Or. Admin. Code § 333-580-0040

Current through Register Vol. 63, No. 11, November 1, 2024

Section 333-580-0040 - Need

Applicants must provide a narrative discussion of each of the following:

(1) Criterion: Does the service area population need the proposed project?

(a) The applicant must identify the service area's need for the proposal in the past, present and future;

(b) In establishing the magnitude of present and future need for each service element, the applicant will:

(A) Use appropriate indicators of a population's need (i.e., population-based use-rates, population-based "medical necessity" rates, or established productivity standards);

(B) Use the standards and need methodologies specified in divisions 585 through 645 of OAR chapter 333 applicable to the services or facilities being proposed;

(C) Consider industry standards and historical experience as appropriate comparisons where plans are silent;

(D) In the case of nursing home beds, determine whether the added beds are consistent with plans adopted by the relevant area agency on aging and the state Seniors and People with Disabilities Division.

(2) Criterion: If the project involves remodeling or replacement of an existing health facility structure, are there significant functional inefficiencies, obsolescence or structural problems which the facility has which seriously compromise the effective delivery of health care to patients, and which would be substantially corrected by the proposed project? The narrative should:

(a) Identify and demonstrate all significant functional inefficiency (including physical access) problems;

(b) Identify and demonstrate all significant obsolescence problems; and

(c) Identify and demonstrate all significant structural problems.

(3) Criterion: Will the proposed project result in an improvement in patients' reasonable access to services? The applicant will identify any potential problems of accessibility including traffic patterns; restrictive admissions policies; access to care for public-paid patients; and restrictive staff privileges or denial of privileges.

(4) Criterion: If the project proposes to serve the needs of members of a health maintenance organization, do these members need the proposed project, considering the special needs and health care utilization rates of this population?

(a) HMOs shall:

(A) Identify the needs of their members, subscribers and enrollees for the proposal;

(B) Demonstrate that the identified needs are reasonable when related to the health care costs of present and future members, subscribers and enrollees;

(C) Describe the proposal's potential for reducing the use of inpatient care in a community through an extension of preventive health services and the provision of more systematic and comprehensive health services;

(D) Identify the availability, and estimate the cost, of obtaining proposed beds, services or equipment from existing providers in the area, who are not HMOs.

(b) A certificate of need shall be issued to meet the needs or reasonably anticipated needs of group members when beds, services or equipment are not available from non-plan providers in the area to be served. Beds, services or equipment are not available to an HMO from a non-HMO provider unless:

(A) They would be available through a long-term contract of sufficient duration and with sufficient provisions for notice of termination to enable the HMO to negotiate an alternative contract with another non-HMO provider, or to develop facilities and/or service capabilities and operate same after notice of contract termination from the non-HMO provider;

(B) They would be available and accessible to physicians associated with the HMO on a basis comparable to physicians not affiliated with the HMO (e.g., HMO physicians have or will have staff privileges);

(C) They could be provided by a non-HMO provider in a manner that can demonstrate to be as cost effective as if they were developed and operated by the HMO; and

(D) They would be available in a manner that is consistent with the HMO's basic method of operation (e.g., acute care centralized at one non-HMO provider as opposed to contracts for care at multiple non-HMO providers).

Or. Admin. Code § 333-580-0040

HD 13-1994, f. & cert. ef. 4-22-94; OHD 11-1998, f. & cert. ef. 10-22-98

Stat. Auth.: ORS 431.120(6), ORS 442.315 & ORS 442.325

Stats. Implemented: ORS 431.120(6), ORS 442.315 & ORS 442.325