333-580-0050 Availability of Resources and Alternative Uses of Those Resources Applicants must provide a narrative discussion of each of the following: (1) Criterion: Does the proposed project represent the most effective and least costly alternative, considering all appropriate and adequate ways of meeting the identified needs? (a) The applicant must demonstrate that the best price for the proposal has been sought and selected; (b) The applicant must demonstrate that proposed solutions to identified needs represent the best solution from among reasonable alternatives: (A) Internal alternatives: (i) The applicant must list the major internal operational adjustments considered which could lower the cost and improve the efficiencies of offering the beds, equipment or service; (ii) The applicant must demonstrate that the alternative considered represents the best solution for the patients, and discuss why other alternatives were rejected; (iii) If the proposal is for an inpatient service, whether new or expanded, applicant must demonstrate this method of delivery is less costly than if done on an outpatient basis; (iv) The applicant must demonstrate that the selected architectural solution represents the most cost effective and efficient alternative to solving the identified needs. (B) External alternatives: (i) If the proposed beds, equipment or services are currently being offered in the service area, applicant must demonstrate: (I) Why approval of the application will not constitute unnecessary duplication of services; (II) Why the proposal is an efficient solution to identified needs; (III) Why the proposal represents the most effective method of providing the proposal; and (IV) That the applicant can provide this proposal at the same or lower cost to the patient than is currently available. (ii) If paragraphs (A)(i) to (A)(iv) of this subsection cannot be demonstrated, the applicant must show that without the proposal, the health of the service area population will be seriously compromised. (C) Less costly alternatives of adequate quality: (i) If a less costly and adequately effective alternative for the proposal is currently available in the area, the applicant must demonstrate why its proposal is: (I) Not an unnecessary duplication; or (II) A more efficient solution to the identified needs. (ii) Applicants must demonstrate that the identified needs of the population to be served cannot be reasonably served under current conditions, or by alternative types of service or equipment or equal quality to the proposal. “Alternatives of adequate quality” does not imply that they need be exactly like those being proposed, but only that they meet identified needs at state approved levels. (D) If there are competing applications for the proposal, each applicant must demonstrate why theirs is the best solution, and why a certificate of need should be granted them. (2) Criterion: Will sufficient qualified personnel, adequate land, and adequate financing be available to develop and support the proposed project? The applicant must demonstrate that there are, or will be sufficient physicians in the area to support the proposal; sufficient nurses available to support the proposal; sufficient technicians available to support the proposal; adequate land available to develop the proposal and accommodate future expansion; and the source(s) and availability of funds for the project. (3) Criterion: Will the proposed project have an appropriate relationship to its service area, including limiting any unnecessary duplication of services and any negative financial impact on other providers? (a) The applicant must identify the extent to which the proposal and its alternatives are currently being offered to the identified service area population, or, in the case of acute inpatient beds, could be offered on the basis of an analysis under division 590 of this chapter; (b) The applicant will discuss to the best of his or her knowledge, any negative impact the proposal will have on those presently offering or reimbursing for similar or alternative services. Areas to be discussed are utilization, quality of care, and cost of care; (c) The applicant must demonstrate that jointly operated or shared services between the applicant and other providers have been considered and the extent to which they are feasible or not; (d) The applicant must demonstrate that all necessary support services and ancillary services for the proposal are available at acceptable levels to insure that patients will have the necessary continuity in their health care. (4) Criterion: Does the proposed project conform to relevant state physical plant standards, and will it represent any improvement in regard to conformity to such standards, compared to other similar services in the area? (a) The proposed project must comply with state licensing, architectural and fire code standards; (b) If the proposal is already being offered in the defined service area, the applicant must describe, to the best of his or her knowledge, to what degree the existing service complies with state licensing, architectural and fire code standards. Statutory/Other Authority: ORS 431.120(6) & 442.315 Statutes/Other Implemented: ORS 431.120(6) & 442.315 History: HD 13-1994, f. & cert. ef. 4-22-94