CHAPTER He-Hea 700 COMPREHENSIVE PHYSICAL REHABILITATION
SERVICES
PART He-Hea 701 DEFINITIONS
He-Hea 701.01 Definitions.
(a) “Applicant” means “applicant” as defined in RSA 151-C:2,
II.
(b)
“Application” means a proposal prepared by a person and filed with board
for a certificate of need.
(c) “Board” means “board”
as defined in RSA 151-C:2, IV.
(d) “Certificate of
need (CON)” means “certificate of need” as defined in RSA 151-C:2, VIII.
(e) “Comprehensive
physical rehabilitation beds” means inpatient specialty beds that are located
in a distinct, clearly defined unit of an acute care hospital or in a
comprehensive physical rehabilitation hospital that is devoted to providing
comprehensive physical rehabilitation services.
(f) “Comprehensive
physical rehabilitation hospital” means
“rehabilitation hospital” as defined in He-P 802.03 (bn) or 42 CFR
412.23(b)(2).
(g) “Comprehensive
physical rehabilitation services” means those specialized medical, social,
educational, vocational, physical, occupational, speech, hearing,
psychological, respiratory and recreational therapies and prosthetic and
orthotic services offered in or as part of a comprehensive physical rehabilitation
hospital for the purposes of restoring an
individual disabled by disease or injury to the highest physical, vocational
and economic usefulness of which he or she is capable.
(h) “Marshall Valuation Service (MVS)” means an
appraisal guide for the development and reporting of replacement building and
equipment costs used to determine construction/renovation costs of commercial
buildings.
(i) “Patient
charges” means the aggregate price charged for patient care services at a
comprehensive physical rehabilitation hospital.
(j) “Relocate” means
to move one or more comprehensive physical rehabilitation beds from one
facility to another.
(k) “Rehabilitation”
means the process of providing, through an interdisciplinary team, coordinated services
to a person in a program designed to achieve the objective of improved
functional ability, health, welfare and the realization of one’s maximum
physical, social, psychological and vocational potential for useful and
productive activity to enhance independence and self-sufficiency.
(l) “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.
Source. #4136, eff 9-29-86, EXPIRED: 9-29-92
New. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
PART He-Hea 702 STANDARDS FOR DETERMINING THE NEED FOR
COMPREHENSIVE PHYSICAL REHABILITATION SERVICES IN THE STATE OF
He-Hea 702.01 Regional
Standard.
(a)
The number of comprehensive physical rehabilitation beds shall be 12 for
each 100,000 persons per the regions established by Table 700.1, “Comprehensive
Physical Rehabilitation Service Areas.”
(b) Requests for additional beds shall be issued
based on a minimum 20-bed unit per region.
Source. #4136, eff 9-29-86, EXPIRED: 9-29-92
New. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
He-Hea 702.02 Determination
of Need for Comprehensive Physical
Rehabilitation Beds.
(a) “REGPOP” means
the total population for persons residing in the regions as designated in Table
700.1, based upon the population statistics published by the
(b) “12” means 12
beds per 100,000 population.
(c) Need for
comprehensive physical rehabilitation beds by region shall be determined by dividing
the region population by 100,000, and multiplying this quotient by 12, as in
the formula below:
((REGPOP/100000) x12
Source. #4136, eff 9-29-86, EXPIRED: 9-29-92
New. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
He-Hea 702.03 Regional
Service Areas. Service areas for
comprehensive rehabilitation services shall be identified in Table 700.01,
“Comprehensive Physical Rehabilitation Service Areas,” below:
COMPREHENSIVE PHYSICAL
REHABILITATION SERVICE AREAS
Academy Grant |
Crawford’s Purchase |
|
Pinkham’s Grant |
|
Cutt’s Grant |
|
|
Atkinson & Gilmant. |
|
|
|
|
Dix’s Grant |
Landaff |
Sargent’s Purchase |
|
Dixville |
|
|
Bean’s Grant |
Dummer |
|
Shelburne |
Bean’s Purchase |
|
|
Stark |
|
Eaton |
|
|
|
Errol |
Low & Burbank’s
Purchase |
Stewartstown |
|
Erving’s Location |
Lyman |
|
|
|
|
Sugar Hill |
Carroll |
Gorham |
Martin's Location |
|
|
Green’s Grant |
|
Thompson & Meserve's |
|
Hadley's Purchase |
Millsfield |
Wentworth’s Location |
|
Hale’s Location |
|
Whitefield |
Colebrook |
Harts Location |
Northumberland |
|
|
|
Odell |
|
|
|
|
|
|
|
Hopkinton |
|
|
Deering |
|
Tilton |
|
Dunbarton |
Loudon |
Tuftonboro |
Barnstead |
Effingham |
Meredith |
|
|
Ellsworth |
Moutonborough |
Warner |
Boscawen |
Epsom |
New |
|
Bow |
|
|
|
|
Freedom |
Northwood |
Weare |
|
Gilford |
Ossipee |
Webster |
|
Gilmanton |
Pembroke |
Wentworth |
|
|
|
|
Campton |
|
|
Wolfeboro |
|
Henniker |
Rumney |
|
|
Hill |
|
|
|
Hillsborough |
Sanbornton |
|
|
Holderness |
|
|
SEACOAST REGION
|
|
|
Raymond |
|
|
New |
|
|
|
Newfields |
Rollinsford |
|
|
|
|
|
Kensington |
|
Seabrook |
|
|
|
Somersworth |
Epping |
Lee |
|
|
|
Madbury |
|
Strafford |
|
Middleton |
Plaistow |
Stratham |
|
|
|
|
SOUTHERN REGION
Allenstown |
|
Litchfield |
|
|
|
|
New |
Atkinson |
Goffstown |
Lyndeborough |
Pelham |
|
Hampstead |
|
|
|
Hollis |
|
Sandown |
|
Hooksett |
|
|
|
|
|
|
|
|
|
|
WESTERN REGION
Acworth |
Francestown |
Lyme |
Roxbury |
Alstead |
Gilsum |
|
|
|
|
Marlow |
|
Antrim |
Grafton |
Mason |
Stoddard |
|
Grantham |
Nelson |
Sullivan |
|
|
Newbury |
Sunapee |
|
|
New |
Sutton |
|
Hancock |
|
Surry |
|
|
|
Swanzey |
Cornish |
Harrisville |
|
|
Croydon |
|
Orford |
|
|
Jaffrey |
|
Unity |
|
|
Piermont |
|
|
Langdon |
|
|
|
|
|
Westmoreland |
Fitzwilliam |
Lempster |
Rindge |
Wilmot |
|
|
|
|
Source. #4136, eff 9-29-86, EXPIRED: 9-29-92
New. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
He-Hea 702.04 Determination
of Unmet Need.
(a)
The board shall make a determination of unmet need for comprehensive
physical rehabilitation beds:
(1) Upon adoption of this chapter; and
(2) Biennially thereafter on July 1.
(b) Unmet need shall
be determined for each region by subtracting the number of licensed or approved
comprehensive rehabilitation beds from that number calculated to be needed
under He-Hea 702.02.
(c) The unmet need
shall be the difference between the calculated need and the number of licensed
or approved beds, subject to a minimum unit of 20 beds.
Source. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
He-Hea 702.05 Access
to Care. Applicants shall ensure
that no resident of the state of
(a) Race;
(b) Color;
(c) Creed;
(d) Age;
(e) Gender;
(f) Sexual
orientation;
(g) Disability; or
(h) Ability to pay.
Source. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
He-Hea 702.06 Location
of Services.
(a) Comprehensive physical rehabilitation
services shall only be offered in a comprehensive physical rehabilitation
hospital.
(b) Any comprehensive physical rehabilitation
hospital holding a CON for comprehensive physical rehabilitation beds and
seeking to relocate such beds either within or outside of the region to an
existing comprehensive physical rehabilitation hospital shall comply with:
(1) He-Hea 704.01;
(2) He-Hea 705;
(3) RSA
151-C:5, II(e); and
(4) RSA151-C:5, II (f)(1).
(c) Any facility receiving the relocated beds
shall be subject to the requirements of RSA 151-C:5, II(e) and (f)(1).
(d) No receipt of relocated beds shall cause the
number of beds in the region where the receiving facility is located to exceed the
need for beds in the region determined under He-Hea 702.01 through He-Hea
702.04, or,
if the number of beds in the region already exceeds the need, to increase the
number of beds.
(e) The purchase price paid by the receiving
facility for the relocation of comprehensive physical rehabilitation beds shall
not be considered in the total project cost that is compared to the threshold
amount set by RSA 151-C:5, II(f).
Source. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
He-Hea 702.07 Staffing
Requirements. Comprehensive physical
rehabilitation services shall meet the staffing requirements of He-P 802.34(a)(2).
Source. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12 (from He-Hea 702.07)
He-Hea 702.08 Impact
on Other Comprehensive Physical Rehabilitation Services.
(a) Applicants shall demonstrate that the implementation of additional comprehensive physical rehabilitation beds will not have a detrimental impact on those facilities offering comprehensive physical rehabilitation services in the affected region.
(b) Demonstration that additional beds will not be detrimental to existing facilities offering comprehensive physical rehabilitation services in the affected region shall be made by providing in the application:
(1) A report that outlines the plan for maintaining existing comprehensive physical rehabilitation beds;
(2) A statistical report which shows how the addition of comprehensive physical rehabilitation beds is projected to affect the provision of comprehensive physical rehabilitation services in the affected region 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 affected region regarding the impact of the proposed project on their
existing comprehensive physical rehabilitation 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. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12 (from He-Hea 702.10)
PART He-Hea 703 CRITERIA FOR EVALUATING COMPREHENSIVE
PHYSICAL REHABILITATION SERVICES
He-Hea 703.01 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 construction, expansion,
renovation or replacement of a comprehensive physical rehabilitation hospital:
(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 within a 10% margin
to the 2011 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 2011 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 2011
(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 2011
(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 2011
(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 2011
(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 2011
(g) For construction
projects, applicants shall provide a comparison of the proposed construction
cost per bed to the 2011 edition of the Marshall Valuation Service, section 15,
page 38;
(h) For construction
projects, applicants shall provide a comparison of the proposed area per bed to
the 2011 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) The expansion, renovation
or replacement of the acute care facility shall be financially feasible;
(k) 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;
(l) Demonstration of financial feasibility shall
be made by providing with the application:
(1) Copies of the facility’s 3–year historical
and 3-year projected financial statements;
(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;
(m) Applicants shall
demonstrate that resources will be available to support the personnel needs of
the proposed construction, expansion, renovation or replacement of the
comprehensive physical rehabilitation facility;
(n) Demonstration of resources shall be made in
the form of a report which provides a 3-year historical and 3-year projected schedule
of all personnel;
(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 including 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.
(s)
Applicants shall document the planned use of comprehensive physical
rehabilitation beds by patients originating from outside the state of New
Hampshire and the impact of these services on the accessibility of beds by New
Hampshire residents;
(t)
Demonstration of the use of beds by out-of-state patients shall be in
the form of a report which shall include:
(1) The projected utilization by non-New
Hampshire residents;
(2) Referral agreements from physicians and other
medical personnel; and
(3) A plan which assures services are, or will
be, provided to residents of the affected service area to attain, maintain, or
both, a use rate consistent with the average use rate in determining need for
services pursuant to He-Hea 702.01;
(u) Applicants shall identify the source of any data or information provided pursuant paragraphs (c) through (t) above.
Source. #4136, eff 9-29-86, EXPIRED: 9-29-92
New. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
PART He-Hea 704 REQUEST FOR APPLICATIONS
He-Hea 704.01 Request
for Applications (RFA).
(a) In accordance
with RSA 151-C:8, I, a request for applications shall be issued if a need for
additional comprehensive physical rehabilitation beds pursuant to He-Hea 702.01
has been delineated.
(b) Notwithstanding
paragraph (a) above, the board shall accept applications for comprehensive
physical rehabilitation beds for less than the 20 bed minimum standard in the
Northern Region.
Source. #7985, eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New. #10155,
eff 6-26-12
He-Hea 704.02 Submission of Applications. Applications in response to an RFA shall be
submitted within 90 days of the publication of the RFA.
Source. #7985,
eff 11-8-03, EXPIRED: 11-8-11
New.
#10028, INTERIM, eff 11-19-11, EXPIRED: 5-17-12
New.
#10155, eff 6-26-12
PART He-Hea 705 GRANTING CERTIFICATES OF NEED
He-Hea 705.01 Approval
of Applications.
(a) The board shall issue
multiple CONs to satisfy the need for which a request for applications was
issued if it determines more than one applicant demonstrates that they equally
satisfy and comply with the standards listed in RSA 151-C:9, II.
(b)
The total number of beds approved shall not exceed the unmet need
determined pursuant to He-Hea 702.01.
Source. #7985, eff 11-8-03, EXPIRED: 11-8-11
New. #10028, INTERIM, eff 11-19-11, EXPIRED:
5-17-12
New. #10155, eff 6-26-12
APPENDIX
RULE |
STATE
STATUTE IMPLEMENTED |
He-Hea 701.01 |
RSA 151-C:2, RSA 151-C:11, I |
He-Hea 702.01 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea 702.02 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea 702.03 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea 702.04 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea 702.05 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea 702.06 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea
702.07 |
RSA 151-C:5(f)(1), RSA 151-C:11, I, RSA
151-C:7, II |
He-Hea 702.08 |
RSA 151-C:5(f)(1), RSA 151-C:11, I |
He-Hea 703 |
RSA 151-C:5(f)(1), RSA 151-C:11, I, RSA
151-C:7, I |
He-Hea 704 |
RSA 151-C:8, I |
He-Hea 705 |
RSA 151-C:9, I, II |