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time of its initial application for licensure as a critical access hospital. (c) An applicant for licensure as a critical access hospital must submit the following as part of its initial application:

(1) a description of the area to be served by the applicant;

(2) a community needs assessment analyzing the availability and utilization of health care services in the applicant’s service area, including acute care, primary care, and emergency services, and a discussion of how conversion to a critical access hospital will better serve community needs;

(3) the applicant’s plan for the delivery of health services within the applicant’s service area;

(4) a financial feasibility study that analyzes the financial impact on the applicant of conversion to a critical access hospital, taking into account relevant operational factors, including changes in utilization, services, staffing, and Medicare reimbursement;

(5) a community education plan that describes the steps that have been or will be taken to educate and involve the residents of the service area in the decision to convert to a critical access hospital;

(6) an emergency services plan that coordinates the provision of emergency medical services in the applicant’s service area;

(7) a description of the volume capacity of the applicant and other related health care resources within the applicant’s service area;

(8) the distance and travel time to other health care resources within the applicant’s service area;

(9) identification of barriers to accessing health care in the applicant’s service area. (d) A critical access hospital must reapply for licensure under this section and provide updates, as applicable, to the information required under (c) of this section, if the hospital proposes to change the hospital’s

(1) onsite or on-call medical staff to provide only mid-level practitioners; or

(2) hours of operation to less than 24 hours per day when no inpatients are in the facility. (e) In addition to the requirement of reapplication for licensure under (d) of this section, if a critical access hospital proposes to change its hours of operation to less than 24 hours per day, each day of the year, the hospital must

(1) revise the emergency medical services plan submitted under (c)(6) of this section to ensure that, at a minimum, a registered nurse will be available at the hospital’s emergency room to receive patients delivered by emergency medical services personnel; and