Alabama Administrative Code
Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY ALABAMA STATE HEALTH PLAN 2014-2017
Chapter 410-2-4 - 2020-2023 Alabama State Health Plan - Facilities
Section 410-2-4-.03 - Nursing Homes
Universal Citation: AL Admin Code R 410-2-4-.03
Current through Register Vol. 42, No. 5, February 29, 2024
(1) Definition. A Nursing Home is a business entity engaged in providing housing, meals and care to sick or disabled individuals who require medical care, nursing care, or rehabilitative services on a daily or more frequent basis. Hospital swing beds are included in Section 410-2-4-.09.
(2) Analysis of Existing Facilities
(a) As of October 2019,
there were 232 licensed nursing homes, excluding state owned and operated
facilities, totaling 27,383 beds operating in the state of Alabama. Average
occupancy for the 228 facilities was approximately 84.8% for Fiscal Year 2018.
Currently, there are approximately 32.9 beds per one thousand persons age 65
and older.
(b) Approximately 84.6 %
of nursing home beds in Alabama are occupied by persons age 65 and older. This
aged population represents 16.5% of the state's total population and is
projected to increase during the coming years.
(c) Nursing homes provide various levels of
care for those needing their services. These include:
1. Short-term post hospital care (PAC) for
those who require specialized rehabilitation after their acute care hospital
episodes. Most of these PAC admissions return home.
2. Long term care for those with complex
chronic conditions requiring care and supervision unavailable in a home setting
through available supports and services.
3. Palliative care for hospice patients
unable to remain in a home environment.
4. Memory care in a secured environment for
those with complex chronic conditions requiring care and supervision
unavailable in a home setting through available supports and services and
suffering from Alzheimer's disease and other forms of dementia.
(3) Long Term Supports and Services
(a) Efforts
should be made to maintain an optimum quality of life for long term care
residents in their home for as long as possible. The types and amounts of
services needed for long term care residents vary. In order to enhance
opportunities for residents needing long term care services, which would allow
them to remain in their homes for as long as possible, the health care and
social needs of these residents should be evaluated by an independent
multidisciplinary team prior to nursing home admission. This team should also
evaluate the ability of resources within the local community to meet the needs
of these residents.
(b) To foster
the ability of Medicaid beneficiaries needing long term care and supports to
remain and thrive in their homes, the Alabama Medicaid Agency implemented a
home and community-based services (HCBS) program. After consultation with
consumers, consumer advocates, and a wide range of health care providers,
Medicaid has further enhanced the HCBS program by developing and implementing
the integrated care network (ICN) program. The ICN program focuses on bringing
medical case management to the home and community-based services (HCBS)
population to permit better medical risk assessment of those in the HCBS
program which promotes their ability to thrive at home. The ICN also case
manages Medicaid beneficiaries in nursing facilities through the existing
minimum data set (or MDS) assessments, which includes a return to home
assessment. Individuals who might otherwise require admission to a nursing home
are now able to remain in their homes because of the home and community-based
services provided through this program. Currently, there are nearly 8,200
residents whose long-term care needs can be met through the program.
(4) Financing
(a) The Alabama Medicaid program was started
in 1970, and as a result, the nursing home industry grew rapidly during the
70s. Since the 1980 adoption of a more restrictive bed need methodology, the
number of beds added have tapered off considerably. Also, with the containment
of health care costs as a primary concern, a moratorium on additional nursing
home beds was established in August of 1984, and lifted in June of 1989, and
was reinstituted in 2005. Medicaid patients account for 53.7% of patient days,
private pay patients 20.7%, and Medicare 14.5% as of FY 2018.
(5) Availability
(a) The 232 licensed nursing homes located in
Alabama are generally geographically well distributed and are accessible to the
majority of the elderly population within thirty (30) minutes normal driving
time. Every Alabama county has a least one nursing home.
(6) Continuity
(a) Discussion
1. Nursing homes should provide care
appropriate to resident needs. To ensure that comprehensive services are
available and to ensure residents are at a proper level of care, nursing homes
should provide, or should have agreements with other health care providers to
provide, a broad range of care. When providing these services, or a part of any
agreement to provide these services, transfer of residents and support service
should be provided as necessary.
(b) Planning Policy
1. The rendering of complementary long-term
care services, such as home health care adult day care, senior citizen
nutrition programs, hospice, etc., to long term care recipients should be
fostered and encouraged. In areas where such services are sufficiently
developed, health care facilities should be encouraged to have agreements that
increase the availability of such services to residents. In areas where such
services are not sufficiently available, facilities should be encouraged to
develop and offer such services. The Alabama Department of Public Health,
Bureau of Provider Standards, is encouraged to make the appropriate changes to
the licensure requirements.
(7) Quality
(a) Quality care is an obligation of all
nursing homes operating in Alabama. Each facility must meet standards of care
as established by the federal government (Medicare and Medicaid Requirements of
Participation) and the Alabama State Board of Health Rules and Regulations. The
Bureau of Provider Standards of the Alabama Department of Public Health is
responsible for determining compliance. Additionally, the Quality Improvement
Organization (QIO) includes some nursing homes in its review.
(8) Nursing Home Bed Need Methodology
(a) Purpose. The purpose of
this nursing home bed need methodology is to identify, by county, the number of
nursing home beds needed to assure the continued availability, accessibility,
and affordability of quality nursing home care for residents of
Alabama.
(b) General. Formulation
of this bed need methodology was accomplished by a committee of the Statewide
Health Coordinating Council (SHCC). The committee which provided its
recommendations to the SHCC, was composed of providers and consumers of health
care. Only the SHCC, with the Governor's final approval, can make changes to
this methodology except that the SHPDA staff shall annually update bed need
projections and inventories to reflect more current population and utilization
statistics. Adjustments are addressed in paragraph (e).
(c) Basic Methodology. Considering the
availability of more home and community-based services for the elderly in
Alabama, there should be a minimum of 40 beds per 1,000 population 65 and older
for each county.
1. The beds need formula is
as follows:
(40 beds per thousand) x (population 65 and older) =Projected Bed Need
2. Due to budgetary
limitations of the Alabama Medicaid Agency, additional nursing home beds cannot
be funded by Medicaid funds; therefore, applications for additional nursing
home beds to be funded by Medicaid should not be approved. Based upon the
funding shortage, projects for additional nursing home beds would not be
financially feasible. Until further action by the Statewide Health Coordinating
Council, there shall be no need for additional skilled nursing beds in the
State of Alabama.
(d)
Planning Policies
1. The county's annual
occupancy for the most recent reporting year should be at least 97% before
additional nursing home beds are approved.
2. Conversion of existing hospital beds to
nursing home beds should be given priority over new construction when the
conversion is significantly less costly and the existing structure can be
adapted economically to meet licensure and certification requirements. The
conversion shall result in a decrease in the facility's licensed acute care
beds equal to or greater than the number of beds to be converted.
3. Bed need projections will be based on a
three-year planning horizon.
4.
Planning will be on a county-wide basis.
5. Subject to SHCC adjustments, no beds will
be added in any county where that county's projected ratio exceeds 40 beds per
1,000 population age 65 and older.
6. No new free-standing nursing home should
be constructed having less than fifty (50) beds.
7. ICF/IID facilities, state and privately
owned, will not be included in the application of the SHCC adopted nursing home
bed need methodology.
8. When any
nursing home facility relinquishes its license to operate, either voluntarily
or involuntarily other than by a Certificate of Need approved transfer, or by
obtaining title by a foreclosure as specified in the opinion rendered by the
Alabama Attorney General, November 17, 1980, the need for the facility and its
resources will automatically be eliminated from the facilities portion of the
State Health Plan. The new bed need requirement in the county where the
facility was located will be that number which will bring the county ratio up
to 40 beds per 1,000 population 65 and older.
(e) Adjustments. The bed need, as determined
by the methodology, is subject to adjustments by the SHCC. The nursing home bed
need may be adjusted by the SHCC if an applicant can prove that the identified
needs of a targeted population are not being met by existing nursing homes in
the county of the targeted population.
For a listing of Nursing Homes or the most current statistical need projections in Alabama contact the Data Division as follows:
|
MAILING ADDRESS (U. S. Postal Service) |
STREET ADDRESS (Commercial Carrier) |
|
PO BOX 303025 MONTGOMERY, AL 36130-3025 |
100 NORTH UNION STREET, SUITE 870 MONTGOMERY, AL 36104 |
|
TELEPHONE: (334) 242-4103 |
FAX: (334) 242-4113 |
EMAIL:
data.submit@ shpda.alabama.gov
WEBSITE:
Author: Statewide Health Coordinating Council (SHCC)
Statutory Authority: Code of Ala. 1975, § 22-21-260(4).
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
