Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 503 - MAINE CERTIFICATE OF NEED PROCEDURES MANUAL FOR HEALTH CARE FACILITIES (OTHER THAN NURSING CARE FACILITIES)
Chapter 10 - PRINCIPLES GOVERNING REVIEWS
Section 144-503-10-1 - Determinations Required

1 Capacity of the applicant to support the project financially over its useful life, in light of the rates the applicant expects to be able to charge for the services to be provided by the project; and

2 Applicant's ability to establish and operate the project in accordance with existing and reasonably anticipated future changes in federal, State and local licensure and other applicable or potentially applicable rules;

1 Whether, and the extent to which, the project will substantially address specific health problems, as measured by health needs in the area to be served by the project;

2 Whether the project will have a positive impact on the health status indicators of the population to be served;

3 Whether the services affected by the project will be accessible to all residents of the area proposed to be served; and

4 Whether the project will provide demonstrable improvements in quality and outcome measures applicable to the services proposed in the project;

1 The impact of the project on total health care expenditures after taking into account, to the extent practical, both costs and benefits of the project and the competing demands in the local service area and statewide for available resources for health care;

2 The availability of State funds to cover any increase in State costs associated with utilization of the project's services; and

3 The likelihood that more effective and accessible, or less costly, alternative technologies or methods of service delivery may become available.

In making a determination under this subsection, the Commissioner shall use data available in the State health plan under section 253, data from the Maine Health Data Organization established in chapter 1683 and other information available to the Commissioner. Particular weight must be given to information that indicates that the proposed health services are innovations in high quality health care delivery, that the proposed health services are not reasonably available in the proposed area and that the facility proposing the new health services is designed to provide excellent quality health care.

1. Projects that protect public health and safety Projects with the primary objective of eliminating threats to patient safety. Projects that incorporate comprehensive disease detection, treatment and rehabilitation, that show evidence of leading to decreases in inappropriate utilization, and other evidence based strategies to reduce the impact of such chronic illness as cardiovascular disease, cancer, asthma, chronic lung disease, diabetes and mental illness, furthering the goal of moving our health care system toward the chronic care model. Projects that reflect a redirection of resources and focus on population-based health and prevention. Such projects will allow us to move toward our goal of shifting resources toward areas of greatest need which is for prevention and care of the chronically ill. Projects that demonstrate best practices in building construction, renovation and operation to minimize environmental impact both internally and externally (e.g. "green" energy).

2. Projects that contribute to lower costs of care and greater efficiencies: Projects that will reduce future demand for health care services Projects that result in reduced operating costs for existing facilities. Projects that physically consolidate hospitals or services that serve all or part of the same area that demonstrate an appropriate, cost effective use for the "abandoned" infrastructure, that do not result in increased costs to the health care system and that, in accordance with State policy as expressed in Maine's Growth Management Act, do not contribute to sprawl. Telemedicine projects that facilitate improvements and cost-efficiencies in the quality of diagnosis and treatment in smaller, rural communities.

3. Projects that advance access to services and reflect a collaborative, evidence-based strategy for introducing new services and technologies: Projects that make the best use of existing capacity/infrastructure in initiatives focused on expanding access to ambulatory or primary care services. Projects introducing new technology or services will only be considered if evidence is provided showing detailed analysis of peer reviewed research and data supporting the technology and need and clearly detailing the impact of the project on health care spending in Maine over the short, medium and long term time horizons. Projects must be recommended by the Maine Quality Forum and documented evidence of collaboration exists to assure shared use of new resources across the State, rather than proliferation and/or duplication of new technology.

In addition, high priority will be assigned to applicants able to demonstrate the following:

RESERVED Applicants demonstrating investment in and/or use of an electronic medical records system with an HL7 interface, allowing for exchange of information. This priority assignment will be available to any applicant, regardless of the project applied for. The policy rationale underlying this priority assignment is our desire to encourage implementation of the infrastructure necessary to facilitate integrated clinical information systems. Such systems will serve to improve the quality of care and , ultimately, reduce the cost of care.

Projects that involve any of the following characteristics cannot be considered priority projects:

Projects that duplicate existing services or facilities in a region or community that has existing capacity for such services. This limitation assists in the orderly development of the health care system and in our efforts to control costs. Projects that result in an increase in the number of inpatient beds in the State. Putting additional beds on-line, without a complementary reduction in beds elsewhere will infuse additional costs into the system. Projects that involve the construction of a new hospital (other than replacement facilities). Projects that involve major expansions of existing services and/or facilities.