Current through Register Vol. 48, No. 12, March 22, 2024
a)
Introduction
This Subpart details the policies and methodologies utilized
to assess the need for beds and services. The calculations and numeric results,
as well as the related data elements that pertain to the methodologies detailed
in this Subpart, are contained in the Inventory of Health Care
Facilities.
b) Formula
Components
Formulas utilized by HFSRB in projecting the need for beds
and services can be categorized as demand based or incidence based need
formulas. Each of these formula types represents a different conceptual outlook
and incorporates different data elements as formula variables.
1) Demand Based Formula. Demand equations
utilize the concept that what has occurred in the past will occur in the
future. The formulas utilize inpatient days of care and population projections
as the key data variables. The first formula step is to establish a utilization
to population ratio (use rate). This ratio basically says that within a
population an average number of inpatient days of care will be generated. This
rate is then applied to the population projection for the same area. This
states that if the rate of use is constant, a future population can be expected
to generate an identifiable number of inpatient days. These projected days are
then converted to a daily census (total projected patient days divided by days
in year) and multiplied by an occupancy target. The projected day figure can be
equated to 100% occupancy of service for which need is projected. An occupancy
factor adjustment is applied to insure that sufficient beds exist to handle
days when inpatient admissions are exceptionally high. This type of formula may
also be adjusted by the application of minimum and maximum use rates in
planning areas that lack facilities or certain types of beds or where a high
concentration of beds and services has caused unnecessary duplication. These
rates are controls and serve to inflate (minimum use rate) or deflate (maximum
use rate) the projected bed need. These rates are established when historical
patterns of use are influenced by a maldistribution of services. By adding to
or subtracting from the number of needed beds, development of new beds and
facilities can be influenced to add beds to underserved areas and to restrict
bed growth in areas of high bed to population ratios.
2) Incidence Based Formula. This type of
formula utilizes the incidence level of a disease or a condition within a
population to predict need. Utilizing national or State rates, the formula
predicts the number of planning area residents who will need hospitalization
based on the number of people who live in the planning area. Utilizing a
standard estimate of how long a patient will be hospitalized, admissions are
converted into patient days. As in the demand formulas, days are then converted
to an average daily census and an occupancy factor adjustment is applied to
obtain area bed need.
c)
Planning Area Development Policies
HFSRB recognizes the need to establish planning areas for the
purpose of assessing and determining the need for health care facilities, beds,
and services. In establishing planning areas the following principles and
factors apply:
1) For purposes of
delineating planning area boundaries and for purposes of calculating population
estimates, the smallest geographical areas to be utilized shall be community
areas for the city of Chicago and townships for all other areas in the State
outside of Chicago.
2) Source of
patient information shall be the primary basis for the allocation of geographic
areas (e.g., townships, community areas, counties) into planning areas. As a
general principle, 50% or more of residents receiving care from facilities or
resources located within the planning area should reside within the planning
area.
HFSRB NOTE: Source of patient information may only be
available on a zip code basis. In such cases, the relationship between zip code
boundaries and community area or township boundaries will be approximated for
use in establishing planning area boundaries.
3) Planning area boundaries should be
established taking into consideration the number and type of existing health
care facilities and services located within the area, shared and overlapping
market areas between or among facilities, and patterns of patient referral to
area health care facilities. Planning areas may vary in size in order to ensure
access within a reasonable travel time.
4) The primary market area for health care
facilities located within a planning area should serve a substantial number of
residents of the planning area. A primary market area means the geographic
location in which 50% or more of a facility's patients/residents reside. HFSRB
recognizes that certain health care facilities (e.g., tertiary and specialty
facilities) may have primary market areas that are not entirely contained
within the planning area in which the facility is located.
5) Planning area boundaries can also be
influenced by the following factors:
A)
natural geographic boundaries;
B)
political boundaries that affect the patterns of services;
C) transportation patterns and
systems;
D) time and distance
required to access service by area residents;
E) affiliations between health care
facilities and other health care entities that affect patterns of
service;
F) trade and economic
market patterns that influence the financing of health care services;
G) the lack of existing health resources or
services in an area;
H) referral
patterns to obtain tertiary services;
I) the impact of reimbursement or managed
care programs;
J) socio-economic
factors such as but not limited to population density, income level, or age
characteristics.
6)
Planning area boundaries may vary by category of service. HFSRB recognizes that
certain services (e.g., neonatal ICU, comprehensive physical rehabilitation,
selected organ transplantation, cardiac surgery, etc.) may require a large
population base in order to assure the provision of quality care and to be cost
effective.
7) Planning areas for
the acute care categories of services of medical-surgical/pediatrics,
obstetrics and intensive care must contain a minimum population of 40,000. This
population base would be sufficient to support a 100 bed hospital based upon a
facility target occupancy of 80% and an inpatient day use rate of 725 days per
1,000 population.
8) Planning areas
for general long-term service must contain a minimum population of 10,000. This
population base would be sufficient to support 100 nursing care beds based upon
a rate of 9 beds per 1,000 population (projected 1997 statewide need divided by
projected 1997 State population) with a target occupancy of 90%.
9) HFSRB recognizes that some long-term care
facilities may have a primary market area that is not contained within the
planning area in which the facility is located. Placement in long-term care
facilities may be influenced by such factors as, but not limited to: location
of next of kin or relatives; seeking services of a specialized nature such as
treatment for various diseases or disabilities; or seeking services related to
religious, ethnic, or fraternal needs. Because of the significant degree of
mobility that is exercised in seeking long term care services, HFSRB shall not
allocate portions of a facility's beds and services to more than one planning
area.
d) Distance
Determinations
Normal travel radius for proposed projects shall be based
upon the location of the applicant facility.
1) For applicant facilities located in the
Chicago Metropolitan counties of Cook, DuPage, Lake, Will and Kane, the radius
shall be 10 miles.
2) For applicant
facilities located in the counties of Kankakee, Grundy, Kendall, DeKalb,
McHenry, Winnebago, Champaign, Sangamon, Peoria, Tazewell, Rock Island,
Madison, Monroe and St. Clair , the radius shall be 17 miles.
3) For applicant facilities located in any
other area of the State, the radius shall be 21 miles.
e) Independent Travel Time Studies may be
prepared and submitted in addition to the information found in subsection (d)
to refine or supplement the determination of the applicable radius, provided
that they are conducted as follows:
1) The
study is conducted by an engineering firm pre-qualified in traffic studies by
the Illinois Department of Transportation or prepared by a professional
engineer also certified by the Institute of Transportation Engineers as a
Professional Traffic Operations Engineer.
2) A 30-minute travel time radius from the
applicant facility shall consist of a minimum of three round trips for each
defined survey route.
3) No more
than one third of the round trips shall start or conclude during a rush hour
period, i.e.:
Morning Peak Period: 6:30 AM-9:30 AM
Evening Peak Period: 3:30 PM-6:30 PM
4) The routes used for determining the travel
time shall be reasonably direct.
5)
Average travel time for a one-way trip will be considered.
6) All travel routes and calculations of the
travel time are to be documented and sealed by the responsible professional
engineer.