospital shall specify on an application forlicensure its licensed bed capacity and its designated authorized
bed capacity. The designated authorized bed capacity shall notexceed the licensed bed capacity.2.A hospital shall have available for inpatient careat all times the total number of beds designated as its authorizedbed capacity.3.A hospital desiring to change its authorized bedcapacity shall submit an application to the Department.4.The hospital’s license certificate from theDepartment shall set forth its licensed bed capacity and itsauthorized bed capacity.5.No hospital may have licensed beds in excess ofthose specified on its certificate of need.6.In the event of a natural disaster or othercatastrophic emergency, the Department may grant a temporary bedincrease to any hospital for reasons of public health or publicsafety. A temporary bed increase may be granted only for aspecified number and shall expire by its terms after a specific,finite period of time.(e)How to Obtain Applications. Information on how toobtain applications and where to submit applications is contained inthe appendix to these rules.(3)Licensing.(a)License. If an applicant submits a timely andcomplete application accompanied by the appropriate license fee andany supporting documentation that may be required by the Department,and if the Department is satisfied on the basis of the applicationthat the applicant is willing and capable ofcompliance with these rules, and if granting such a license wouldnot violate any other state or federal law or regulation, thenthe Department, as agent for the Board, may grant a license to theapplicant.All licenses granted shall expire at midnight onDecember 31 of the year in which the license is granted. TheDepartment, as agent for the Board, may deny a license.A licenseshall only be valid at the licensed premises and for the individualor business entity licensed.It is a condition of licensure thatthe licensee must continuously occupy the licensed premises andremain open to the public as a hospital, fully staffed and otherwisecapable of admitting and treating patients. If a hospital fails toremain open and staffed as required for 30 days, its license shallbecome void.If a licensee abandons the licensed premises, thelicense shall immediately become void.(b)License Renewal. Licenses may be renewed by theapplicant as a matter of course upon submission of a completedrenewal application and payment of the required fee.When the
Department has served written notice on the hospital of its intentto revoke or downgrade the license, a renewal applicationshall be filed but does not affect the proposed adverse licensureaction.(c)License Certificate. A license certificate shall beissued by the Department to every successful initial licensureapplicant and to every successful renewal applicant.It shallset forth the name and physical address of the hospital, the name ofthe governing authority, the type of hospital, the expiration dateof the license, the hospital’s licensed bed capacity, and itsauthorized bed capacity.(d)Change of Ownership. A hospital license is nottransferrable. In the event that the legal ownership of the right tooccupy a hospital’s premises is transferred to an individualor entity other than the licensee, the hospital license shall becomevoid and continued operation of the hospital shall be unlawfulpursuant to §22-21-22, Code of Ala. 1975, and subject to penaltiesas provided in §22-21-33, Code of Ala. 1975, unless an applicationfor a change of ownership has been submitted to and approved by theDepartment prior to the transfer of legal ownership. An applicationfor change of ownership shall be submitted on the form prescribed bythe Department, shall be accompanied by the requisite applicationfee set forth in §22-21-24, Code of Ala. 1975, and shall be subjectto the same requirements and considerations as are set forth abovefor initial license applications. An application for a change ofownership shall be submitted and signed by the prospective newlicensee, or its agent, and also either signed by the currentlicensee or its agent, or accompanied by a court orderdemonstrating that the current licensee has been dispossessed ofthe legal right to occupy the premises and that the prospectivenew licensee has been awarded the legal right to occupy thepremises. Upon approval of a change of ownership, the Departmentshall notify the current licensee and the new license applicant,and shall issue a license certificate to the new licensee.Indicia of ownership of a hospital include the right to hire,terminate, and to determine the compensation and benefits paid tothe hospital’s administrator and other staff, the right toreceive payment from patients and third parties for servicesprovided by the hospital, the right to establish and to change thepolicies, procedures, and protocols under which the hospitaloperates, and the right to overrule operational decisions made bythe hospital administrator and other staff.(e)Change in Bed Capacity. A hospital may apply for achange in licensed bed capacity or authorized bed capacity bysubmitting a completed application on a form prescribed by theDepartment and, for a change in licensed bed capacity, accompaniedby the fee prescribed in §22-21-24, Code of Ala. 1975, together withsuch other documentation as the Department may require, which shallinclude Certificate of Need approval or a letter of non-
reviewability if the application is for an increase in the number oflicensed beds. Upon approval of a change of bed capacity, theDepartment shall notify the licensee and shall issue a revisedlicense certificate to the licensee, which may be predicated on thereturn of the old license certificate.(f)Change of Name. A hospital may apply for a change ofname by submitting a completed application on a formprescribed by the Department. There is no application fee for achange of name application. The Department may in its discretiondeny an application for a change of name if the Departmentdetermines that the proposed name is misleading to the public orthat the name is overly similar to the name of an alreadylicensed hospital. Separately licensed hospitals owned by the samegoverning authority may have names that are similar to one anotherand distinguished from one another in some other manner, such as ageographic description. Upon approval of a change of name, theDepartment shall notify the licensee and shall issue a revisedlicense certificate to the licensee, which may be predicated on thereturn of the old license certificate.(g)Relocation. A hospital license is valid only at thepremises stated on the most recent license application or renewalapplication, and recited as a physical address on the currenthospital license certificate. Prior to physically relocating ahospital, the licensee of the hospital shall submit a relocationapplication to the Department on a form prescribed by theDepartment. Upon approval of a change of address, the Departmentshall notify the licensee and shall issue a revised licensecertificate to the licensee, which may be predicated on the returnof the old license certificate.(h)Single Campus Requirement. A hospital’s campus shallconsist of the premises occupied by the hospital’s largest buildingtogether with all parcels of property that the hospital’s governingauthority owns or has the legal right to occupy and which are notseparated from the remainder of the campus by anything other than apublic right of way. All hospital services required by these rulesshall be offered on-campus.So long as it does not violate anyother law or legal requirement, a hospital’s governing authority mayoffer any health care services other than a reference laboratory onthe hospital campus without the need for additional licensure fromthe Board, even if such services would require licensure if offeredby a free-standing facility. A hospital may, however, elect to seeklicensure for such a facility located on its campus.Suchservices shall remain under the control and supervision of thegoverning authority. All on-campus facilities and services aresubject to the rules of the Board, including applicable life safetycode, building, and plan review requirements. If the hospitaloperates a facility away from its campus that would require separatelicensure if not provider-based, such as an end stage renal dialysiscenter or a rehabilitation center, then that facility must beseparately licensed and meet all licensure requirements for that
type of facility. A hospital may operate any facility that does notrequire separate licensure away from its campus, but if thehospital bills Medicare or Medicaid under its hospital providernumber for services provided in the off-campus facility, that offcampus facility shall be deemed to be part of the hospital forlicensure purposes and shall be subject to the rules of theBoard, including applicable life safety code, building, and planreview requirements. No part of a hospital may be more than 35 milesfrom its campus. Provided, however, that this subsectionis not intended to authorize the operation of an off-campusemergency department or multiple non-contiguous hospitals to operateunder a single license.(i)Denial of a License1.The Board may deny a license to any applicant ongrounds of insufficient evidence of the willingness or ability tocomply with §§22-21-20 through 22-21-34, Code of Ala. 1975, or theserules, including the following reasons:(i)The applicant or any principal associated with theapplicant has violated any provision of §§22-21-20
§22-21-24, Code of Ala. 1975 . An application for a name change, an application for a decrease in authorized or licensed bed capacity, or an application for a relocation is not subject to a license application fee. An application fee is non-refundable. Any application fee submitted
David Rountree, Alabama Public Service Commission david.rountree@psc.alabama.gov (334) 242-5194 Mac Sadler, Alabama Department of Revenue mac.sadler@revenue.alabama.gov (334) 242-1498 DeLois Thigpen, Alabama Executive Budget Office delois.thigpen@budget.alabama.gov (334) 242-7245 Tammy Wallace, Alabama State Board
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