D.C. Mun. Regs. tit. 29, r. 29-407

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-407 - GENERAL REVIEW CRITERIA

407.1

Review criteria shall be established by the SHPDA within the guidelines established under Public Law 93-641, as amended.

407.2

The criteria may vary according to the purpose for which a particular review is being conducted or the type of health service reviewed.

407.3

The following minimum criteria shall be used in conducting reviews:

(a) The relationship of the health services being reviewed to the District's State Health Plan (SHP) and Annual Implementation Plan (AIP) and any special plans which may be approved by the SHCC;

(b) The relationship of the health services being reviewed to the long-range development plan of the provider proposing the services;

(c) The need that the population served or to be served has for the services proposed to be offered or expanded, and the extent to which low-income persons, racial and ethnic minorities, women, handicapped persons, and other underserved groups are likely to have access to those services;

(d) In the case of a reduction or elimination of a service, including the relocation of a facility or a service, the need that the population presently served has for the service; the extent to which that need will be met by the proposed relocation or by alternative arrangements; and the effect of the reduction, elimination, or relocation of the service on the ability of low-income persons, racial and ethnic minorities, women, handicapped persons, and other underserved groups to obtain needed health care;

(e) The availability of alternative, less costly, and more effective methods of providing services;

(f) The immediate and long-term financial feasibility of the proposal and the probable impact of the proposal on the costs of and charges for providing health services in the District;

(g) The relationship of the services proposed to be provided to the District's existing (and proposed) health care system;

(h) The availability of resources (including health manpower, management personnel, and funds for capital and operating needs) for the provision of other health services;

(i) The relationship, including the organizational relationship, of the health services proposed to be provided, to ancillary or support services in the District;

(j) The special needs and circumstances of those entities that provide a substantial portion of their services or resources, or both, to individuals not residing in the District or in adjacent health service areas. These entities may include medical and other health professions schools, multidisciplinary clinics, and specialty centers;

(k) The special needs and circumstances of health maintenance organizations (HMOs) for which assistance may be provided under Title XIII of the Public Health Services Act. These needs and circumstances shall be limited to the following:

(1) The needs of enrolled members and reasonable anticipated new members of the HMO or proposed HMO for the health services proposed to be provided by the organization; and

(2) The availability of the health services from non-HMO providers or other HMOs in a reasonable and cost-effective manner which is consistent with the basic method of operation of the HMO or proposed HMO.

(l) The special needs and circumstances of biomedical and behavioral research projects which are designed to meet a national need and for which local conditions offer special advantages;

(m) The contribution of the project in meeting the health related needs of members of medically underserved groups and members of groups which have traditionally experienced difficulties in obtaining equal access to health services, particularly those needs identified in the District's SHP and API as deserving a priority; and

(n) The special circumstances of health care institutions with respect to the need for conserving energy.

407.4

In assessing the availability of the health services from non-HMO providers or other HMOs under § 407.3(k) (2), the SHPDA and SHCC shall consider only whether the health services from these providers would meet the following availability criteria:

(a) Availability under a contract of at least five (5) years duration;

(b) Availability and convenient accessibility through physicians, other professionals associated with the HMO, or other proposed HMO;

(c) Availability at a cost that will be no more than if the health service were provided by the HMO or the proposed HMO; and

(d) Availability in a manner that is administratively feasible to the HMO or proposed HMO.

407.5

In the case of a construction project, the following minimum criteria shall be used in conducting reviews:

(a) The costs and methods of the proposed construction, including the costs and methods of energy conservation;

(b) The probable impact of the construction project under review on the costs of providing health services by the applicant; and

(c) The relationship of the construction project to the SHPDA's evaluation of the condition of health care facilities required by § 1523(a)(7) of Public Law 93-641, as amended.

D.C. Mun. Regs. tit. 29, r. 29-407

Final Rulemaking published at 28 DCR 1086 (March 13, 1981)