Or. Admin. Code § 333-560-0010

Current through Register Vol. 63, No. 12, December 1, 2024

Section 333-560-0010 - Abbreviated Certificate of Need Review for Specific Projects

The following types of projects are eligible for abbreviated review:

(1) The establishment of new health services or new facilities which, based on documentation submitted by the applicant and found acceptable by the Division, will predominantly or exclusively service medically indigent patients:

(a) Such documentation should include any admissions policies or needs tests to be used by the applicant in determining the appropriateness of admissions. Documentation should also include information on projected revenues for the facility or service, including the sources of such revenues;

(b) If the facility or service, in the future, wishes to provide services to persons who are not medically indigent, either because of a change of ownership or for other reasons, the applicant must submit a new letter of intent detailing the proposed changes in the population to be served. The Division may consider such a change to constitute the establishment of a new health service subject to review, if it concludes that the patients to be served will no longer be predominantly medically indigent, and if it concludes that there will be a substantial impact on the cost of patient care;

(c) For the purposes of this section, persons will be considered to be medically indigent if they are uninsured by either public or private insurers or payers for the types of services being proposed and if their household or family income is equal to or less than 200 percent of the poverty income established in federal regulations. Except for projects involving long-term care facilities or services, persons will also be considered to be medically indigent if they are eligible for Medicaid services.

(2) Partnerships or joint ventures between hospitals/health systems and existing non-hospital-based, long-term care facilities neither of which is owned or controlled by the same entity, when all of the following criteria are met:

(a) The project does not result in a net increase in licensed long-term care beds in the service area. In this context "service area" has the same meaning as it is given in OAR 333-610-0030(1);

(b) The partnership or joint venture is for a minimum of two years and is terminable only for cause. As used in this rule, the term "partnership" is intended to be defined broadly, so that it covers collaboration beyond just a legal partnership including, but not limited to, a jointly owned corporation or a limited liability corporation. Not withstanding OAR 333-550-0010(3)(a), if the beds operated under the partnership or joint venture are proposed to be sold or otherwise transferred, the transfer shall be subject to the full review process detailed in division 570 of this chapter and to the application and review criteria established in division 580, or if applicable, an expedited review under this chapter. If as part of the partnership or joint venture, conversion of existing space within a hospital building occurred, expedited review cannot later be sought under 333-560-0110. If the beds operated under the partnership or joint venture are to be relocated back to the non-hospital-based, long-term care facility the bed relocation is eligible for an abbreviated review;

(c) The hospital/health system and the long-term care facility can demonstrate to the satisfaction of the Division that projected per diem inpatient routine service costs in the partnership or joint venture setting (calculated in conformance with Medicare cost report parameters) will not exceed 125 percent of the per diem routine service cost limitation computed by the fiscal intermediary for freestanding skilled nursing facilities in its urban or rural location during the first two years of operation. The routine cost limitation may be adjusted, as appropriate, to allow for reasonable inflation as measured by the DRI (HCFA) McGraw Hill Nursing Facility Market Basket Index;

(d) The applicant shall submit a completed copy of Forms CN-3 and CN-11. The applicant shall also submit a summary for the first two years of operation of projected revenue, expenses, operating income, non-operating revenue and net income with and without the project;

(e) Projects approved under OAR 333-560-0010(2) are subject to the full review process detailed in division 570 of this chapter and to the application and review criteria established in division 580, or, if applicable, an expedited review under this chapter, if the cost limitation required under subsection (2)(c) of this rule is not maintained for the first two years of operation.

(3) A project involving the relicensing of long-term care beds by a facility participating in a Seniors and People with Disabilities Division approved Nursing Home Vision 2000 Project ("Vision 2000 Project"), if all of the following conditions are met:

(a) The number of long-term care beds to be added by the facility does not exceed the number of long-term care beds delicensed by the facility because of participation in the Vision 2000 project; and

(b) Relicensure of beds to be added will occur within five years of the date that the first bed or beds were delicensed at the facility because of participation in the Vision 2000 Project; and

(c) Notwithstanding OAR 333-565-0000(4), an application fee of $1,500 is paid;

(d) The following applies to Seniors and People with Disabilities Division approved Vision 2000 Projects:

(A) Notwithstanding any contrary provision in OAR chapter 333, during the five-year period referred to in subsection (3)(b) of this rule, the delicensed beds will be counted as existing long-term care beds for determining the need for additional long-term care beds in the geographical service area under division 610 of this chapter. The delicensed beds will not be considered existing long-term care beds for the purpose of 333-560-0110 and 333-560-0120;

(B) Notwithstanding paragraph (3)(d)(A) of this rule, if a Vision 2000 Project participating facility notifies the Division in writing of its intention not to seek relicensure of some or all the beds within the five-year period, these beds will not be counted as existing long-term care beds for determining the need for additional long-term care beds in the geographical service area under division 610 of this chapter, and the facility will be foreclosed from seeking the addition of these beds under section (3) of this rule;

(C) The sale of a Vision 2000 Project participating facility does not affect the ability of the facility to seek the addition of beds under section (3) of this rule as long as the other requirements of the rule are met.

(4) Development of a freestanding hospice facility, as that term is used in OAR 333-500-0010(1)(a), if all the following conditions are met:

(a) The number of freestanding hospice facilities that can be approved under this section is limited to a total of six. Facilities approved under this section will be required to report the information specified in subsection (4)(e) of this rule to the Certificate of Need Program which will allow it to monitor the effect of these facilities and to develop appropriate rules by which to judge the need for any future facilities;

(b) Projects will be considered for abbreviated review in the order in which a completed letter of intent is received for the project. The provisions of OAR 333-560-0030 shall not apply;

(c) The applicant shall submit a completed copy of Forms CN-1 and CN-3;

(d) The applicant shall submit a population-based needs assessment for the proposed facility. The needs assessment shall include, but not be limited to, the following elements:

(A) A discussion of why this facility is needed in the geographic area served by the applicant. This discussion shall take into account the actual and projected death rates by age and sex; an estimate of how many of those individuals would have been eligible for hospice services and the historical utilization of hospice services; an estimate of how many of those individuals would have benefited from inpatient hospice care and the historical utilization of inpatient care for hospice patients; the applicant's market share of hospice services and any anticipated changes in that market share; the effect of the proposed facility on the utilization of inpatient care in all settings both by the patients served by the applicant and by other hospice providers in the geographic area (if any); projected population growth by age and sex for the area; and household composition, particularly the number of people living alone by age and sex. The discussion shall also include information about the availability of inpatient care in the geographic area, an explanation of why it is preferable for patients to receive care in the proposed facility as opposed to other possible settings and an explanation of how the availability of the proposed facility will impact the continuum of care available in the geographic area; and

(B) A projected income statement for the first five years of operation of the facility accompanied by a narrative explaining the assumptions underlying the projections. Information concerning payer source, number of admissions, numbers of deaths and discharges, and length of stay shall be provided. If the facility is to provide residential care beds, such information shall also be provided for those beds. The income statement shall follow the format used by Form CN-5.

(e) The applicant agrees to provide the following information to the Certificate of Need Program on an annual basis for a period of five years after the facility begins operation:

(A) An income statement accompanied by a narrative discussion of the information provided. Information concerning payer source, number of admissions, numbers of deaths and discharges, and length of stay shall be provided. If the facility provides residential care beds, such information shall also be provided for those beds. The income statement shall follow the format used by Form CN-5;

(B) A statement with supporting data discussing the impact on the age adjusted rates of nursing home and hospital deaths in the geographic area served by the applicant; the impact on the rate of hospice admissions to nursing homes and hospitals in the area; and the impact on the rate of deaths of hospice patients in nursing homes and hospitals; and

(C) A statement discussing data collected from a satisfaction survey tool which measures whether families and other persons closely associated with the patient were satisfied with the different aspects of their loved one's end-of-life care and the environment provided by the facility.

(5) Development of a new Oregon State Hospital facility.

(a) A project for a new Oregon State Hospital is not required to meet any review criteria and notwithstanding OAR 333-565-0000(4) an application fee is not required.

(b) Notwithstanding OAR 333-560-0020(5), the granting of abbreviated review may be rescinded following an informal hearing only if the Division finds that the project is not a new Oregon State Hospital facility.

Or. Admin. Code § 333-560-0010

HD 13-1994, f. & cert. ef. 4-22-94; HD 14-1994(Temp), f. & cert. ef. 4-28-94; HD 9-1995(Temp), f. & cert. ef. 11-14-95; HD 3-1997, f. & cert. ef. 2-3-97; OHD 5-1998, f. & cert. ef. 6-16-98; OHD 11-1998, f. & cert. ef. 10-22-98; OHD 10-2002, f. 7-3-02 cert. ef. 7-5-02; PH 10-2003(Temp), f. & cert. ef. 7-31-03 thru 1-15-04; PH 2-2004, f. & cert. ef. 1-16-04; PH15-2008, f. &cert. ef. 10-7-08

Forms referenced are available from the agency.

Publications: Publications referenced are available from the agency.

Stat. Auth.: ORS 431.120(6) & 442.315

Stats. Implemented: ORS 431.120(6) & 442.315