Agency for Healthcare Administration says rural emergency hospital rules adopted; 83 non‑emergent care plans submitted, 63 approved

Kimberly Smoak, deputy secretary for the Agency for Healthcare Administration, told the Senate Health Policy Committee that the agency has adopted state rules to implement the federal rural emergency hospital designation and that hospitals have begun submitting required non‑emergent care access plans (NCAPs).

Smoak said the agency created a new hospital classification in state licensure rules to mirror the federal rural emergency hospital option created by the Consolidated Appropriations Act of 2021. The rules, which Smoak said were adopted and effective June 1, 2025, set out criteria — including a 50‑bed cap, 24/7 rural emergency services and required transfer agreements with Level I or II trauma centers — for hospitals seeking the designation.

"We have the rules and requirements," Smoak told the committee. "Right now in the state, we do not have any rural emergency hospitals designated." She said the state survey agency will perform federal and state surveys for any applicants because no national accreditor had been identified to handle those surveys on CMS's behalf.

Smoak then described non‑emergent care access plans, required by provisions in Senate Bill 7016. The plans must be submitted with hospital licensure renewals and include patient education about appropriate care settings, procedures to connect patients without primary care to community resources (for example, urgent care centers or federally qualified health centers), and processes for managed‑care coordination for Medicaid members.

Smoak gave examples from plans the agency reviewed: one hospital’s plan included a one‑page infographic explaining when to seek emergency care; another reported sending discharged patients a text message within three days that linked to local primary‑care resources; and one promising plan said the hospital would assist the patient in scheduling a primary‑care appointment.

On early implementation, Smoak told the committee the agency has received 83 NCAP submissions since July 1; 63 have been approved and 20 remain in the licensure review process. "When we receive a licensure application, we have 30 days to review it," she said.

Committee members asked about the technical capacity to carry out the data exchanges and referrals the plans require. Smoak said the state uses a health information exchange (HIE) encounter notification service to share admit/transfer/discharge data; she added the state recently transitioned to a new HIE vendor ("Chris Shared Services") and offered to follow up with more details on capacity and implementation issues.

Senators also asked whether existing rural hospitals are likely to convert to the new federal designation. Smoak cited one hospital that had expressed interest — North Walton Hospital — and said the agency is ready to work with any hospital that chooses to apply. She noted financial incentives on the Medicare side may make the designation attractive for some hospitals.

The committee also discussed federal funding opportunities. Smoak said the agency intends to apply for the federal Rural Health Transformation Fund described in recent federal legislation and that staff had recently engaged with federal officials in Washington.

The agency offered to continue providing data to the committee as the NCAP renewals and licensure reviews produce more operational information.

The committee paused the presentation for questions and planned to take public testimony after the second agency presentation.