1 certificate of public need in other states susan puglisi, esq. senior policy analyst virginia...
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Certificate of Public Need in Other States
Susan Puglisi, Esq. Senior Policy Analyst
Virginia Department of Health Office of Licensure and Certification
July 1, 2015
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Overview and History
• Certificate of Public Need is more commonly called Certificate of Need (CON) in other states.
• Many CON laws were initially put into effect as part of the federal Health Planning Resources Development Act of 1974.
• 35 states including Virginia and the District of Colombia have some form of CON in place.
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Overview
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State by State: What is regulated?
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State by State: What is Regulated?Regulated Services Number of States
Nursing Home Beds/Long Term Care Beds 35+DC (including VA)
Acute Hospital Beds 28 (including VA)
Ambulatory Surgical Centers 27 (including VA)
Long Term Acute Care 26 + DC (including VA)
Cardiac Catheterization 26 (including VA)
Psychiatric Services 26 (including VA)
Rehabilitation 25 (including VA)
Open Heart Surgery 25 (including VA)
Radiation Therapy 23 (including VA)
Neo-Natal Intensive Care 23 (including VA)
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State by State: What is Regulated? Regulated Services Number of States
Intermediate Care Facilities for Individuals with Intellectual Disability(ICF/IID)
22 (including VA)
Organ Transplants 21 (including VA)
Positron Emission Tomography 20 (including VA)
Substance/ Drug Abuse 19
Magnetic Resonance Imagining 18 + DC (including VA)
Home Health 18
Hospice 18
Mobile Hi Technology (CT/MRI/PET, etc) 15 + DC (Including VA)
Obstetrics Services 15 (including VA)
Gamma Knives 15 (including VA)
Additional services regulated: Air Ambulance, Ambulance services, Burn Care, CT scanners, Lithotripsy, Medical Office Buildings, Renal Failure/Dialysis, Assisted Living Facilities, Subacute Services, Swing Beds, & Ultrasound
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State by State: The Review Process
Less than 60 days
60 days 75 days 90 days 120 days more than 120 days
0
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Length of Review
# of States
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State by State: Who holds the Authority
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54
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Who Holds the Authority to issue CONs
DepartmentCommissionerReview BoardAgencyOfficeDirectorOther
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State by State: Application FeesState(s) Maximum Fee
South Carolina $7,000Delaware $10,000New Hampshire & Alabama $12,000Michigan $15,000Ohio, Vermont, Virginia $20,000Iowa $21,000Kentucky $25,000Tennessee $45,000Washington $46,253Florida, Georgia, & North Carolina $50,000Mississippi & Alaska $75,000Oregon $90,000Illinois & West Virginia $100,000Maine $250,000D.C. $300,000
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State by State: Application FeesState(s) Minimum Fee
Vermont & Massachusetts $250
Montana & New Hampshire $500
Iowa $600
Virginia, Georgia, Kentucky & Missouri $1,000
Mississippi $1,250
West Virginia $1,500
Illinois $2,500
Michigan & Tennessee $3,000
D.C. Maine & Ohio $5,000
Florida $10,000
Washington $12,874
Oregon $13,500
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State by State: Conditions
• 24 states permit conditional certificates• 11 states do not have limitations set on what
conditions can be placed on certificates• Those states which do have restrictions on conditions
usually have the following restrictions:• The conditions must be related to the specific project• The conditions must be related to the CON statute and
regulations
• Virginia law is the most restrictive regarding conditions – prescribing which conditions may be used
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State by State: Review MoratoriaState Moratoria
Alabama Moratoria on nursing homes and in-patient hospice beds
Florida Moratorium for additional community nursing home beds lifted July 2014
Louisiana Moratorium on nursing homes
Mississippi Moratorium on home health agencies and long term care facilities
Nebraska Moratoria on nursing home and rehabilitation beds; certain exceptions
New Hampshire Moratoria on nursing homes, skilled nursing facilities, intermediate care facilities and rehabilitation facilities. Rehabilitation beds.
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State by State: Review MoratoriaState Moratoria
New Jersey, Virginia Long Term Care Applications are subject to the issuance of a call for applications
Rhode Island Moratorium on Nursing facility beds
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State by State: Monitoring
• 28 states require some form of monitoring after a certificate is issued• 21 States require progress reports
• Some required quarterly• Others due at specific benchmarks
• 10 States require annual reporting• A majority of states require some form of financial
and cost reporting• 1 state requires all CON regulated facilities to report
annually
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NO CON: State by State
• 15 states currently do not have a CON program: • Arizona, California, Colorado, Idaho, Indiana, Kansas,
Minnesota, New Mexico, North Dakota, Pennsylvania, South Dakota, Texas, Utah, Wisconsin, & Wyoming
• In 1987, the federal government repealed the CON mandate and throughout the 1980s, states began retiring their CON programs. By 1990 12 states repealed their CON program. By 2000 an additional 3 had repealed their programs. Since 2000, Wisconsin is the only state to repeal it’s program.
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Questions?