Current through Register Vol. 48, No. 12, March 22, 2024
The information requirements contained in this Section are
applicable to all projects except projects that are solely for discontinuation.
An applicant shall document the qualifications, background, character
and financial resources to adequately provide a proper service for the
community and also demonstrate that the project promotes the
orderly and economic development of health care facilities in the State
of Illinois that avoids unnecessary duplication of facilities or
service. [
20
ILCS 3960/2 ]
a) Background of Applicant - Review Criteria
1) An applicant must demonstrate that it is
fit, willing and able, and
has the qualifications, background and
character to adequately provide a proper standard of health care service for
the community. [
20
ILCS 3960/6 ] In evaluating the qualifications,
background and character of the applicant, HFSRB shall consider whether adverse
action has been taken against the applicant, including corporate officers or
directors, LLC members, partners, and owners of at least 5% of the proposed
health care facility, or against any health care facility owned or operated by
the applicant, directly or indirectly, within 3 years preceding the filing of
the application. A health care facility is considered "owned or operated" by
every person or entity that owns, directly or indirectly, an ownership
interest. If any person or entity owns any option to acquire stock, the stock
shall be considered to be owned by that person or entity (see 77 Ill. Adm. Code
1100 and 1130 for definitions of terms such as "adverse action", "ownership
interest" and "principal shareholder").
EXAMPLES:
Examples of facilities owned or operated by an applicant
include:
The applicant, Partnership ABC, owns 60% of the shares of
Corporation XYZ, which manages the Good Care Nursing Home under a management
agreement. The applicant, Partnership ABC, owns or operates Good Care Nursing
Home.
The applicant, Healthy Hospital, a corporation, is a
subsidiary of Universal Health, the parent corporation of Healthcenter
Ambulatory Surgical Treatment Center (ASTC), its wholly-owned subsidiary. The
applicant, Healthy Hospital, owns and operates Healthcenter ASTC.
Dr. Wellcare is the applicant. His wife is the director of a
corporation that owns a hospital. The applicant, Dr. Wellcare, owns or operates
the hospital.
Drs. Faith, Hope and Charity own 40%, 35% and 10%,
respectively, of the shares of Healthfair, Inc., a corporation, that is the
applicant. Dr. Charity owns 45% and Drs. Well and Care each own 25% of the
shares of XYZ Nursing Home, Inc. The applicant, Healthfair, Inc., owns and
operates XYZ Nursing Home, Inc.
2) The applicant shall submit the following
information:
A) A listing of all health care
facilities currently owned and/or operated by the applicant in Illinois or
elsewhere, including licensing, certification and accreditation identification
numbers, as applicable;
B) A
listing of all health care facilities currently owned and/or operated in
Illinois, by any corporate officers or directors, LLC members, partners, or
owners of at least 5% of the proposed health care facility;
C) A certified listing from the applicant of
any adverse action taken against any facility owned and/or operated by the
applicant during the 3 years prior to the filing of the application;
D) A certified listing of each applicant,
corporate officer or director, LLC member, partner and owner of at least 5% of
the proposed facility, identifying those individuals that have been:
i) cited, arrested, taken into custody,
charged with, indicted, convicted or tried for, or pled guilty to the
commission of any felony or misdemeanor or violation of the law, except for
minor parking violations; or
ii)
the subject of any juvenile delinquency or youthful offender
proceeding;
E) Unless
convictions have been expunged, all convictions shall be detailed in writing
and any police or court records regarding any matters disclosed shall be
submitted for HFSRB's consideration;
F) A certified listing of each applicant,
corporate officer or director, LLC member, partner and owner of at least 5% of
the proposed facility who has been charged with fraudulent conduct or any act
involving moral turpitude. Any such matter shall be disclosed in
detail;
G) A certified listing of
each applicant, corporate officer or director, LLC member, partner and owner of
at least 5% of the proposed facility who has any unsatisfied judgments against
him or her;
H) A certified listing
of each applicant, corporate officer or director, LLC member, partner and owner
of at least 5% of the proposed facility. Any matter shall be discussed in
detail;
I) A certified listing of
each applicant, corporate officer or director, LLC member, partner and owner of
at least 5% of the proposed facility who is in default in the performance or
discharge of any duty or obligation imposed by a judgment, decree, order or
directive of any court or governmental agency. Any matter shall be discussed in
detail;
J) Authorization permitting
HFSRB and IDPH access to any documents necessary to verify the information
submitted, including, but not limited to: official records of IDPH or other
State agencies; the licensing or certification records of other states, when
applicable; and the records of nationally recognized accreditation
organizations. Failure to provide the authorization shall constitute an
abandonment or withdrawal of the application without any further action by
HFSRB. Any fees paid will be forfeited.
3) If, during a given calendar year, an
applicant submits more than one application for permit, the documentation
provided with the prior applications may be utilized to fulfill the
requirements of this subsection (a). In these instances, the applicant shall
attest that the information has been previously provided, cite the project
number of the prior application, and certify that no changes have occurred
regarding the information that has been previously provided. The applicant is
able to submit amendments to previously submitted information, as needed to
update and/or clarify data.
4) The
documentation for the Background of the Applicant is required one time per
application, regardless of the number of categories of service involved in a
proposed project.
b)
Purpose of the Project - Information Requirements
The applicant shall document that the project will provide
health services that improve the health care or well-being of the market area
population to be served. The applicant shall define the planning area or market
area, or other, per the applicant's definition.
1) The applicant shall address the purpose of
the project, i.e., identify the issues or problems that the project is
proposing to address or solve. Information to be provided shall include, but is
not limited to, identification of existing problems or issues that need to be
addressed, as applicable and appropriate for the project. Examples of such
information include:
A) The area's
demographics or characteristics (e.g., rapid area growth rate, increased aging
population, higher or lower fertility rates) that may affect the need for
services in the future;
B) The
population's morbidity or mortality rates;
C) The incidence of various diseases in the
area;
D) The population's financial
ability to access health care (e.g., financial hardship, increased number of
charity care patients, changes in the area population's insurance or managed
care status);
E) The physical
accessibility to necessary health care (e.g., new highways, other changes in
roadways, changes in bus/train routes or changes in housing
developments).
2) The
applicant shall cite the source of the information (e.g., local health
department Illinois Project for Local Assessment of Need (IPLAN) documents,
Public Health Futures, local mental health plans, or other health assessment
studies from governmental or academic and/or other independent
sources).
3) The applicant shall
detail how the project will address or improve the previously referenced
issues, as well as the population's health status and well-being. Further, the
applicant shall provide goals with quantified and measurable objectives with
specific time frames that relate to achieving the stated goals.
4) For projects involving modernization, the
applicant shall describe the conditions being upgraded. For facility projects,
the applicant shall include statements of age and condition and any regulatory
citations. For equipment being replaced, the applicant shall also include
repair and maintenance records.
c) Safety Net Impact Statement - Information
Requirements
All health care facilities, with the exception of
skilled and intermediate long term care facilities licensed under the Nursing
Home Care Act, shall provide a safety net impact statement, which shall be
filed with an application for a substantive project (see Section
1110.40
). Safety net services are the services provided by health care
providers or organizations that deliver health care services to persons with
barriers to mainstream health care due to lack of insurance, inability to pay,
special needs, ethnic or cultural characteristics, or geographic
isolation. [
20
ILCS 3960/5.4 ]
1) A safety net impact statement shall
describe, if reasonably known by the applicant, all of the following
information:
A)
The project's
material impact, if any, on essential safety net services in the
community;
B)
The
project's impact on the ability of another provider or health care system to
cross-subsidize safety net services; and
C)
How the discontinuation of a
facility or service might impact the remaining safety net providers in a given
community.
2) A
safety net impact statement shall also include all of the following:
A) Certification describing the amount of
charity care provided by the applicant for the 3 fiscal years prior to
submission of the application. The amount calculated by hospital
applicants shall be in accordance with the reporting requirements in the
Illinois Community Benefits Act. Non-hospital applicants shall report charity
care, at cost, in accordance with an appropriate methodology specified by the
Board. (See 77 Ill. Adm. Code
1120.20(c).)
B) Certification describing the amount of
care provided to Medicaid patients for the 3 fiscal years prior to submission
of the application. Hospital and non-hospital applicants shall provide Medicaid
information consistent with data reported in IDPH's Inpatients and Outpatients
Served by Payor Source and Inpatient and Outpatient Revenue by Payor
Source.
C)
Any information
the applicant believes is directly relevant to safety net services, including
information regarding teaching, research, and any other service. [
20
ILCS 3960/5.4(d)(3) ]
3) Safety Net Impact Statement
Response
A)
Any person, community
organization, provider or health system or other entity wishing to comment upon
or oppose the application may file a safety net impact statement response with
the Board, which shall provide additional information concerning a project's
impact on the safety net services in the community. [
20
ILCS 3960/5.4(f) ]
B)
Applicants shall be provided an
opportunity to submit a reply to any safety net impact statement
response. [
20
ILCS 3960/5.4(g) ]
4) HFSRB State Board Staff Report
The HFSRB State Board Staff Report shall indicate:
A) Whether a safety net impact statement was
filed by the applicant;
B) Whether
the safety net impact statement included information on charity care,
the amount of care provided to Medicaid patients, and information on teaching
research, or any other service provided by the applicant that is directly
relevant to safety net services [
20
ILCS 3960/5.4(h) ]; and
C)
Names of the parties submitting
responses and the number of responses and replies, if any, that were
filed [
20
ILCS 3960/5.4(h) ].
d) Alternatives to the
Proposed Project - Information Requirements
The applicant shall document that the proposed project is the
most effective or least costly alternative for meeting the health care needs of
the population to be served by the project.
1) Alternative options shall be addressed.
Examples of alternative options include:
A)
Proposing a project of greater or lesser scope and cost;
B) Pursuing a joint venture or similar
arrangement with one or more providers or entities to meet all or a portion of
the project's intended purposes; developing alternative settings to meet all or
a portion of the project's intended purposes;
C) Utilizing other health care resources that
are available to serve all or a portion of the population proposed to be served
by the project; and
D) Other
considerations.
2)
Documentation shall consist of a comparison of the project to alternative
options. The comparison shall address issues of cost, patient access, quality
and financial benefits in both the short term (within one to 3 years after
project completion) and long term. This may vary by project or
situation.
3) The applicant shall
provide empirical evidence, including quantified outcome data, that verifies
improved quality of care, as available.