N.H. Admin. Code § He-Hea 1904.01

Current through Register No. 50, December 12, 2024

Section He-Hea 1904.01 - Criteria

In addition to the criteria included in He-Hea 303.02 through He-Hea 303.09 and the standards in He-Hea 1903, applicants shall meet the following criteria when applying for a CON for ambulatory surgical facilities:

(a) Proposed ambulatory surgical facility projects shall be financially feasible;

(b) In order to assess the current and long-range financial feasibility of the proposed project, each applicant shall demonstrate that resources:

(1) Are available to fund the proposed capital costs and operating costs;

(2) Will be available to maintain operations in the event of interruptions to cash flow; and

(3) Will be available to ensure the continued operation of the proposed project;

(c) Demonstration of financial feasibility shall be made by providing with the application:

(1) For an existing facility, copies of the facility's financial statements for:

a. The past 3 fiscal years; or

b. Since the facility has been in existence, if less than 3 years;

(2) For all facilities, documentation in the form of projected financial statements through 3 fiscal years after project completion;

(3) A statement of the sources of funds to finance the proposed project; and

(4) Documentation from the applicant's lender, underwriter or other anticipated source of capital which includes:

a. Financed amount;

b. Rate of interest; and

c. Term of debt;

(d) Applicants shall provide a description of the proposed service area, which includes the following:

(1) Demographic characteristics of the proposed service area by age and sex compositions;

(2) Income levels of the area populations;

(3) Anticipated payer source by population totals and percentages expressed as:

a. Medicare;

b. Medicaid;

c. Private insurance companies;

d. Self-pay; and

e. Health maintenance organizations;

(e) Applicants shall assess the medical needs of the proposed service area which would be met by the proposed project;

(f) Assessment of the medical needs of the proposed service area shall be made in the form of a report included with the application which addresses:

(1) Demographics of the service area population, which shall include:

a. Age; and

b. Sex;

(2) Geographic access problems, such as excessive travel times and distances to existing facilities; and

(3) Lack of specialized ambulatory surgery services in the proposed service area to meet the medical need of the current population;

(g) The applicant shall document physicians' difficulty in performing ambulatory surgery services or obtaining admitting privileges at existing ambulatory surgical facilities and hospital outpatient surgery rooms in the proposed service area;

(h) Demonstration of difficulty pursuant to (g) above shall be made in the form of a report in the application addressing physicians' difficulty in performing ambulatory surgery services or obtaining admitting privileges including but not limited to:

(1) Medical reasons;

(2) Availability and cost of ambulatory surgery services; and

(3) Staffing;

(i) In order to determine the financial feasibility of the project pursuant to RSA 151-C:7, II, applicants shall submit an assessment of costs and methods of construction of the proposed project.

(j) The assessment shall be made by providing preliminary floor plans showing space allocations expressed on a per square foot basis;

(k) Applicants shall provide a comparison of the anticipated proposed construction cost per square foot to the 2008 edition of the Marshall Valuation Service, section 15, for the proposed class and type of construction;

(l) Applicants shall include a report with the application which provides:

(1) Details of all the project costs and space of the proposed project;

(2) An analysis of the class and quality of construction pursuant to section one of the 2008 edition Marshall Valuation Service;

(3) The allocation of costs within a multiple use building;

(4) The calculations of site costs and land costs where facilities are proposed to have multiple uses;

(5) The methodology used in calculating construction costs for renovations;

(6) The methodology used in calculating construction costs involving leasehold improvements; and

(7) The anticipated useful life of the building for depreciation purposes;

(m) Construction costs to be compared with the 2008 edition of the Marshall Valuation Service shall include:

(1) Labor;

(2) Materials;

(3) Fixed equipment;

(4) Building permits;

(5) Architectural and engineering fees;

(6) Site preparation for the building;

(7) Utilities from structure to street;

(8) Insurance costs during construction; and

(9) Interest costs during construction;

(n) The applicant shall follow the outline of the calculator method set forth in section 10 of the 2008 edition of the Marshall Valuation Service to determine construction costs according to the Marshall Valuation Service;

(o) The costs and factors to take into account pursuant to (n) above shall include:

(1) The base cost found in the outpatient surgical center table in section 15, page 25 of the 2008 edition of the Marshall Valuation Service;

(2) An adjustment to heating, ventilating, and air conditioning costs for:

a. Extreme climate; and

b. A different type of HVAC system from that assumed in the table, if necessary;

(3) All fire protection system costs;

(4) Elevator costs if not included in base cost;

(5) Number of stories multiplier;

(6) Story height multipliers;

(7) Floor area - perimeter multipliers; and

(8) Cost multipliers from section 99 of the 2008 edition of the Marshall Valuation Service;

(p) The report of project costs shall also list the alternatives considered in developing the proposed project and the reasons for accepting or rejecting these alternatives;

(q) Applicants shall document the impact of projected patient charges as a result of the proposed project;

(r) Documentation of patient charges shall be made in the form of a report included with the application identifying:

(1) For an existing facility, a schedule of patient charges for:

a. The past 3 fiscal years; or

b. Since the facility has been in existence, if less than 3 years;

(2) For all facilities, a schedule of patient charges projected through 3 years after project completion;

(s) Ambulatory surgery services shall be provided in a safe and efficient manner;

(t) In the case of existing facilities, demonstration of safe ambulatory surgery services shall be made by providing with the application:

(1) Copies of inspection surveys and reports from state, federal and/or accrediting agencies;

(2) Copies of corrective action plans if deficiencies have been cited by state, federal and/or accrediting agencies;

(3) A report detailing how patients will be protected from hazards which might occur during the construction/renovation project; and

(4) A signed statement made by the applicant per He-Hea 303.05(c) or (d);

(u) Personnel resources shall be available to support the proposed ambulatory surgery project;

(v) Demonstration of sufficient personnel resources for the ambulatory surgery project shall be made by providing a report with the application which provides:

(1) The staffing pattern pursuant to the applicable licensing requirements of RSA 151;

(2) A schedule of all personnel:

a. For an existing facility, for:

1. The past 3 fiscal years; or

2. Since the facility has been in existence, if less than 3 years;

b. For all facilities, projected through 3 years after project completion; and

(3) The number of medical staff employed by or with admission privileges to the facility, by specialty; and

(w) Applicants shall identify the source of any data or information provided pursuant to paragraphs (d) through (v) above.

N.H. Admin. Code § He-Hea 1904.01

#7269, eff 5-10-00, EXPIRED: 5-10-08

New. #9261, eff 9-13-08