A federal appeals court on Friday upheld a Kentucky law requiring abortion clinics to have admitting privileges at a hospital within 30 miles of the clinic.

A divided panel of appellate judges reinstated a rule requiring the clinics to have a written agreement with an area hospital and ambulance service in case of emergencies in order to operate. Written transfer agreements have been required in the state for more than two decades and are meant as a way to ensure patients who experience complications can be moved to a hospital immediately.

But changes to regulations in 2017 made it harder for abortion providers to obtain such agreements, leaving EMW Women’s Surgical Center PSC in Louisville – the only provider of abortions in the state at the time – without a license.

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The 2-1 ruling from the Sixth U.S. Circuit Court of Appeals reverses a 2018 district court ruling that found the law, first passed in 1998, violated constitutionally protect due process right.

EMW Women’s Surgical Center first challenged the law in 2017 after a licensing fight with then-Gov. Matt Bevin.

Planned Parenthood of Indiana and Kentucky later joined the suit, claiming Bevin had used transfer agreements to block the clinic’s license to provide abortions.

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Two clinics have since been allowed to provide abortions after Democratic Gov. Andy Beshear, who supports abortion rights, took office in late 2019.

In Friday’s ruling, the appeals court said the “district court erred in concluding that Kentucky would be left without an abortion facility.”

The appeals court rejected the clinics’ argument their facilities were in jeopardy of closing because the Kentucky law allows clinics to apply for a 90-day waiver if they are denied a licensing agreement, which they could theoretically reapply for each quarter and continue to operate.

“(We) must presume that the Inspector General will consider waiver applications in good faith and will not act ‘simply to make it more difficult for (women) to obtain an abortion,’” the ruling stated.

Kentucky Attorney General Daniel Cameron praised the court’s decision.

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“The Sixth Circuit’s ruling keeps in place an important Kentucky law for protecting the health and safety of patients by finding that Planned Parenthood and EMW failed to prove that they could not comply with the statute and regulation,” Cameron said in a statement.