Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: The committee is amending this rule to
remove need methodologies for new major medical units, add three (3) full years
of utilization data for new/additional units, add robotic surgery utilization
requirements, and add three (3) full years of data for new hospital
projects.
(1) For new units
or services in the service area, use the following:
(A) Provide the minimum annual utilization for each of
the other providers in the service area for the most recent three (3) full
years, if applicable. The provider(s) should achieve at least the following
community need rates as follows by the final year:
1. Magnetic resonance imaging procedures:
2,000
2. Positron emission
tomography/computed tomography procedures: 1,000
3. Lithotripsy treatments: 1,000
4. Linear accelerator treatments:
3,500
5. Cardiac catheterization
procedures (include coronary angioplasties): 500
6. Gamma knife treatments: 200
7. Computed tomography: 3,500
8. Robotic surgery system: 240
(B) For long-term care hospitals
(such as a hospital-within-a-hospital or long-term acute care hospital), the
applicant should comply with the standards as described in
42 CFR, section
412.23(e), and the bed need
should meet the applicable population-based bed need methodology in
19 CSR
60-50.450;
(C) Alternate methodologies may also be
provided.
(2) For
additional units or services, provide the applicant's annual utilization for
the most recent three (3) full years, if applicable. The applicant should
achieve at least the following community need rates as follows, by the final
year:
(A) Magnetic resonance imaging
procedures: 3,000
(B) Positron
emission tomography/computed tomography procedures: 1,000
(C) Lithotripsy treatments: 1,000
(D) Linear accelerator treatments:
6,000
(E) Cardiac catheterization
procedures: 750
(F) Gamma knife
treatments: 200
(G) Computed
tomography: 4,000
(H) Robotic
surgery system: 240
(3)
For replacement equipment, utilization standards are not used, but rather the
following questions shall be answered:
(A)
What is the financial rationale for the replacement?
(B) How has the existing unit exceeded its
useful life in accordance with American Hospital Association
guidelines?
(C) How does the
replacement unit affect quality of care, utilization, and operational
efficiencies compared to the existing unit?
(D) Is the existing unit in constant need of
repair?
(E) Has the current lease
on the existing unit expired?
(F)
What technological advances and capabilities will the new unit
include?
(G) How will patient
satisfaction be improved?
(H) How
will the new unit improve outcomes and/or clinical improvements?
(I) By what percentage will this replacement
increase patient charges?
(4) For the construction of a new hospital,
the following questions shall be answered:
(A)
What methodology was utilized to determine the need for the proposed
hospital?
(B) Provide the most
recent three (3) full years of evidence that the average occupancy of the same
type(s) of beds at each other hospital in the proposed service area exceeds
eighty percent (80%).
(C) What
impact would the proposed hospital have on utilization of other hospitals in
the service area?
(D) What is the
unmet need according to the following population-based bed need formula using
(Unmet Need = (R x P) - U), where:
P = Year 2025 population in the service area;
U = Number of licensed and approved beds in the service area;
and
R = Community need rate of one (1) bed per population in the
service area as follows:
1.
Medical/surgical bed: 570
2.
Pediatric bed: 8,330
3. Psychiatric
bed: 2,080
4. Substance
abuse/chemical dependency bed: 20,000
5. Inpatient rehabilitation bed:
9,090
6. Obstetric bed:
5,880
*Original authority: 197.320, RSMo 1979, amended 1993,
1995, 1999.
