AN ACT relating to respiratory care.

Reproduced from the official legislative record. Confirm the current text and status at the official source.

UNOFFICIAL COPY 26 RS BR 910 Page 1 of 52 XXXX 2/18/2026 10:54 AM Jacketed AN ACT relating to respiratory care.1

Be it enacted by the General Assembly of the Commonwealth of Kentucky:2 SECTION 1. A NEW SECTION OF KRS CHAPTER 314A IS CREATED TO3 READ AS FOLLOWS:4 An advanced practice respiratory therapist who is employed by a health facility as5 defined in KRS 216B.015 may determine whether or not a patient is dead in6 accordance with the requirements of KRS 446.400. The advanced practice respiratory7 therapist shall notify the patient's attending physician or other appropriate practitioner8 of the death in accordance with the facility's policy. The advanced practice respiratory9 therapist is authorized to sign the provisional report of death as furnished by the state10 registrar of vital statistics.11 SECTION 2. KRS 314A.010 IS REPEALED AND REENACTED TO READ12 AS FOLLOWS:13 As used in this chapter:14 (1) "Accredited program" means a training program accredited by CoARC that15 qualifies the graduate to sit for the registry examination or the entry level16 examination administered by NBRC or its equivalent;17 (2) "Advanced practice respiratory care" means the performance of services by an18 advanced practice respiratory therapist, under prospective medical direction, in19 the diagnosis and treatment of patients with cardiopulmonary diseases or20 conditions in a setting in which the advance practice respiratory therapist is21 engaged in providing direct patient care, including prescribing legend drugs, and22 ordering, administering, and directing the administration of drugs, treatments,23 and medical devices;24 (3) "Advanced practice respiratory therapist" means an individual who holds a25 current and active license issued pursuant to this chapter that authorizes the26 practice of advanced practice respiratory care;27 UNOFFICIAL COPY 26 RS BR 910 Page 2 of 52 XXXX 2/18/2026 10:54 AM Jacketed (4) "Board" means the Kentucky Board of Respiratory Care;1 (5) "Certification period" means an uninterrupted two (2) year period ending on2 December 31 of the year preceding a licensee's renewal deadline. The3 certification period is established as the timeframe for each applicant or licensee4 to earn any required continuing education;5 (6) "CoARC" means the Commission on Accreditation for Respiratory Care or its6 equivalent;7 (7) "Continuing education" means educational activities primarily designed to keep8 respiratory therapists and advanced practice respiratory therapists informed of9 developments in the respiratory care field or any special areas of practice10 engaged in by those persons;11 (8) "Direct supervision" means supervision of a student respiratory therapist by a12 respiratory therapist or an advanced practice respiratory therapist with a current13 and active license issued pursuant to this chapter who shall be on the premises14 where respiratory care services are provided and available for immediate15 consultation at all times the student respiratory therapist is engaged in direct16 patient care;17 (9) "Documented competency" means adherence to guidelines established by health18 facilities, medical staff, or accreditation agencies. These guidelines shall be in19 accordance with national standards of practice deemed appropriate by the20 American Association for Respiratory Care or its equivalent;21 (10) "Expired" means a licensure status that applies to a licensee following a22 licensee’s failure to file a timely and complete renewal application;23 (11) "Inactive" means a licensure status that applies to a licensee who:24 (a) Made a successful initial application to place his or her license in inactive25 status; or26 (b) Filed a timely renewal application with the appropriate fee indicating the27 UNOFFICIAL COPY 26 RS BR 910 Page 3 of 52 XXXX 2/18/2026 10:54 AM Jacketed licensee’s request to renew his or her inactive status;1 (12) "Legend drug" means any drug defined by the Federal Food, Drug and Cosmetic2 Act, as amended, to require its label to bear the statement "Caution: Federal law3 prohibits dispensing without prescription";4 (13) "License" or "licensure" means the board's official authorization to practice5 respiratory care for the time specified by the board in accordance with this6 chapter;7 (14) "Medical director" means a licensed physician who is knowledgeable in the8 diagnosis, treatment, and assessment of respiratory problems and whose9 responsibilities are established by statutes and administrative regulations10 governing the operation of facilities licensed under KRS Chapter 216B, as well as11 statutes and administrative regulations dealing with hospice, home health, and12 other settings where respiratory care services may be delivered;13 (15) "NBRC" means the National Board for Respiratory Care, Incorporated, or its14 equivalent;15 (16) "Physiologic ventilatory support" means to bring fresh air for gas exchange into16 the lungs and to allow for the exhalation of air that contains carbon dioxide;17 (17) "Practice of respiratory care" means the procedures employed in the therapy,18 management, rehabilitation, gathering of assessment information, or other19 procedures administered to patients with deficiencies or abnormalities that affect20 their cardiopulmonary system and associated aspects of cardiopulmonary and21 other system functions. This includes but is not limited to the:22 (a) Provision of respiratory care procedures to ensure the safety, comfort,23 personal hygiene, and protection of patients, and the performance of24 disease prevention and restorative measures;25 (b) Administration of pharmacologic and therapeutic agents related to the26 cardiopulmonary care necessary for treatment, disease prevention, or27 UNOFFICIAL COPY 26 RS BR 910 Page 4 of 52 XXXX 2/18/2026 10:54 AM Jacketed rehabilitation regimes prescribed by a physician, physician assistant,1 advanced practice registered nurse, or advanced practice respiratory2 therapist;3 (c) Observation of signs and symptoms of cardiopulmonary illness, reactions to4 treatment, or general physical condition, along with a determination of5 whether these signs, symptoms, reactions, behavior, or general appearance6 exhibit abnormal characteristics;7 (d) Performance of standard procedures according to observed abnormalities,8 or reporting them to the physician in charge or other caretakers; and9 (e) Initiation of standard or emergency procedures;10 (18) "Prospective medical direction" means protocols, guidelines, training, and11 education for the setting in which the advance practice respiratory therapist is12 engaged to provide direct patient care, approved by the medical director for that13 setting or a physician designated by a medical director who provides care in that14 setting;15 (19) "Reactivation" means a licensee’s return to active status following a licensee’s16 application for reactivation or a licensee’s timely and complete renewal17 application requesting a return to active status. Only a licensee whose license is18 in inactive status may apply for reactivation of a license;19 (20) "Respiratory care" includes respiratory therapy, inhalation therapy, or other20 cardiopulmonary terms;21 (21) "Respiratory therapist" means a person who holds a current and active license22 issued pursuant to this chapter that authorizes the practice of respiratory care,23 and includes the following:24 (a) A "registered respiratory therapist," which means an individual who has:25 1. Successfully completed a training program accredited by CoARC;26 2. Successfully completed the registry examination for registered27 UNOFFICIAL COPY 26 RS BR 910 Page 5 of 52 XXXX 2/18/2026 10:54 AM Jacketed respiratory therapists administered by NBRC; and1 3. If credentialed after July 1, 2002, retained his or her credentialed2 status through ongoing compliance with NBRC continuing3 competency requirements applicable to registered respiratory4 therapists;5 (b) A "certified respiratory therapist," which means an individual who has:6 1. Successfully completed a training program accredited by CoARC;7 2. Successfully completed the entry level certification examination for8 certified respiratory therapists administered by NBRC; and9 3. If credentialed after July 1, 2002, retained his or her credentialed10 status through ongoing compliance with NBRC continuing11 competency requirements applicable to certified respiratory therapists;12 (c) An individual previously designated as a registered respiratory therapist or13 certified respiratory therapist who has not retained his or her credential14 through ongoing compliance with NBRC continuing competency15 requirements;16 (d) A "graduate respiratory therapist," which means an individual who:17 1. Has graduated from an approved educational program;18 2. Has been issued a temporary license by the board; and19 3. Is eligible to sit for the entry level certification examination that will20 be administered by NBRC; and21 (e) A "student respiratory therapist," which means an individual enrolled in an22 education and training program accredited by CoARC:23 1. For respiratory therapists and whose sponsoring educational24 institution assumes responsibility for the supervision of and services25 rendered by the student respiratory therapist while the student is26 functioning in a clinical training capacity; or27 UNOFFICIAL COPY 26 RS BR 910 Page 6 of 52 XXXX 2/18/2026 10:54 AM Jacketed 2. Who is also employed for compensation to provide respiratory care1 services as established in Section 6 of this Act; and2 (22) "Suspend" or "suspension" means a disciplinary action that requires a licensee3 to cease practice for a specified period, after which the licensee may return to4 active unrestricted practice without the necessity of a reinstatement or5 reactivation application.6 Section 3. KRS 314A.100 is amended to read as follows:7 (1) A respiratory therapist[care practitioner] may perform respiratory care procedures8 under medical direction with documented competency, in accordance with agency9 or facility guidelines and only in accordance with the prescription of a physician,10 physician assistant, advanced practice registered nurse, or advanced practice11 respiratory therapist. The procedures shall include[,] but not be limited to[,] the12 assessment and therapeutic use of the following:13 (a) Medical gases, exclusive of general anesthesia;14 (b) Aerosols, humidification, and environmental control systems;15 (c) Pharmacologic agents related to cardiopulmonary procedures, unless16 prohibited by the medical staff of the licensed health-care facility;17 (d) Mechanical or physiological ventilatory support;18 (e) Bronchopulmonary hygiene and[,] maintenance of the natural airways;19 (f) Insertion without cutting tissues and maintenance of artificial airways; and20 (g) Specific assessment and testing procedures such as drawing and analyzing of21 arterial blood gases employed in the medical measurement and monitoring of22 cardiac function as it relates to pulmonary pathophysiology.23 (2) The practice of respiratory care may be performed in hospitals or in other settings24 where respiratory care is to be provided in accordance with a prescription of a25 physician, physician assistant, advanced practice registered nurse, or advanced26 practice respiratory therapist. In addition, respiratory care may be provided during27 UNOFFICIAL COPY 26 RS BR 910 Page 7 of 52 XXXX 2/18/2026 10:54 AM Jacketed the transportation of a patient[,] or under any circumstances where an emergency1 necessitates respiratory care.2 (3) The respiratory therapist[care practitioner] may transcribe and implement[ a3 physician's] written or verbal orders of a physician, physician assistant, advanced4 practice registered nurse, or advanced practice respiratory therapist pertaining to5 the practice of respiratory care procedures as defined in this section.6 (4) The respiratory therapist's and advanced practice respiratory therapist's[care7 practitioner's] scope of practice shall include practice standards and guidelines as8 developed for their respective roles by the American Association for Respiratory9 Care[,] or its equivalent, and as incorporated by the board through promulgation of10 administrative regulations in accordance with KRS Chapter 13A.11 (5) An advanced practice respiratory therapist with documented competency may12 provide services and procedures under prospective medical direction and in13 accordance with protocols and guidelines beyond those allowed for a respiratory14 therapist, including, if related to cardiopulmonary care:15 (a) Patient assessment;16 (b) Care management;17 (c) Medication management;18 (d) Ordering the administration of airway tests;19 (e) Airway procedures;20 (f) Hemodynamic and diagnostic procedures;21 (g) Advanced cardiopulmonary procedures;22 (h) Education;23 (i) Prevention;24 (j) Continuity of care; and25 (k) Prescribing legend drugs to a patient following consideration of a complete26 medical history and bona fide medical examination.27 UNOFFICIAL COPY 26 RS BR 910 Page 8 of 52 XXXX 2/18/2026 10:54 AM Jacketed Section 4. KRS 314A.105 is amended to read as follows:1 (1) This chapter does not prohibit:2 (a) The performance of respiratory care which is an integral part of the program3 of study by students enrolled in an accredited program;4 (b) Self-care by the patient nor the gratuitous care by a friend or member of the5 family who does not represent or hold himself or herself out to be a6 respiratory therapist or advanced practice respiratory therapist[care7 practitioner];8 (c) Respiratory care services provided in the case of an emergency;9 (d) Persons from engaging in cardiopulmonary research;10 (e) The performance of respiratory care by trained paramedical personnel; and11 (f) Volunteer health practitioners providing services under KRS 39A.350 to12 39A.366.13 (2) Nothing in this section shall limit, preclude, or otherwise restrict the practices of14 other licensed personnel in carrying out their duties under the terms of their license.15 SECTION 5. KRS 314A.110 IS REPEALED AND REENACTED TO READ16 AS FOLLOWS:17 (1) To be eligible for initial licensure as a respiratory therapist, the applicant shall18 have a registered respiratory therapist (RRT) or certified respiratory therapist19 (CRT) credential issued by NBRC.20 (2) A temporary license may be issued by the board to a graduate respiratory21 therapist for a period not to exceed six (6) months from graduation. A temporary22 license is available only once per individual and is not eligible for renewal or23 reinstatement. The holder of a temporary license who does not successfully pass24 an NBRC entry-level certification examination within six (6) months shall cease25 and desist performing any services as a graduate respiratory therapist. Failure to26 comply shall subject the individual to prosecution for unlicensed practice.27 UNOFFICIAL COPY 26 RS BR 910 Page 9 of 52 XXXX 2/18/2026 10:54 AM Jacketed (3) (a) In order for a student respiratory therapist to be employed for compensation1 to provide respiratory care services, he or she shall apply to the board for a2 limited license to practice as a student respiratory therapist. The limited3 license shall permit the student respiratory therapist to perform respiratory4 care procedures for which he or she has received training under the direct5 supervision of a respiratory therapist or an advanced practice respiratory6 therapist who holds an active license issued by the board. The limited7 license to practice as a student respiratory therapist excludes the8 performance of continuous mechanical or physiological ventilatory support9 and blood gas analysis.10 (b) 1. The limited license to practice as a student respiratory therapist may11 be granted only to individuals actively enrolled in an accredited12 program and for a period not to exceed three (3) years.13 2. The holder of a limited license shall cease and desist performing any14 services as a student respiratory therapist immediately upon the15 cessation of active enrollment in the accredited program identified in16 the student respiratory therapist's licensure application for any17 reason.18 (c) The limited license is not required for individuals actively enrolled in an19 accredited program while performing uncompensated clinical activities20 required by the program.21 (4) Respiratory therapists duly authorized to practice in another state and in good22 standing in that state and with NBRC, and who have an RRT or a CRT credential23 or its equivalent, may be conferred a license by endorsement by the board if the24 requirements for licensure or certification in that state are substantially equal to25 the requirements of this section.26 (5) (a) A respiratory therapist applying for licensure who:27 UNOFFICIAL COPY 26 RS BR 910 Page 10 of 52 XXXX 2/18/2026 10:54 AM Jacketed 1. Received the NBRC CRT or RRT credential prior to July 1, 2002,1 shall retain his or her NBRC designation as a CRT or RRT; or2 2. Received the CRT or RRT credential from NBRC after July 1, 2002,3 shall retain his or her CRT or RRT credential as long as the4 respiratory therapist has fulfilled and maintained compliance with the5 NBRC's continuing competency program requirements.6 (b) Persons holding a license through the limited mechanism of grandfather7 status and those respiratory therapists receiving their CRT or RRT8 credential after July 1, 2002, who do not fulfill and maintain compliance9 with NBRC's continuing competency requirements shall solely be10 designated as respiratory therapists.11 (6) To be eligible for initial or renewal licensure as an advanced practice respiratory12 therapist, the applicant shall first have a current active respiratory therapist13 license issued by the board. The applicant shall also successfully complete a14 CoARC accredited graduate level education, a training program for advanced15 practice respiratory care, and shall successfully:16 (a) Complete an NBRC advanced practice respiratory therapist competency17 exam; or18 (b) Have and maintain all of the following credentials offered by NBRC:19 1. Registered respiratory therapist;20 2. Registered pulmonary function technologist;21 3. Adult critical care specialist;22 4. Certified asthma educator; and23 5. Neonatal pediatric respiratory care specialist.24 (7) Advanced practice respiratory therapists duly authorized to practice in other25 states and in good standing with the relevant state licensure entity and NBRC,26 and who have an RRT or a CRT credential or its equivalent, may be conferred an27 UNOFFICIAL COPY 26 RS BR 910 Page 11 of 52 XXXX 2/18/2026 10:54 AM Jacketed advanced practice respiratory therapist license by endorsement by the board if the1 requirements for licensure or certification in that state are substantially equal to2 the requirements of this section.3 Section 6. KRS 314A.112 is amended to read as follows:4 To be eligible for limited licensure to practice as a student respiratory5 therapist[mandatory certification as a respiratory care practitioner], the applicant shall6 meet the criteria established under this chapter and any administrative regulation7 promulgated to carry out[ the provisions of] this chapter. A limited license to practice as8 a student respiratory therapist shall not be reinstated or renewed. If an individual9 previously granted a limited license changes accredited programs or practice setting,10 the initial limited license shall be deactivated upon the cessation of enrollment in the11 initial accredited program or change of practice setting, and a separate application for12 a limited license to practice as a student respiratory therapist shall be required as a13 prerequisite for employment for compensation to provide respiratory care services.14 Section 7. KRS 314A.115 is amended to read as follows:15 A person applying for active status renewal of his or her respiratory therapist license or16 advanced practice respiratory therapist license[mandatory certificate] shall show17 evidence of completion of continuing professional education[ in respiratory care] as18 prescribed by the board in administrative regulations promulgated in accordance with19 KRS Chapter 13A.20 Section 8. KRS 314A.200 is amended to read as follows:21 (1) There is hereby created a Board of Respiratory Care which shall consist of seven22 (7) voting members appointed by the Governor:[.]23 (a) Four (4) members shall be respiratory therapists[care practitioners] holding24 an active license[a valid mandatory certificate] and practicing in Kentucky;25 (b) Two (2) members shall be pulmonologists who are licensed and practicing26 physicians in Kentucky; and27 UNOFFICIAL COPY 26 RS BR 910 Page 12 of 52 XXXX 2/18/2026 10:54 AM Jacketed (c) One (1) member shall be a citizen at large who is not associated with or1 financially interested in respiratory care.2 (2) Members shall be appointed to the board for terms of three (3) years, expiring on3 October 30 of the third year. A[No] person shall not be appointed to serve more4 than two (2) consecutive terms.5 (3) By May 30 of years in which the term of a respiratory therapist board member6 will[respiratory care practitioner terms] expire, the Kentucky Society for7 Respiratory Care shall submit to the Governor a list of names of candidates8 qualified for the appointment of respiratory therapist board member[care9 practitioner], in numbers not less than twice the numbers of appointments to be10 made, from which the Governor shall make each appointment or appointments by11 October 31 of that year. The Governor shall also appoint the pulmonologist and12 citizen at-large members by October 31 of any year in which a term expires.13 (4) A vacancy on the board shall be filled by the Governor as provided under14 subsection (1) of this section. The appointment shall be for the remaining portion of15 the member's term.16 (5) The Governor or board may remove a member from the board for cause or as17 provided under administrative regulations promulgated by the board in accordance18 with KRS Chapter 13A.19 (6) The board shall reorganize annually and select a chairperson. Four (4) voting20 members of the board shall constitute a quorum to do business. The board shall21 hold at least one (1) regular meeting each year. Additional meetings may be held22 upon the call of the chairperson or at the written request of any two (2) members of23 the board. All meetings of the board shall be open and public to the extent permitted24 by law, subject to KRS 61.805 to 61.850 and 61.870 to 61.884.25 Section 9. KRS 314A.205 is amended to read as follows:26 (1) The board shall administer, coordinate, and enforce[ the provisions of] this chapter,27 UNOFFICIAL COPY 26 RS BR 910 Page 13 of 52 XXXX 2/18/2026 10:54 AM Jacketed evaluate the qualifications of applicants, and may issue subpoenas, examine1 witnesses, and administer oaths, and shall investigate persons engaging in practices2 which violate[ the provisions of] this chapter.3 (2) The board shall conduct hearings in accordance with KRS Chapter 13B and keep4 records and minutes as shall be necessary to an orderly dispatch of business.5 (3) The board shall promulgate administrative regulations in accordance with KRS6 Chapter 13A to carry out[ the provisions of] this chapter.7 (4) Every person who holds a license[mandatory certificate] to practice respiratory care8 in this state shall be governed and controlled by the rules of professional conduct9 promulgated by the board.10 (5) The enumeration of specific powers elsewhere in this chapter shall not be construed11 as a limitation of the general powers conferred by this section.12 (6) The board shall fix appropriate and reasonable fees for licensure[mandatory13 certification,] and[ shall] periodically review and modify these fees as necessary.14 Section 10. KRS 314A.215 is amended to read as follows:15 (1) The board members shall receive a compensation of one hundred[fifty] dollars16 ($100)[($50)] per day for their services[,] and per diem and traveling expenses to17 the extent authorized by board policy.18 (2) The board shall employ and, at its pleasure, discharge a secretary and such19 attorneys, inspectors, clerks, and any other employees as shall be deemed20 necessary, and shall outline their duties and fix their compensation. The amount of21 per diem and mileage paid to employees shall be provided by board policy.22 (3) All money received by the board shall be deposited in the State Treasury into a23 separate trust fund for the board. The board shall be financed solely and24 individually from income accruing to it from fees, licenses[mandatory certificates],25 and other charges collected by the board.26 SECTION 11. KRS 314A.220 IS REPEALED AND REENACTED TO READ27 UNOFFICIAL COPY 26 RS BR 910 Page 14 of 52 XXXX 2/18/2026 10:54 AM Jacketed AS FOLLOWS:1 (1) The board shall issue a license to all applicants who meet the requirements of this2 chapter and who pay to the board the initial licensure fee prescribed by the board3 in administrative regulations promulgated in accordance with KRS Chapter 13A.4 (2) Licensure fees for a respiratory therapist license or advanced practice respiratory5 therapist license shall be prescribed by administrative regulation promulgated by6 the board in accordance with KRS Chapter 13A.7 (3) (a) Each respiratory therapist license or advanced practice respiratory therapist8 license shall expire on January 30 every two (2) years. All licenses not9 renewed by January 30 of the second year following the date of issuance10 shall be deemed expired.11 (b) Licensure of respiratory therapists and advanced practice respiratory12 therapists is subject to Section 7 of this Act. Licenses issued by the board13 shall expire and shall not be renewed in active status unless the renewal14 applicant attests to the board his or her compliance with Section 7 of this15 Act, including a statement regarding the total number of continuing16 education units earned during the certification period.17 (c) A person with an expired license who applies for reinstatement within five18 (5) years from the date of the expiration shall not be required to submit to19 any examination as a condition to reinstatement. A reinstatement applicant20 shall show compliance with the current continuing education requirement21 in force at the time of the license reinstatement application.22 (d) A person shall not practice respiratory care in this state unless the23 individual holds an active license.24 (e) A person with an expired license who seeks to return to active status after25 five (5) years from the date of expiration shall meet current standards for26 initial licensure, except for individuals who have fulfilled and maintained27 UNOFFICIAL COPY 26 RS BR 910 Page 15 of 52 XXXX 2/18/2026 10:54 AM Jacketed compliance with the NBRC's continuing competency requirements, who1 may apply for reinstatement of an expired license at any time pursuant to2 this chapter and the administrative regulations promulgated by the board in3 accordance with KRS Chapter 13A.4 (4) (a) A suspended license is subject to expiration and shall be renewed in inactive5 status in accordance with this chapter. The renewal shall not entitle the6 licensee, while the license remains suspended, to engage in the practice of7 respiratory care or in any other activity or conduct in violation of the8 suspension order.9 (b) A license revoked on disciplinary grounds shall not be renewed, and is10 subject to reinstatement during a five (5) year period from the date of the11 revocation order, pursuant to the terms of the revocation order, this chapter,12 and the administrative regulations promulgated by the board.13 (c) After five (5) years of revoked status, a licensee seeking to return to active14 status shall meet current standards for initial licensure, except for15 individuals who have fulfilled and maintained compliance with the NBRC's16 continuing competency requirements, who may apply for reinstatement of a17 revoked license at any time permitted pursuant to the terms of the18 revocation order, this chapter, and the administrative regulations19 promulgated by the board.20 (d) An applicant for reactivation shall provide evidence of continuing education21 in accordance with the administrative regulations promulgated by the22 board.23 (e) In a disciplinary order issued pursuant to Section 12 of this Act, the board24 may require individualized conditions for return to practice following a25 period of suspension or revocation.26 Section 12. KRS 314A.225 is amended to read as follows:27 UNOFFICIAL COPY 26 RS BR 910 Page 16 of 52 XXXX 2/18/2026 10:54 AM Jacketed (1) The board may refuse to issue a license[certificate], or may suspend, revoke,1 impose probationary conditions upon, impose an administrative fine, issue a written2 reprimand or admonishment, deny reactivation or reinstatement, or any3 combination thereof regarding any licensee[certificate holder] upon proof that the4 licensee[certificate holder] has:5 (a) Committed any crime, act of dishonesty, or corruption, if in accordance with6 KRS Chapter 335B. If the act constitutes a crime, conviction in a criminal7 proceeding is not a condition precedent to disciplinary action. Upon8 conviction of the crime, the judgment and sentence are presumptive evidence9 at the ensuing disciplinary hearing of the guilt of the licensee[certificate10 holder] or applicant. Conviction includes all instances in which a plea of no11 contest is the basis of conviction;12 (b) Misrepresented or concealed a material fact in obtaining, renewing or13 reinstating a license[certificate];14 (c) Committed any unfair, false, misleading, or deceptive act or practice;15 (d) Been incompetent or negligent in the practice of respiratory care;16 (e) Violated any state statute or administrative regulation governing the practice17 of respiratory care or any activities undertaken by a respiratory therapist or18 advanced practice respiratory therapist[care practitioner], which shall19 include violation of KRS 304.39-215 and conduct that is subject to the20 penalties under KRS 304.99-060(4) or (5);21 (f) Failed to comply with an order issued by the board or an assurance of22 voluntary compliance;23 (g) Violated the code of ethics as set forth in administrative regulations24 promulgated by the board; or25 (h) Violated any applicable provision of any federal or state law, if in accordance26 with KRS Chapter 335B.27 UNOFFICIAL COPY 26 RS BR 910 Page 17 of 52 XXXX 2/18/2026 10:54 AM Jacketed (2) One (1) year from the date of revocation, any person whose license[certificate] has1 been revoked may petition the board for reinstatement. The board shall investigate2 the petition and may reinstate the license[certificate] upon a finding that the3 individual has complied with any terms prescribed by that board and is again able to4 competently engage in the practice of respiratory care.5 (3) The board may reconsider, modify, or reverse its probation, suspensions, or other6 disciplinary actions.7 (4) The surrender, suspension, revocation, denial of reinstatement, or expiration of a8 license[certificate] shall not serve to deprive the board of jurisdiction to proceed9 with disciplinary action under this chapter.10 Section 13. KRS 314A.230 is amended to read as follows:11 (1) A treating respiratory therapist or advanced practice respiratory therapist[care12 practitioner] who provides or facilitates the use of telehealth shall ensure:13 (a) That the informed consent of the patient, or another appropriate person with14 authority to make the health care treatment decision for the patient, is15 obtained before services are provided through telehealth; and16 (b) That the confidentiality of the patient's medical information is maintained as17 required by this chapter and other applicable law. At a minimum,18 confidentiality shall be maintained through appropriate processes, practices,19 and technology as designated by the board and that conform to applicable20 federal law.21 (2) The board shall promulgate administrative regulations in accordance with KRS22 Chapter 13A to implement this section and as necessary to:23 (a) Prevent abuse and fraud through the use of telehealth services;24 (b) Prevent fee-splitting through the use of telehealth services; and25 (c) Utilize telehealth in the provision of respiratory care services and in the26 provision of continuing education.27 UNOFFICIAL COPY 26 RS BR 910 Page 18 of 52 XXXX 2/18/2026 10:54 AM Jacketed (3) For purposes of this section, "telehealth" means the use of interactive audio, video,1 or other electronic media to deliver health care. It includes the use of electronic2 media for diagnosis, consultation, treatment, transfer of health or medical data, and3 continuing education.4 Section 14. KRS 314A.990 is amended to read as follows:5 (1) Any person who violates[ any of the provisions of] this chapter shall be guilty of a6 misdemeanor punishable by imprisonment in the county jail not exceeding six (6)7 months, or by a fine not exceeding one thousand dollars ($1,000), or by both.8 (2) When any person other than a respiratory therapist or advanced practice9 respiratory therapist[care practitioner] holding a valid license[mandatory10 certificate] has engaged in any act or practice which constitutes an offense against11 this chapter, the Franklin Circuit Court, on application of the board, may issue an12 injunction or other appropriate order restraining such conduct.13 (3) For any violation of this chapter where the board may revoke, suspend, probate,14 reprimand, admonish, or fine a license or licensee in accordance with this15 chapter, or may deny licensure, reactivation, or reinstatement, the board may, in16 lieu of or in addition to other remedies, impose a civil penalty against the violator17 of not more than five thousand dollars ($5,000) per violation.18 Section 15. KRS 164.0401 is amended to read as follows:19 For the purposes of KRS 164.0401 to 164.0407:20 (1) "Council" means the Council on Postsecondary Education;21 (2) "Dedicated funds" means a gift, grant, or donation to the fund that is subject to22 restrictions imposed by a private grantor under KRS 164.0401 to 164.0407;23 (3) "Eligible healthcare credential" means:24 (a) An alcohol and drug counselor license, clinical alcohol and drug counselor25 license, clinical alcohol and drug counselor associate license, professional art26 therapist license, professional art therapist associate license, or community27 UNOFFICIAL COPY 26 RS BR 910 Page 19 of 52 XXXX 2/18/2026 10:54 AM Jacketed health worker certificate issued pursuant to KRS Chapter 309;1 (b) Any emergency medical services license or certificate issued pursuant to KRS2 Chapter 311A;3 (c) Any medical imaging, radiation, or other license issued pursuant to KRS4 Chapter 311B;5 (d) A dental hygienist or dental assistant license issued pursuant to KRS Chapter6 313;7 (e) Any nursing license or certificate issued pursuant to KRS Chapter 314 or8 registration as a state registered nursing aide with the Kentucky Board of9 Nursing;10 (f) A respiratory therapist license[care practitioner certificate] issued pursuant to11 KRS Chapter 314A;12 (g) Any psychology license or certificate issued pursuant to KRS Chapter 319;13 (h) Any occupational therapy license issued pursuant to KRS Chapter 319A;14 (i) Any behavior analyst license issued pursuant to KRS Chapter 319C;15 (j) Any physical therapy certificate or license issued pursuant to KRS Chapter16 327;17 (k) Any social worker, marriage and family therapist, or professional counselor18 certificate or license issued pursuant to KRS Chapter 335;19 (l) A physician assistant license issued pursuant to KRS Chapter 311; and20 (m) A dietitian license or nutritionist certificate issued pursuant to KRS Chapter21 310;22 (4) "Grantor" means an individual or an entity that gifts, grants, or donates moneys to23 the Kentucky healthcare workforce investment fund established in KRS 164.0402;24 (5) "Healthcare partner" means a grantor to the Kentucky healthcare workforce25 investment fund that is:26 (a) A healthcare provider as defined in KRS 367.4081;27 UNOFFICIAL COPY 26 RS BR 910 Page 20 of 52 XXXX 2/18/2026 10:54 AM Jacketed (b) A healthcare facility licensed by and operating in Kentucky;1 (c) A qualified mental health professional as defined in KRS 202A.011; or2 (d) Any healthcare or healthcare-related association, individual, or corporation3 doing business in and incorporated under the laws of the Commonwealth;4 (6) "Healthcare program" means an education or training program that is a specific5 requirement to an eligible healthcare credential, including but not limited to a high6 school healthcare vocational program;7 (7) "Historically underserved county" means a county of the Commonwealth with8 enhanced workforce demands, as demonstrated by:9 (a) Objective healthcare workforce data that demonstrates needs and demands10 upon its healthcare workforce that exceed the statewide average; and11 (b) Final unemployment figures calculated by the Department of Workforce12 Development demonstrating a countywide rate of unemployment that exceeds13 the statewide unemployment rate of the Commonwealth:14 1. In the most recent five (5) consecutive calendar years; or15 2. By two hundred percent (200%) in the most recent calendar year; and16 (8) "Kentucky resident" is a Kentucky resident as defined by the council pursuant to17 KRS 164.020(8).18 Section 16. KRS 216.2920 is amended to read as follows:19 As used in KRS 216.2920 to 216.2929, unless the context requires otherwise:20 (1) "Ambulatory facility" means an outpatient facility, including an ambulatory21 surgical facility, freestanding or mobile technology unit, or an urgent treatment22 center, that is not part of a hospital and that provides one (1) or more ambulatory23 procedures to patients not requiring hospitalization;24 (2) "Cabinet" means the Cabinet for Health and Family Services;25 (3) "Charge" means all amounts billed by a hospital or ambulatory facility, including26 charges for all ancillary and support services or procedures, prior to any adjustment27 UNOFFICIAL COPY 26 RS BR 910 Page 21 of 52 XXXX 2/18/2026 10:54 AM Jacketed for bad debts, charity contractual allowances, administrative or courtesy discounts,1 or similar deductions from revenue. However, if necessary to achieve comparability2 of information between providers, charges for the professional services of hospital-3 based or ambulatory-facility-based physicians shall be excluded from the4 calculation of charge;5 (4) "Facility" means any hospital, health care service, freestanding birthing center, or6 other health care facility, whether operated for profit or not;7 (5) "Health care provider" or "provider" means any pharmacist as defined pursuant to8 KRS Chapter 315, and any of the following independent practicing practitioners:9 (a) Physicians, osteopaths, and podiatrists licensed pursuant to KRS Chapter 311;10 (b) Chiropractors licensed pursuant to KRS Chapter 312;11 (c) Dentists licensed pursuant to KRS Chapter 313;12 (d) Optometrists licensed pursuant to KRS Chapter 320;13 (e) Physician assistants regulated pursuant to KRS Chapter 311;14 (f) Nurse practitioners licensed pursuant to KRS Chapter 314;[ and]15 (g) Advanced practice respiratory therapists licensed pursuant to KRS Chapter16 314A; and17 (h) Other health-care practitioners as determined by the Cabinet for Health and18 Family Services by administrative regulation promulgated pursuant to KRS19 Chapter 13A;20 (6) "Hospital" means a facility licensed pursuant to KRS Chapter 216B as either an21 acute-care hospital, psychiatric hospital, rehabilitation hospital, or chemical22 dependency treatment facility;23 (7) "Procedures" means those surgical, medical, radiological, diagnostic, or therapeutic24 procedures performed by a provider, as periodically determined by the cabinet in25 administrative regulations promulgated pursuant to KRS Chapter 13A as those for26 which reports to the cabinet shall be required. "Procedures" also includes27 UNOFFICIAL COPY 26 RS BR 910 Page 22 of 52 XXXX 2/18/2026 10:54 AM Jacketed procedures that are provided in hospitals or other ambulatory facilities, or those that1 require the use of special equipment, including fluoroscopic equipment, computer2 tomographic scanners, magnetic resonance imagers, mammography, ultrasound3 equipment, or any other new technology as periodically determined by the cabinet;4 (8) "Quality" means the extent to which a provider renders care that obtains for patients5 optimal health outcomes; and6 (9) "Secretary" means the secretary of the Cabinet for Health and Family Services.7 Section 17. KRS 216.380 is amended to read as follows:8 (1) The licensure category of critical access hospital is hereby created for existing9 licensed acute-care hospitals which qualify under this section for that status.10 (2) It shall be unlawful to operate or maintain a critical access hospital without first11 obtaining a license from the Cabinet for Health and Family Services. An acute-care12 hospital converting to a critical access hospital shall not require a certificate of13 need. A certificate of need shall not be required for services provided on a14 contractual basis in a critical access hospital. A certificate of need shall not be15 required for an existing critical access hospital to increase its acute-care bed16 capacity to twenty-five (25) beds.17 (3) Except as provided in subsection (4) of this section, only a hospital licensed as a18 general acute-care hospital may be relicensed as a critical access hospital if:19 (a) The hospital is located in a county in a rural area that is:20 1. Located more than a thirty-five (35) mile drive, or, where the terrain is21 mountainous or only secondary roads are available, located more than a22 fifteen (15) mile drive, from another acute-care hospital or critical23 access hospital; or24 2. Certified by the secretary as a necessary provider of health care services25 to area residents;26 (b) For the purposes of paragraph (a) of this subsection, a hospital shall be27 UNOFFICIAL COPY 26 RS BR 910 Page 23 of 52 XXXX 2/18/2026 10:54 AM Jacketed considered to be located in a rural area if the hospital is not in a county which1 is part of a standard metropolitan statistical area, the hospital is located in a2 rural census tract of a metropolitan statistical area as determined under the3 most recent modification of the Goldsmith Modification, or is designated by4 the state as a rural provider. The secretary shall designate a hospital as a rural5 provider if the hospital is not located in a county which has the largest county6 population of a standard metropolitan statistical area;7 (c) Except as provided in paragraph (d) of this subsection, the hospital provides8 not more than twenty-five (25) acute care inpatient beds for providing acute9 inpatient care for a period that does not exceed, as determined on an annual,10 average basis, ninety-six (96) hours; and11 (d) [If ]The hospital is operating swing beds under which the hospital's inpatient12 hospital facilities are used for the provision of extended care services, the13 hospital may be designated as a critical access hospital so long as the total14 number of beds that may be used at any time for furnishing of either extended15 care services or acute inpatient services does not exceed twenty-five (25)16 beds. For the purposes of this section, any bed of a unit of the hospital that is17 licensed as a nursing facility at the time the hospital applies to the state for18 designation as a critical care access hospital shall not be counted.19 (4) The secretary for health and family services may designate a facility as a critical20 access hospital if the facility:21 (a) Was a hospital that ceased operations on or after ten (10) years prior to April22 21, 2000; or23 (b) Was a hospital that was converted to a licensed ambulatory health center or24 other type of licensed health clinic or health center and, as of the effective25 date of that conversion, meets the criteria for licensure as a critical access26 hospital under this subsection or subsection (3) of this section.27 UNOFFICIAL COPY 26 RS BR 910 Page 24 of 52 XXXX 2/18/2026 10:54 AM Jacketed (5) A critical access hospital shall provide the following services:1 (a) Twenty-four (24) hour emergency-room care that the secretary determines is2 necessary for insuring access to emergency care services in each area served3 by a critical access hospital; and4 (b) Basic laboratory, radiologic, pharmacy, and dietary services. These services5 may be provided on a part-time, off-site contractual basis.6 (6) A critical access hospital may provide the following services:7 (a) Swing beds or a distinct unit of the hospital which is a nursing facility in8 accordance with KRS Chapter 216B and subject to approval under certificate9 of need;10 (b) Surgery;11 (c) Normal obstetrics;12 (d) Primary care;13 (e) Adult day health care;14 (f) Respite care;15 (g) Rehabilitative and therapeutic services including, but not limited to, physical16 therapy, respiratory therapy, occupational therapy, speech pathology, and17 audiology, which may be provided on an off-site contractual basis;18 (h) Ambulatory care;19 (i) Home health services which may be established upon obtaining a certificate20 of need; and21 (j) Mobile diagnostic services with equipment not exceeding the major medical22 equipment cost threshold pursuant to KRS Chapter 216B and for which there23 are no review criteria in the State Health Plan.24 (7) In addition to the services that may be provided under subsection (6) of this section,25 a critical access hospital may establish the following units in accordance with26 applicable Medicare regulations and subject to certificate of need approval:27 UNOFFICIAL COPY 26 RS BR 910 Page 25 of 52 XXXX 2/18/2026 10:54 AM Jacketed (a) A psychiatric unit that is a distinct part of the hospital, with a maximum of ten1 (10) beds; and2 (b) A rehabilitation unit that is a distinct part of the hospital, with a maximum of3 ten (10) beds notwithstanding any other bed limit contained in law or4 regulation.5 (8) Psychiatric unit and rehabilitation unit beds operated under subsection (7) of this6 section shall not be counted in determining the number of beds or the average7 length of stay of a critical access hospital for purposes of applying the bed and8 average length of stay limitations under paragraph (c) of subsection (3) of this9 section.10 (9) The following staffing plan shall apply to a critical access hospital:11 (a) The hospital shall meet staffing requirements as would apply under section12 1861(e) of Title XVIII of the Federal Social Security Act to a hospital located13 in a rural area except that:14 1. The hospital need not meet hospital standards relating to the number of15 hours during a day, or days during a week, in which the hospital shall be16 open and fully staffed, except insofar as the facility is required to make17 available emergency services and nursing services available on a18 twenty-four (24) hour basis; and19 2. The hospital need not otherwise staff the facility except when an20 inpatient is present; and21 (b) Physician assistants,[ and] nurse practitioners, and advanced practice22 respiratory therapists may provide inpatient care within the limits of their23 statutory scope of practice and with oversight by a physician who is not24 required to be on-site at the hospital.25 (10) A critical access hospital shall have a quality assessment and performance26 improvement program and procedures for review of utilization of services.27 UNOFFICIAL COPY 26 RS BR 910 Page 26 of 52 XXXX 2/18/2026 10:54 AM Jacketed (11) A critical access hospital shall have written contracts assuring the following1 linkages:2 (a) Secondary and tertiary hospital referral services which shall provide for the3 transfer of a patient to the appropriate level of care and the transfer of patients4 to the critical access hospital for recuperative care;5 (b) Ambulance services;6 (c) Home health services; and7 (d) Nursing facility services if not provided on-site.8 (12) If the critical access hospital is part of a rural health network, the hospital shall have9 the following:10 (a) An agreement for patient referral and transfer, development, and use of11 communications systems including telemetry and electronic sharing of patient12 data, and emergency and nonemergency transportation; and13 (b) An agreement for credentialing and quality assurance with a network hospital,14 peer review organization, or other appropriate and qualified entity identified15 in the state rural health plan.16 (13) The Cabinet for Health and Family Services and any insurer or managed care17 program for Medicaid recipients that contracts with the Department for Medicaid18 Services for the receipt of Federal Social Security Act Title XIX funds shall provide19 for reimbursement of services provided to Medicaid recipients in a critical access20 hospital at rates that are at least equal to those established by the Federal Health21 Care Financing Administration or Centers for Medicare and Medicaid Services for22 Medicare reimbursement to a critical access hospital.23 (14) The Cabinet for Health and Family Services shall promulgate administrative24 regulations pursuant to KRS Chapter 13A necessary to implement this section.25 Section 18. KRS 217.015 is amended to read as follows:26 For the purposes of KRS 217.005 to 217.215:27 UNOFFICIAL COPY 26 RS BR 910 Page 27 of 52 XXXX 2/18/2026 10:54 AM Jacketed (1) "Advertisement" means all representations, disseminated in any manner or by any1 means, other than by labeling, for the purpose of inducing, or which are likely to2 induce, directly or indirectly, the purchase of food, drugs, devices, or cosmetics;3 (2) "Bread" and "enriched bread" mean only the foods commonly known and described4 as white bread, white rolls, white buns, enriched white bread, enriched rolls, and5 enriched white buns, as defined under the federal act. For the purposes of KRS6 217.136 and 217.137, "bread" or "enriched bread" also means breads that may7 include vegetables or fruit as an ingredient;8 (3) "Cabinet" means the Cabinet for Health and Family Services or its designee;9 (4) "Color" means but is not limited to black, white, and intermediate grays;10 (5) "Color additive" means a material that:11 (a) Is a dye, pigment, or other substance made by a process of synthesis or similar12 artifice, or extracted, isolated, or otherwise derived, with or without13 intermediate or final change of identity, from a vegetable, animal, mineral, or14 other source. Nothing in this paragraph shall be construed to apply to any15 pesticide chemical, soil or plant nutrient, or other agricultural chemical solely16 because of its effect in aiding, retarding, or otherwise affecting, directly or17 indirectly, the growth or other natural physiological process of produce of the18 soil and thereby affecting its color, whether before or after harvest; or19 (b) When added or applied to a food, drug, or cosmetic, or to the human body or20 any part thereof, is capable, alone or through reaction with another substance,21 of imparting color. "Color additive" does not include any material that has22 been or may in the future be exempted under the federal act;23 (6) "Contaminated with filth" means any food, drug, device, or cosmetic that is not24 securely protected from dust, dirt, and as far as may be necessary by all reasonable25 means, from all foreign or injurious contaminants;26 (7) "Cosmetic" means:27 UNOFFICIAL COPY 26 RS BR 910 Page 28 of 52 XXXX 2/18/2026 10:54 AM Jacketed (a) Articles intended to be rubbed, poured, sprinkled, sprayed on, introduced into,1 or otherwise applied to the human body or any part thereof for cleansing,2 beautifying, promoting attractiveness, or altering the appearance; and3 (b) Articles intended for use as a component of those articles, except that the term4 shall not include soap;5 (8) "Device," except when used in subsection (48) of this section, KRS 217.035(6),6 KRS 217.065(3), KRS 217.095(3), and KRS 217.175(10), means instruments,7 apparatus, and contrivances, including their components, parts, and accessories,8 intended:9 (a) For use in the diagnosis, cure, mitigation, treatment, or prevention of disease10 in man or other animals; or11 (b) To affect the structure or any function of the body of man or other animals;12 (9) "Dispense" means to deliver a drug or device to an ultimate user or research subject13 by or pursuant to the lawful order of a practitioner, including the packaging,14 labeling, or compounding necessary to prepare the substance for that delivery;15 (10) "Dispenser" means a person who lawfully dispenses a drug or device to or for the16 use of an ultimate user;17 (11) "Drug" means:18 (a) Articles recognized in the official United States pharmacopoeia, official19 homeopathic pharmacopoeia of the United States, or official national20 formulary, or any supplement to any of them;21 (b) Articles intended for use in the diagnosis, cure, mitigation, treatment or22 prevention of disease in man or other animals;23 (c) Articles, other than food, intended to affect the structure or any function of the24 body of man or other animals; and25 (d) Articles intended for use as a component of any article specified in this26 subsection but does not include devices or their components, parts, or27 UNOFFICIAL COPY 26 RS BR 910 Page 29 of 52 XXXX 2/18/2026 10:54 AM Jacketed accessories;1 (12) "Enriched," as applied to flour, means the addition to flour of vitamins and other2 nutritional ingredients necessary to make it conform to the definition and standard3 of enriched flour as defined under the federal act;4 (13) "Environmental Pesticide Control Act of 1972" means the Federal Environmental5 Pesticide Control Act of 1972, Pub. L. 92-516, and all amendments thereto;6 (14) "Fair Packaging and Labeling Act" means the Fair Packaging and Labeling Act as it7 relates to foods and cosmetics, 15 U.S.C. secs. 1451 et seq., and all amendments8 thereto;9 (15) "Federal act" means the Federal Food, Drug and Cosmetic Act, 21 U.S.C. secs. 30110 et seq., 52 Stat. 1040 et seq., or amendments thereto;11 (16) "Filled milk" means any milk, cream, or skimmed milk, whether or not condensed,12 evaporated, concentrated, frozen, powdered, dried, or desiccated, to which has been13 added, or which has been blended or compounded with, any fat or oil other than14 milk fat, except the fat or oil of contained eggs and nuts and the fat or oil of15 substances used for flavoring purposes only, so that the resulting product is an16 imitation or semblance of milk, cream, skimmed milk, ice cream mix, ice cream, or17 frozen desserts, whether or not condensed, evaporated, concentrated, frozen,18 powdered, dried, or desiccated, whether in bulk or in containers, hermetically19 sealed or unsealed. This definition does not mean or include any milk or cream20 from which no part of the milk or butter fat has been extracted, whether or not21 condensed, evaporated, concentrated, powdered, dried, or desiccated, to which has22 been added any substance rich in vitamins, nor any distinctive proprietary food23 compound not readily mistaken for milk or cream or for condensed, evaporated,24 concentrated, powdered, dried, or desiccated milk or cream, if the compound is25 prepared and designed for the feeding of infants or young children, sick or infirm26 persons, and customarily used on the order of a physician, and is packed in27 UNOFFICIAL COPY 26 RS BR 910 Page 30 of 52 XXXX 2/18/2026 10:54 AM Jacketed individual containers bearing a label in bold type that the contents are to be used for1 those purposes; nor shall this definition prevent the use, blending, or compounding2 of chocolate as a flavor with milk, cream, or skimmed milk, desiccated, whether in3 bulk or in containers, hermetically sealed or unsealed, to or with which has been4 added, blended or compounded no other fat or oil other than milk or butter fat;5 (17) "Flour" means only the foods commonly known as flour, white flour, wheat flour,6 plain flour, bromated flour, self-rising flour, self-rising white flour, self-rising7 wheat flour, phosphated flour, phosphated white flour, and phosphated wheat flour,8 defined under the federal act;9 (18) "Food" means:10 (a) Articles used for food or drink for man or other animals;11 (b) Chewing gum; and12 (c) Articles used for components of any such article;13 (19) "Food additive" means any substance the intended use of which results or may be14 reasonably expected to result, directly or indirectly, in its becoming a component or15 otherwise affecting the characteristics of any food, including any substance16 intended for use in producing, manufacturing, packing, processing, preparing,17 treating, packaging, transporting, or holding food; and including any source of18 radiation intended for any of these uses, if the substance is not generally19 recognized, among experts qualified by scientific training and experience to20 evaluate its safety, as having been adequately shown through scientific procedures21 or, in the case of a substance used in a food prior to January 1, 1958, through either22 scientific procedures or experience based on common use in food to be safe under23 the conditions of its intended use; except that the term does not include:24 (a) A pesticide chemical in or on a raw agricultural commodity;25 (b) A pesticide chemical to the extent that it is intended for use or is used in the26 production, storage, or transportation of any raw agricultural commodity;27 UNOFFICIAL COPY 26 RS BR 910 Page 31 of 52 XXXX 2/18/2026 10:54 AM Jacketed (c) A color additive; or1 (d) Any substance used in accordance with a sanction or approval granted prior to2 the enactment of the Food Additives Amendment of 1958, pursuant to the3 federal act; the Poultry Products Inspection Act, 21 U.S.C. secs. 451 et seq.;4 or the Meat Inspection Act of 1907; and amendments thereto;5 (20) "Food processing establishment" means any commercial establishment in which6 food is manufactured, processed, or packaged for human consumption, but does not7 include retail food establishments, home-based processors, or home-based8 microprocessors;9 (21) "Food service establishment" means any fixed or mobile commercial establishment10 that engages in the preparation and serving of ready-to-eat foods in portions to the11 consumer, including but not limited to: restaurants; coffee shops; cafeterias; short12 order cafes; luncheonettes; grills; tea rooms; sandwich shops; soda fountains;13 taverns; bars; cocktail lounges; nightclubs; roadside stands; industrial feeding14 establishments; private, public or nonprofit organizations or institutions routinely15 serving food; catering kitchens; commissaries; charitable food kitchens; or similar16 places in which food is prepared for sale or service on the premises or elsewhere17 with or without charge. It does not include food vending machines, establishments18 serving beverages only in single service or original containers, or retail food stores19 which only cut, slice, and prepare cold-cut sandwiches for individual consumption;20 (22) "Food storage warehouse" means any establishment in which food is stored for21 subsequent distribution;22 (23) "Immediate container" does not include package liners;23 (24) "Imminent health hazard" means a significant threat or danger to health that is24 considered to exist when there is evidence sufficient to show that a product,25 practice, circumstance, or event creates a situation that requires immediate26 correction or cessation of operation to prevent illness or injury based on:27 UNOFFICIAL COPY 26 RS BR 910 Page 32 of 52 XXXX 2/18/2026 10:54 AM Jacketed (a) The number of potential illnesses or injuries; or1 (b) The nature, severity, and duration of the anticipated illness or injury;2 (25) "Interference" means threatening or otherwise preventing the performance of lawful3 inspections or duties by agents of the cabinet during all reasonable times of4 operation;5 (26) "Label" means a display of written, printed, or graphic matter upon the immediate6 container of any article; and a requirement made by or under authority of KRS7 217.005 to 217.215 that any word, statement, or other information appearing on the8 label shall not be considered to be complied with unless the word, statement, or9 other information also appears on the outside container or wrapper, if any there be,10 of the retail package of the article, or is easily legible through the outside container11 or wrapper;12 (27) "Labeling" means all labels and other written, printed, or graphic matter:13 (a) Upon an article or any of its containers or wrappers; or14 (b) Accompanying the article;15 (28) "Legend drug" means a drug defined by the Federal Food, Drug and Cosmetic Act,16 as amended, and under which definition its label is required to bear the statement17 "Caution: Federal law prohibits dispensing without prescription.";18 (29) "Meat Inspection Act" means the Federal Meat Inspection Act, 21 U.S.C. secs. 7119 et seq., 34 Stat. 1260 et seq., including any amendments thereto;20 (30) "New drug" means:21 (a) Any drug the composition of which is such that the drug is not generally22 recognized among experts qualified by scientific training and experience to23 evaluate the safety of drugs as safe for use under the conditions prescribed,24 recommended, or suggested in the labeling thereof; or25 (b) Any drug the composition of which is such that the drug, as a result of26 investigations to determine its safety for use under prescribed conditions, has27 UNOFFICIAL COPY 26 RS BR 910 Page 33 of 52 XXXX 2/18/2026 10:54 AM Jacketed become so recognized, but which has not, otherwise than in the investigations,1 been used to a material extent or for a material time under the conditions;2 (31) "Official compendium" means the official United States pharmacopoeia, official3 homeopathic pharmacopoeia of the United States, official national formulary, or4 any supplement to any of them;5 (32) "Person" means an individual, firm, partnership, company, corporation, trustee,6 association, or any public or private entity;7 (33) "Pesticide chemical" means any substance that alone in chemical combination, or in8 formulation with one or more other substances, is an "economic poison" within the9 meaning of the Federal Insecticide, Fungicide and Rodenticide Act and10 amendments thereto, and that is used in the production, storage, or transportation of11 raw agricultural commodities;12 (34) "Poultry Products Inspection Act" means the Federal Poultry and Poultry Products13 Inspection Act, 21 U.S.C. secs. 451 et seq., Pub. L. 85-172, 71 Stat. 441, and any14 amendments thereto;15 (35) "Practitioner" means medical or osteopathic physicians, dentists, chiropodists, and16 veterinarians who are licensed under the professional licensing laws of Kentucky to17 prescribe and administer drugs and devices. "Practitioner" includes optometrists18 when administering or prescribing pharmaceutical agents authorized in KRS19 320.240(12) to (14), advanced practice registered nurses as authorized in KRS20 314.011 and 314.042, physician assistants when administering or prescribing21 pharmaceutical agents as authorized in KRS 311.858, advanced practice22 respiratory therapists as authorized in Sections 2 and 3 of this Act, and health care23 professionals who are residents of and actively practicing in a state other than24 Kentucky and who are licensed and have prescriptive authority under the25 professional licensing laws of another state, unless the person's Kentucky license26 has been revoked, suspended, restricted, or probated, in which case the terms of the27 UNOFFICIAL COPY 26 RS BR 910 Page 34 of 52 XXXX 2/18/2026 10:54 AM Jacketed Kentucky license shall prevail;1 (36) "Prescription" means a written or oral order for a drug or medicine, or combination2 or mixture of drugs or medicines, or proprietary preparation, that is signed, given,3 or authorized by a medical, advanced practice registered nurse, advanced practice4 respiratory therapist, dental, chiropody, veterinarian, or optometric practitioner,5 and intended for use in the diagnosis, cure, mitigation, treatment, or prevention of6 disease in man or other animals;7 (37) "Prescription blank" means a document that conforms with KRS 217.216 and is8 intended for prescribing a drug to an ultimate user;9 (38) "Raw agricultural commodity" means any food in its raw or natural state, including10 all fruits that are washed, colored, or otherwise treated in their unpeeled natural11 form prior to marketing;12 (39) "Retail food establishment" means any food service establishment, retail food store,13 or a combination of both within the same establishment;14 (40) "Retail food store" means any fixed or mobile establishment where food or food15 products, including prepackaged, labeled sandwiches or other foods to be heated in16 a microwave or infrared oven at the time of purchase, are offered for sale to the17 consumer, and intended for off-premises consumption, but does not include18 establishments which handle only prepackaged, snack-type, nonpotentially19 hazardous foods, markets that offer only fresh fruits and vegetables for sale, food20 service establishments, food and beverage vending machines, vending machine21 commissaries, food processing establishments, or home-based processors;22 (41) "Salvage distributor" means a person who engages in the business of distributing,23 peddling, or otherwise trafficking in any salvaged merchandise;24 (42) "Salvage processing plant" means an establishment operated by a person engaged in25 the business of reconditioning, labeling, relabeling, repackaging, recoopering,26 sorting, cleaning, culling or who by other means salvages, sells, offers for sale, or27 UNOFFICIAL COPY 26 RS BR 910 Page 35 of 52 XXXX 2/18/2026 10:54 AM Jacketed distributes for human or animal consumption or use any salvaged food, beverage,1 including beer, wine and distilled spirits, vitamins, food supplements, dentifices,2 cosmetics, single-service food containers or utensils, containers and packaging3 materials used for foods and cosmetics, soda straws, paper napkins, or any other4 product of a similar nature that has been damaged or contaminated by fire, water,5 smoke, chemicals, transit, or by any other means;6 (43) "Second or subsequent offense" has the same meaning as it does in KRS 218A.010;7 (44) "Secretary" means the secretary of the Cabinet for Health and Family Services;8 (45) "Temporary food service establishment" means any food service establishment9 which operates at a fixed location for a period of time, not to exceed fourteen (14)10 consecutive days;11 (46) "Traffic" has the same meaning as it does in KRS 218A.010;12 (47) "Ultimate user" has the same meaning as it does in KRS 218A.010;13 (48) If an article is alleged to be misbranded because the labeling is misleading, or if an14 advertisement is alleged to be false because it is misleading, in determining whether15 the labeling or advertisement is misleading, there shall be taken into account,16 among other things, not only representations made or suggested by statement, word,17 design, device, sound, or in any combination thereof, but also the extent to which18 the labeling or advertisement fails to reveal facts that are material in the light of the19 representations or material with respect to consequences which may result from the20 use of the article to which the labeling or advertisement relates under the conditions21 of use prescribed in the labeling or advertisement thereof or under the conditions of22 use as are customary or usual;23 (49) The representation of a drug in its labeling or advertisement as an antiseptic shall be24 considered to be a representation that it is a germicide, except in the case of a drug25 purporting to be, or represented as, an antiseptic for inhibitory use as a wet26 dressing, ointment, dusting powder, or other use involving prolonged contact with27 UNOFFICIAL COPY 26 RS BR 910 Page 36 of 52 XXXX 2/18/2026 10:54 AM Jacketed the body;1 (50) The provisions of KRS 217.005 to 217.215 regarding the selling of food, drugs,2 devices, or cosmetics shall be considered to include the manufacture, production,3 processing, packing, exposure, offer, possession, and holding of those articles for4 sale, the sale, dispensing, and giving of those articles, and the supplying or applying5 of those articles in the conduct of any food, drug, or cosmetic establishment;6 (51) "Home" means a primary residence occupied by the processor, that contains only7 two (2) ranges, ovens, or double-ovens, and no more than three (3) refrigerators8 used for cold storage. This equipment shall have been designed for home use and9 not for commercial use, and shall be operated in the kitchen within the residence;10 (52) "Formulated acid food product" means an acid food in which the addition of a small11 amount of low-acid food results in a finished equilibrium pH of 4.6 or below that12 does not significantly differ from that of the predominant acid or acid food;13 (53) "Acidified food product" means a low-acid food to which acid or acidic food is14 added and which has a water activity value greater than 0.85, and a finished15 equilibrium pH of 4.6 or below;16 (54) "Low-acid food" means foods, other than alcoholic beverages, with a finished17 equilibrium pH greater than 4.6, and a water activity value greater than 0.85;18 (55) "Acid food" means foods that have a natural pH of 4.6 or below;19 (56) "Home-based processor" means a person who in his or her home, produces or20 processes non-potentially hazardous foods, including but not limited to dried herbs,21 spices, nuts, candy, dried grains, whole fruit and vegetables, mixed-greens, jams,22 jellies, sweet sorghum syrup, preserves, fruit butter, bread, fruit pies, cakes, or23 cookies, and who has a gross income of no more than sixty thousand dollars24 ($60,000) annually from the sale of the products;25 (57) "Home-based microprocessor" means a farmer who, in the farmer's home or26 certified or permitted kitchen, produces or processes foods, including but not27 UNOFFICIAL COPY 26 RS BR 910 Page 37 of 52 XXXX 2/18/2026 10:54 AM Jacketed limited to acid foods, formulated acid food products, acidified food products, or1 low-acid canned foods, and who has a gross income of no more than sixty thousand2 dollars ($60,000) annually from the sale of the product;3 (58) "Certified" means any person or home-based microprocessor who:4 (a) Has attended the Kentucky Cooperative Extension Service's microprocessing5 program or pilot microprocessing program and has been identified by the6 Kentucky Cooperative Extension Service as having satisfactorily completed7 the prescribed course of instruction; or8 (b) Has attended some other school pursuant to 21 C.F.R. sec. 114.10;9 (59) "Farmer" means a person who is a resident of Kentucky and owns or rents10 agricultural land pursuant to subsection (9) of KRS 132.010 or horticultural land11 pursuant to subsection (10) of KRS 132.010. For the purposes of KRS 217.136 to12 217.139, "farmer" also means any person who is a resident of Kentucky and has13 grown the primary horticultural and agronomic ingredients used in the home-based14 microprocessed products which they have produced; and15 (60) "Farmers market temporary food service establishment" means any temporary food16 service establishment operated by a farmer who is a member of the market which17 operates within the confines of a farmers market registered with the Kentucky18 Department of Agriculture for the direct-to-consumer marketing of Kentucky-19 grown farm products from approved sources for a period of time not to exceed two20 (2) days per week for any consecutive six (6) months period in a calendar year.21 Section 19. KRS 311.646 is amended to read as follows:22 (1) A health-care practitioner may prescribe injectable epinephrine devices and23 bronchodilator rescue inhalers in the name of an authorized entity or to a certified24 individual for use in accordance with this section.25 (2) A pharmacist may dispense injectable epinephrine devices and bronchodilator26 rescue inhalers pursuant to a prescription issued in the name of an authorized entity27 UNOFFICIAL COPY 26 RS BR 910 Page 38 of 52 XXXX 2/18/2026 10:54 AM Jacketed or to a certified individual.1 (3) The Department for Public Health, the Kentucky Board of Medical Licensure, the2 Kentucky Board of Nursing, the Kentucky Board of Respiratory Care, the3 American Red Cross, or other training programs approved by the Department for4 Public Health may conduct in-person or online[on-line] training for administering5 lifesaving treatment to persons believed in good faith to be experiencing severe6 allergic reactions and asthma symptoms or respiratory distress and issue a7 certificate of training to persons completing the training. The training shall include8 instructions for recognizing the symptoms of anaphylaxis and asthma and9 administering an injectable epinephrine device or a bronchodilator rescue inhaler.10 (4) An individual who has a certificate issued under this section may:11 (a) Receive a prescription for injectable epinephrine devices and bronchodilator12 rescue inhalers from a health-care practitioner;13 (b) Possess prescribed injectable epinephrine devices and bronchodilator rescue14 inhalers; and15 (c) In an emergency situation when a physician is not immediately available and16 the certified individual in good faith believes a person is experiencing a severe17 allergic reaction, asthma symptoms, or respiratory distress regardless of18 whether the person has a prescription for an injectable epinephrine device or a19 bronchodilator rescue inhaler or has previously been diagnosed with an20 allergy or asthma:21 1. Administer an injectable epinephrine device or a bronchodilator rescue22 inhaler to the person; and23 2. Provide an injectable epinephrine device or a bronchodilator rescue24 inhaler to the person for immediate self-administration.25 (5) An authorized entity that acquires and stocks a supply of injectable epinephrine26 devices or bronchodilator rescue inhalers with a valid prescription shall:27 UNOFFICIAL COPY 26 RS BR 910 Page 39 of 52 XXXX 2/18/2026 10:54 AM Jacketed (a) Store the injectable epinephrine devices and bronchodilator rescue inhalers in1 accordance with manufacturer's instructions and with any additional2 requirements established by the department; and3 (b) Designate an employee or agent who holds a certificate issued under this4 section to be responsible for the storage, maintenance, and general oversight5 of injectable epinephrine devices and bronchodilator rescue inhalers acquired6 by the authorized entity.7 (6) Any individual or entity who administers or provides an injectable epinephrine8 device to a person who is experiencing a severe allergic reaction shall contact the9 local emergency medical services system as soon as possible.10 (7) Any individual or entity who acquires and stocks a supply of injectable epinephrine11 devices in accordance with this section shall notify an agent of the local emergency12 medical services system and the local emergency communications or vehicle13 dispatch center of the existence, location, and type of the injectable epinephrine14 devices acquired if a severe allergic reaction has occurred.15 Section 20. KRS 353.510 is amended to read as follows:16 As used in KRS 353.500 to 353.720, unless the context otherwise requires:17 (1) "Department" means the Department for Natural Resources;18 (2) "Commissioner" means the commissioner of the Department for Natural Resources;19 (3) "Director" means the director of the Division of Oil and Gas as provided in KRS20 353.530;21 (4) "Commission" means the Kentucky Oil and Gas Conservation Commission as22 provided in KRS 353.565;23 (5) "Person" means any natural person, corporation, association, partnership, receiver,24 governmental agency subject to KRS 353.500 to 353.720, trustee, so-called25 common-law or statutory trust, guardian, executor, administrator, or fiduciary of26 any kind, federal agency, state agency, city, commission, political subdivision of27 UNOFFICIAL COPY 26 RS BR 910 Page 40 of 52 XXXX 2/18/2026 10:54 AM Jacketed the Commonwealth, or any interstate body;1 (6) "Correlative rights" means the reasonable opportunity of each person entitled2 thereto to recover and receive or receive, without waste, the oil and gas in and3 under or produced from a tract or tracts in which the person owns or controls an4 interest, or proceeds thereof;5 (7) "Oil" means natural crude oil or petroleum and other hydrocarbons, regardless of6 gravity, which are produced at the well in liquid form by ordinary production7 methods and which are not the result of condensation of gas after it leaves the8 underground reservoir;9 (8) "Gas" means all natural gas, including casinghead gas, and all other hydrocarbons10 not defined in subsection (7) of this section as oil;11 (9) "Pool" means:12 (a) An underground reservoir containing a common accumulation of oil or gas or13 both; or14 (b) An area established by the department or the commission as a pool.15 Each productive zone of a general structure which is completely separated from any16 other zone in the structure, or which for the purpose of KRS 353.500 to 353.72017 may be so declared by the department, is covered by the word "pool";18 (10) "Field" means the general area which is underlaid or appears to be underlaid by at19 least one (1) pool; and "field" includes the underground reservoir containing oil or20 gas or both. The words "field" and "pool" mean the same thing when only one (1)21 underground reservoir is involved; however, "field," unlike "pool," may relate to22 two (2) or more pools;23 (11) "Just and equitable share of production" means, as to each person, an amount of oil24 or gas or both substantially equal to the amount of recoverable oil and gas in that25 part of a pool underlying his tract or tracts;26 (12) "Abandoned," when used in connection with a well or hole, means a well or hole27 UNOFFICIAL COPY 26 RS BR 910 Page 41 of 52 XXXX 2/18/2026 10:54 AM Jacketed which has never been used, or which, in the opinion of the department, will no1 longer be used for the production of oil or gas or for the injection or disposal of2 fluid therein;3 (13) "Workable bed" means:4 (a) A coal bed actually being operated commercially;5 (b) A coal bed that the department decides can be operated commercially and the6 operation of which can reasonably be expected to commence within not more7 than ten (10) years; or8 (c) A coal bed which, from outcrop indications or other definite evidence, proves9 to the satisfaction of the commissioner to be workable, and which, when10 operated, will require protection if wells are drilled through it;11 (14) "Well" means a borehole:12 (a) Drilled or proposed to be drilled for the purpose of producing gas or oil;13 (b) Through which gas or oil is being produced; or14 (c) Drilled or proposed to be drilled for the purpose of injecting any water, gas, or15 other fluid therein or into which any water, gas, or other fluid is being16 injected;17 (15) "Shallow well" means any well drilled and completed at a depth of six thousand18 (6,000) feet or less except, in the case of any well drilled and completed east of19 longitude line 84 degrees 30', shallow well means any well drilled and completed at20 a depth of six thousand (6,000) feet or above the base of the lowest member of the21 Devonian Brown Shale, whichever is the deeper in depth;22 (16) "Deep well" means any well drilled and completed below the depth of six thousand23 (6,000) feet or, in case of a well located east of longitude line 84 degree 30', a well24 drilled and completed at a depth below six thousand (6,000) feet or below the base25 of the lowest member of the Devonian Brown Shale, whichever is deeper;26 (17) "Operator" means:27 UNOFFICIAL COPY 26 RS BR 910 Page 42 of 52 XXXX 2/18/2026 10:54 AM Jacketed (a) For a deep well, any owner of the right to develop, operate, and produce oil1 and gas from a pool and to appropriate the oil and gas produced therefrom,2 either for himself or for himself and others. In the event that there is no oil3 and gas lease in existence with respect to the tract in question, the owner of4 the oil and gas rights therein shall be considered as the royalty owner to the5 extent of the prevailing royalty in the oil and gas in that portion of the pool6 underlying the tract owned by the owner, and as operator as to the remaining7 interest in such oil and gas. In the event the oil is owned separately from the8 gas, the owner of the right to develop, operate, and produce the substance9 being produced or sought to be produced from the pool shall be considered as10 "operator" as to such pool; and11 (b) For a shallow well, any owner of the right to develop, operate, and produce oil12 and gas from a pool and to appropriate the oil and gas therefrom, either for13 himself or herself, or for himself or herself and others. If there is no oil and14 gas lease in existence with respect to the tract in question, the owner of the oil15 and gas rights therein shall be considered as operator to the extent of seven-16 eighths (7/8) of the oil and gas in that portion of the pool underlying the tract17 owned by the owner, and as a royalty owner as to the one-eighth (1/8) interest18 in the oil and gas. If the oil is owned separately from the gas, the owner of the19 right to develop, operate, and produce the substance being produced or sought20 to be produced from the pool shall be considered as operator as to the pool;21 (18) "Royalty owner" means any owner of oil and gas in place, or oil and gas rights, to22 the extent that the owner is not an operator as defined in subsection (17) of this23 section;24 (19) "Drilling unit" generally means the maximum area in a pool which may be drained25 efficiently by one (1) well so as to produce the reasonable maximum oil or gas26 reasonably recoverable in the area. Where the regulatory authority has provided27 UNOFFICIAL COPY 26 RS BR 910 Page 43 of 52 XXXX 2/18/2026 10:54 AM Jacketed rules for the establishment of a drilling unit and an operator, proceeding within the1 framework of the rules so prescribed, has taken the action necessary to have a2 specified area established for production from a well, the area shall be a drilling3 unit;4 (20) "Underground source of drinking water" means those subsurface waters identified5 as in regulations promulgated by the department which shall be consistent with the6 definition of underground source of drinking water in regulations promulgated by7 the Environmental Protection Agency pursuant to the Safe Drinking Water Act, 428 U.S.C. secs. 300(f) et seq.;9 (21) "Underground injection" means the subsurface emplacement of fluids by well10 injection but does not include the underground injection of natural gas for purposes11 of storage;12 (22) "Endangerment of underground sources of drinking water" means underground13 injection which may result in the presence in underground water, which supplies or14 can reasonably be expected to supply any public water system, of any contaminant15 and if the presence of the contaminant may result in the system's not complying16 with any national primary drinking water regulation or may otherwise adversely17 affect the health of persons;18 (23) "Class II well" means wells which inject fluids:19 (a) Which are brought to the surface in connection with conventional oil or20 natural gas production and may be commingled with waste waters from gas21 plants which are an integral part of production operations, unless those waters22 are classified as a hazardous waste at the time of injection;23 (b) For enhanced recovery of oil or natural gas; and24 (c) For storage of hydrocarbons which are liquid at standard temperature and25 pressure;26 (24) "Fluid" means any material or substance which flows or moves whether in a27 UNOFFICIAL COPY 26 RS BR 910 Page 44 of 52 XXXX 2/18/2026 10:54 AM Jacketed semisolid, liquid, sludge, gas, or any other form or state;1 (25) "Horizontal well" means a well, the wellbore of which is initially drilled on a2 vertical or directional plane and which is curved to become horizontal or nearly3 horizontal, in order to parallel a particular geological formation and which may4 include multiple horizontal or stacked laterals;5 (26) "Vertical well" means a well, the wellbore of which is drilled on a vertical or6 directional plane into a formation and is not turned or curved horizontally to allow7 the wellbore additional access to the oil and gas reserves in the formation;8 (27) "Prevailing royalty" means the royalty rate or percentage that the department or the9 commission determines is the royalty most commonly applicable with regard to the10 tract or unit in the issue. The royalty rate set by the department or the commission11 shall not be less than one-eighth (1/8) or twelve and one-half percent (12.5%);12 (28) "Best management practices" means demonstrated practices intended to control site13 runoff and pollution of surface water and groundwater to prevent or reduce the14 pollution of waters of the Commonwealth;15 (29) "Abandoned storage tank facility" means any aboveground storage tank or16 interconnected grouping of tanks that is no longer being actively used and17 maintained in conjunction with the production and storage of crude oil or produced18 water;19 (30) "Spill prevention, control, and countermeasure structures" means containment20 structures constructed around a storage facility to contain facility discharges;21 (31) "Landowner" means any person who owns real property where an abandoned22 storage tank facility is currently located;23 (32) "Chemical Abstracts Service" means the division of the American Chemical24 Society that is the globally recognized authority for information on chemical25 substances;26 (33) "Chemical abstracts service number" means the unique identification number27 UNOFFICIAL COPY 26 RS BR 910 Page 45 of 52 XXXX 2/18/2026 10:54 AM Jacketed assigned to a chemical by the Chemical Abstracts Service;1 (34) "Chemical" means any element, chemical compound, or mixture of elements or2 compounds that has its own specific name or identity, such as a chemical abstracts3 service number;4 (35) "Chemical disclosure registry" means the chemical registry known as FracFocus5 developed by the Groundwater Protection Council and the Interstate Oil and Gas6 Compact Commission. If that registry becomes permanently inoperable, the7 chemical disclosure registry shall mean another publicly accessible Web site that is8 designated by the commissioner;9 (36) "Division" means the Kentucky Division of Oil and Gas;10 (37) "Emergency spill or discharge" means an uncontrolled release, spill, or discharge11 associated with an oil or gas well or production facility that has an immediate12 adverse impact to public health, safety, or the environment as declared by the13 secretary of the cabinet;14 (38) "Health professional" means a physician, physician assistant, nurse practitioner,15 registered nurse, advanced practice respiratory therapist, or emergency medical16 technician licensed by the Commonwealth of Kentucky;17 (39) "High-volume horizontal fracturing treatment" means the stimulated treatment of a18 horizontal well by the pressurized application of more than eighty thousand19 (80,000) gallons of water, chemical, and proppant, combined for any stage of the20 treatment or three hundred twenty thousand (320,000) gallons in the aggregate for21 the treatment used to initiate or propagate fractures in a geological formation for the22 purpose of enhancing the extraction or production of oil or natural gas;23 (40) "Proppant" means sand or any natural or man-made material that is used in a24 hydraulic fracturing treatment to prop open the artificially created or enhanced25 fractures once the treatment is completed;26 (41) "Total water volume" means the total quantity of water from all sources used in a27 UNOFFICIAL COPY 26 RS BR 910 Page 46 of 52 XXXX 2/18/2026 10:54 AM Jacketed high-volume hydraulic fracturing treatment;1 (42) "Trade secret" means information concerning the volume of a chemical or relative2 concentration of chemicals used in a hydraulic fracturing treatment that:3 (a) Is known only to the hydraulic fracturing treatment's owners, employees,4 former employees, or persons under contractual obligation to hold the5 information in confidence;6 (b) Has been perfected and appropriated by the exercise of individual ingenuity7 which gives the hydraulic fracturing treatment's owner an opportunity to8 retain or obtain an advantage over competitors who do not know the9 information; and10 (c) Is not required to be disclosed or otherwise made available to the public under11 any federal or state law or administrative regulation;12 (43) "Cabinet" means the Energy and Environment Cabinet;13 (44) "Stratigraphic test well" means an exploratory borehole drilled for the sole purpose14 of acquiring subsurface geological and structure test data;15 (45) "Notice" means the sending of certified mail to the last known address. The date of16 delivery shall be the earlier of the date shown on the certified mail return receipt or17 the date thirty (30) days after the date shown on the postal service proof of mailing.18 For the purposes of KRS 353.620, 353.630, 353.640, and 353.700, any unknown or19 nonlocatable owner shall be deemed to have received notice, provided that the20 person giving the notice has caused to be published, no more than thirty (30) days21 prior to the submission of an application or order issued pursuant to an application,22 one (1) notice in the newspaper of the largest circulation in each county in which23 any tract, or portion thereof, affected or proposed to be affected, is located. The24 applicant shall provide a copy of the published notification to the director within25 twenty (20) days of the date of publication. The notice shall:26 (a) State, as applicable, that an application is being filed with the division or that27 UNOFFICIAL COPY 26 RS BR 910 Page 47 of 52 XXXX 2/18/2026 10:54 AM Jacketed an order has been issued pursuant to an application filed with the division;1 (b) Describe any tract, or portion thereof, affected or proposed to be affected;2 (c) In the case of an unknown owner, identify the name of the last known owner;3 (d) In the case of a nonlocatable owner, identify the owner and the owner's last4 known address; and5 (e) State that any party claiming an interest in any tract, or portion thereof,6 affected or proposed to be affected, shall contact the operator at the published7 address;8 (46) (a) "Control person" means a person who:9 1. Has the ability to commit the financial or real property assets or working10 resources of an entity to comply with this chapter and the administrative11 regulations promulgated hereunder with respect to the operations of a12 well or the manner in which a well is operated;13 2. Has any other relationship that gives that person authority to determine14 the manner in which a well is operated, plugged, and abandoned. This15 includes a rebuttable presumption that an ineligible person is directing16 the actions of his or her spouse or child who files an application;17 3. Is an officer, director, or general partner of an entity; or18 4. Has an ownership interest in an entity equaling or exceeding fifty19 percent (50%), except that the cabinet may determine that a person has20 controlling interest in an entity with less than fifty percent (50%)21 ownership.22 (b) Unless the person is determined to qualify under paragraph (a) of this23 subsection, "control person" does not include:24 1. An independent third-party service company;25 2. A contract operator;26 3. A well tender or pumper;27 UNOFFICIAL COPY 26 RS BR 910 Page 48 of 52 XXXX 2/18/2026 10:54 AM Jacketed 4. The owner of a non-operated undivided working interest;1 5. A limited partner;2 6. A unitholder in a limited liability company; or3 7. Any other person who by virtue of a joint operating agreement, entity4 governance agreement, or other contractual relationship does not have5 the right to control the manner in which a well is operated and plugged6 and abandoned;7 (47) "Eligible well" means:8 (a) An orphan well; or9 (b) Any abandoned well that poses an imminent threat to human health, safety, or10 the environment; and11 (48) "Orphan well" means any oil or gas well, as defined in subsection (14) of this12 section, which has been determined by the cabinet to be improperly abandoned or13 improperly closed, and that has no known owner or operator with continuing legal14 responsibility or all owners or operators with continuing legal responsibility for the15 well are determined to be financially insolvent following a reasonable investigation16 conducted by the cabinet.17 Section 21. KRS 405.024 is amended to read as follows:18 (1) As used in this section:19 (a) "Cabinet" means the Cabinet for Health and Family Services;20 (b) "Caregiver" means an adult person with whom a minor resides, including a21 grandparent, stepgrandparent, stepparent, aunt, uncle, or any other adult22 relative of the minor;23 (c) "De facto custodian" has the same meaning as defined in KRS 403.270;24 (d) "Department" means the Department of Education;25 (e) "Health care provider" means any licensed medical, surgical, dental,26 psychological, or osteopathic practitioner; nurse practitioner; advanced27 UNOFFICIAL COPY 26 RS BR 910 Page 49 of 52 XXXX 2/18/2026 10:54 AM Jacketed practice respiratory therapist; occupational, physical, or speech therapist;1 hospital; public or private health clinic; or their agents or employees; and2 (f) "Health care treatment":3 1. Means any necessary medical and dental examination, diagnostic4 procedure, and treatment, including but not limited to hospitalization,5 developmental screening, mental health screening and treatment,6 preventive care, immunizations recommended by the federal Centers for7 Disease Control and Prevention's Advisory Committee on Immunization8 Practices, well-child care, blood testing, and occupational, physical, and9 speech and language therapies; and10 2. Does not mean any procedure to terminate a pregnancy, pregnancy11 determination testing, HIV or AIDS testing, controlled substance12 testing, or any other testing for which a separate court order or informed13 consent is required under other applicable law.14 (2) The caregiver shall create an affidavit establishing the caregiver's ability to15 authorize health care treatment for a minor and to make school-related decisions for16 a minor. The affidavit shall include but not be limited to the following information:17 (a) The name and address of the caregiver;18 (b) The caregiver's relationship to the minor to whom the affidavit applies;19 (c) A statement that the caregiver is over the age of eighteen (18);20 (d) The name and date of birth of the minor to whom the affidavit applies;21 (e) A statement that the minor resides in the caregiver's home;22 (f) A statement that the caregiver shall be allowed to authorize the provision of23 health care treatment to the minor, or to withhold such authorization;24 (g) A statement that the caregiver shall be the person responsible for enrolling the25 minor in school and acting as the minor's legal contact with the school for the26 purposes of making decisions on enrollment, attendance, extracurricular27 UNOFFICIAL COPY 26 RS BR 910 Page 50 of 52 XXXX 2/18/2026 10:54 AM Jacketed activities, discipline, and all other school-related activities;1 (h) A statement identifying the minor's parents, de facto custodian, guardian, or2 legal custodian and describing the caregiver's relationship to the parents, de3 facto custodian, guardian, or legal custodian;4 (i) A statement that no other party has legal standing in custody issues for the5 minor other than those parties identified in paragraph (h) of this subsection;6 (j) The dated signatures of the minor's parents, de facto custodian, guardian, or7 legal custodian indicating their approval of the caregiver's ability to authorize8 the provision of health care treatment to the minor and to make school-related9 decisions for the minor. If a parent or parents, de facto custodian, guardian, or10 legal custodian are unavailable to sign the affidavit, the affidavit shall include11 a statement describing the circumstances of their unavailability and a12 statement of the caregiver's reasonable efforts to locate them;13 (k) The dated signature of the caregiver;14 (l) A statement that acknowledges that a person making false statements in the15 affidavit shall be subject to criminal penalties;16 (m) A statement that acknowledges that execution of the affidavit does not confer17 upon the caregiver the status of a de facto custodian, guardian, or legal18 custodian of the minor; and19 (n) A statement that acknowledges the requirement for the caregiver to notify any20 health care provider or school to which the affidavit was presented if the21 minor ceases to reside with the caregiver or the affidavit is revoked by the22 minor's parent or parents, de facto custodian, guardian, legal custodian, or23 caregiver.24 (3) The health care authorization portion of the affidavit described in subsection (2) of25 this section shall be valid for one (1) year and may be renewed annually thereafter26 unless it is revoked by the minor's parent or parents, de facto custodian, guardian,27 UNOFFICIAL COPY 26 RS BR 910 Page 51 of 52 XXXX 2/18/2026 10:54 AM Jacketed legal custodian, or caregiver, or if the minor no longer resides with the caregiver.1 Execution or revocation of the health care authorization portion of the affidavit2 shall not operate as a complete execution or revocation of the entire affidavit.3 (4) The education authorization portion of the affidavit described in subsection (2) of4 this section shall be valid for one (1) year and may be renewed annually thereafter5 unless it is revoked by the minor's parent or parents, de facto custodian, guardian,6 legal custodian, or caregiver, or if the minor no longer resides with the caregiver.7 Execution or revocation of the education authorization portion of the affidavit shall8 not operate as a complete execution or revocation of the entire affidavit.9 (5) A caregiver may authorize the provision of health care treatment or may refuse the10 provision of health care treatment to a minor residing with the caregiver if the11 caregiver presents to a health care provider a duly executed affidavit as described in12 subsection (2) of this section.13 (6) The decision of a caregiver to authorize or refuse health care treatment for a minor14 shall be superseded by a decision of a parent, de facto custodian, guardian, or legal15 custodian of the minor.16 (7) A health care provider shall honor a caregiver's authorization to provide health care17 treatment to a minor, or the caregiver's decision to withhold such authorization, if18 the caregiver presents to the provider a duly executed affidavit described in19 subsection (2) of this section. A health care provider shall refuse to honor the20 caregiver's decision to seek or refuse health care treatment if the provider has actual21 knowledge that a parent, de facto custodian, legal custodian, or guardian has made a22 superseding decision to authorize or refuse health care treatment for the minor. [The23 provisions of ]This subsection shall not be construed to prohibit a health care24 provider from providing health care treatment for a condition that, left untreated,25 could reasonably be expected to substantially threaten the health or life of the26 minor.27 UNOFFICIAL COPY 26 RS BR 910 Page 52 of 52 XXXX 2/18/2026 10:54 AM Jacketed (8) A person who relies in good faith on a duly executed affidavit as described in1 subsection (2) of this section in providing or refusing health care treatment shall:2 (a) Be under no obligation to undertake further investigation into the3 circumstances forming the basis of the caregiver's authorization to the4 provision or refusal of health care treatment; and5 (b) Not be subject to criminal or civil liability or professional disciplinary action6 because of that reliance.7 (9) [The provisions of ]This section shall not be construed to relieve any health care8 provider from liability for negligence in the provision of health care treatment.9 (10) An affidavit described in subsection (2) of this section may be revoked by the10 minor's parent, de facto custodian, guardian, legal custodian, or caregiver, and shall11 be revoked if the minor to whom it applies ceases to reside with the caregiver. If an12 affidavit is revoked, the caregiver shall give written notice of revocation to any13 health care provider to which the affidavit was presented for the purpose of14 obtaining health care for the minor.15 (11) A person who knowingly makes a false statement in an affidavit described in16 subsection (2) of this section shall be guilty of a Class A misdemeanor.17

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