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 NEW HAMPSHIRE

 

          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 New Hampshire office of state planning for the most recent 12 months.

 

          (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:

 

Table 700.1

 

COMPREHENSIVE PHYSICAL REHABILITATION SERVICE AREAS

 

NORTHERN REGION

 

Academy Grant

Crawford’s Purchase

Jefferson

Pinkham’s Grant

Albany

Cutt’s Grant

Kilkenny Township

Pittsburg

Atkinson & Gilmant.

Dalton

Lancaster

Randolph

Bartlett

Dix’s Grant

Landaff

Sargent’s Purchase

Bath

Dixville

Lincoln

Second College Grant

Bean’s Grant

Dummer

Lisbon

Shelburne

Bean’s Purchase

Easton

Littleton

Stark

Berlin

Eaton

Livermore

Stratford

Benton

Errol

Low & Burbank’s Purchase

Stewartstown

Bethlehem

Erving’s Location

Lyman

Success Township

Cambridge

Franconia

Madison

Sugar Hill

Carroll

Gorham

Martin's Location

Tamworth

Chandler’s Purchase

Green’s Grant

Milan

Thompson & Meserve's

Chatham

Hadley's Purchase

Millsfield

Wentworth’s Location

Clarksville

Hale’s Location

Monroe

Whitefield

Colebrook

Harts Location

Northumberland

Woodstock

Columbia

Haverhill

Odell

 

Conway

Jackson

 

 

 

CENTRAL REGION

 

Alexandria

Concord

Hopkinton

Thornton

Alton

Deering

Laconia

Tilton

Ashland

Dunbarton

Loudon

Tuftonboro

Barnstead

Effingham

Meredith

Wakefield

Belmont

Ellsworth

Moutonborough

Warner

Boscawen

Epsom

New Hampton

Washington

Bow

Franklin

Northfield

Waterville Valley

Bradford

Freedom

Northwood

Weare

Bridgewater

Gilford

Ossipee

Webster

Bristol

Gilmanton

Pembroke

Wentworth

Brookfield

Groton

Pittsfield

Windsor

Campton

Hebron

Plymouth

Wolfeboro

Canterbury

Henniker

Rumney

 

Center Harbor

Hill

Salisbury

 

Chichester

Hillsborough

Sanbornton

 

 

Holderness

Sandwich

 

 

SEACOAST REGION

 

Barrington

Fremont

New Castle

Raymond

Brentwood

Greenland

New Durham

Rochester

Danville

Hampton

Newfields

Rollinsford

Dover

Hampton Falls

Newington

Rye

Durham

Kensington

Newmarket

Seabrook

East Kingston

Kingston

Newton

Somersworth

Epping

Lee

North Hampton

South Hampton

Exeter

Madbury

Nottingham

Strafford

Farmington

Middleton

Plaistow

Stratham

 

Milton

Portsmouth

 

 

SOUTHERN REGION

 

Allenstown

Deerfield

Litchfield

Nashua

Amherst

Derry

Londonderry

New Boston

Atkinson

Goffstown

Lyndeborough

Pelham

Auburn

Hampstead

Manchester

Salem

Bedford

Hollis

Merrimack

Sandown

Brookline

Hooksett

Milford

Wilton

Candia

Hudson

Mont Vernon

Windham

Chester

 

 

 

 

WESTERN REGION

 

Acworth

Francestown

Lyme

Roxbury

Alstead

Gilsum

Marlborough

Sharon

Andover

Goshen

Marlow

Springfield

Antrim

Grafton

Mason

Stoddard

Bennington

Grantham

Nelson

Sullivan

Canaan

Greenfield

Newbury

Sunapee

Charlestown

Greenville

New Ipswich

Sutton

Chesterfield

Hancock

New London

Surry

Claremont

Hanover

Newport

Swanzey

Cornish

Harrisville

Orange

Temple

Croydon

Hinsdale

Orford

Troy

Danbury

Jaffrey

Peterborough

Unity

Dorchester

Keene

Piermont

Walpole

Dublin

Langdon

Plainfield

Warren

Enfield

Lebanon

Richmond

Westmoreland

Fitzwilliam

Lempster

Rindge

Wilmot

 

 

 

Winchester

 

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 New Hampshire will be refused comprehensive physical rehabilitation services by them on the basis 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 Marshall Valuation Service;

 

(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 Marshall Valuation Service, section 15:

 

(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 Marshall Valuation Service to determine construction costs;

 

          (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 Marshall Valuation Service:

 

(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 Marshall Valuation Service;

 

          (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, 57 Regional Drive, Concord, NH;

 

(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