Current through Register Vol. 47, No. 6, September 18, 2024
(1)
Purpose
and scope.
a. These standards are
measures of criteria found in Iowa Code section
10A.714(1)
"a" through "g." Criteria that are measured
by a standard are cited in parentheses following each standard.
b. Certificate of need applications that are
to be evaluated against these standards include applications to:
(1) Construct, develop, offer new, modernize,
replace, renovate, or relocate intermediate care or skilled nursing care beds
in nursing homes or hospitals.
(2)
Expand bed capacity in intermediate care or skilled nursing care facilities or
designated units in hospitals.
(2)
Definitions.
"Intermediate care facility" or
"ICF" means any institution, place, building, or agency
providing for a period exceeding 24 consecutive hours accommodation, board, and
nursing services, the need for which is certified by a physician, to three or
more individuals, not related to the administrator or owner thereof within the
third degree of consanguinity, who by reason of illness, disease, or physical
or mental infirmity require nursing services that can be provided only under
the direction of a registered nurse or a licensed practical nurse.
"Rural counties" means all counties not
designated by the U.S. Census as SMA (Standard Metropolitan Area)
counties.
"Skilled nursing facility" or
"SNF" means any institution, place, building, or agency
providing for a period exceeding 24 consecutive hours accommodation, board, and
nursing services, the need for which is certified by a physician, to three or
more individuals not related to the administrator or owner thereof within the
third degree of consanguinity who by reason of illness, disease, or physical or
mental infirmity require continuous nursing care services and related medical
services, but do not require hospital care. The nursing care services provided
must be under the direction of a registered nurse on a 24-hour-per-day
basis.
"Urban counties" means those counties
designated by the U.S. Census as SMA (Standard Metropolitan Area)
counties.
(3)
Availability and need. (Iowa Code section
10A.714(1)
"c," "d," "e," "g," "h")
a.
The following formula shall be used as a means of projecting the approximate
number of intermediate and skilled nursing care beds needed to serve the
projected population five years into the future:
(1) Rural counties:
[.09(65 + population) + .0015 (64 " population)] * 110% equals
total long-term care bed need Combined SNF and ICF bed need equals 2/3 (total
long-term care bed need) Assumed RCF bed need equals 1/3 (total long-term care
bed need).
(2) Urban
counties:
[.07(65 + population) + .0015 (64 " population)] * 110% equals
total long-term care bed need Combined SNF and ICF bed need equals 2/3 (total
long-term care bed need) Assumed RCF bed need equals 1/3 (total long-term care
bed need).
(3) Department
of economic development population projections are adopted for use in the
determination of long-term care bed need.
(4) The department of inspections, appeals,
and licensing will calculate long-term care bed need figures annually, using
population projections five years into the future.
b. For purposes of comparing "need" to
"existing" beds in a given county, the following shall be considered in the
calculation of "existing" beds:
(1) ICF and
SNF beds licensed at freestanding facilities in the county.
(2) Additional ICF and SNF beds previously
approved through certificate of need but not yet licensed.
(3) ICF and SNF beds in designated units in
hospitals in the county.
c. The statistical calculation of bed need
shall serve as a guideline for the health facilities council in reviewing need
for the proposed long-term care beds. Other factors that may be considered by
the council include, but are not limited to:
(1) The availability and utilization of other
ICF and SNF services in the county, or within the applicant's service
area.
(2) The availability and
utilization of other long-term care services in nearby hospitals, such as
skilled care available through the swing bed program.
(3) The availability of supportive living
arrangements that may or may not be licensed as residential care facilities
(RCF).
(4) The availability of home
health and other in-home services.
(5) The availability of other services to the
elderly.
(6) The availability of
ICF and SNF services in neighboring counties.
(7) Utilization by out-of-state residents of
facilities in counties bordering other states, where the applicant provides
evidence that in-migration of long-term care patients exceeds out-migration to
the bordering state.
(8) Programs
and services directed at special populations whose needs cannot otherwise be
met, or whose needs cannot be met cost-effectively at other
facilities.
d. In
documenting need for a project, the applicant shall identify the service area
and target population, including a description of the methodology used by the
applicant in determining need for the requested beds and the expected sources
of referrals. The applicant shall document that the number of beds requested is
appropriate to address the identified need. The applicant shall also identify
how the target population is currently being cared for, and what hardship is
being experienced by the absence of the proposed beds.
(4)
Quality. (Iowa Code
section 10A.714(1)
"i," "k") The applicant shall document that the applicant has
contacted the health facilities division of the department of inspections and
appeals to conform with physical standards, staffing requirements, and other
licensing requirements to assess the potential for provision of quality care at
the facility. When necessary, the applicant shall attempt to arrange an on-site
visit to the facility to determine compliance with physical requirements, and
shall provide documentation of this site visit or attempts to arrange such a
site visit.
(5)
Continuity. (Iowa Code section
10A.714(1)
"g," "h," "k")
a. The
applicant shall document the relationship of the facility's proposed services
to other health and long-term care services in the community such as physician
and hospital services, habilitation, rehabilitation, transportation or other
services. The facility should be capable of providing or arranging for the
provision of a continuum of long-term care services.
b. The facility should be capable of
providing or arranging for the provision of a comprehensive program of
coordinated patient services. The applicant shall provide evidence of contracts
for services, appropriate staffing patterns and ratios, and licensure of
personnel as necessary.
(6)
Accessibility and
acceptability. (Iowa Code section
10A.714(1)
"c," "d")
a. Population
subgroups that have traditionally been underserved, such as adolescents, the
elderly, women, racial minorities, mentally ill, intellectually disabled, and
developmentally disabled should be considered when planning for or reviewing
long-term care facilities.
b. The
applicant shall document to what extent Medicaid patients will be served by the
proposed beds, using past Medicaid utilization as an indicator or, in the case
ofanew facility, projecting anticipated Medicaid utilization.
(7)
Costs and financial
feasibility. (Iowa Code section
10A.714(1)
"e," "f," "i," "p")
a. The
applicant shall identify capital and operating costs associated with the
project, identify sources of funding to cover those costs, and demonstrate that
the project is financially feasible.
b. Construction costs shall be in line with
construction costs of other similar projects.
c. The applicant shall provide budgets for
the first three years of operation, including documentation of all assumptions
used. The budget shall include anticipated sources of revenue, including the
percentage of revenue from private pay, Medicaid, Medicare and other patient
revenues.
d. Proposed charges per
patient day should be justifiable when compared to current charges of other
similarly licensed facilities in the applicant's service area, or other similar
facilities elsewhere in the state. If charges are significantly higher or
lower, the applicant shall provide a description of proposed programs or
services that explain the difference in charges.
