Current through Register Vol. 49, No. 2, February 2024
HSC Regulation 100M Nursing Home Bed Methodology
(12/08)
DEFINITIONS:
* The term "Licensed Beds" means the bed count as
reflected on the current license issued by the Department of Human Services,
Office of Long-Term Care.
* The term "Beds in Transition" means beds that
originate from a licensed facility and are being transferred or moved to a new,
existing or replacement facility in a different county and are awaiting final
licensing of new construction. For purposes of projected need and the awarding
of additional beds, the Beds in Transition shall not be considered licensed
beds in the county into which they are being moved until the beds become
licensed in that county.
I.
POPULATION BASED METHODOLOGY (PROJECTED TO 2014)
A. Population Based Methodology calculates
the projected nursing home bed need using estimated population data for four
age groups (see below) for a service area (county)
Need is projected five
(5) years forward from the current State Fiscal Year using the most recent data
available from the UALR Institute of Economic Advancement. No change from
original. Last sentence reworded to mirror language in ALF Population Based
Methodology.
AGE GROUP BEDS PER 1000 POPULATION
|
Below 65
|
.7
|
|
65 to 74
|
10.0
|
|
75 to 84
|
39.3
|
|
85 and above
|
160.0
|
B.
Occupancy Requirement.
In order to
qualify for issuance of a Permit of Approval for additional beds in the county
under the Population Based Need Methodology, counties which have a projected
net "need" under this section must have had an average overall occupancy
of at least 80% for the most recently available occupancy as reported by
DHS.[Moved from original Section
I, Paragraph 2].
C.
Exceeding Projected Net Need.
The Agency may exceed the projected net "need" when
theprojected net "need" is less than 10 beds in order to approve
one applicant for a 10 bed increase (i.e., the 10 beds would not be spread over
two (2) or more applicants).[Moved from original Section
I, B.]
D.
Exception to Occupancy
Requirement. The Commission may disregard the overall
county occupancy one time in order to approve a 70 bed facility in a county
where the projected need for the county exceeds the "existing" (i.e., licensed
and approved) beds by 250 or more beds.[Moved from original Section
I, C.].
[ This section below was moved to create a new Section
called "IV. APPLICATION APPROVAL PRIORITIES"].
II.
UTILIZATION
BASEDMETHODOLOGY
A. Nursing homes may acquire up to 10% of its
licensed capacity or 10 beds, whichever is greater, if the applicant nursing
home:
1. averaged 90.0% or greater occupancy
according to the most recent 12 month occupancy data available from DHS
and
2. currently has
no Approved but Unlicensed Beds and had no Approved but Unlicensed Beds during
the previous 12 month period and
3. acquires beds from a facility that
averaged 70% or less occupancy for the previous 12 month period according
to the most recent 12 month occupancy data available from Dept. of Human
Services and
4. is located
in a county without a Population Based need and
5. has not acquired beds pursuant to this
Subsection
II. A. in the previous 12 month
period.
Beds may not be transferred back or returned to the original
facility unless all the requirements of this section Part II. A. are
satisfied.
B.
Nursing homes with less than 60 licensed beds could be approved to expand to 70
beds, if the facility:
1. averaged 90.0% or
greater occupancy according to the most recently available occupancy as
reported by DHS.
2 currently has no
approved but unlicensed beds and had no approved but unlicensed beds during the
previous State fiscal year,
3. is
located in a county without a Population Based "need"; and
4. Is not located in a county where the
number of approved but unlicensed beds equals 10% or more of the county's
licensed beds in the previous 12 month period,
C. Notwithstanding the foregoing provisions
of this section
II but subject to section
IV E and F herein, and subject to
commission approval, an existing facility may relocate beds within the county
where the facility is located. In doing so, the facility may either move all or
some of its existing beds or the facility may acquire and move beds from
another facility located within the same county.
D. In any county where every nursing home
facility in the county has an occupancy rate of at least 90.0%, and there is no
population based need, an applicant may add 10% of their licensed capacity or
10 beds, which ever is greater, if the facility currently has no approved but
unlicensed beds and had no approved but unlicensed beds during the previous
State fiscal year.
[ Moved to Unfavorable Review]
III.
REPLACEMENT
OF FACILITIES AND BEDS
A. Qualified
applicants would be applicants who propose to replace existing beds with "new
construction."
As used in this methodology, "new construction" means the
replacement of an entire facility with a newly constructed facility, or the
relocation of existing beds into a newly constructed facility.
This section prohibits the relocation of existing beds for
purposes of "adding on" to an existing facility, irrespective of whether the
"add on" is new construction.
B. Applicants may be approved for up to a 20%
increase of their present licensed capacity when replacing a facility under
this Subsection. Except as otherwise provided in this Subsection, applicants
cannot combine any criteria to increase existing licensure by more than 20%.
The sole exception is the case of facilities expanding up to 70 beds. This does
not affect applicants, which qualify for approval under I. A. 1. of this
methodology .
C. Qualified
applicants cannot combine any criteria to increase existing licensure by more
than 20% except in the case of facilities expanding up to 70 beds. This does
not affect applicants which qualify for approval under I.A.1. of this
methodology.
D. Qualified
applicants may move to another county or counties if:
1. the beds are located where "existing"
(i.e. licensed and approved) beds exceed the projected county need by 100 or
more beds;
2. the number of beds
being moved does not exceed the projectednet need of the county
(or counties) to which the beds are being moved and;
3. the moved beds are used for "new
construction" and
4.
the
occupancy for the county to which the facility or beds are being moved has had
an average overall occupancy of 80% or more for the most recently available
occupancy as reported by DHS.
IV.
APPLICATION APPROVAL
PRIORITIES
A. In any one
review cycle, for all applications submitted under sections
I and
III of this methodology, only one
(1) application may be approved for each county. For example, if there are two
(2) applications submitted under section
I and one (1) application
submitted under section
III for the same county, only one
of the three applications may be approved in any one review cycle.
B. With respect to applications submitted
under section
II, one application per county
may be approved per review cycle, in addition to the one (1) application to be
approved as described in section
IV. A.1.
C.
When making a decision
on applications submitted for the same county in the same review cycle,
additional beds available (according to the county's projected net need) will
be awarded in the following ranked order:
1. Beds available shall first be allocated to
applicants who propose to add beds to an existing licensed facility whose
facility had a 96.0% average occupancy rate or greater for the most recently
available occupancy as reported by DHS, provided all requirements for approval
of the application(s) are met.
Beds awarded pursuant to this first priority shall be either a
number of beds equivalent of up to a 10% increase in the facility's existing
number of licensed beds or 10 beds, whichever is greater.
The maximum number of beds awarded to existing facility
applicant(s) pursuant to this priority in a single review cycle shall be
35.
2. Remaining beds
available shall next be allocated to applicants who propose to replace
facilities pursuant to Section
III, the Replacement methodology,
who are eligible for a 20% increase in their licensed capacity; this
paragraph (2) is not intended to require a county to have a projected net need
to qualify for a Section
III20 % increase
but rather is intended to ensure that if there is a 20% increase approval in
that review cycle, the additional beds awarded will be deducted from any
projected net need before any other application with lesser priority is
approved;
3. Remaining
available beds shall next be allocated to applicants who have an existing
facility with less than 70 beds who are proposing to expand to 70 beds. These
applicants may be approved for a number of additional beds necessary to enable
them to expand to 70 beds. However, if these applicants have less than 70 beds
and more than 60 licensed beds they may be approved for up to a 10 bed
increase.
4.
Remaining beds
available shall next be allocated to applicants proposing to construct a new
facility which the Agency finds meet all criteria for approval.
V.
UNFAVORABLE REVIEW
A.
An
application for a Permit of Approval under the HSC Regulation 100M Nursing Home
Methodology will be denied if it:
1.
does not agree to eliminate all three (3) or more bed units in the applicant
facility. A facility may have three (3) or more beds units only in order to
comply with specific regulations for intensive care, Alzheimer's disease,
and/or sub-acute care units (pertinent regulations to be promulgated by the
Department of Human Services, Office of Long-Term Care),
2. is for an applicant home with current life
threatening compliance issues that could not be corrected by the proposed
construction, or
3. is for any
nursing home found to have had an H level deficiency or higher by the Office of
Long Term Care in the twelve (12) months preceding the date the application is
placed under review or from the date the application is placed under review
until the final decision of the Commission. This section is intended to
prohibit the expansion of existing facilities with a history of serious
non-compliance. This section, however, shall not apply to applicants under
Section III who are replacing older
facilities.
4. will cause a
facility to exceed 140 beds, or
5.
will create a facility with fewer than 70 beds.
6. would create an under-served area. The
Commission will make this determination.
7. is located in a county where the number of
Approved but Unlicensed beds equals 10% or more of the county's licensed beds
in the previous state fiscal year. e.g. if in 1997 County "A" had 140 licensed
beds with a 28 bed approval then the facilities in County "A" would not be
eligible for additional beds under either the Population Based or Utilization
Based methodology. The rationale is that an increase in beds would have
affected occupancy.
[This section moved to the new "Section IV. Application
Review Priorties", Section B.]
[This section moved to the new "Section IV. Application
Review Priorties", Section B.]
B. An application for a POA will be denied if
the owner/operator applying for a Permit of Approval has abandoned one or more
long-term facilities either in Arkansas or in another state.
C. The Agency may consider an out of state
applicant's compliance and enforcement history in determining whether to grant
a Permit of Approval.
NOTE: Occupancy data on Medicaid certified facilities
will be based on the report supplied by the Department of Human Services,
Division of Medical Services to the Health Services Permit Agency. Occupancy
data on facilities that did not report to the Department of Human Services,
Office of Long-Term Care will be based on the survey conducted by the Health
Services Permit Agency. (Non-reporting facilities include facilities without
Medicaid beds and those facilities which changed ownership during the previous
calendar year.)
V.
Lifecare Nursing Facility
(10/02)
The Arkansas Health Services Commission and the Arkansas Health
Services Agency amend their rules, policies, and procedures in relation to
applications for long-term care facilities as follows:
A. Continuing care providers, as established
by the Arkansas General Assembly and codified in A.C.A.
23-93-101 -
23-93-114
and regulated by the Arkansas Insurance Commissioner, shall be governed by the
statutory and regulatory provisions relating to applications for long-term care
facilities.
B. Continuing care
"life care providers", as established by the Arkansas General Assembly and
codified in A.C.A.
23-93-201
et seq., regulated by The Insurance Commissioner of Arkansas and requiring no
additional charges for nursing care or personal care services beyond those
charged all residents of the facility who are not receiving nursing care of
personal care services, shall be governed by statutory andregulatory provisions
relating to applications for long-term care facilities, except:
1. After issuance of a license by the
Department of Insurance as a "life care provider", the life care provider may
apply for a Permit of Approval for a nursing facility based on one bed per ten
constructed, licensed units occupied by bona fide residents upon a signed
agreement that no individual will be directly admitted to the nursing facility
who has not been a bona fide resident of the life care provider.
2.
(i)
Additional beds for the life care provider nursing facility may be requested on
an annual basis, provided it is in compliance with and has a current license
from the Department of Insurance and the Office of Long Term Care, based on one
bed per additional ten constructed, licensed units occupied by bona fide
residents of the life care provider which have been constructed, licensed, and
occupied by bona fide residents and in existence for at least twelve (12)
months from the last application under this sub-section, and based on the
occupancy of the nursing facility during the previous twelve months, requiring
the previous twelve months, until the nursing facility reaches a total of
seventy (70) beds, and provided no individual has been admitted to the nursing
facility who had not been a bona fide resident of the life care provider. The
life care provider shall furnish the Health Services Agency all information
requested to substantiate the application. or
(ii) Additional beds for the life care
provider nursing facility may be requested on an annual basis, if no new
constructed, licensed units have been added to the life care provider, based on
the utilization of the nursing facility during the previous twelve months,
requiring seventy percent (70%) occupancy over the previous twelve months, and
shall entitle the life care provider, provided it is in compliance with and has
a current license from the Department of Insurance and the Office of Long Term
Care, to an additional ten beds, or ten percent (10%), whichever is greater,
until the nursing facility reaches a total of seventy (70) beds, provided no
individual has been directly admitted to the nursing facility who has not been
a bona fide resident of the life care provider. The life care provider shall
furnish the Health Services Agency all information requested to substantiate
the application.
(iii) Only one of
these methods may be used in a calendar year.
3. Should the life care provider's license be
revoked by the Arkansas Department of Insurance, this Commission shall
recommend to the Office of Long Term Care that the nursing facility lose its
license to own and operate a nursing facility. Should a life care provider
nursing facility directly admit residents who have not been bona fide residents
of the life care provider to the nursing facility, the life care provider shall
not be allowed to apply for new beds for a total of five (5) years.
4. The nursing facility or beds of a life
care provider shall not be sold or transferred to any other entity. Any sale or
transfer shall automatically forfeit the license of the facility or beds and
bar the life care provider from applying for additional beds for ten (10)
years.
5. Nursing facility beds of
a life care provider shall not be counted when computing bed need for a county,
as they are not available to the public.
POPULATION BASED FORMULA (04/03)
This methodology projects nursing home bed need using estimated
population in four age groups (see below) of a service area (county):
AGE GROUP BEDS PER 1000 POPULATION
|
Below 65 .66
|
|
65 to 74 10.8
|
|
75 to 84 42.97
|
|
85 and above 182.5
|
NOTE: The projection for a county represents the number of
patients estimated to need beds. Since all nursing homes cannot be expected to
operate at 100% occupancy year round, 5% additional beds are added to the
initial projection to allow for patient fluctuation, i.e., the initial
projection (using the above mentioned bed figures) represents 95% of the total
beds needed.
