Current through all regulations passed and filed through September 16, 2024
(A) Except as otherwise specifically provided
in this rule or in another rule of this chapter, the director shall apply all
of the criteria prescribed by this rule when reviewing an application for a
certificate of need that relates to an existing or proposed long-term care
facility, including an application for:
(1)
The establishment, development, or construction of a new long-term care
facility;
(2) The replacement of an
existing long-term care facility.
(3) The renovation of or addition to a
long-term care facility that involves a capital expenditure of
four
million dollars or more, not including expenditures for equipment, staffing, or
operational costs;
(4) An increase
in long-term care bed capacity;
(5)
A relocation of long-term care beds from one physical facility or site to
another, excluding relocation of beds within a long-term care facility or among
buildings of a long-term care facility at the same site;
(6) The expenditure of more than one hundred
ten per cent of the maximum expenditure specified in a certificate of need
concerning long-term care beds.
(B) Contiguous county relocations.
Applications for certificate of need that propose an increase in beds that is
attributable to a relocation of existing beds from an existing long-term care
facility as defined in division (A) of section
3702.594 of the Revised Code to
another existing long-term care facility located within a county that is
contiguous to the county from which the beds are to be relocated that meet all
of the following conditions may be submitted at any time:
(1) Not more than a total of thirty long-term
care facility beds are proposed for relocation to the same existing long-term
care facility regardless of the number of applications filed. Once the
cumulative total of beds relocated under section
3702.594 of the Revised Code to
a long-term care facility reaches thirty, no further applications under this
paragraph will be accepted until a period of five years has elapsed since the
implementation of the most recent reviewable activity implemented under section
3702.594 of the Revised Code has
expired; and
(2) After the proposed
relocation, there will be existing nursing home long-term care facility beds
remaining in the county from which the beds are relocated.
(C) The director shall not grant a
certificate of need under this rule unless the application contains
documentation that the project will comply with the following requirements as
applicable:
(1) For homes required to be
licensed under Chapter 3721. of the Revised Code, the requirements for
licensure under Chapter 3721. of the Revised Code and Chapter 3701-17 of the
Administrative Code;
(2) For
hospital long-term care beds, beds in county homes as defined in section
5155.31 of the Revised Code that
are long-term care facilities as defined in this chapter, and long-term care
beds in a long-term care facility, the requirements for certification as a
nursing facility or skilled nursing facility under Title XVIII or XIX of the
Social Security Act. 49 Stat. 620 (1935),
42 U.S.C.
301, as amended (1981).
(D) The director shall consider the long-term
care bed capacity of proposed projects for the establishment, construction, or
development of new long-term care facilities, including replacement facilities.
The director may consider the following criteria:
(1) Whether the proposed facility's size is
essential to serve a special health care need that otherwise will not be
served, or will serve a special health care need in accordance with current,
evidence-based standards of care;
(2) Whether the proposed facility is the only
feasible alternative for cost-effective correction of physical plant
deficiencies; or
(3) Whether the
proposed facility is part of a continuing care retirement or life care
community and the application demonstrates the following:
(a) The applicant will be contractually
obligated to provide long-term care to current residents of the continuing care
retirement or life care community; and
(b) The continuing care retirement or life
care community currently provides and will continue to provide preference in
admission to contractual residents of the community.
(E) In reviewing a certificate of
need application under this rule, the director may examine and consider, in
accordance with this paragraph, any state or federal records relating to the
licensure under Chapter 3721. of the Revised Code or, if applicable, the
participation as a provider under Title XVIII or XIX of the Social Security
Act, 49 Stat. 620 (1935), 42
U.S.C. 301, as amended (1981), of any
long-term care facilities owned, operated, or managed by the applicant, the
owner or the operator of the longterm care facility to which the application
relates, or by any principal participant, as defined in paragraph (V) of rule
3701-12-01 of the Administrative
Code, in an entity which is or will be the applicant, owner, or operator. The
application shall contain a list of all relevant long-term care facilities with
dates of ownership, operation, or management. The director also may consider
records pertaining to ownership or operation by these persons of long-term care
facilities in other states.
(1) The director
shall deny the certificate of need if the provisions of division (B) of section
3702.59 of the Revised Code
apply to an application for the addition of long-term care beds to an existing
long-term care facility or an application for the development of a new
long-term care facility.
(2) The
director also may deny the certificate of need if the applicant, owner,
operator, or any principal participant has been the subject of a final
determination of medicare or medicaid fraud or abuse.
(F) Comparative review applications. In
determining which applications should receive preference in a comparative
review process, the director shall consider, in conjunction with all other
applicable criteria prescribed by this chapter, all of the following as
weighted priorities. Applications that meet all applicable criteria for
certificate of need approval and that receive the most points under this
paragraph will be given preference. When applications that meet all applicable
criteria for certificate of need approval and that are under a comparative
review process for the same county receive an equal number of points under this
paragraph, the director shall give preference to the application that
demonstrates the greatest need for the reviewable activity. The director may
approve all or part of a proposed activity.
(1) Whether the project, as described in the
application, is or will be part of a continuing care retirement community
(CCRC) that complies with paragraph (J)(3) of this rule upon completion of the
reviewable activity. This criterion is weighted with four points for a CCRC
with at least a four to one ratio of alternative beds to long-term care beds,
three points with at least a three to one ratio, two points with at least a two
to one ratio and one point with at least a one to one ratio. No points will be
given if the ratio is less than one to one.
(a) The alternative beds shall be available
to the residents and potential residents of the long-term care
facility.
(b) Appropriate
agreements shall exist between the long-term care facility and the alternative
facility for transfer of residents.
(c) The applicant shall certify that the
capital expenditure for the proposed alternative facility will be obligated,
within the meaning of paragraph (A)(1)(b) of rule
3701-12-18 of the Administrative
Code, at the same time as the capital expenditure for the portion of the
project involving the longterm care facility.
(d) The applicant shall certify that no
application will be filed by any person for a certificate of need for
conversion of the alternative beds to longterm care beds for at least two years
after the proposed alternative beds are occupied by residents.
(e) The application shall contain a
certification that if for any reason the alternatives to inpatient long-term
care cannot be developed or provided, development of the portion of the project
involving the long-term care facility will be discontinued and the director
will be notified immediately.
(f)
The application shall contain documentation of how the long-term care facility
and the alternative beds proposed will be integrated into the existing and
projected community system for caring for elderly and individuals with
disabilities. This documentation shall include at least:
(i) A thorough inventory of existing and
projected alternative beds to inpatient long-term care within the
county;
(ii) A description of the
planning process leading to selection of the alternative beds proposed in the
application, including discussions with appropriate community groups such as
local aging agencies regarding the community's needs for alternative services;
and
(iii) An analysis of the need
in the community for the proposed alternative beds, taking into account the
needs of the target population, the existing and projected alternative services
and beds in the community, the ability of the target population to assume the
cost for an alternative bed, and the expected effect of the alternative beds on
utilization of long-term care facilities. The application also shall contain a
demonstration of the economic viability of the proposed alternative
beds.
(2)
Whether the beds will serve a medically underserved population such as
low-income individuals, individuals with disabilities, or individuals who are
members of racial or ethnic minority groups.
(a) If the project in which the beds will be
included will serve low-income individuals or individuals who are members of
racial or ethnic minority groups, this criterion is weighted with one point for
each medically underserved population to be served by the project that is
documented as being greater than or equal to twenty-five per cent of the
population of the defined service area.
(b) If the project in which the beds will be
included will primarily serve individuals with special health care needs such
as traumatic or acquired brain injury, cerebral palsy, spinal cord injury or
disability, multiple sclerosis, acquired immune deficiency syndrome or other
similar conditions. This criterion is weighted three points.
(3) Whether the project in which
the beds will be included will provide alternatives to institutional care, such
as adult day-care, home health care, respite or hospice care, mobile meals,
residential care, independent living, or congregate living services. This
criterion is weighted with two points.
(4) Whether the long-term care facility's
owner or operator will participate in medicaid waiver programs for alternatives
to institutional care. This criterion is weighted with two points.
(5) Whether the project in which the beds
will be included will reduce alternatives to institutional care by converting
residential care beds or other alternative care beds to long-term care beds.
This criterion is weighted with negative two points.
(6) Whether the long-term care facility in
which the beds will be placed has positive resident and family satisfaction
surveys. This criterion is weighted with one point.
(7) Whether the long-term care facility in
which the beds will be placed has fewer than fifty long-term care beds. This
criterion is weighted with one point.
(8) Whether the long-term care facility in
which the beds will be placed is located within the service area of a hospital
and is or will be designed to accept patients for rehabilitation after an
in-patient hospital stay. This criterion is weighted with two points.
(9) Whether the long-term care facility in
which the beds will be placed is or proposes to become a nurse aide training
and testing site. This criterion is weighted with one point.
(10) The rating, under the centers for
medicare and medicaid services' five star nursing home quality rating system,
of the long-term care facility in which the beds will be placed. This criterion
is weighted with one point for a four star rating and two points for a five
star rating at the time the application is declared complete.
(G) Applications submitted under
section 3702.593 of the Revised Code.
The director shall:
(1) Limit the number of
beds approved for a county to no more than the number of beds determined to be
needed in the receiving county;
(2)
Maintain, after the relocation, the number of beds in the source facility's
service area at least equal to the state bed need rate. For purposes of this
paragraph, a facility's service area shall be either of the following:
(a) The census tract in which the facility is
located, if the facility is located in an area designated by the United States
secretary of health and human services as a health professional shortage area
under the "Public Health Service Act," 88 Stat. 682 (1944),
42 U.S.C.
254(e), as
amended;
(b) The area that is
within a fifteen mile radius of the facility's location, if the facility is not
located in a health professional shortage area;
(i) For the purpose of this rule, "fifteen
mile radius" means the circular area extending fifteen and zero tenths of a
mile from the facility's main entrance;
(ii) The fifteen mile radius from the
facility's main entrance shall be determined utilizing global positioning
system ("GPS") data.
(3) Require the operator of the long-term
care facility from which beds were relocated to reduce the number of beds
operated in the facility by a number of beds equal to at least ten per cent of
the number of beds relocated. If these beds are in a home licensed under
Chapter 3721. of the Revised Code, the long-term care facility shall have the
beds removed from the license. If the beds are in a facility that is certified
as a skilled nursing facility or nursing facility under Title XVIII or XIX of
the "Social Security Act," the facility shall surrender the certification of
those beds. If the beds are registered as long-term care beds under section
3701.07 of the Revised Code, the
long-term care facility shall surrender the registration of these beds. In
calculating the number of beds to be surrendered to the director, the number of
beds shall be rounded up to the nearest whole number.
(a) This reduction shall be completed not
later than the implementation date of the project for which the beds were
relocated.
(b) If the director has
not received evidence from the facility from which the beds are relocated, of
the reduction of the required number of beds on or before the date of the
completion of the project, the director shall remove those beds from the
facility license, certification, or registration.
(H) When a certificate of need
application is approved during the four year review process, upon completion of
the project for which the certificate of need was granted a number of beds
equal to the number of beds relocated shall cease to be operated in the
longterm care facility from which the beds were relocated, except that the beds
may continue to be operated for not more than fifteen days to allow relocation
of residents to the facility to which the beds have been relocated. Effective
fifteen days after the beds are relocated:
(1)
If the relocated beds are in a home licensed under Chapter 3721. of the Revised
Code, the facility's license will be automatically reduced by the number of
beds relocated;
(2) If the beds are
in a facility that is certified as a skilled nursing facility or nursing
facility under Title XVII or XIX of the "Social Security Act," the certificate
shall be surrendered; or
(3) If the
beds are registered under section
3701.07 of the Revised Code as
long-term care beds, the director shall remove those beds from
registration.
(I) For
applications that propose an increase in beds that is attributable to a
replacement or relocation of existing beds from an existing long-term care
facility within the same county, the director shall authorize no additional
beds beyond those being replaced or relocated.
(J) The director shall utilize the following
formula when determining the number of longterm care beds needed for each
county for the review process prescribed in division (B) of section
3702.593 of the Revised Code:
(1) State bed need rate calculation:
Total statewide inpatient days ÷ total bed days available of
these facilities = statewide long-term care bed occupancy rate
Statewide long-term care bed occupancy rate x total statewide
long-term care bed supply = total statewide number of beds occupied
Total statewide number of beds occupied ÷ ninety per cent =
total statewide number of beds needed
Total statewide number of beds needed ÷ projected statewide
population aged sixty-five and older) x one thousand = state bed need
rate
For purposes of this rule:
Total statewide inpatient days means: the sum of inpatient days
for all facilities identified by facility type as "Nursing Facility" that filed
a medicaid cost report for the calendar year that is two years prior to the
year in which a bed need is published for the first review process and the
first phase of a four year review process.
Total bed days available of these facilities means: the sum of
the long-term care bed capacity for each nursing facility that is multiplied by
the number of calendar days in the reporting year. The reporting year for each
facility will include only the number of calendar days that the facility was
authorized to provide care and was providing services.
Total statewide long-term care bed supply means: utilize the
most recent longterm care bed supply per county that is determined by the
director. The longterm care bed supply per county shall include all of the
following:
(a) Licensed nursing home
beds;
(b) Beds certified as nursing
facility or skilled nursing facility under Title XVIII or XIX of the Social
Security Act. 49 Stat. 620 (1935),
42 U.S.C.
301, as amended (1981);
(c) Beds in any portion of a hospital that
are properly registered under section
3701.07 of the Revised Code as
long-term care beds, excepting beds recategorized pursuant to section
3702.521 of the Revised
Code;
(d) Beds in a county home or
county nursing home as defined in section
5155.31 of the Revised Code that
were timely and properly reported as long-term care beds pursuant to section
5155.38 of the Revised Code;
and
(e) Beds held as "approved"
beds under an approved certificate of need.
Projected statewide population aged sixty-five and over means:
based on the Ohio department of development's projections for the year that is
at least five years after the year in which a bed need is published for the
four year review process.
(2) County bed need calculation;
Projected county population aged sixty-five and older ÷ one
thousand) x state bed need rate = number of beds needed for the county
Number of beds needed for the county - bed supply for the
county = bed need or excess for the county
For purposes of this rule:
Projected county population aged sixty-five and older means:
the projections for each county that were used in determining the projected
statewide population aged sixty-five and over.
Bed supply for the county means: the bed supply for each county
that was used in determining the total statewide long-term care bed
supply.
(K) If
the formula projects a bed need for a county with an average annual occupancy
rate of less than eighty-five per cent, the director shall find that there is
no bed need.
(L) If the formula
projects a bed excess for a county with an average annual occupancy rate of
greater than ninety per cent, the director may approve an increase in beds
equal to up to ten per cent of the long-term care bed supply for that
county.
(M) Except as provided in
paragraph (L) of this rule, if the formula projects a bed excess of one hundred
beds or less for a county, the director shall find that there is no excess or,
if the formula projects a bed excess of more than one hundred beds, the
director shall find that there is a bed excess for the projected number of beds
less one hundred.
(N) Not later
than October 1, 2023 and every four years thereafter, the director shall
publish on the department of health's website the following:
(1) Each county with a bed need and the
number of beds needed for the county; and
(2) Each county with a bed excess and the
number of excess beds for the county.
