CHAPTER He-Hea 900  LONG-TERM CARE FACILITIES

 

REVISION NOTE:

 

Document #10977, effective 11-20-15, readopted with amendments Chapter He-Hea 900 on long term care facilities.  Document #10977 made extensive changes to the wording, format, and numbering of the rules in the former Chapter He-Hea 900.  Document #10917 combined what had been Part He-Hea 901 through Part He-Hea 909 in the former Chapter He-Hea 900 into Part He-Hea 901 through Part He-Hea 907 in the amended Chapter He-Hea 900.  The former Chapter He-Hea 900 had last been filed under Document #8917, effective 6-22-07.  The rules in former Chapter He-Hea 900 did not expire on 6-22-15 since they were extended pursuant to RSA 541-A:14-a until replaced by the rules in Document #10977, effective 11-20-15.

 

Document #10977 supersedes all prior filings for the rules in the former Chapter He-Hea 900.  The filings affecting the former Chapter He-Hea 900 include the following documents:

 

            #4096, effective 7-22-86

            #4325, effective 10-21-87

            #5270, effective 11-6-91, EXPIRED 11-6-97

            #6654, INTERIM, effective 12-18-97, EXPIRED 4-17-98

            #6801, effective 7-15-98, EXPIRED 7-15-06

            #7442, effective 2-2-01

            #8690, effective 7-25-06, EXPIRED 1-21-07

            #8917, effective 6-22-07

 

PART He-Hea 901  PURPOSE AND DEFINITION

 

          He-Hea 901.01  Purpose.  This chapter implements an institutional health service standard for providers of long-term care services per RSA 151-C:5, II, (f) that is intended to promote reasonable distribution of these services and stimulate competition among qualified providers.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 901.02  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 the 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)  “Construction” means “construction” as defined in RSA 151-C:2, XII.

 

          (f)  “Continuing care contract” means a contractual arrangement between the operator and resident of a CCRC that is in force for not less than one year, which details the rights and obligations of each party to the contract and which guarantees the resident nursing home care and other services for the duration of residence in the CCRC in exchange for an entrance or other fee.

 

          (g)  “Continuing care retirement community (CCRC)” means a residential complex which:

 

(1)  Operates a residential unit and a nursing home under a single independent corporate structure;

 

(2)  Operates a residential unit and nursing home on a single campus or, if not on the same campus, operates the nursing home within one mile of the residential complex; and

 

(3)  Documents the existence of one of the following:

 

a.  A continuing care contract with the residents of the CCRC in exchange for an entrance or other fee offering health care and support services including but not limited to:

 

1.  Independent living;

 

2.  Dietary services;

 

3.  Medical services;

 

4.  Housekeeping; and

 

5.  Nursing home services; or

 

b.  In lieu of a continuing care contract, a prominently and publicly displayed posted continuing care policy.

 

          (h)  “Continuum of care” means a comprehensive system of services having diagnostic, preventative, therapeutic, rehabilitative, supportive and maintenance services in institutional and non-institutional settings, including but not limited to:

 

(1)  Medical care;

 

(2)  Mental health services;

 

(3)  Primary health care;

 

(4)  Nursing care;

 

(5)  Therapy;

 

(6)  Nutrition services;

 

(7)  Home health care;

 

(8)  Pharmaceutical services;

 

(9)  Personal care services;

 

(10)  Domestic services;

 

(11)  Full range of living arrangements;

 

(12)  Transportation;

 

(13)  Information and referral services; and

 

(14)  Respite care.

 

          (i)  “Detrimental” means a significant adverse impact on the ability to maintain the accessibility, quality and cost of health care services in the area.

 

          (j)  “Entrance fee” means an initial or deferred payment of a sum of money made as full or partial payment to ensure the resident a place in the CCRC. The term also includes “accommodation fee” or “admission fee”.

 

          (k)  “Long-term care (LTC)” means medical and support services provided to individuals who are frail and dependent due to chronic physical or mental impairments in order to assist them in attaining an optimal level of physical, social and psychological functioning.

 

          (l)  “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.

 

          (m) “Nursing home” means “nursing home” as defined in RSA 151-C:2, XXVI.  The term also includes “long-term-care facility.”

 

          (n)  “Person” means “person” as defined in RSA 151-C:2, XXVIII.

 

          (o) “Posted continuing care policy” means a written description, provided by the CCRC, of the obligations, rights and privileges of, and the services available to, all residents of the CCRC.

 

          (p)  "Priority" means the right described in He-Hea 903 given to a long-term care facility that has surrendered beds to add the same number of beds or portion thereof to its facility in advance of a request for applications for additional long-term care beds in the state.

 

          (q)  “Provider” means a person holding a certificate of need and licensed to do business in the state providing long-term care services in an institutional setting.

 

          (r)  “Quality assurance plan” means a continuous plan of collection, screening, and evaluation of information concerning patient care, placement, and clinical performance leading to the methods of resolving and/or eliminating problems as identified by professional and administrative staffs, patients and their families, and other professionals in the delivery of health care services.

 

          (s)  “Region” means the counties as set forth in table 900.1 of He-Hea 902.02.

 

          (t)  “Renovation” means a capital expenditure allotted to any combination of repairs, remodeling, or reconfiguration of existing space.

 

          (u)  “Replacement” means a capital expenditure allotted to the rebuilding, in whole or in part, of a long-term care facility on a new or the original site.

 

          (v)  “Resident” means:

 

(1)  The purchaser of a continuing care contract who physically resides in the residential unit of a CCRC; or

 

(2)  A person who physically resides in the residential unit of the CCRC which has a posted continuing care policy.

 

          (w)  “Residential complex” means an amalgamation of housing arrangements that includes one or more of the following on one physical site:

 

(1)  Buildings;

 

(2)  Apartments;

 

(3)  Flats;

 

(4)  Homes;

 

(5)  Cottages; or

 

(6)  Rooms.

 

          (x)  “Residential unit” means an apartment, sheltered care facility, or other independent living arrangement that does not require licensure as a nursing home under He-P 803.

 

          (y)  “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.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

PART He-Hea 902  METHODOLOGY FOR DETERMINING NEED

 

          He-Hea 902.01  Determination of Need for Long-Term Care Facility Beds.

 

          (a)  “Region population aged 65+” means the total number of persons aged 65 and over residing in the regions designated in Table 900.1, based upon county population statistics provided by the NH office of energy and planning.

 

          (b)  To calculate additional bed need of long-term care facility beds, applicants shall multiply the region population aged 65+ by 40, then divide this product by 1000, as in the formula below:

 

Bed Need = Region Population Aged 65+ x 40

1000

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 902.02  Regional Bed Need Formula.  Service areas for long-term care shall be as identified in Table 900.1 “Long-Term Care Service Area”, below:

 

Table 900.1

 

LONG-TERM CARE SERVICE AREA

 

REGION (1)

Belknap County

 

REGION (2)

Carroll County

 

REGION (3)

Cheshire County

 

REGION (4)

Coos County

 

REGION (5)

Grafton County

 

REGION (6)

Hillsborough County

 

REGION (7)

Merrimack County

 

REGION (8)

Rockingham County

 

REGION (9)

Strafford County

 

REGION (10)

Sullivan County

 

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 902.03  Determination Of Unmet Need.

 

          (a)  The board shall make a determination of unmet need for long-term care beds on January 1 of each year.

 

          (b)  Unmet need shall be determined by subtracting the number of licensed or approved long-term care beds and those refilled under a priority pursuant to He-Hea 903.01(d), exclusive of those long-term care beds licensed or approved under He-Hea 907, from that number calculated to be needed under He-Hea 902.01 for each region.

 

          (c)  The unmet need shall be the difference between the calculated need and the existing bed inventory, not to exceed the standard pursuant to RSA 151-C:4, III(b).

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 902.04  Ranking of Areas With Demonstrated Unmet Need.

 

          (a)  The board shall rank areas with unmet need after a determination of unmet need has occurred per He-Hea 902.03.

 

          (b)  The degree of unmet bed need for each region shall be determined by calculating the ratio of unmet need to total need. 

 

          (c)  The region with the largest unmet need to total need ratio shall be ranked as the highest priority.

 

          (d)  Each region shall be assigned a priority ranking in order of ratio of unmet need arranged from highest unmet need to lowest unmet need.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

He-Hea 902.05  Requests for Applications (RFA) to Fulfill Unmet Need.

 

          (a)  Once the board has created a priority ranking of unmet need pursuant to He-Hea 903.01(d), the board shall issue requests for applications every 45 days for one region at a time until no region has an unmet need.

 

          (b)  Requests shall be issued in accordance with RSA 151-C:8, I, based on the ranking order specified in He-Hea 902.04.

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

PART He-Hea 903  SURRENDER AND TRANSFER OF BEDS

 

          He-Hea 903.01  Surrender of Beds.

 

          (a)  Prior to surrendering beds, a nursing facility shall notify the board of its intent to surrender any number of licensed beds issued under a certificate of need.

 

          (b)  Any nursing facility surrendering beds shall submit a letter of intent to the board that documents the following:

 

(1)  The name of the facility;

 

(2)  The address and location of the facility;

 

(3)  The total number of licensed beds;

 

(4)  The CON docket number, if applicable;

 

(5)  The proposed number of surrendered beds;

 

(6)  The reason for surrendering the beds; and

 

(7)  The anticipated benefits or cost savings, or both, as a result of the surrender.

 

          (c)  Letters of intent shall be filed in accordance with He-Hea 206.  The board shall approve any letter of intent that is complete.

 

          (d)  Any facility that has surrendered beds shall be granted a priority to fulfill bed need prior to the issuance of an RFA pursuant to He-Hea 902.05.  The facility may refill all previously surrendered beds or only a portion thereof.  A facility that has surrendered beds shall not add a greater number of beds than specified in its surrender notification.

 

          (e)  Any facility proposing to refill a priority for nursing beds shall be subject to RSA 151-C:5, II(f)(1), RSA 151-C:8 and He-Hea 301.

 

          (f)  Any beds filled under a priority status shall be subtracted from the unmet need determined by He-Hea 902.03, prior to the issuance of an RFA pursuant to He-Hea 902.05.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 903.02  Transfer of Priority Status.

 

          (a)  Any nursing facility that has surrendered its beds under He-Hea 903.01 may transfer its priority status to any other facility provided notice is made to the board.  Upon transfer, the facility holding the transfer shall be the owner of the priority status of beds.

 

          (b)  Notice of transfer shall be made jointly, in writing, by the facility intending to transfer the priority and the facility receiving the transfer.

 

          (c)  The notice shall:

 

(1)  Identify the name, address, and location of the transferring facility;

 

(2)  Identify the name, address, and location of the receiving facility; and

 

(3)  Be signed by both parties authorized to make and accept the transfer.

 

          (d)  Any facility owning the priority status of beds due to a transfer shall be subject to the requirements of He-Hea 903.01(d) and He-Hea 903.01(e).

 

          (e)  Any purchase price paid by the transferee for the transfer of priority status 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.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

PART He-Hea 904  STANDARDS FOR LONG-TERM CARE FACILITY CONSTRUCTION, EXPANSIONS, RENOVATIONS OR REPLACEMENT

 

          He-Hea 904.01  Requests for Long-Term Care Facility Construction,  Renovation or Replacement.

 

          (a)  Pursuant to RSA 151-C:4, III(a), requests for submission of an application for long term care facility construction, expansion, renovation, or replacement shall be accepted for:

 

(1)  Replacement or renovation of existing beds as necessary to:

 

a.  Meet life safety code requirements; or

 

b.  Remedy deficiencies noted in:

 

i.  A licensing inspection pursuant to RSA 151; or

 

ii.  State survey and certification process pursuant to titles XVIII and XIX of the Social Security Act; or

 

(2)  Construction or renovation necessary in order to:

 

a.  Repair or refurbish an existing facility; or

 

b.  Accommodate beds obtained by transfer to an existing facility.

 

          (b)  Requests shall be made by filing a letter of intent with the board at any time.

 

          (c)  The letter of intent shall:

 

(1)  Meet the requirements of He-Hea 206.01 and He-Hea 207.01; and

 

(2)  Contain the following information:

 

a.  The name of the requestor that intends to file an application, including the names of all affiliates of such requestor;

 

b.  The location of the facility to be constructed, expanded, renovated, or replaced;

 

c.  A description of the issues that have prompted the proposed construction, expansion, renovation, or replacement, including but not limited to:

 

1.  Life safety code review results;

 

2.  Licensing inspection results;

 

3.  State survey or federal certification review results;

 

4.  Repair or refurbishment needs, such as:

 

i.  Floors and surfaces;

 

ii.  Paint and finishes; and

 

iii.  Air handling or plumbing;

 

5.  Space constraints of the physical plant; or

 

6. Other issues affecting the facility’s current or future operation;

 

d.  A report indicating how the project is projected to affect the service area in terms of:

 

1.  Utilization;

 

2.  Patient charges;

 

3.  Market share; and

 

4.  Personnel services;

 

e.  The impact of the proposed project on other area long-term care facilities; and

 

f.  A report of the end results of the project in terms of:

 

1.  Quality;

 

2.  Affordability;

 

3.  Staffing; and

 

4.  Operating costs.

 

          (d)  The board shall review the letter of intent at its next regularly scheduled meeting and determine if the requestor has met the requirements of He-Hea 904.01(c) in order to allow submission of an application for CON review.

 

          (e)  All applications filed in response to a request for a long term care facility construction, expansion, renovation, or replacement shall be submitted to the board within 6 months of approval of the letter of intent.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 904.02  Quality Assurance Plan.

 

          (a)  All applicants shall demonstrate the availability of a quality assurance plan to objectively and systematically monitor patient placement and care on a continuous basis.  The plan shall conform to the requirements of He-P 803.24.

 

          (b)  Demonstration shall be in the form of:

 

(1)  A copy of the quality assurance plan for those facilities with existing long-term care services; or

 

(2)  A copy of the proposed quality assurance plan for new facilities.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

He-Hea 904.03  Financial Accessibility.

 

          (a)  In order to assess the level of financial accessibility to services by all persons served or to be served by the proposed project, all applicants shall demonstrate that resources are available to provide services to all patients of the proposed services, and in particular the financially underserved and Medicaid recipients.

 

          (b)  Demonstration shall be made by providing documentation with the application identifying the projected number of patients indicated as:

 

(1)  Private-paying;

 

(2)  Medicaid;

 

(3)  Medicare; and

 

(4)  Total patient days for each of these patient groups above.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 904.04  Staffing Requirements.  All applicants shall ensure that staffing meets the requirements of He-P 803.17 and He-P 803.18.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 904.05  Impact on Existing Facilities.

 

          (a)  All applicants shall demonstrate that increases in market share as a result of the construction, expansion, renovation or replacement of long-term beds or facilities will not be detrimental to the occupancy rates in other long-term care facilities in the region.

 

          (b)  Demonstration that increases in market share will not be detrimental shall be made by providing a report in the application addressing how the construction, expansion, renovation or replacement of long-term care beds or facilities will not have a detrimental impact on other facilities in the immediate area and region.

 

Source.  # 7442, eff 2-2-01; ss by #8917, eff 6-22-07; ss by #10977, eff 11-20-15 (from He-Hea 907.04)

 

PART He-Hea 905  CRITERIA FOR EVALUATING LONG-TERM CARE BEDS AND FACILITIES

 

          He-Hea 905.01  Criteria.  In addition to all other requirements in RSA 151-C:7 and He-Hea 303.02 through He-Hea 303.09, all applicants shall meet the following criteria for consideration of a CON for construction, expansion, renovation, or replacement of long-term care beds or facilities:

 

          (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 2015 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;

 

(2)  A comparison of these costs, which shall be within 10% of the 2015 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 2015 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 2015 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)  Applicants shall follow the outline of the calculator method set forth in section 10 of the 2015 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 “nursing homes (convalescent hospitals)” table in section 15, page 26 of the 2015 Marshall Valuation Service;

 

(2)  An adjustment to heating, ventilation, and air-conditioning costs for extreme climate and the system used per the refinements table in section 15, page 36 of the 2015 Marshall Valuation Service;

 

(3)  Sprinkler system costs;

 

(4)  Story height multipliers;

 

(5)  Perimeter multipliers; and

 

(6)  Cost multipliers from section 99 of the 2015 Marshall Valuation Service;

 

          (g)  For construction projects, applicants shall provide a comparison of the proposed construction cost per bed to the 2015 edition of the Marshall Valuation Service, section 15, page 39;

 

          (h)  For construction projects, applicants shall provide a comparison of the proposed area per bed to the 2015 edition of the Marshall Valuation Service, section 15, page 39;

 

 

          (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)  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;

 

          (k)  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)  The assumptions used to prepare the projected financial statements;

 

(3)  A statement of the sources of funds to finance the proposed project; and

 

(4)  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;

 

          (l)  Applicants shall demonstrate that resources will be available to support the personnel needs of the proposed construction, expansion, renovation, or replacement of long-term care beds or facilities;

 

          (m)  Demonstration of resources shall be made in the form of a report that provides a 3-year historical and 3-year projected schedule of all personnel;

 

          (n)  Applicants filing an application pursuant to RSA 151-C:4, III(a) shall  provide with the application documentation identifying the issues that have led to the need for construction, renovation, or replacement, including but not limited to:

 

(1)  Life safety code review results;

 

(2)  Licensing inspection results;

 

(3)  State survey or federal certification review results;

 

(4)  Repair or refurbishment needs, such as:

 

a.  Floors and surfaces;

 

b.  Paint and finishes; and

 

c.  Air handling or plumbing;

 

(5)  Space constraints of the physical plant; or

 

(6)  Other issues affecting the facility’s current or future operation

 

          (o)  Applicants may document the existence of additional expenses in operations at the facility as a result of needed construction, renovation, or replacement including:

 

(1)  Housekeeping;

 

(2)  Maintenance;

 

(3)  Fire safety operations; or

 

(4)  Other, which shall be specified;

 

          (p)  Demonstration of additional expenses shall be made by providing with the application a report specifying the type of expenses incurred, expressed as any combination of:

 

(1)  Dollar amount;

 

(2)  Man hours;

 

(3)  Supplies; and

 

(4)  Equipment;

 

          (q)  For facilities where structural safety deficiencies, life safety, or inspection violations have been cited, applications shall demonstrate the level of such deficiencies cited by providing copies of reports as produced by a:

 

(1)  State or local licensing agency; or

 

(2)  National accrediting agency;

 

          (r)  Applicants shall identify the source of any data or information provided pursuant paragraphs (c) through (q) above.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 905.02  Submission of Applications.  Applications filed in response to an RFA shall be:

 

(a)  Prepared using the board’s application form pursuant to He-Hea 304; and

 

(b)  Submitted to the board within 90 days of the publication of the RFA.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

PART He-Hea 906  GRANTING CERTIFICATES OF NEED

 

          He-Hea 906.01  Approval of Application.

 

          (a)  For applications submitted in response to an RFA, the board shall grant a certificate of need to the applicant(s) who, pursuant to RSA 151-C:9, II, demonstrates superiority on cost effectiveness, quality and affordability, and best meets the standards and criteria of He-Hea 904 and He-Hea 905, or He-Hea 907.

 

          (b)  The total number of beds approved shall not exceed the unmet need.

 

          (c)  Applications filed in response to a request for construction, expansion, renovation or replacement transfer shall be granted a certificate of need if it is demonstrated that they meet the standards and criteria of He-Hea 904 and He-Hea 905.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 906.02  Certificate of Need Denial.  No person who has had a health facilities license revoked, Medicare or Medicaid certification involuntarily terminated, or who has been convicted of civil or criminal Medicare or Medicaid fraud or patient abuse shall be granted a CON.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

PART He-Hea 907  STANDARDS FOR NURSING HOMES WITHIN CCRCS

 

          He-Hea 907.01  Limitation on Nursing Home Beds.  Any facility that meets the definition of a CCRC and which seeks approval for additional beds under this chapter, shall be approved at no more than one nursing home bed for every 4 residential units in the CCRC.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 907.02  Limitation on Admissions and Certification.  Any CCRC that seeks certificate of need approval for long-term care beds shall, as a condition of approval, agree to the following:

 

          (a)  Admissions to the nursing home component of a CCRC shall be limited to persons who have been residents of the CCRC for a period of not less than 180 consecutive days immediately preceding admission into the nursing home;

 

          (b)  The restriction in He-Hea 907.02 (a) above shall not apply to:

 

(1)  Any medically indicated admission to the nursing home resulting from an illness or accident which occurred subsequent to residence in the CCRC; or

 

(2)  An admission by a non-resident spouse of a resident of the CCRC;

 

          (c)  A CCRC may obtain medical assistance certification for no more than one bed for every 4 persons residing in federally or state subsidized housing for low-income persons residing in the CCRC, except for those CCRCs which can demonstrate to the board a past and continuing policy of subsidizing through endowments residents of the CCRC who are in need;

 

          (d)  Demonstration of medical assistance certification per He-Hea 907.02(c), above, shall be made by providing the following documentation:

 

(1)  The number of patients annually subsidized by endowments by the CCRC; and

 

(2)  A financial statement of the CCRC’s current endowment fund with a statement of the number of patients for whom the CCRC will provide subsidized care in the future; and

 

          (e)  No CCRC shall admit to its nursing home any person who qualifies for medical assistance unless that person was a resident of the CCRC’s subsidized low-income housing prior to admission to the nursing home.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 907.03  Special Review Criteria.  Any CCRC that seeks a certificate of need to add nursing home beds shall comply with RSA 151-C:7, He-Hea 303.02 through He-Hea 303.09, and the following:

 

          (a)  The applicant shall provide with the application an itemized and detailed description of how the facility meets the definition of a CCRC;

 

          (b)  The CCRC shall have the resources to cover the full cost of any resident’s required care in the nursing home unit of the CCRC by demonstrating it has adequate financial resources to do so without resorting to medical assistance funding, except as allowed under He-Hea 909.07(b); 

 

          (c)  Proof of adequate resources shall be made by providing with the application an independent financial analysis of the CCRC’s ability to cover the cost of care for its residents;

 

          (d)  The CCRC shall cover all costs of nursing home care in facilities not owned or operated by the CCRC in the event that nursing home beds are not available in the CCRC and the resident requires nursing home services;

 

          (e)  The applicant shall submit a financial analysis with the application which documents that it has adequate resources to cover the costs of nursing care outside of the CCRC;

 

          (f)  In addition to (e) above, the applicant shall submit with the application a plan for the coverage of nursing home care when beds are not available at the CCRC.  This plan shall include signed written statements from the administrators of nursing homes within a 15 mile radius of the CCRC with whom the applicant intends to enter into an agreement stating that they agree to admit CCRC residents who need nursing home care until a bed becomes available in the CCRC;

 

          (g)  The CCRC shall agree to readmit to the CCRC’s nursing home any persons admitted to an acute care hospital or other healthcare facility for treatment as soon as a bed becomes available;

 

          (h)  Proof of a readmission policy shall be made by providing with the application a signed statement attesting to this policy.  This requirement shall not apply to any patient whose medical, personal and psychosocial needs cannot be met by the facility or to any person who is known to have or suspected of having a communicable disease;

 

          (i)  Written policies shall exist or be established upon implementation of the project, guaranteeing that a bed in a CCRC’s nursing home is available to a nursing home patient for at least 45 consecutive days following admission of that nursing home patient to an acute care hospital for inpatient treatment or care;

 

          (j)  Proof of guarantee shall be made by providing with the application copies of the established or proposed policies;

 

          (k)  In the case of a new CCRC, demand for the residential component of the CCRC in the service area shall be demonstrated;

 

          (l)  Demand for a CCRC shall be demonstrated by providing with the application:

 

(1)  A definition of the service area for the CCRC, including demographic data and any available market studies justifying the location of the CCRC, and the nursing home in that service area; and

 

(2)  Evidence of prepaid deposits for placement in the CCRC; and

 

          (m)  The nursing home service areas described in He-Hea 902.02 shall not apply to the applications by or on behalf of the CCRCs.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 907.04  Application Process.

 

          (a)  Applications to construct or add nursing home beds in a CCRC shall not be subject to the requirements of RSA 151-C:8, I if the proposal:

 

(1)  Pertains specifically to the facility for which a CON is sought; and

 

(2)  Does not indicate a need for additional services beyond the limitation per He-Hea 907.01;

 

          (b)  Applications shall be prepared and submitted using the board’s application form pursuant to He-Hea 304.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

          He-Hea 907.05  Board Action.

 

          (a)  Applications shall be processed in accordance with the requirements of RSA 151-C:8, II – XIII.

 

          (b)  If an application demonstrates that it meets the standards and criteria of sections He-Hea 904, He-Hea 905 and He-Hea 907, a certificate of need shall be issued to the applicant.

 

Source.  (See Revision Note at chapter heading for He-Hea 900) #10977, eff 11-20-15

 

Appendix I

 

Rule

Specific State Statute the Rule Implements

He-Hea 901.01

RSA 151-C:1

He-Hea 901.02

RSA 151-C:2

He-Hea 902

RSA 151-C:4, III(b)

He-Hea 903.01

RSA 151-C:6, III

He-Hea 903.02

RSA 151-C:6, III

He-Hea 904.01

RSA 151-C:4, III(b)

He-Hea 904.02

RSA 151-C:7, IV

He-Hea 904.03

RSA 151-C:7, III and V

He-Hea 904.04

RSA 151-C:7, II

He-Hea 904.05

RSA 151-C:5, II(f)(1), RSA 151-C:7, I

He-Hea 905.01

RSA 151-C:7, I-V, RSA 151-C:11, I

He-Hea 905.02

RSA 151-C:8

He-Hea 906.01

RSA 151-C:9

He-Hea 906.02

RSA 151-C:7, IV

He-Hea 907.01

RSA 151-C:5, II(f)(1)

He-Hea 907.02

RSA 151-C:5, II(f)(1)

He-Hea 907.03

RSA 151-C:7, I-V, RSA 151-C:11, I

He-Hea 907.04

RSA 151-C:8

He-Hea 907.05

RSA 151-C:8

 

Appendix II: Incorporation by Reference Information

 

Rule

Title

Obtain at:

He-Hea 905.01(a) MVS, 2015, section 15.

 

He-Hea-905.01(b)(2) MVS, 2015, section 15.

 

He-Hea 905.01(c)(1) MVS, 2015, section 1.

 

He-Hea 905.01(d) MVS, 2015, section 15.

 

He-Hea 905.01(e) MVS, 2015, section 10.

 

He-Hea 905.01(f)(1) MVS, 2014, section 15, page 26.

 

He-Hea 905.01(f)(2) MVS, 2014, section 15, page 36.

 

He-Hea 905.01 (f)(6) MVS, 2015, section 99.

 

He-Hea 905.01(g) MVS, 2015, section 15, page 39.

 

He-Hea 905.01(h) MVS, 2014, section 15, page 39.

Marshall Valuation Service, 2015 edition

Marshall & Swift/Boeckh, LLC

350 S. Grand Avenue

34th Floor

Los Angeles, CA  90071

www.marshallswift.com

Telephone (800) 544-2678. 

 

Cost for the 2015 edition of the manual is $599.95.