 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 22. HEALTH |
|
SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
|
Chapter 22-B43. CERTIFICATE OF NEED REVIEW PROCEDURES |
Section 22-B4307. CONSIDERATIONS AND CRITERIA FOR REVIEW
-
4307.1 SHPDA and the SHCC, shall develop, adopt, and use general criteria and standards set forth in Section 4012 of this title and the specific considerations and criteria in this section to conduct a CON review. The applicant shall bear the burden of producing evidence and assurances sufficient to persuade the Director that the applicant can satisfy the requirements of each applicable criterion or standard.
4307.2 SHPDA shall evaluate an HMO, an ambulatory care facility, or HCF that is controlled, directly or indirectly, by an HMO or combination of HMOs, by the criteria and considerations set forth in Subsection 4307.15.
4307.3A review may consider the relationship between the health services being proposed and the applicable AIP and HSP. Each decision of SHPDA, or the appropriate judicial or administrative review body, to issue a CON shall be consistent with the HSP, except in emergency circumstances that pose an imminent threat to public health.
4307.4 A review may consider the availability of less costly or more effective alternative methods of providing the services to be offered, expanded, reduced, relocated, or eliminated.
4307.5A review may consider the immediate and long-term financial feasibility of the proposal, and the probable impact of the proposal on the costs of and charges for providing health services by the person proposing the service.
4307.6A review may consider the need that the population served or to be served has for the services proposed to be offered or expanded, and the extent to which all residents of the area, particularly low income persons, racial and ethnic minorities, women, persons with disabilities, the elderly, or other underserved groups, are likely to have access to those services.
4307.7A review may consider the contribution of the proposed service in meeting the health related needs of members of medically underserved groups that have traditionally experienced difficulties in obtaining equal access to health services (such as low income persons, racial and ethnic minorities, women, and persons with disabilities), particularly those needs identified in the applicable AIP and HSP as deserving priority.
4307.8SHPDA may consider the following for the purpose of determining accessibility of the proposed service:
(a)The rate at which medically underserved populations currently use the applicant’s services as compared to the percentage of the population in the applicant’s service area that is medically underserved, and the rate at which medically underserved populations are expected to use the proposed services;
(b)The applicant’s performance with meeting its obligation, if any, under any applicable federal and District regulations requiring the applicant to provide uncompensated care, community service, or access by minorities, and persons with disabilities to programs receiving Federal financial assistance (including the existence of any civil rights access complaints against the applicant);
(c) The rate at which the applicant serves Medicare, Medicaid, District program and medically indigent patients; and
(d) The extent to which the applicant offers a range of means for a person to access its services (e.g., outpatient services, admission by house staff, admission by personal physicians).
4307.9A review may consider the relationship of the services proposed to be provided to the existing health care delivery system.
4307.10A review may consider the availability of resources (including health personnel, management personnel, and funds for capital and operating needs) for providing the services proposed to be provided and the need for alternative uses for those resources as identified by the applicable AIP and HSP.
4307.11 A review may consider the relationship of the health services proposed to be provided to ancillary or support services.
4307.12A review may consider the effect of the means proposed for the delivery of health services on the clinical needs of health professional training programs in the area where the services are to be provided.
4307.13A review may consider the special needs and circumstances of those entities that provide a substantial portion of their services or resources, or both, to individuals not residing in the District or in an adjacent health service area. Those entities may include medical and other health professions schools, multidisciplinary clinics, and specialty centers.
4307.14A review may consider the special needs and circumstances of HMOs. Those needs and circumstances shall be limited to the following:
(a)The needs of enrolled members and reasonably anticipated new members of the HMO for the health services proposed to be provided by the organization; and
(b)The availability of the new health services from non-HMO providers or other HMOs in a reasonable and cost-effective manner that is consistent with the basic method of operation of the HMO. In assessing the availability of these health services from these providers, SHPDA shall consider only whether the services from these providers would meet the following requirements:
(1)The services shall be available under a contract of at least five (5) years’ duration;
(2)The services shall be available and conveniently accessible through physicians and other health professionals associated with the HMO (such as, whether physicians associated with the HMO have or will have full staff privileges at a non-HMO hospital);
(3)The services shall cost no more than if the services were provided by the HMO; and
(4) The services shall be available in a manner that is administratively feasible to the HMO.
4307.15A review may consider the special needs and circumstances of biomedical and behavioral research projects that are designed to meet a national need and for which local conditions offer special advantages.
4307.16A review of a construction project may consider the following:
(a)The costs and methods of the proposed construction, including the costs and methods of providing energy;
(b)The probable impact of the construction project under review on the costs of providing health services by the applicant and on the costs and charges to the public of providing health services by other persons; and
(c)Compliance with applicable General Services’ Administration guidelines.
4307.17 If proposed health services are to be available in a limited number of facilities, a review may consider the extent to which the health professional schools in the area will have access to the services for training purposes.
4307.18 A review may consider the special circumstances of an HCF with respect to the need for conserving energy.
4307.19 A review may consider the effect of competition on the supply of the health services being reviewed.
4307.20 A review may consider improvements or innovations in financing and delivering health services that foster competition and serve to promote quality assurance and cost effectiveness.
4307.21 A review may consider the efficiency and appropriateness of using existing services and facilities similar to the health services or facilities proposed to be provided.
4307.22 A review may consider the quality of care provided by existing facilities for a review of existing services or facilities.
4307.23 When an osteopathic or allopathic facility applies for a CON to construct, expand, or modernize an HCF, acquire major medical equipment, or add services, SHPDA may consider the need for that construction, expansion, modernization, acquisition of equipment, or addition of services based on the need for and the availability in the community of services and facilities for osteopathic and allopathic physicians and their patients. SHPDA may consider the application in terms of its impact on existing and proposed institutional training programs for doctors of osteopathy and medicine at the student, internship, and residency training levels.
4307.24 Criteria used for reviews in accordance with this section may vary according to the purpose for which a particular review is being conducted or the type of health service reviewed.
4307.25SHPDA may adopt or revise review criteria and standards for all applications or particular types of applications.
4307.26 SHPDA may establish or revise criteria and standards by including them in an adopted HSP.
4307.27The criteria and standards adopted by SHPDA under Subsections 4307.25 and 4307.27 shall be incorporated in this title by reference.