CHAPTER He-Hea 2100
LONG-TERM ACUTE CARE HOSPITAL SERVICES
(a) “Acute care hospital” means a facility licensed as a general
hospital under RSA 151.
(b) “Applicant” means “applicant” as defined in RSA 151-C:2, II.
(c) “Board” means “board” as defined in RSA 151-C:2, IV.
(d) “Board-certified”
means the confirmation given by a national or regional association to a
physician as having passed special examinations
for his or her medical specialty.
(e) “Centers for
Medicare and Medicaid Services (CMS)” means the federal agency responsible for
the management of the Medicare and Medicaid programs, 2 national health
insurance programs for the economically disadvantaged and persons aged 65 and
over.
(f) “Certificate of
need (CON)” means “certificate of need” as defined in RSA 151-C:2, VIII.
(g) “Deeming authority” means the authority granted by CMS to an accrediting
organization to enforce CMS standards relating to Medicare and Medicaid
participation.
(h) “Department”
means the N.H. department of health and human services.
(i) “Detrimental” means an adverse impact on the
ability to maintain the accessibility, quality and cost of health care services
in the area.
(j) “Diagnosis Related
Groups code (DRG)” means the statistical symbol used to categorize major
diagnosis and procedures, age, sex and the presence of complications or co
morbidities, of hospitalized patients for medical records and reimbursement
purposes.
(k) “Free-standing long-term acute care hospital
(free-standing LTACH)” means a long-term acute care hospital that is owned, operated and located distinctly apart from any existing licensed facility.
(l) “Hospital
within a Hospital (HwH)” means a long-term acute care hospital that:
(1) Is licensed
pursuant to RSA 151;
(2) Occupies space
in a building or on the same campus also used by an existing licensed acute
care hospital; and
(3) Can certify that
it will comply with CMS requirements to meet conditions of participation for an
HwH.
(m) “Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)” means a not-for-profit-accrediting
organization that provides healthcare and accrediting performance standards to
healthcare organizations. It includes
the term “The Joint Commission (TJC).”
(n)
“Long-term acute care bed” means a bed in an LTACH reserved for patients
receiving long-term acute care services.
(o) “Long-term acute care hospital (LTACH)” means
a facility that is certified by CMS as a long-term acute care hospital and
licensed pursuant to RSA 151, and provides a broad spectrum of clinical
services to acutely ill and medically complex patients requiring, on average, a
length of stay of 25 days or greater.
(p) “Marshall
Valuation Service” means an appraisal guide for the development and reporting
of replacement building and equipment costs
used to determine construction/renovation costs of commercial buildings.
(q) “Quality improvement program” means a
comprehensive, ongoing facility-wide program designed to:
(1)
Assess the provision of long-term acute care services;
(2) Identify quality
improvement opportunities and system failures; and
(3) Assure that remedial
action is implemented and evaluated.
(r)
“Satellite long-term acute care hospital (satellite LTACH)” means an
extension of an existing long-term acute care hospital that:
(1) Is licensed
pursuant to RSA 151;
(2) Provides long term acute inpatient services
to patients in the same building or on the same campus as an acute care
hospital but is not operated under common ownership or control with the host
acute care hospital; and
(3) Can certify that
it will comply with CMS requirements to meet conditions of participation for a
satellite LTACH.
(s) “Story height multiplier” means the number by
which the base cost of a building is multiplied to adjust for any variation in average story height from the base of
12 feet.
Source. #9110, eff 3-25-08
PART He-Hea 2102 STANDARDS FOR DETERMINING THE NEED FOR LONG-TERM ACUTE CARE HOSPITALS IN THE STATE OF
He-Hea
2102.01 Bed Minimum Requirement. To promote the efficient
use of resources, promote quality and ensure financial viability, minimum bed counts shall be as
follows:
(a) Minimum size for a freestanding LTACH shall be 60 licensed beds;
(b) Minimum size for an HwH or satellite LTACH shall be 20 licensed
beds; and
(c) Notwithstanding paragraph (b) above, the minimum size for an HwH or
satellite LTACH within the service area of a critical access hospital shall be
10 licensed beds.
Source. #9110, eff 3-25-08
He-Hea 2102.02 Statewide Standard. The number of long-term acute care beds
statewide shall be .5 for each 10,000 persons.
Source. #9110, eff 3-25-08
He-Hea
2102.03 Determination of Need for
Long-Term Acute Care Hospitals.
(a)
“POP” means the current population of
NH as determined by NH Office of Energy and Planning.
(b)
“5” means .5 beds per 10,000
population.
(c)
Need for long-term acute care beds shall be determined by dividing state
population by 10,000, and multiplying the quotient by .5, as in the formula
below:
(POP/10,000)(.5)
Source. #9110, eff 3-25-08
He-Hea
2102.04
Determination of Unmet Need.
(a) The board shall make a determination of unmet
need for LTACH beds no later than 45 days from the initial effective date
of this chapter, and either:
(1) Two years after
license and operation of any LTACH awarded a CON; or
(2) Every three years thereafter on July 1.
(b) Unmet need shall be determined by subtracting the number of licensed or approved LTACH beds from that number calculated to be needed under He-Hea 2102.03.
(c)
The unmet need shall
be the difference between the calculated need and the number of licensed or
approved beds.
Source. #9110, eff 3-25-08
He-Hea 2102.05 Access to Care. Applicants shall ensure that no resident of
the state of
(h)
Ability to pay.
Source. #9110, eff 3-25-08
He-Hea
2102.06
Location of Services.
LTACH services shall only be offered at a:
(b) Satellite LTACH; or
(c) HwH.
Source. #9110, eff 3-25-08
He-Hea 2102.07 Transfer of
Long-Term Acute Care Beds.
(a) Any LTACH holding a CON for long-term
acute care beds in the state may transfer all or a portion of
those beds to another licensed LTACH within the state provided notice is made to the board.
(b) Notice of transfer
shall be made jointly in writing, by the facility
intending to transfer beds and the facility receiving
the beds identifying the name, address and location of the transferring and receiving facility, and be signed
and authorized by both parties.
(d) Any purchase price
paid by the transferee for the transfer of long term acute care
beds shall not be considered in the total project cost that is compared to the
threshold amount set by RSA 151-C:5, II.
Source. #9110, eff 3-25-08
He-Hea 2102.08 Administrative
Requirements. Applicants for a CON shall develop treatment
policies which, at minimum, address:
(d) Patient discharges,
including a plan for continuity of patient care;
(e) Individual treatment
plan(s) for each patient;
(f) Medical records;
and
(g) Availability of
services provided by the hospital to
its inpatients, directly or through
contractual agreements, or both, which shall include, at minimum:
(2) Nursing
services;
(3) Diagnostic radiology services;
(4) Social work and case
management services;
(5) Nutritional services;
(9) Cardiopulmonary/respiratory
services; and
(10) Such diagnostic, therapeutic, surgical and
medical services as are necessary to treat medically complex patients in an
LTACH setting, including but not limited to:
a. Excisional debridement;
b. Percutaneous tracheotomies,
c. Central venous access;
d. Telemetry; and
e. IV therapy.
Source. #9110, eff 3-25-08
He-Hea 2102.09 Staffing
Requirements.
(a) Applicants for a proposed LTACH shall provide a staffing plan that includes licensed
professionals who provide services to the
LTACH’s patients as:
(1) Employees;
(2) Under contract; or
(3) As members of the LTACH’s organized medical
staff.
(b) The following
personnel complement shall be available in the LTACH:
(1) A director of nursing services who shall be a
registered nurse currently licensed in the state of
(2) A medical director who shall be:
a. A medical doctor or doctor of osteopathic
medicine currently licensed as a physician in the state of
b. Board-certified in a specialty relevant to
the services provided by the LTACH;
(3) A pharmacist who shall be currently licensed
by the state of
(4) A dietician who shall be licensed by the
state of
(5) Board-certified,
a. Cardiology;
b. Pulmonology;
c. Infectious disease; and
d. Internal medicine;
(6) Additional professionals licensed in the
state of
a. Registered nurses;
b. Licensed practical nurses;
c. Respiratory care providers;
d. Physical therapists;
e. Occupational therapists;
f. Speech-language assistants; and
g. Speech-language pathologists.
(7) Additional personnel, including but not
limited to:
a. Social workers; and
b. Laboratory personnel.
Source. #9110, eff 3-25-08
He-Hea 2102.10 Quality Improvement Program.
(a)
Each facility shall establish and maintain a
comprehensive, ongoing, facility wide quality improvement program which
involves assessment of all quality improvement activities conducted in the
provision of its health care programs and services at
all levels which includes no less than:
(1) Establishment of standards and criteria for the assessment
of the quality of health care services provided and the
appropriateness of the resources utilized;
(3) Ongoing review of programs and services by physicians and other health
professionals; and
(4) A mechanism to assure the utilization of systematic data
collection based on valid samples of the total
patient population to measure performance and patient results, and to make
recommendations to physicians and departments of needed changes.
(b) Each facility shall
establish and maintain a current and complete clinical record for every patient
treated.
(c) Each applicant
currently operating a LTACH and those filing an application for additional services shall provide a copy of its quality improvement
program which indicates how the existing and additional services comply with
standards required by this section and:
(4) Other accrediting body that has
received deeming authority from CMS.
(d) An applicant who does
not currently provide LTACH services but files an
application for a CON shall:
(1) Develop the proposed
quality improvement program in accordance with this section;
(2) Include a copy of such plan in its application for a CON;
and
(3) Develop each service
specified in such plan in accordance with:
a. JCAHO, if
accreditation will be sought;
d. Other accrediting
body that has received deeming authority from CMS.
Source. #9110, eff 3-25-08
He-Hea
2102.11 Impact on Other Providers.
(a) Applicants
proposing to establish, expand or renovate a freestanding LTACH, satellite
LTACH or HwH shall demonstrate that the proposed facility shall maintain or
improve, for the proposed service area, the:
(1) Quality of
care;
(2) Access to and availability of health care
services; and
(3) Cost effectiveness
of health care services provided.
(b) Demonstration
shall be made by submitting with the application:
(1) A copy of an existing or proposed quality
improvement program pursuant to He-Hea 2102.10;
(2) To the extent data is available, a statistical report in the application
which shows how the proposed project is projected to affect health care
services in the proposed service area in terms of:
a. Utilization;
b. Patient charges;
c. Market share;
d. Physician referral
patterns;
e. Personnel resources;
and
f. Referral sources.
(3) Any correspondence from other facilities in the service area regarding the impact of the proposed project on their existing health care services
including their continued ability to:
a. Maintain quality health care services;
b. Provide essential community services;
c. Provide emergency services; and
d. Provide charity care; and
(4) A report in the application addressing how
the establishment, expansion or renovation of a freestanding LTACH, satellite
LTACH or HwH will not have a detrimental impact on health services within the
proposed service area.
Source. #9110, eff 3-25-08
PART He-Hea 2103 CRITERIA FOR EVALUATING LONG-TERM ACUTE CARE HOSPITAL SERVICES
He-Hea
2103.01 Criteria. In addition to the criteria in RSA 151-C:7
and He-Hea 303, applicants shall meet the criteria set forth in this section:
(a) Proposed LTACH services 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; and
(2) Will be available to maintain
operations in the event of interruptions to cash flow;
(c) Demonstration of
financial feasibility shall be made by providing with the application:
(1) For those applicants with existing LTACH programs and
filing an application for a CON, 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 for the next 3 fiscal years; and
(3) A copy of a letter from the applicant’s lender stating the
method of financing which includes:
(d)
Applicants shall provide a description of the state and patient populations which includes the following:
(1) Demographic characteristics of the state by age and sex compositions;
(2) Income levels of the state population;
(3) Anticipated payer source by population totals and
percentages expressed as:
c. Private
insurance companies;
e. Health
maintenance organizations;
(e) Applicants shall
document the anticipated impact on patient charges as a result of the proposed
project;
(f)
Documentation of the proposed project’s
anticipated impact on patient charges shall be made in the form of 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
for 3 years after project completion; and
(3) The anticipated project-related changes in patient charges;
(g) LTACH services shall
be available and accessible to all persons in the state, including those
persons in the state who might not have the means to pay for such services;
(h)
Applicants shall demonstrate
the extent to which LTACH services are available and accessible to all persons within its
institution by providing a report in the application that:
(1) Delineates the amount that is presently or planned to be
budgeted to cover the cost of free care, reduced fee care, and bad debts; and
(2) Separately delineates the amount of free care from bad
debts in the projected financial report;
(i)
Personnel resources shall be available to support
the proposed LTACH services project;
(j)
Demonstration of sufficient personnel resources
for the LTACH services shall be made in the form of a
report included in the application which includes:
(1) A table listing the personnel which shall include each
position and job title:
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 for 3 years after project completion;
(2) The number of medical staff employed by or with admission
privileges to the facility;
(3) An outline of the recruitment policies and procedures;
(4) A schedule of contracted services which shall list the
services that are provided,
including, but not limited to:
c. Diagnostic
evaluation services;
e. Social
services; and
(k) 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 for the
proposed project;
(l) The assessment shall
be made by providing preliminary floor plans showing space allocations
expressed on a per square foot basis;
(m) Applicants shall provide
a comparison of the anticipated proposed construction cost per square foot to
the January 2007 edition of the Marshall Valuation Service, section 15, for the
proposed class and type of construction;
(n) 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 January 2007 edition of the Marshall Valuation
Service;
(3) The allocation of costs within a multiple use building;
(4) The allocations 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;
(o) The following
construction costs shall be compared with the January 2007 edition of the
Marshall Valuation Service:
(5) Architectural and engineering fees;
(6) Site preparation for the building;
(7) Utilities from structure to lot line;
(8) Insurance costs during construction; and
(9) Interest costs during construction;
(p) The applicant shall
follow the outline of the calculator method set forth in section 10 of the
January 2007 edition of the Marshall Valuation Service to determine
construction costs according to the Marshall Valuation Service;
(q) The costs and factors
to take into account pursuant to (o) above shall include:
(1) The base cost found in the general hospital table in
section 15, page 24;
(2) An adjustment to heating, ventilating, and air-conditioning
costs for:
b. A
different type of HVAC system from that assumed in the table, if necessary;
(3) All fire protection systems costs;
(4) Elevator costs, if not included in the base cost;
(5) Number of stories multiplier;
(7) Floor area - perimeter multipliers; and
(8) Cost multipliers from section 99 of the January 2007
edition of the Marshall Valuation Service;
(r) LTACH services shall be provided in a safe and
efficient manner;
(s) In the case of
existing facilities, demonstration of safe services shall be made by providing
with the application:
(1) Copies of inspection surveys and reports from state,
federal, or accrediting agencies;
(2) Copies of corrective action plans if deficiencies have been
cited by state, federal or accrediting agencies;
(3) A copy of the
facility’s emergency procedure and evacuation plan to be followed in case of
fire or other emergencies;
(4) A report detailing how patients will be protected from hazards
which might occur during the construction or renovation project; and
(5) A signed statement made by the applicant pursuant to He-Hea
303.05(c) or (d);
(t)
For new facilities,
demonstration of safe services shall be made by providing with the application:
(1) A copy of the facility’s emergency procedure and evacuation
plan to be followed in case of fire or other emergencies; and
(2) A signed statement made by the applicant
pursuant to He-Hea 303.05(c) or (d);
(u) Applicants shall document
the planned use of beds by patients originating from outside the State of New
Hampshire and the impact of these services on the accessibility of beds by New
Hampshire residents; and
(v) Demonstration of the
use of beds by out-of-state patients shall be in the form of a report
including:
(1) The projected utilization by non-New Hampshire residents;
and
(2) Referral agreements from physicians and other medical
personnel.
Source. #9110, eff 3-25-08
PART He-Hea 2104 REQUEST FOR APPLICATIONS
He-Hea 2104.01 Request for
Applications (RFA). In accordance with RSA 151-C:8, I, a request
for applications shall be issued if a need for additional long-term acute care beds pursuant to He-Hea 2102.04 has been delineated, subject to a
minimum of 10 beds.
Source. #9110, eff 3-25-08
He-Hea 2104.02 Submission of Applications. Applications in response to an RFA shall be
submitted within 90 days of the publication of the RFA.
Source. #9110, eff 3-25-08
PART He-Hea 2105 GRANTING CERTIFICATES OF NEED
He-Hea 2105.01 Approval of Applications.
(a)
The board shall issue multiple CONs to satisfy
the need for which a request for applications was issued if it determines
multiple applicants demonstrate that they equally satisfy and comply with the
standards listed in RSA 151-C:9, II.
(b) The total number of
beds approved shall not exceed the unmet need determined pursuant to He-Hea 2102.04.
(c)
Any CON issued under this chapter shall carry a condition that shall:
(1) Limit the
applicant to offering or developing long-term acute care beds and services
consistent with the board’s approval; and
(2) Prohibit the
applicant from offering or developing any new institutional health services,
including but not limited to, comprehensive physical rehabilitation services,
without first securing an appropriate CON from the board.
Source. #9110, eff 3-25-08
APPENDIX
RULE |
STATUTE |
|
|
He-Hea 2101.01 |
RSA 151-C:2, RSA 151-C:11, I |
He-Hea 2102.01 – He-Hea
2102.04 |
RSA 151-C:5(f)(1), RSA
151-C:11, I |
He-Hea 2102.05 |
RSA 151-C:5(f)(1), RSA 151-C:11,
I, RSA 151-C:7, III |
He-Hea 2102.06 – He-Hea
2102.08 |
RSA 151-C:5(f)(1), RSA
151-C:11, I |
He-Hea 2102.09 |
RSA 151-C:5(f)(1), RSA
151-C:11, I, RSA 151-C:7, II |
He-Hea 2102.10 |
RSA 151-C:5(f)(1), RSA
151-C:11, I, RSA 151-C:7, IV |
He-Hea 2102.11 |
RSA 151-C:5(f)(1), RSA
151-C:11, I |
He-Hea 2103 |
RSA 151-C:5(f)(1), RSA
151-C:11, I, RSA 151-C:7, I |
He-Hea 2104 |
RSA 151-C:8, I |
He-Hea 2105 |
RSA 151-C:9, II, II |