216 R.I. Code R. 216-RICR-40-10-22.14 - Findings and Recommendations

A. At the conclusion of its review of each application for new institutional health services or new health care equipment, the Health Services Council shall make recommendations to the state agency relative to approval or denial of the new institutional health services or new health care equipment proposed.

B. Such recommendations shall explicitly address the information required in accordance with § 22.5(C) of this Part and the relevant considerations outlined in § 22.10(L) of this Part. Such findings and recommendations shall take into consideration policies adopted publicly by the state agency, and any apparent or real differences shall be illustrated as to the factors of consideration involved.

C. The findings of the Health Services Council shall include commentary where applicable, on the following elements derivable from the information provided in accordance with § 22.10(L) of this Part:

1. The relationship of the proposal to such state health plans as may be formulated by the state agency;

2. The applicant's demonstration of public need for the specific proposal and the scope thereof;

3. A detailed analysis of all elements (capital and operating) of the total project cost including prospective sources of payment for associated operating expenses;

4. The incremental cost to the health care system of provision of the additional services and the consequent impact of the proposal upon the overall costs of the institution, upon patient charges, and upon the reimbursement system;

5. The feasibility of the proposal including the mix of financing and the reasons therefore as they relate to the overall financial structure of the applicant and such other factors as may impinge upon the feasibility of the proposal;

6. The derivable operating efficiencies (i.e., economies of scale or substitution of capital for personnel) which may result in lower total or unit costs;

7. The efficiency and appropriateness of the use of existing inpatient facilities providing inpatient services similar to those proposed (if applicable);

8. The efficiency and appropriateness of the proposed new institutional health services, including the extent to which the proposed new service or equipment, if implemented, will not result in any unnecessary duplication of existing services or equipment;

9. The affordability of the proposal; and

10. For proposals subject to R.I. Gen. Laws § 23-15-6(e) of the Act, the relative priority of the proposal compared to all other proposals simultaneously under review.

D. The Health Services Council shall not make a recommendation to the state agency that a proposal be approved unless it is found that the proposal is affordable to the people of the state. In determining whether or not a proposal is affordable, the Health Services Council shall consider the condition of the state's economy, the statements of authorities and/or parties affected by the proposals, and such other factors as it may deem appropriate.

E. In addition, the following written findings shall be made prior to the approval of any proposal for provision of additional inpatient services:

1. That superior alternatives to such inpatient services in terms of cost, efficiency and appropriateness do not exist and that the development of such alternatives is not practicable;

2. That, in the case of new construction, alternatives to new construction such as modernization or sharing arrangements have been considered and have been implemented to the maximum extent practicable;

3. That patients will experience serious problems in terms of cost, availability, or accessibility in obtaining inpatient care of the type proposed in the absence of the proposed new service; and

4. That, in the case of a proposal for addition of beds for the provision of nursing facilities the relationship of the addition to the plans of the agencies of the state responsible for providing and financing long term care has been considered.

F. The state agency shall make written findings (taking into account the accessibility of the health care facility as a whole) on the extent to which the proposal, if approved, will meet the following accessibility criteria:

1. The extent to which low income persons, racial and ethnic minorities, women, handicapped persons, and the elderly presently have access to such services and the extent to which such groups are likely to have access to this service;

2. In the case of a reduction, elimination or relocation of a service, the need that the population presently served has for the service, the extent to which that need will be adequately met by the proposed relocation or by alternative arrangements, and the effect of the reduction, elimination or relocation of the service on the ability of the groups noted in § 22.14(F)(1) of this Part to obtain needed health care;

3. The performance of the applicant regarding its provision of uncompensated care, community services or access by minorities and handicapped persons to programs receiving federal financial assistance, including the existence of any civil rights access complaints against the applicant;

4. The extent to which Title XVIII (Medicare), Title XIX (Medicaid) and medically indigent patients are served by the applicant;

5. 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);

6. The extent to which the applicant grants medical staff privileges to physicians who serve the indigent; and

7. The extent to which the applicant takes actions necessary to remove barriers that limit access to the health services of the applicant (e.g., transportation, language, facility design and financial barriers).

G. The state agency shall render a written decision (which shall be the final decision for the purpose of determining the applicable time frame in accordance with R.I. Gen. Laws § 23-15-6(b)(2) of the Act on all applications for new health care equipment or new institutional health services based on the findings and recommendations of the Health Services Council unless the state agency shall afford written justification for variance therefrom. In the case of approvals of new health care equipment or new institutional health services for the provision of health services to inpatients, the state agency's decision shall include the written findings required in accordance with R.I. Gen. Laws § 23-15-6(b)(6)(i) of the Act. The provisions of § 22.14(B) of this Part shall have applicability to the formulation of the written decisions of the state agency.

H. If the state agency renders a decision contrary to the findings and recommendations of the Health Services Council, it must afford written justification for its variance therefrom.

I. In rendering its decision, the state agency may approve or disapprove, in whole or in part, any application as submitted.

J. Each decision of the state agency to issue or not to issue a certificate of need must be based on the review by the state agency conducted in accordance with the procedures and criteria adopted under this Part and on the record of the administrative proceedings held on the application for the certificate or the state agency's proposal to withdraw the certificate.

K. In any case where the state agency finds that an approved project does not satisfy the criteria in § 22.14(E) of this Part it may, if it approves the application, impose the condition that the applicant take affirmative steps to meet those criteria.

Notes

216 R.I. Code R. 216-RICR-40-10-22.14