Current through Register Vol. 24-18, September 15, 2024
The determination of need for any project shall be based on
the following criteria, except these criteria will not justify exceeding the
limitation on increases of nursing home beds provided in WAC
246-310-810.
(1) The population served
or to be served has need for the project and other services and facilities of
the type proposed are not or will not be sufficiently available or accessible
to meet that need. The assessment of the conformance of a project with this
criterion shall include, but need not be limited to, consideration of the
following:
(a) In the case of a reduction,
relocation, or elimination of a service, the need the population presently
served has for the service, the extent to which the need will be met adequately
by the proposed relocation or by alternative arrangements, and the effect of
the reduction, elimination, or relocation of the service on the ability of
low-income persons, racial and ethnic minorities, women, handicapped persons,
and other underserved groups and the elderly to obtain needed health
care;
(b) In the case of health
services or facilities proposed to be provided, the efficiency and
appropriateness of the use of existing services and facilities similar to those
proposed;
(c) In the case of an
application by an osteopathic or allopathic facility the need for and the
availability in the community of services and facilities for osteopathic and
allopathic physicians and their patients, and the impact on existing and
proposed institutional training programs for doctors of osteopathy and medicine
at the student, internship, and residency training levels; and
(d) In the case of a project not involving
health services, the contribution of the project toward overall management and
support of such services.
(2) All residents of the service area,
including low-income persons, racial and ethnic minorities, women, handicapped
persons, and other underserved groups and the elderly are likely to have
adequate access to the proposed health service or services. The assessment of
the conformance of a project with this criterion shall include, but not be
limited to, consideration as to whether the proposed services makes a
contribution toward meeting the health-related needs of members of medically
underserved groups which have traditionally experienced difficulties in
obtaining equal access to health services, particularly those needs identified
in the applicable regional health plan, annual implementation plan, and state
health plan as deserving of priority. Such consideration shall include an
assessment of the following:
(a) The extent
to which medically underserved populations currently use the applicant's
services in comparison to the percentage of the population in the applicant's
service area which is medically underserved, and the extent to which medically
underserved populations are expected to use the proposed services if
approved;
(b) The past performance
of the applicant in meeting obligations, if any, under any applicable federal
regulations requiring provision of uncompensated care, community service, or
access by minorities and handicapped persons to programs receiving federal
financial assistance (including the existence of any unresolved civil rights
access complaints against the applicant);
(c) The extent to which medicare, medicaid,
and medically indigent patients are served by the applicant; and
(d) The extent to which the applicant offers
a range of means by which a person will have access to its services (e.g.,
outpatient services, admission by house staff, admission by personal
physician).
(3) The
applicant has substantiated any of the following special needs and
circumstances the proposed project is to serve.
(a) The special needs and circumstances of
entities such as medical and other health professions schools,
multidisciplinary clinics and specialty centers providing a substantial portion
of their services or resources, or both, to individuals not residing in the
health service areas in which the entities are located or in adjacent health
service areas.
(b) The special
needs and circumstances of biomedical and behavioral research projects designed
to meet a national need and for which local conditions offer special
advantages.
(c) The special needs
and circumstances of osteopathic hospitals and nonallopathic
services.
(4) The
project will not have an adverse effect on health professional schools and
training programs. The assessment of the conformance of a project with this
criterion shall include consideration of:
(a)
The effect of the means proposed for the delivery of health services on the
clinical needs of health professional training programs in the area in which
the services are to be provided; and
(b) If proposed health services are to be
available in a limited number of facilities, the extent to which the health
professions schools serving the area will have access to the services for
training purposes.
(5)
The project is needed to meet the special needs and circumstances of enrolled
members or reasonably anticipated new members of a health maintenance
organization or proposed health maintenance organization and the services
proposed are not available from nonhealth maintenance organization providers or
other health maintenance organizations in a reasonable and cost-effective
manner consistent with the basic method of operation of the health maintenance
organization or proposed health maintenance organization. In assessing the
availability of health services from these providers, the department shall
consider only whether the services from these providers:
(a) Would be available under a contract of at
least five years' duration;
(b)
Would be available and conveniently accessible through physicians and other
health professionals associated with the health maintenance organization or
proposed health maintenance organization (for example - whether physicians
associated with the health maintenance organization have or will have full
staff privileges at a nonhealth maintenance organization hospital);
(c) Would cost no more than if the services
were provided by the health maintenance organization or proposed health
maintenance organization; and
(d)
Would be available in a manner administratively feasible to the health
maintenance organization or proposed health maintenance organization.
(6) For nursing home projects
including distinct part long-term care units located in a hospital and licensed
under chapter 70.41 RCW, the following criterion shall apply in addition to
those found in WAC
246-310-380.
(a) In the case of an application for new
nursing home beds, the department shall find no need if the state is at or
above the statewide estimated bed need, except as referenced in WAC
246-310-380(5).
However, the department may put under review and subsequently approve or deny
applications that propose to redistribute nursing home beds to a planning area
under the established ratio. The department may also consider applications that
propose to add beds in planning areas under the established ratio using beds
banked and for which the need for the beds is not deemed met, under the
provisions of
RCW
70.38.115(13). For the above
projects, the need for such projects, shall, in part, be determined using
individual planning area estimated bed need numbers.
(b) If the state is below the statewide
estimated bed need or for those projects referenced above, the department shall
determine the need for nursing home beds, including distinct part long-term
care units located in a hospital licensed under chapter 70.41 RCW, based on:
(i) The availability of other nursing home
beds in the planning area to be served; and
(ii) The availability of other services in
the planning area to be served. Other services to be considered include, but
are not limited to: Assisted living facilities (as defined in chapter 18.20
RCW); enhanced adult residential care (as defined in chapter 74.39A RCW); adult
residential care (as defined in chapter 74.39A RCW); adult family homes (as
defined in chapter 70.128 RCW); hospice, home health and home care (as defined
in chapter 70.127 RCW); personal care services (as defined in chapter 74.09
RCW); and home and community services provided under the community options
program entry system waiver (as referenced in chapter 74.39A RCW). The
availability of other services shall be based on data which demonstrates that
the other services are capable of adequately meeting the needs of the
population proposed to be served by the applicant. The following variables
should be evaluated in this analysis when available:
(A) The current capacity of nursing homes and
other long-term care services;
(B)
The occupancy rates of nursing homes and other long-term care services over the
previous two-year period;
(C)
Proposed residential care projects scheduled to be completed within the same
period of time indicated on the nursing home certificate of need application;
and
(D) The ability of the other
long-term care services to serve all people regardless of payor
source.
Statutory Authority: Chapter 70.38 RCW. 96-24-052, §
246-310-210, filed 11/27/96, effective 12/28/96. Statutory Authority:
RCW
70.38.135 and
70.38.919. 92-02-018 (Order 224),
§ 246-310-210, filed 12/23/91, effective 1/23/92. Statutory Authority:
RCW
43.70.040. 91-02-049 (Order 121), recodified
as § 246-310-210, filed 12/27/90, effective 1/31/91. Statutory Authority:
RCW
70.38.135. 85-05-032 (Order 2208), §
248-19-370, filed 2/15/85; 81-09-012 (Order 210), § 248-19-370, filed
4/9/81, effective 5/20/81. Statutory Authority: Chapter 70.38 RCW. 79-12-079
(Order 188), § 248-19-370, filed
11/30/79.
