Current through Register Vol. 47, No. 12, March 26, 2025
(a) This
methodology will be utilized to evaluate certificate of need applications for
the certification of long-term ventilator beds, which are operated in
residential health care facilities for individuals experiencing respiratory
failure who can be treated through mechanical ventilation. It is the intent of
the State Hospital Review and Planning Council that this methodology, when used
in conjunction with the planning standards and criteria set forth in section
709.1 of this Part, become a
statement of planning principles and decision making tools for directing the
distribution of long-term ventilator beds. The goals and objectives of the
methodology expressed herein are expected to ensure that an adequate number of
long-term ventilator beds are available to provide access to care and avoid the
unnecessary duplication of resources.
(b) The factors for determining the public
need for long-term ventilator beds shall include, but not be limited to, the
following:
(1) The planning areas for
determining the public need for long-term ventilator beds shall be the
designated health systems regions.
(2) The number of long-term ventilator beds
in each health systems region required to meet the public need shall be
determined by dividing the projected annual patient days for the service by
365, and dividing the result by 0.95 to allow for a 95 percent occupancy rate.
The projected long-term ventilator patient days used in this calculation shall
be determined as follows:
(i) The annual
number of potential candidates for long-term ventilator beds shall be
determined by calculating the total number of annual general hospital
discharges in the planning area for DRG 475 (respiratory system diagnosis with
ventilator support), plus an additional 10 percent, and multiplying the
resulting figure by 0.32.
(ii) The
number of potential candidates for long-term ventilator beds shall be
multiplied by a 125-day length-of-stay to project the annual number of patient
days for long-term ventilator patients.
(3) The review of certificate of need
applications will consider the documented referral patterns in the planning
area, the expected length-of-stay based on the case-mix of long-term and
short-term patients, the ability of the applicant to successfully wean
ventilator patients, and the ability and commitment of the applicant to accept
the difficult-to-place ventilator patients (e.g., ventilator patients with
hemodialysis needs or patients with bacterial infections).
(4) The long-term ventilator bed need
methodology will be reviewed within three years from the effective date of this
section.
(c)
(1) The bed need estimates developed pursuant
to subdivision (b) of this section shall constitute the public need for
ventilator beds in the planning area subject to further adjustments in
accordance with subdivision (d) of this section.
(2) Notwithstanding that there is an
indication of need in a planning area for additional long-term ventilator beds
as determined in accordance with subdivision (b) of this section, there shall
be a rebuttable presumption that there is no need for any additional long-term
ventilator beds in such planning area if the overall occupancy rate for
existing long-term ventilator beds in such planning area is less than 95
percent based on the most recently available data. It shall be the
responsibility of an applicant in such instances to demonstrate that there is a
need for additional long-term ventilator beds despite the less than 95 percent
occupancy rate in the planning area utilizing the factors set forth in
subdivision (d) of this section.
(3) The department shall evaluate the
appropriateness of the 95 percent occupancy threshold criterion in this
section, based on the most recent data available, within three years of the
effective date of this section.
(d) Notwithstanding any other provision of
this section, when the estimates of need for long-term ventilator beds
developed in accordance with subdivision (b) of this section indicate the need
for additional beds, such estimates of additional need may be modified, based
on information and data gathered from relevant sources relating to significant
local factors pertaining to the planning area, or on statewide factors, where
relevant, which factors may include, but not necessarily be limited to, those
set forth in paragraphs (1) through (3) of this subdivision. When making
recommendations to the State Hospital Review and Planning Council and the
Public Health Council concerning the impact of the factors set forth in this
subdivision, the department shall, to the extent practicable, indicate the
relative priority of such factors:
(1) the
impact of requirements pertaining to placing persons with disabilities into the
most integrated setting appropriate so as to enable persons with disabilities
to interact with non-disabled persons to the fullest extent possible;
(2) recommendations made by the local health
systems agency, if applicable;
(3)
documented evidence of the unduplicated number of patients on waiting lists who
are appropriate for admission to long-term ventilator care who experience a
long stay in acute care facilities awaiting discharge to a residential health
care facility for long-term ventilator care.
