The Indiana Department of Health (department) was unable to begin the rulemaking process within 60 days of the authorizing statute's effective date as it was necessary to consult with stakeholders regarding the proposed rule and to submit the rule to the State Budget Committee for a review of fees.

P.L. 147-2023 authorizing rural emergency hospital licensure was effective July 1, 2023. The department submitted the rule to the Indiana Office of Management and Budget (OMB) and State Budget Agency (SBA) for review on October 18, 2023. The rule was presented to the State Budget Committee for a review of fees on April 19, 2024. The department received OMB and SBA approval to commence the public comment period on August 23, 2024.