The applicant shall document that the number of LTACH beds to
be established or added is necessary to serve the planning area's population,
based on the following:
2) Service to Planning Area Residents
A) Applicants proposing to establish or add
beds shall document that the primary purpose of the project will be to provide
necessary health care to the residents of the area in which the proposed
project will be physically located (i.e., the planning or geographical service
area, as applicable), for each category of service included in the
project.
B) Applicants proposing to
add beds to an existing LTACH service shall provide patient origin information
for all admissions for the last 12-month period, verifying that at least 75% of
admissions were residents of the area. For all other projects, applicants shall
document that at least 75% of the projected patient volume will be from
residents of the area.
C)
Applicants proposing to expand an existing LTACH service shall submit patient
origin information by zip code, based upon the patient's legal residence (other
than a health care facility).
3) Service Demand - Establishment of LTACH
Service
The number of beds proposed to establish a new category of
hospital bed service is necessary to accommodate the service demand experienced
annually by the existing applicant facility over the latest 2-year period, as
evidenced by historical and projected referrals, or, if the applicant proposes
to establish a new hospital, the applicant shall submit projected referrals.
The applicant shall document subsection (b)(3)(A) and either subsection
(b)(3)(B) or (C).
A) Historical
Referrals
If the applicant is an existing facility, the applicant shall
document the number of referrals to other facilities, for each proposed
category of hospital service, for each of the latest 2 years. Documentation of
the referrals shall include patient origin by zip code, name and specialty of
referring physician, and name and location of the recipient hospital.
B) Projected Referrals
An applicant proposing to establish a category of service or
establish a new hospital shall submit the following:
i) Physician referral letters that attest to
the physician's total number of patients (by zip code of residence) who have
received care at existing LTACH facilities located in the area or had a length
of stay of over 25 days in a general acute care hospital and were considered to
be LTACH candidates, annually over the latest 2-year period prior to submission
of the application; and an estimate as to the number of patients that will be
referred to the applicant's facility;
ii) An estimated number of patients the
physician will refer annually to the applicant's facility within a 24-month
period after project completion. The anticipated number of referrals cannot
exceed the physician's documented historical caseload;
iii) Each referral letter shall contain the
physician's notarized signature, the typed or printed name of the physician,
the physician's office address and the physician's specialty; and
iv) Verification by the physician that the
patient referrals have not been used to support another pending or approved CON
application for the subject services.
C) Projected Service Demand - Based on Rapid
Population Growth
If a projected demand for service is based upon rapid
population growth in the applicant facility's existing market area (as
experienced annually within the latest 24-month period), the projected service
demand shall be determined as follows:
i) The applicant shall define the facility's
market area based upon historical patient origin data by zip code or census
tract;
ii) Population projections
shall be produced, using, as a base, the population census or estimate for the
most recent year, for county, incorporated place, township or community area,
by the U.S. Census Bureau or IDPH;
iii) Projections shall be for a maximum
period of 10 years from the date the application is submitted;
iv) Historical data used to calculate
projections shall be for a number of years no less than the number of years
projected;
v) Projections shall
contain documentation of population changes in terms of births, deaths and net
migration for a period of time equal to, or in excess of, the projection
horizon;
vi) Projections shall be
for total population and specified age groups for the applicant's market area,
as defined by HFSRB, for each category of service in the application;
and
vii) Documentation on
projection methodology, data sources, assumptions and special adjustments shall
be submitted to HFSRB.
D)
Type of Patients
The applicant shall identify the type of patients that will
be served by the project by providing the anticipated diagnosis (by DRG
classification) for anticipated admissions to the facility. The applicant shall
also indicate the types of service (e.g., ventilator care, etc.) to be provided
by the project.
4) Service Demand - Expansion of Bed Category
of Service
The number of beds to be added for each category of service
is necessary to reduce the facility's experienced high occupancy and to meet a
projected demand for service. The applicant shall document subsection (b)(4)(A)
and either subsection (b)(4)(B) or (C):
A) Historical Service Demand
i) An average annual occupancy rate that has
equaled or exceeded occupancy standards for the category of service, as
specified in 77 Ill. Adm. Code
1100, for each of the latest 2 years.
ii) If patients have been referred to other
facilities in order to receive the subject services, the applicant shall
provide documentation of the referrals, including: patient origin by zip code;
name and specialty of referring physician; and name and location of the
recipient hospital, for each of the latest 2 years.
B) Projected Referrals
The applicant shall provide the following:
i) Physician referral letters that attest to
the number of patients (by zip code of residence) that have received care at
existing LTACH facilities located in the area or had a length of stay of over
25 days in a general acute care hospital and were considered to be LTACH
candidates, during the 12-month period prior to submission of the
application;
ii) An estimated
number of patients the physician will refer annually to the applicant's
facility within a 24-month period after project completion. The anticipated
number of referrals cannot exceed the physician's documented historical
caseload. The percentage of project referrals used to justify the proposed
expansion cannot exceed the historical percentage of applicant market share,
within a 24-month period after project completion;
iii) Each referral letter shall contain the
physician's notarized signature, the typed or printed name of the physician,
the physician's office address and the physician's specialty; and
iv) Verification by the physician that the
patient referrals have not been used to support another pending or approved CON
application for the subject services.
C) Projected Service Demand - Based on Rapid
Population Growth
If a projected demand for service is based upon rapid
population growth in the applicant facility's existing market area (as
experienced annually within the latest 24-month period), the projected service
demand shall be determined as follows:
i) The applicant shall define the facility's
market area based upon historical patient origin data by zip code or census
tract;
ii) Population projections
shall be produced, using, as a base, the population census or estimate for the
most recent year, for county, incorporated place, township or community area,
by the U.S. Census Bureau or IDPH;
iii) Projections shall be for a maximum
period of 10 years from the date the application is submitted;
iv) Historical data used to calculate
projections shall be for a number of years no less than the number of years
projected;
v) Projections shall
contain documentation of population changes in terms of births, deaths and net
migration for a period of time equal to or in excess of the projection
horizon;
vi) Projections shall be
for total population and specified age groups for the applicant's market area,
as defined by HFSRB, for each category of service in the application;
and
vii) Documentation on
projection methodology, data sources, assumptions and special adjustments shall
be submitted to HFSRB.
5) Service Accessibility
The number of beds being established or added for each
category of service is necessary to improve access for planning area residents.
The applicant shall document the following:
A) Service Restrictions
The applicant shall document that at least one of the
following factors exists in the planning area:
i) The absence of the proposed service within
the planning area;
ii) Access
limitations due to payor status of patients, including, but not limited to,
individuals with health care coverage through Medicare, Medicaid, managed care
or charity care;
iii) Restrictive
admission policies of existing providers;
iv) The area population and existing care
system exhibit indicators of medical care problems, such as an average family
income level below the State average poverty level, high infant mortality, or
designation by the Secretary of Health and Human Services as a Health
Professional Shortage Area, a Medically Underserved Area, or a Medically
Underserved Population;
v) For
purposes of this subsection (b)(5) only, all services within the established
radii outlined in 77 Ill. Adm. Code
1100.510(d)
meet or exceed the utilization standard specified in 77 Ill. Adm. Code
1100.
B) Supporting
Documentation
The applicant shall provide the following documentation, as
applicable, concerning existing restrictions to service access:
i) The location and utilization of other
planning area service providers;
ii) Patient location information by zip
code;
iii) Independent time-travel
studies;
iv) A certification of
waiting times;
v) Scheduling or
admission restrictions that exist in area providers;
vi) An assessment of area population
characteristics that document that access problems exist;
vii) Most recently published IDPH Hospital
Questionnaire.
6) Conversion of Existing General Acute Care
Beds - Review Criterion
An applicant proposing to establish a Long Term Acute Care
Hospital category of service through the conversion of existing general acute
care beds shall:
A) Address Section
1110.30 for discontinuation of
categories of service;
B) Identify
modifications in scope of services or elimination of clinical service areas,
not covered in Section
1110.290 (e.g., Emergency
Department Classification, Surgical Services, Outpatient Services,
etc.);
C) Submit a statement as to
whether the following clinical service areas are to be available to the general
population (non-LTACH): operating rooms, surgical procedure rooms, diagnostic
services, therapy services (physical, occupational, speech, respiratory) and
other outpatient services; and
D)
Document that changes in clinical service areas will not have an adverse impact
upon the health care delivery system. An applicant shall document that a
written request for information on any adverse impact was received by all
hospitals within the established radii outlined in 77 Ill. Adm. Code
1100.510(d),
and that the request included a statement that a written response be provided
to the applicant no later than 15 days after receipt. Failure by an existing
facility to respond to the applicant's request for information within the
prescribed 15-day response period shall constitute a nonrebuttable assumption
that the existing facility will not be adversely impacted.
