CHAPTER
He-Hea 1000 ACUTE CARE FACILITIES
PART
He-Hea 1001 PURPOSE
He-Hea 1001.01 Purpose.
(a)
This chapter implements a standard for the consideration of acute care
facility construction, expansions, renovations and/or replacements.
(b)
These standards are intended to:
(1) Improve the:
a. Quality of care;
b. Access and availability to services; and
c. Cost effectiveness of services provided, and
(2) Not be detrimental to the health care system
of the area.
Source. #4097, eff 7-22-86; ss by #4498, eff
11-21-90; ss by #5236, eff 9-27-91 (from He-Hea 1001.02), EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
PART
He-Hea 1002 DEFINITIONS
He-Hea
1002.01 Definitions.
(a)
“Acute care facility” means a hospital which cares primarily for
patients having conditions or undergoing procedures which could result in
severe or serious injury or diseases.
(b)
“Adjusted Admission” means a calculation performed by hospitals to factor
in outpatient and other hospital service activity to traditional inpatient
admission totals to arrive at a total account of hospital business.
(c)
“Application” means a proposal prepared by a person and filed with board
for a certificate of need.
(d)
“Applicant” means “applicant” as defined in RSA 151-C:2, II.
(e)
“Board” means “board” as defined in RSA 151-C:3.
(f)
“Capital expenditure” means a disbursement which, under generally accepted
accounting principles is not properly chargeable as an expense of operation or
maintenance, and includes acquisition by purchase, by transfer or by lease or
comparable arrangement or through donation if the expenditure would have been
considered a capital expenditure if the acquisition had been by purchase.
(g)
“Certificate of need (CON)” means “certificate of need” as defined in
RSA 151-C:2, VIII.
(h)
“Length of stay” means the number of days a patient stays in a facility.
(i)
“Market share population” means the number and/or percent of patients in
a given service area utilizing a specific acute care facility.
(j)
“Marshall Valuation Service (MVS)” means an appraisal guide for the
development and reporting of replacement building and equipment costs used to
determine construction costs of commercial buildings.
(k)
“Normile methodology” means a mathematical model used to determine bed
need which assumes that the incidence of need for hospital care follows a
normal distribution of occurrence.
(l)
“Occupancy” means the ratio of beds that is calculated by dividing the
total beds occupied by the total licensed bed capacity of the hospital as
licensed by the New Hampshire department of health and human services, bureau
of health facilities administration.
(m)
“Operating revenue” means the revenue collected from the provision of
patient care services.
(n)
“Patient charges” means the aggregate price charged for patient care
services at a healthcare facility.
(o)
“Person” means “person” as defined in RSA 151-C: 2, XXVIII.
(p)
“Renovation” means a capital expenditure which repairs, remodels and/or
reconfigures existing space.
(q)
“Replacement” means a capital expenditure which rebuilds in whole or in
part an acute care facility on a new or the original site.
(r)
“Service area” means a geographic area which is served by each acute
care hospital and is determined by service area boundaries extrapolated through
hospital utilization patterns from a data base known as the uniform hospital
discharge data system that is maintained in accordance with RSA 126:25.
(s)
“Story height multiplier” means the number by which the base cost of a
building is multiplied to adjust for any variation in average story height from
the base of 12 feet.
(t)
“Total patient days” means the sum of the number of days patients stay
at a healthcare facility.
(u) “Uniform hospital discharge data
set (UHDDS)” means a dataset containing data from all
Source. #4097, eff 7-22-86; ss by #4988, eff
11-21-90; ss by #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
PART
He-Hea 1003 STANDARDS FOR EXPANSION,
RENOVATION OR REPLACEMENT OF ACUTE CARE FACILITIES
He-Hea 1003.01 Service Area.
(a)
Service areas for each acute care hospital shall be determined by
applying the DRGs common to all acute care hospitals in the state based upon
the database known as the uniform hospital discharge data set maintained in accordance
with RSA 126:25.
(b)
A city or town shall be part of the service area of the hospital:
(1) From which a plurality
of patients from the town are discharged; and
(2) Is contiguous to the
service area to which it is assigned.
(c)
Notwithstanding He-Hea 1003.01 (b) above, in cases where the city or
town is not contiguous to other towns in the hospital service area, the city or
town shall be assigned to the hospital service area of the next highest
plurality which is contiguous.
(d) Based upon the application of (a) through (c)
above, hospital service areas shall be identified as set forth in Table 1003-1
"Service Areas by Hospital," below:
|
|
Orford |
Cornish |
|
|
Croydon |
Lyme |
|
|
Piermont |
|
Grafton |
|
|
Grantham |
|
|
|
Gorham |
Shelburne |
|
|
Success |
Dummer |
|
|
CATHOLIC
MEDICAL CENTER/ELLIOT HOSPITAL
|
|
|
|
Goffstown |
|
|
Hooksett |
New
|
Alstead |
Langdon |
Sullivan |
|
|
Surry |
Fitzwilliam |
Marlow |
Swanzey |
Gilsum |
Nelson |
|
Harrisville |
|
|
|
Roxbury |
Westmoreland |
|
Stoddard |
|
Allenstown
|
Deering |
|
|
Dunbarton |
|
Barnstead |
Epsom |
Warner |
Boscawen |
Henniker |
|
Bow |
Hillsborough |
Webster |
|
Hopkinton |
Weare |
|
Loudon |
|
|
Northwood |
|
|
Pembroke |
|
COTTAGE
HOSPITAL
|
|
|
|
|
|
|
|
Plaistow |
|
Kensington |
Raymond |
|
|
Seabrook |
Epping |
Newfields |
|
|
|
Stratham |
|
|
|
|
|
|
|
|
|
Middleton |
New
|
Strafford |
|
Freedom |
Tuftonboro |
|
Ossipee |
|
Effingham |
|
Wolfeboro |
|
Hill |
|
|
Tilton |
|
|
|
|
|
Meredith |
Sanbornton |
Gilford |
Moultonborough |
|
Gilmanton |
New
|
|
Beans
Grant |
|
Lyman |
|
Greens
Grant |
Martins
Location |
Carroll |
Hadleys
Purchase |
Pinkhams
Grant |
|
Landaff |
Sargents
Purchase |
Crawfords |
|
Sugar
Hill |
Cutts
Grant |
|
Thompson
and Meserve |
|
Low
and Burbanks Grant |
|
|
|
|
|
Eaton |
|
Beans
Purchase |
Harts
Location |
|
|
Hales
Location |
|
Antrim
|
|
Rindge |
|
Hancock |
|
|
Jaffrey |
|
Francestown |
New
|
|
|
|
|
|
|
Wilmot |
|
Sunapee |
|
Newbury |
Sutton |
|
Atkinson
|
Hampstead |
|
|
|
|
|
Sandown |
|
|
|
|
|
|
|
ST.
JOSEPH’S HOSPITAL/ SOUTHERN NH
|
Litchfield |
|
|
Lyndeborough |
|
Hollis |
Mason |
|
|
|
|
|
|
|
|
|
|
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Holderness |
|
|
|
Wentworth |
Campton |
|
|
|
|
|
Ellsworth |
Rumney |
|
Atkinson
and Gilmanton Grant |
Dixs
Grant |
|
|
Dixville |
Stewartstown |
Colebrook |
Ervings
Location |
Wentworth
Location |
|
|
|
Ackworth
|
|
Unity |
|
Lempster |
|
|
|
Stark |
Errol |
Millsfield |
|
|
Northumberland |
Whitefield |
Kilkenny |
Odell |
|
|
Lee |
Somersworth |
|
Madbury |
|
|
Rollinsford |
|
(e) Notwithstanding (d) above, any party in any proceeding
shall have the opportunity to demonstrate a service area different from that
shown in Table 1003-1 based on the results of applying the methodology in (b)
and (c).
(f) Applicants may identify a secondary service area
for its proposed project based on patient origin data specific to patient care
services under consideration in the application rather than general patient
origin data.
(g) Any party that proposes a service area under
(e) or (f) above shall notify any
affected acute care hospital of such proposal.
(h) Notification of the proposed service area
shall be made in writing with a copy provided to the board as part of the
application.
Source. #4097, eff 7-22-86; ss by #4988, eff
11-21-90; ss by #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED: 4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
(from He-Hea 1003.02)
He-Hea 1003.02 Service Area Population.
(a)
Applicants shall develop:
(1)
Current and projected populations for their hospital service area and
secondary service area; and
(2) Current and projected age and gender cohorts
for their hospital service area and secondary service area.
(b)
Population estimates for (a) above shall be obtained from:
(1) The
(2) The
(3) The office of health statistics and data
management, division of public health services, department of health and human
services; or
(4) A nationally recognized demographic data
provider.
(c)
Age groups for (a) above shall be
determined as follows:
(1) 0-14;
(2) 15-44;
(3) 45-64;
and
(4) 65
and older.
(d)
Notwithstanding (c) above, applicants shall have the opportunity to demonstrate
different age groupings that apply specifically to their proposal in terms of:
(1) Women of child-bearing age;
(2) Infants;
(3)
Pediatric patients; or
(4) Geriatric patients.
(e)
In the event of any dispute brought before the board relative to age and
gender cohorts presented in any application, the board shall rely upon the age
and gender population estimates as provided by the New Hampshire office of
energy and planning, 57 Regional Drive, Concord, N.H. to make a final
determination on the proposal.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1003.03 Market Share. Applicants shall report their market share
for each town in the proposed service area by using discharge data from the
uniform discharge dataset maintained in accordance with RSA 126:25.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
(from He-Hea 1003.05)
He-Hea 1003.04 Projected Patient Days Calculation.
(a)
“UR” means use rate which is a table of age and gender use rates that is
computed by the applicant by dividing the total patient days statewide for the
most recent 12 months as obtained from the UHDDS by the statewide population for the same time
period divided by 1,000;
(b)
“Ppop” means projected population by age and sex cohort for each of the
cities and towns in the hospital service area as well as any secondary service
area defined by the applicant;
(c)
“MS” means market share as determined by the percentage of discharges
the applicant receives from a given town as reported by all
(d)
“OPD” means outside patient days which is the historical annual patient
days generated by persons residing outside the state of N.H.utilizing the
applicant’s hospital multiplied by the historical growth rate for this category
of patient days.
(e)
To determine projected patient days, applicants shall multiply the use rates
by the projected populations and market share for each town, and then add the
outside patient days to the sum of these two figures, as in the formula below:
(f)
The applicant shall sum all results of (e) above to arrive at total
projected patient days for the identified service area.
(g)
Age groups for (a) above shall be
determined as follows:
(1) 0-14;
(2) 15-44;
(3) 45-64;
and
(4) 65
and older.
(h) Notwithstanding (g) above, applicants shall
have the opportunity to demonstrate different age groupings that apply
specifically to their proposal in terms of:
(1) Women of child-bearing age;
(2) Infants;
(3) Pediatric patients; or
(4) Geriatric patients.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07 (from He-Hea 1003.05); ss
by #9457, eff 4-21-09 (from He-Hea 1003.04)
He-Hea 1003.05 Net Revenue per Adjusted Admission
Calculation.
(a)
“Total Admissions” means the total number of patients admitted to the
hospital within a given year.
(b)
“Inp_Rev” means the gross inpatient revenue collected from patients
admitted to the hospital in a given year.
(c)
Out_Rev” means the gross outpatient revenue collected from patients
treated in the outpatient setting of a hospital in a given year.
(d)
“DPU” means the gross total distinct part unit revenue, which is the sum
of psychiatric and physical rehabilitation revenue collected from patients
admitted to these units of a hospital for such care in a given year.
(e)
“HH_Rev” means the gross home health revenue collected from patients
provided services in the home from the hospital in a given year.
(f)
To calculate adjusted admissions of a hospital, applicants shall divide
the sum of gross inpatient revenue, gross outpatient revenue, gross distinct part
unit revenue and gross home health revenue by the sum of gross inpatient
revenue and gross distinct part unit revenue, then multiply this result by
total admissions, as in the formula below:
Total
Admissions X (Inp_Rev + Out_Rev + DPU_Rev + HH_Rev) /
(Inp_Rev
+ DPU_Rev)
(g)
To determine the net revenue per adjusted admission for a hospital,
applicants shall divide the total net revenue by the adjusted admissions result
determined by (f) above.
(h)
The result of (g) above shall be applied to the criterion found in
He-Hea 1004.01(l).
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07 (from He-Hea 1003.06); ss
by #9457, eff 4-21-09
He-Hea 1003.06 Bed Replacement.
(a)
Requests for replacement of existing beds shall be developed on the
basis of the following minimum and optimal occupancy rates based upon total
operational beds for general hospitals, by service category, as set forth in
Table 1003-2, “Bed Replacement Calculation Table”.
Service Category |
Minimum Occupancy
|
Optimal Occupancy
|
Medical/Surgical |
75% |
90% |
Obstetrics |
60% |
85% |
Pediatrics |
|
|
Less than 40 beds |
60% |
85% |
More than 40 beds |
65% |
90% |
ICU/CCU |
60% |
85% |
Psychiatric |
70% |
90% |
(b)
“ADC” means average daily census which is computed by dividing the total
patient days computed in He-Hea 1003.04 by 365.
(c)
“fp” means probability factor which at a 95% confidence level for
medical/surgical and pediatric service converts to a multiple of 1.65 and a 99%
confidence level for CCU, ICU, and obstetric
services converts to a multiple of 2.33.
(d)
Need for replacement of existing beds shall be determined by multiplying
the square root of the average daily census by the probability factor, then
adding the product of these 2 figures by the average daily census, as in the
formula below:
Bed
Need = ADC + (fpÖADC)
(e)
Notwithstanding (a) through (d) above, any hospital given Medicare
designation as a critical access hospital shall not be held to the occupancy
rates set forth in Table 1003-2.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07 (from He-Hea 1003.07); ss
by #9457, eff 4-21-09 (from He-Hea 1003.01)
He-Hea 1003.07 Impact on Other Providers.
(a)
Applicants proposing to establish, expand or renovate an acute care
facility shall demonstrate that the proposed facility shall not have a detrimental
impact on health services within the proposed service area in terms of:
(1) Quality of care;
(2) Access to and availability of health care
services; and
(3) Cost effectiveness of health care services
provided.
(b)
Demonstration shall be made by submitting with the application:
(1) A copy of an existing or proposed quality
improvement program pursuant to He-Hea 303.05;
(2) To the extent data is available, a statistical report in the application
which shows how the proposed project is projected to affect health care
services in the proposed service area in terms of:
a. Utilization;
b. Patient charges;
c. Market share;
d. Physician referral patterns;
e. Personnel resources; and
f. Referral sources.
(3) Any correspondence from other facilities in the service area regarding the impact of the proposed
project on their existing health care services including their continued
ability to:
a. Maintain quality health care services;
b. Provide essential community services;
c. Provide emergency services; and
d. Provide charity care.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07 (from He-Hea 1003.08); ss
by #9457, eff 4-21-09
PART
He-Hea 1004 CRITERIA FOR FACILITY
EXPANSIONS, RENOVATIONS OR REPLACEMENT OF ACUTE CARE FACILITIES
He-Hea 1004.01 Criteria. In addition to all other requirements in RSA
151-C:7 and He-Hea 303.02 through He-Hea 303.09, applicants shall meet the
following criteria for consideration of a CON for expansion, renovation or
replacement of an acute care facility:
(a)
Applicants shall demonstrate that the anticipated proposed construction
cost per bed, cost per square foot and square foot per bed shall be comparable
in cost and size by a 10% margin to the 2008 edition of Marshall Valuation
Service, section 15;
(b)
Demonstration of project costs shall be made in the form of a report included
with the application which provides:
(1) A detail of the costs and space by department
or area affected by the proposed project; and
(2) A comparison of these costs which shall be
within 10% of the 2008 edition of Marshall Valuation Service, section 15, for
the proposed class and type of construction; and
(3) An identification of the square footage
for each department or area before and after the project;
(c)
Applicants shall include a report in the application which provides:
(1) An analysis of the class and quality of
construction pursuant to section one of the 2008
(2) The allocation of costs within a multiple use
building;
(3) The allocations of site costs and land costs
where facilities are proposed to have multiple uses;
(4) The methodology used in calculating
construction costs for renovations;
(5) The methodology used in calculating
construction costs involving leasehold improvements; and
(6) The anticipated useful life of the building
for depreciation purposes;
(d)
The following construction costs shall be compared with the 2008
(1) Total costs associated with:
a. Labor;
b. Materials; and
c. Fixed equipment;
(2) Building permits;
(3) Architectural and engineering fees;
(4) Site preparation for the building;
(5) Utilities from structure to lot line;
(6) Insurance costs during construction; and
(7) Interest costs during construction;
(e) The applicant shall follow the outline of the
calculator method set forth in section 10 of the 2008
(f)
The costs and factors to take into account pursuant to (e) above shall
include:
(1) The base cost found in the general hospital
table in section 15, page 24 of the 2008
(2) An adjustment to heating, ventilation and
air-conditioning costs for extreme climate:
(3) Sprinkler system costs;
(4) Story height multipliers;
(5) Perimeter multipliers; and
(6) Cost multipliers from section 99 of the 2008
(g)
For inpatient projects, applicants shall provide a comparison of the proposed
construction cost per bed to the 2008 edition of the Marshall Valuation
Service, section 15, page 38;
(h)
For inpatient projects, applicants shall provide a comparison of the proposed
area per bed to the 2008 edition of the Marshall Valuation Service, section 15,
page 38;
(i)
Applicants shall describe anticipated operational cost savings that may
occur as a result of the project due to:
(1) Consolidation of services;
(2) Improved heating and maintenance costs;
(3) Environmental design of the constructed or renovated
space;
(4) Space for future expansion; or
(5) Other factors not listed above.
(j)
Applicants shall document the projected impact on hospital financial
activity as a result of the proposed project;
(k) Documentation
shall be made in the form of a report included with the application that
contains:
(1) The trended and projected increases in net
revenue per adjusted admission as calculated in He-Hea 1003.05 for the
past 3 years and continuing through 3 years after project completion; and
(2) Any case mix adjustment that would apply.
(l)
The expansion, renovation or replacement of the acute care facility
shall be financially feasible;
(m)
In order to assess the current and long-range financial feasibility of
the proposed project, applicants shall demonstrate that resources:
(1) Are available to fund the proposed capital
costs and operating costs;
(2) Will be available to maintain operations in
the event of interruptions to cash flow; and
(3) Will be available to ensure the continued
operation of the proposed project;
(n)
Demonstration of financial feasibility shall be made by providing with
the application:
(1) Copies of the facility’s financial statements
for the past 3 fiscal years and continuing through 3 years after project
completion;
(2) A statement of the sources of funds to
finance the proposed project;
(3) Documentation from the applicant’s lender,
underwriter or other anticipated source of capital, which includes:
a. Financed amount;
b. Rate of interest; and
c. Term of debt; and
(4) A computation of financial ratios as outlined
in He-Hea 1004.02 through He-Hea 1004.05 for the past 3 years and continuing
through 3 years after project completion using the financial figures in the
applicant’s historical and projected financial statements;
(o)
Applicants shall demonstrate that resources will be available to support
the personnel needs of the proposed expansion, renovation or replacement of the
acute care facility;
(p)
Demonstration of resources shall be made in the form of a report which
provides a schedule of all personnel for the past 3 years and continuing
through 3 years after project completion;
(q)
Applicants shall document the assumptions used to determine the overall
financial feasibility of the proposed projects to expand, renovate or replace
their respective facilities;
(r)
Documentation of assumptions shall be made in the form of a report which
includes the following:
(1) The source of the documents used to determine
the population projections of the primary and secondary service areas, if
different than the office of energy and planning,
(2) The changes in market conditions which would
result in a change in market share;
(3) The causes of any anticipated changes in the
overall length of stay in the hospital;
(4) The assumptions used to prepare the projected
financial statements; and
(5) Other assumptions the applicant considers
pertinent to the project’s feasibility.
Source. #4097, eff 7-22-86; ss by #4456, eff 7-25-88;
ss by #4988, eff 11-21-90; ss by #5236, eff 9-27-91, EXPIRED:9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1004.02 Operating Margin Ratio.
(a)
“Total operating revenues” means the sum of all revenue collected from
the provision of patient care services.
(b)
“Operating expenses” means the annual costs of the day-to-day provision
of patient care services.
(c)
To calculate operating margin ratio, the applicant shall subtract
operating expenses from total operating revenues, and then divide the result by
total operating revenues, as in the formula below:
Total
operating revenues - operating expenses
Total
operating revenues
Source. #4097, eff 7-22-86; ss by #4456, eff 7-25-88;
ss by #4988, eff 11-21-90; ss by #5236, eff 9-27-91, EXPIRED:9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1004.03 Debt Services Ratio.
(a)
“Cash flow” means the sum of total revenue less total expenses plus
depreciation and interest payment.
(b)
“Principal payment” means the amount of a loan due during one year which
is attributable to the principal portion of the debt, less interest costs.
(c)
“Interest expense” means the yearly cost of borrowed funds.
(d)
To calculate debt services ratio, applicants shall divide cash flow by
the sum of principal payment plus interest expense, as in the formula below:
Cash
flow
Principal
payment + interest expense
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #m 8918, eff 6-22-07;
ss by #9457, eff 4-21-09
He-Hea 1004.04 Debt to Equity Ratio.
(a)
“Long term liabilities” means a facility’s debt which is likely to take more
than one year to be paid.
(b)
“Fund balance” means the excess of assets over liabilities.
(c)
To calculate debt to equity ratio, applicants shall divide long term
liabilities by fund balance, as in the formula below:
Long
term liabilities
Fund
balance
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1004.05 Current Ratio.
(a) “Current assets” means a facility’s economic
resources which are likely to be converted to cash in one year.
(b)
“Current liabilities” means debt of a facility paid within one year of
incurrence.
(c)
To calculate current ratio, applicants shall divide current assets by
current liabilities, as in the formula below:
Current
assets
Current
liabilities
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07); ss by #9457, eff 4-21-09
PART
He-Hea 1005 FILING DATES FOR EXPANSION,
RENOVATION OR REPLACEMENT OF ACUTE CARE FACILITIES
He-Hea 1005.01 Requests for Applications. The board shall issue a request for
applications on August 1 of each year pursuant to RSA 151-C:8, I if potential
need has been determined based upon the receipt of a letter of intent from a
provider.
Source. #4456, eff 7-25-88; ss by #4988, eff
11-21-90; ss by #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1005.02 Submission of Applications. Applications shall be:
(a)
Prepared using the board’s application form per He-Hea 304; and
(b)
Submitted to the board 90 days after a request for applications has been
issued by the board.
Source. #4456, eff 7-25-88; ss by #4988, eff
11-21-90; ss by #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
PART
He-Hea 1006 STANDARDS FOR NEW ACUTE CARE
BEDS
He-Hea 1006.01 Need for New Acute Care Beds.
(a)
The number of acute care beds statewide shall not exceed 2.5 for each
1,000 persons;
(b)
The board shall apply the use rate in (a) above to 5 year projected
population statistics that are prepared and available through the New Hampshire
office of energy and planning, 57 Regional Drive, Concord, NH.
(c)
The result of the calculation of (b) above shall
constitute the 5 year projected statewide need for acute care beds.
(d)
The board shall make a determination of unmet need for acute care beds
on June 1st of each year.
(e)
Unmet need shall be determined by subtracting the number of licensed and
CON approved beds from that number calculated to be needed in (c) above.
Source. #4456, eff 7-25-88; ss by #4988, eff
11-21-90; ss by #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1006.02 Service Area. Hospital Service areas shall be based upon:
(a)
The calculation per He-Hea 1003.01; and
(b)
Table 1003-1 “Service Areas by Hospital.”
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRESD
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1006.03 Service Area Population.
(a)
Applicants shall develop:
(1) Current and projected populations for their
hospital service area and secondary service area; and
(2) Current and projected age and gender cohorts for their hospital service area and secondary service area.
(b)
Population estimates for (a) above shall be obtained from:
(1) The
(2) The
(3) The office of health statistics and data
management, division of public health services, department of health and human
services; or
(4) A nationally recognized demographic data
provider.
(c)
Age
groups for (a) above shall be determined as follows:
(1) 0-14;
(2) 15-44;
(3) 45-64;
and
(4) 65
and older.
(d)
Notwithstanding (c) above, applicants shall have the opportunity to
demonstrate different age groupings that apply specifically to their proposal
in terms of:
(1) Women of child-bearing age;
(2) Infants;
(3) Pediatric patients; or
(4) Geriatric patients.
(e)
In the event of any dispute brought before the board relative to age and
gender cohorts presented in any application, the board shall rely upon the age
and gender population estimates as provided by the New Hampshire office of
energy and planning, 57 Regional Drive, Concord, N.H. to make a final
determination on the proposal.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
(from He-Hea 1006.02)
He-Hea 1006.04 Market Share. Applicants shall report their market share
for each town in the proposed service area by using discharge data from the
UHDDS.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1006.05 Projected Patient Days. Applicants shall provide projected patient
days to support the proposed new beds from:
(a)
The common hospital DRGs as outlined in He-Hea 1003.01;
(b)
Any class of DRGs specific to the proposal; or
(c)
Both (a) and (b) above.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff
4-21-09(from He-Hea 1006.06
He-Hea 1006.06 Projected Patient Days Calculation.
(a) “UR” means use
rate which is a table of age and gender use rates that is computed by the
applicant by dividing the total patient days statewide for the most recent 12
months as obtained from the UHDDS by the
statewide population for the same time period divided by 1,000;
(b)
“Ppop” means
projected population for each age and sex cohort for the cities and towns in the hospital service area as well as any secondary service area defined by the applicant;
(c)
“MS” means
market share as determined by the percentage of discharges the applicant
receives from a given town as reported by all
(d)
“OPD” means
outside patient days which is the historical annual patient days generated by
persons residing outside the state of N.H.utilizing the applicant’s hospital
multiplied by the historical growth rate for this category of patient
days.
(e)
To determine projected patient days, applicants shall multiply the use
rates by the projected populations and market share for each town, then add the
outside patient days to the sum of these two
figures, as in the formula below:
(f)
The applicant shall sum all results of (e) above to arrive at total projected
patient days for the identified service area.
(g)
Age groups for (a) above shall be
determined as follows:
(1) 0-14;
(2) 15-44;
(3) 45-64;
and
(4) 65
and older.
(h)
Notwithstanding (g) above, applicants shall have the opportunity to
demonstrate different age groupings that apply specifically to their proposal
in terms of:
(1) Women
of child-bearing age;
(2) Infants;
(3) Pediatric
patients; or
(4) Geriatric
patients.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1006.07 Occupancy Rates.
(a) Requests for additional beds shall be developed
on the basis of the following minimum and optimal occupancy rates based upon
total operational beds for general hospitals, by service category, as set forth
in Table 1006-1, “Bed Calculation Table”.
Service Category |
Minimum Occupancy
|
Optimal Occupancy
|
Medical/Surgical |
75% |
90% |
Obstetrics |
60% |
85% |
Pediatrics |
|
|
Less than 40 beds |
60% |
85% |
More than 40 beds |
65% |
90% |
ICU/CCU |
60% |
85% |
Psychiatric |
70% |
90% |
(b)
“ADC” means average daily census which is computed by dividing the total
patient days calculated in He-Hea 1006.06 by 365.
(c)
“fp” means probability factor which at a 95% confidence level for medical/surgical
and pediatric service converts to a multiple of 1.65 and a 99% confidence level
for CCU, ICU and obstetric services converts
to a multiple of 2.33.
(d)
Need for additional beds shall be determined by multiplying the square
root of the average daily census by the probability factor, then adding the
product of these 2 figures by the average daily census, as in the formula
below:
Bed
Need = ADC + (fpÖADC)
(e) Notwithstanding (a)
through (d) above, applicants shall not apply the calculation to any need for
additional beds utilized for observation status.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1006.08 Impact
on Other Providers.
(a) Applicants
proposing to establish, expand or renovate an acute care facility shall
demonstrate that the proposed facility shall not have a detrimental impact on
health services within the proposed service area in terms of:
(1) Quality of care;
(2) Access to and availability of health care
services; and
(3) Cost effectiveness of health care services
provided.
(b) Demonstration
shall be made by submitting with the application:
(1) A
copy of an existing or proposed quality improvement program pursuant to He-Hea
303.05;
(2) To
the extent data is available, a statistical
report in the application which shows how the proposed project is projected to
affect health care services in the proposed service area in terms of:
a. Utilization;
b. Patient charges;
c. Market share;
d. Physician referral patterns;
e. Personnel resources; and
f. Referral sources.
(3) Any correspondence from other facilities in the service area regarding the impact of the proposed
project on their existing health care services including their continued
ability to:
a. Maintain quality health care services;
b. Provide essential community services;
c. Provide emergency services; and
d. Provide charity care.
Source. #9457, eff 4-21-09; ss by #9457, eff 4-21-09
PART
He-Hea 1007 CRITERIA FOR NEW ACUTE CARE
BEDS
He-Hea 1007.01 Criteria. In addition to all other requirements in RSA
151-C:7, He-Hea 303.02 through
He-Hea 303.09, and He-Hea 1004.01,
applicants shall meet the following criteria for consideration of a CON for new
acute care beds:
(a)
Applicants shall demonstrate the impact of adding new acute care beds to
the healthcare system of the state;
(b)
Demonstration of impact of new beds shall be made by a statistical
report in the application which shows how the proposed project is projected to
affect the existing hospitals in the service area in terms of:
(1) Utilization;
(2) Patient charges;
(3) Market share;
(4) Physician referral patterns; and
(5) Personnel resources;
(c)
Applicants shall also provide a report with the application that
supports the need for new beds in terms of:
(1) Referrals from area health care providers as
evidenced by letters of support;
(2) Historical trends in volume such as:
a. Admissions;
b. Average length of stay;
c. Patient days; and
d. Occupancy rates;
(3) Changes in market share;
(4) The addition of new services with different
market patterns;
(5) The addition of specialized services with
different market patterns; and
(6) Any other causes presented to support the
anticipated need for acute care beds.
Source. #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
PART
He-Hea 1008 FILING DATES FOR NEW BEDS
He-Hea 1008.01 Request for Applications. In accordance with RSA 151-C:8, I requests
for applications shall be issued on August 1st of each year if a
need has been delineated for new acute care beds pursuant to He-Hea 1006.01.
Source. #5236, eff 9-27-91, EXPIRED: 9-27-97
New. #6655, INTERIM, eff 12-18-97, EXPIRED:
4-17-98
New. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
He-Hea 1008.02 Submission of Applications. Applications for new acute care beds shall
be:
(a)
Prepared using the board’s application form per He-Hea 304; and
(b)
Submitted to the board 90 days after the issuance of a request for
applications.
Source. #6840, eff 8-28-98, EXPIRED: 8-28-06
New. #8742, INTERIM, eff 10-21-06, EXPIRED:
4-19-07
New. #8918, eff 6-22-07; ss by #9457, eff 4-21-09
APPENDIX
Rule |
statute |
|
|
He-Hea 1001.01 |
RSA 151-C:1 |
|
|
He-Hea 1002.01 |
RSA 151-C:2 |
|
|
He-Hea 1003.01 – He-Hea 1003.06 |
RSA 126:25, RSA 151-C:5,II(a), RSA 151-C;11, I |
He-Hea 1003.07 |
RSA 151-C:5, II(a), RSA 151-C:11, I |
|
|
He-Hea 1004.01 – He-Hea 1004.05 |
RSA 151-C:5, II(a), RSA 151-C:7, I-II, RSA
151-C:11, I |
|
|
He-Hea 1005.01 –
He-Hea 1005.02 |
RSA 151-C:8, I |
|
|
He-Hea 1006.01 –
He-Hea 1006.07 |
RSA 126:25, RSA
151-C:5, II (a); RSA 151-C:11, I |
He-Hea 1006.08 |
RSA 151-C:5, II(a); RSA
151-C:11, I |
|
|
He-Hea 1007.01 |
RSA 151-C:5, II(a), RSA 151-C:7, I-II, RSA
151-C:11, I |
|
|
He-Hea 1008.01 –
He-Hea 1008.02 |
RSA 151-C:8, I |