Ga. Comp. R. & Regs. R. 111-2-2-.33 - Specific Review Considerations for Life Plan Community (LPC) Sheltered Nursing Facilities
(1)
Applicability. A Certificate
of Need will be required prior to the establishment of a new or expanded LPC
Sheltered Nursing Facility, if not exempt as provided by O.C.G.A. §
31-6-47(a)(17)
and Ga. Comp. R. & Regs. r.
111-2-2-.03(20).
These Rules apply to sheltered nursing facilities located in LPC facilities
defined herein as Type A and Type B Life Plan Communities. A LPC that has
obtained nursing facility beds approved under the standards contained in Ga.
Comp. R. & Regs. r.
111-2-2-.30 does not qualify for
sheltered nursing facility beds, and to convert existing nursing facility beds
to sheltered nursing facility beds, such a LPC must apply for a new Certificate
of Need. Conversely, a LPC that obtains sheltered nursing facility beds under
these Rules may not qualify for beds under Ga. Comp. R. & Regs. r.
111-2-2-.30, and is therefore only
required to complete these specific review considerations for the sheltered
nursing facility beds.
(2)
Duration. Notwithstanding Ga. Comp. R. & Regs. r.
111-2-2-.02(6), the
initial implementation period of a Certificate of Need granted for a new or
expanded LPC Sheltered Nursing Facility pursuant to these Rules shall be
twenty-four (24) months from the effective date.
(3)
Definitions.
(a) "A Life Plan Community" (LPC) is an
organization which offers a contract to provide an individual of retirement
status, other than an individual related by consanguinity or affinity to the
provider furnishing the care, with board and lodging, licensed nursing facility
care and medical or other health related services, or both. These services are
provided for a minimum period of more than one (1) year and may be for as long
as the lifetime of the resident.
(b) "Type A Life Plan Community" (Type A LPC)
provides LPC services at the same location for the life of an individual,
including mutually terminable contracts, and in consideration of the payment of
an entrance fee with or without other periodic charges. A Type A LPC offers
nursing facility care for a little or no substantial increase in monthly
payments, except normal operating costs and inflation adjustments.
(c) "Type B Life Plan Community" (Type B LPC)
provides LPC services at the same location for a period in excess of one year,
including mutually terminable contracts, and in consideration of the payment of
an entrance fee with other periodic charges. A Type B LPC offers a specified
amount of nursing facility care for little or no substantial increase in
monthly payments except normal operating costs and inflation adjustments. After
the specified amount of nursing care is received, residents pay either a
discounted rate or the full per diem rate for nursing care required.
(d) "A Continuing Care Contract" means
furnishing pursuant to an agreement shelter, food, and either nursing care or
personal services, whether such nursing care or personal services are provided
in the facility or in another setting designated by the agreement for
continuing care, to an individual not related by consanguinity or affinity to
the provider furnishing such care upon payment of an entrance fee. Other
personal services provided shall be designated in the continuing care
agreement. Agreements to provide continuing care include agreements to provide
care for any duration, including agreements that are terminable by either
party.
(e) "LPC Sheltered Nursing
Facility", for purposes of these Rules, is a nursing facility that meets the
definition of a nursing facility as defined by Ga. Comp. R. & Regs. r.
111-2-2-.30 of the Rules of the
Department. A LPC Sheltered Nursing Facility shall be for the exclusive use of
residents of a Type A or Type B LPC.
(f) "Official State Health Component Plan"
means the document related to the above-named services developed by the
Department, established by the Georgia Health Strategies Council, and signed by
the Governor of Georgia.
(g)
"Resident" is an individual entitled to receive continuing care in a Type A or
Type B Life Plan Community.
(4)
Standards.
(a) The numerical need for a new LPC
sheltered nursing facility shall be based on a ratio of one nursing facility
bed for each five independent living units. The applicant for a LPC Sheltered
Nursing Facility shall demonstrate to the Department that the potential market
for LPC Independent Living Units in the proposed service area is based on a
valid feasibility study which takes into account factors such as, but not
limited to, the age and annual household income of the target population and
the geographic area to be served.
(b) The numerical need for an expanded LPC
sheltered nursing facility shall be based on a ratio of one nursing facility
bed for each four independent living units provided that the LPC's existing
nursing facility has experienced an occupancy rate of at least eighty percent
(80%) during the most recent year.
(c) Sheltered nursing facility beds approved
under these Rules shall be used exclusively for persons who are residents of
the LPC, and who are a party to a continuing care contract with the facility or
the parent organization and who have lived in a non-nursing unit of the LPC for
a period of at least ninety (90) days. Exceptions shall be allowed when one
spouse or sibling is admitted to the nursing unit at the time the other spouse
or sibling moves into a non-nursing unit, or when the medical condition
requiring nursing care was not known to exist or be imminent when the
individual became a party to the continuing care contract.
(d) The applicant shall provide evidence of
intent that at no time will the nursing facility be certified for participation
in the Medicaid Program.
(e) A LPC
which is the applicant for a new or expanded LPC sheltered nursing facility
shall provide evidence of the intent and ability to meet all appropriate
authorization and disclosure requirements of the Georgia State Department of
Insurance and of any appropriate accrediting agency(ies). The LPC shall furnish
reports in such form and at such times as may be specified, which accurately
and fully disclose it has met specified requirements.
(f) A new or expanded LPC sheltered nursing
facility shall provide evidence of the intent and ability to meet all
appropriate requirements regarding licensure and accreditation of the nursing
facility as follows:
1. Compliance with all
appropriate licensure requirements and operational procedures required by the
Healthcare Facility Regulation Division;
2. No uncorrected operational standards in
any existing Georgia general or LPC sheltered nursing facilities owned and/or
operated by the entity, its affiliates, or its principals. Plans to correct
physical plant deficiencies must be provided;
3. No previous conviction of Medicaid and/or
Medicare fraud by the entity, its affiliates, or its principals;
4. Provision of a plan for a comprehensive
quality improvement program which includes, but is not limited to, procedures
and plans for staff training and a program to monitor specific quality
indicators and measure the facility's performance and patient outcomes
accordingly; and
5. Intent to meet
accreditation requirements of the appropriate accrediting
agency(ies).
(g) A LPC
which is the applicant for a new or expanded LPC sheltered nursing facility
shall demonstrate the existence of a Health Care Fund whose liability is
documented by a relevant Actuarial Study and certified by a qualified actuary;
or the existence of a Long Term Care Insurance Policy issued to individual
residents; or a Group Long Term Care Insurance Policy issued to the LPC for the
coverage of all residents. An Individual or Group Insurance Policy must conform
to all the requirements of Chapter 120-20-16 of the Rules and Regulations of
the State of Georgia Insurance Department entitled "Long Term Care Insurance
Regulation". The period and scope of coverage must be identical to the period
and scope of coverage in the continuing care contract.
(h) A LPC in which a new or expanded
sheltered nursing facility is to be located shall provide the Department with
requested information and statistical data related to the operation and
programmatic elements of the LPC and the Sheltered Nursing Facility. Analyses
are predicated upon accurate, consistent, and systematically obtained
information.
Notes
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