reglab/statecodes huggingface dataset:
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.03 - Failure To Incur The Obligation

Current through Register Vol. 42, No. 9, June 28, 2024
If the holder of the Certificate of Need fails to incur the
				firm commitment or obligation within the initial twelve-month (12 month)
				period, or during any extension period, then the certificate shall be
				terminated and shall be null and void. No extension can be granted except upon
				written application for the extension before the initial expiration date of the
				Certificate of Need. If there has been no firm commitment or obligation or
				application for an extension filed with SHPDA within the initial twelve-month
				(12 month) period, then the certificate shall be terminated and shall be null
				and void.
Author:
Alva M. Lambert
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-270, as amended by Act
				  98-341.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.04 - Failure To Commence Construction

Current through Register Vol. 42, No. 9, June 28, 2024
(1) If the holder of the Certificate of Need
			 fails to commence the construction project within the time period stated in the
			 construction contract or to complete the construction project within the time
			 period stated in the construction contract, then the Certificate of Need shall
			 be terminated and shall be null and void, unless tolled or extended pursuant to
			 statute or SHPDA rule or regulation. The completion date of the construction
			 project specified in the construction contract may be extended by mutual
			 agreement of the parties to the contract, without SHPDA approval. Provided
			 SHPDA, or an Administrative Law Judge appointed by the Governor on appeal for a
			 fair hearing, may for causes beyond the control of the holder of the
			 Certificate of Need, upon written request, by the holder of the Certificate of
			 Need detailing the reasons therefore, continue the Certificate of Need in force
			 if the commencement of the construction project is delayed for a period not to
			 exceed sixty (60) days or if during the specified construction period, the
			 construction work should cease for not more than six (6) months, or in the
			 event of default in the construction contract by the contractor, or if, for any
			 cause, the construction work has not ceased or otherwise been stopped for a
			 period exceeding sixty (60) consecutive days. Further, the Executive Director
			 of SHPDA may, upon written request by the holder of the Certificate of Need
			 detailing the reasons therefor, continue the Certificate of Need.
(2) All written requests filed pursuant to
			 this rule must be filed in accordance with the provisions of Rule
			 410-1-3-.09.
Author:
Alva M. Lambert
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-270, as amended by Act
				  98-341.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.05 - Completion Of The Obligation

Current through Register Vol. 42, No. 9, June 28, 2024
Upon completion of the construction project and issuance by the
				contractor of the certificate of completion, a copy of which shall be forwarded
				to the state agency, or upon receipt by the agency of proof of purchase of
				equipment, or upon receipt by the state agency by the chief executive officer
				or other authorized person, of a letter of inauguration of the service, then
				the Certificate of Need shall be considered fully vested and not subject to
				revocation, modification, or further review by the state agency, except in
				instances involving actual fraud, and the approval granted pursuant to the CON
				shall be continued in full force and effect.
Author:
Alva M. Lambert
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-270, as amended by Act
				  98-341.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.06 - Application For Extension

Current through Register Vol. 42, No. 9, June 28, 2024
No later than one month before the date of expiration of the
				Certificate of Need, the holder of the Certificate of Need may exercise his
				right to apply for an extension using the appropriate State Agency form. It
				shall be the duty of the holder of the Certificate of Need to request such form
				and submit the same in completed form to the State Agency no later than one
				month before the date of expiration of the Certificate of Need. Such request
				shall be accompanied by a fee of twenty-five percent (25%) of the original
				Certificate of Need application fee associated with the project. Failure to
				submit such completed application by such date shall render the application
				denied, and shall result in the Certificate of Need being rendered null and
				void as of its termination date.
Author:
Alva M. Lambert
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-265(b).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.07 - Criteria For Extension

Current through Register Vol. 42, No. 9, June 28, 2024
(1) The
			 state agency will review the application for extension of the certificate of
			 need against each of the criteria enumerated and described below. No extension
			 of the certificate of need may be granted if the application indicates a
			 substantial change in the scope of the project. Each of the following must be
			 met:
(a) architectural progress must be
			 shown, if appropriate to the application, by working drawings that have been
			 completed and approved by the Bureau of Licensure and Certification, Department
			 of Public Health; and
(b) the
			 applicant must have acquired fee simple title long-term leasehold or option to
			 purchase or lease to the facility site and show that approved water, sewage
			 disposal, and other utilities will be made available to the site. The
			 certificate of need will be limited to the site or proposed site stated in the
			 application or at a public hearing. Any change in site requires prior approval
			 of the Certificate of Need Review Board.
Author:
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.08 - Surrender Of Certificate Of Need

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A holder of a Certificate of Need may
			 elect to surrender his Certificate of Need, not incurring an obligation
			 thereunder. For the surrender to be effective, the holder of the Certificate of
			 Need must notify the State Agency pursuant to Rule
			 410-1-3-.09 of the intent to
			 surrender the certificate and of the effective date of the action. Upon
			 notification, the Certificate of Need shall be automatically
			 terminated.
(2) A holder of a
			 Certificate of Need will be deemed to have abandoned his certificate, if once
			 having completed construction or inaugurated the service, he then suspends
			 operation of the facility or provision of the service for an uninterrupted
			 period of twelve (12) months or longer.
Author:
Alva M. Lambert
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-270.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-11 - DURATION AND EXTENSION OF THE CERTIFICATE OF NEED › Section 410-1-11-.09 - Certificate Of Need Not Transferable

Current through Register Vol. 42, No. 9, June 28, 2024
(a) Upon, as applicable, (1) the completion
			 of construction and issuance of a certificate of completion; (2) the receipt of
			 proof of the purchase of equipment; or (3) the inauguration of a new health
			 service, the Certificate of Need issued for such project shall be vested in and
			 continued in force and effect as a part of the health care facility and shall
			 survive changes of ownership of the health care facility without further
			 certificate of need approval by this agency.
(b) Prior to becoming vested under subsection
			 (a), a certificate of need shall not be transferable, assignable, or
			 convertible, other than to an entity under common ownership or control. As used
			 in this subsection only, "ownership and control" means ownership, directly or
			 through one or more affiliates, of 50 percent or more of the shares of stock
			 entitled to vote for the election of directors, in the case of a corporation,
			 or 50 percent or more of the voting equity interests in the case of any other
			 type of legal entity, or status as a general partner in any partnership, or any
			 other arrangement whereby an entity including, without limitation, any
			 governmental entity, controls or has the right to control the selection of 50
			 percent or more of the board of directors, managing members, or equivalent
			 governing body of a legal entity. An "affiliate" under the preceding sentence
			 means any corporation, limited liability company, partnership, or other legal
			 entity that directly or indirectly controls or is controlled by or is under
			 common control with such entity. Any agreement entered into by an applicant,
			 prior to the issuance of a certificate of need, to transfer ownership or
			 control of such health care facility to another person after the certificate
			 becomes vested shall be disclosed to SHPDA prior to a decision by the
			 Certificate of Need Review Board to grant or deny such certificate.
(c) The transfer of equity interests in, or
			 change of names or merger of, any legal business entity which holds a
			 Certificate of Need shall not constitute a transfer, assignment, or conversion
			 of the Certificate of Need and shall not require SHPDA approval unless the
			 transaction also involves implementing one or more of the new institutional
			 health services or a new health care facility or health maintenance
			 organization described in Sections
			 22-21-263(a)(2), (3) or
			 (4),
Code of Ala.
1975.
(d) A Certificate of Need
			 holder shall notify SHPDA of any change of ownership or control in accordance
			 with
Ala. Admin. Code r
.
			 410-1-7-.04.
Author:
Alva M. Lambert
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-270, as amended by Act
				  98-341.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-12 - ADOPTION OF RULES AND REGULATIONS › Section 410-1-12-.01 - Notice Of Intended Action

Current through Register Vol. 42, No. 9, June 28, 2024
Prior to the adoption, amendment, or repeal of any rule, the
				Certificate of Need Review Board shall give at least 35 days notice of its
				intended action by publishing said notice in the Alabama Administrative
				Monthly.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §§
										22-21-274,
				  41-22-5.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-12 - ADOPTION OF RULES AND REGULATIONS › Section 410-1-12-.02 - Notice And Public Comment

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 The notice of intended action shall include the following:
(a) a statement of either the terms or
			 substance of the intended action or a description of the subjects and issues
			 involved;
(b) the time, place, and
			 manner in which interested persons may present their views thereon.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-12 - ADOPTION OF RULES AND REGULATIONS › Section 410-1-12-.03 - Public Hearing

Current through Register Vol. 42, No. 9, June 28, 2024
At the next regular monthly meeting of the Certificate of Need
				Review Board following the expiration of the thirty-five (35) day notice
				period, a public hearing on any proposed rule changes will be held before the
				adoption of the proposed rule or rules. All interested parties who make timely
				written request will be afforded the opportunity to speak.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §
										41-22-5(a).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-12 - ADOPTION OF RULES AND REGULATIONS › Section 410-1-12-.04 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
The effective date of these rules and regulations, of all
				amendments thereto and repeals thereof, and of the adoption of emergency rules
				shall be determined in accordance with the Alabama Administrative Procedure
				Act.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §
										41-22-5.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-1-12 - ADOPTION OF RULES AND REGULATIONS › Section 410-1-12-.05 - Emergency Rules

Current through Register Vol. 42, No. 9, June 28, 2024
Emergency rules will be adopted pursuant to the Alabama
				Administrative Procedure Act.
Author:
Statutory Authority:
Code of Ala.
				  1975
, §
										41-22-5.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-1 - INTRODUCTION TO HEALTH PLANNING › Section 410-2-1-.01 - Statutory Authority

Current through Register Vol. 42, No. 9, June 28, 2024
The
Alabama State Health Plan
(SHP) is
				required by §
								22-21-260(4),
Code of Ala. 1975
.
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(4).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-1 - INTRODUCTION TO HEALTH PLANNING › Section 410-2-1-.04 - Alabama Health Policy Analysis

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Policy is defined as a definite course or
			 method of action selected from among alternatives and in light of given
			 conditions to guide and determine present and future decisions. Policy may be
			 expressed in writing or it may be implied by actions and commitments. Action
			 policy may imply, in fact, that no policy is desired, thereby leaving the
			 decision makers free to meet any given condition with actions that may or may
			 not be considered as precedent setting.
(2) Basic to analyzing Alabama State Health
			 Policy is the determination of who sets the policies and how or to what degree
			 these policies interface to meet a general overall health policy.
(3) Health policy in Alabama finds its basis
			 in State statutes as determined by the Legislature, State budgets, decisions
			 and expectations of the Governor, expressions of the Statewide Health
			 Coordinating Council in the State Health Plan, and regulatory decisions made by
			 the State Certificate of Need Review Board.
(4) The Governor, through the cabinet and
			 legislative programs, expresses a general health policy for maximizing a high
			 rate of wellness for all citizens. The Governor's actions indicate a special
			 concern for child health, infant mortality, prevention, the socio/medical
			 problems of teenage pregnancy, the availability and accessibility of health
			 care in the rural areas, the special health problems of the elderly, mentally
			 ill, and disabled, and treatment of opioid addictions. The Governor's concerns
			 are manifested in budget requests and funding in these areas through the
			 various state agencies, such as the State Health Planning and Development
			 Agency, the Alabama Medicaid Agency, the Alabama Department of Mental Health,
			 the Alabama Department of Public Health, and the Alabama Department of Human
			 Resources.
(5) The Governor's
			 concern for overall health planning and development is highlighted by the
			 appointment of providers and consumers to function in the planning and
			 regulatory areas.
Rule .03 was renumbered .04 per certification published March
				  31, 2020; effective May 15, 2020.
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(4).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-2 - HEALTH PRIORITIES › Section 410-2-2-.01 - Introduction

Current through Register Vol. 42, No. 9, June 28, 2024
(1) This section of
			 the Alabama State Health Plan underscores certain health issues which warrant
			 focused attention. These few issues have been selected for a variety of
			 reasons, including:
(a) Unusual severity in
			 our state, e.g. infant mortality;
(b) Special opportunities, e.g. The Medicaid
			 Omnibus Budget Reconciliation Act (OBRA) option;
(c) Problems of access to health care, e.g.
			 the issue of the uninsured and the vulnerability of rural
			 hospitals.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-2 - HEALTH PRIORITIES › Section 410-2-2-.02 - Maternal And Child Health

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 The Problem
(a) Alabama's infant mortality
			 was 9.0 per 1,000 live births in 2005. In 2014 the provisional rate improved to
			 8.7 deaths per 1,000 live births, a drop from the 2005 rate. Reasons for the
			 improvements include a number of factors related primarily to improved Medicaid
			 coverage.
1. Medicaid has been expanded to
			 serve more children and pregnant women who do not receive cash assistance such
			 as Aid to Families with Dependent Children. This trend started in 1988 with
			 expansion of eligibility to pregnant women and children up to age one (1) with
			 incomes under 100 percent (100%) of the federal poverty level and now up to one
			 hundred thirty-three percent (133%) of the federal poverty level.
2. As of September 1, 1991, Medicaid had
			 workers out-stationed at hospitals, county health departments and other health
			 facilities throughout the state to determine Medicaid eligibility for children
			 and pregnant women who need help with payment for health care but who do not
			 qualify for cash assistance.
3. The
			 Alabama Medicaid Agency received a 1915(b) waiver to create the Alabama
			 Coordinated Care Network for maternity, family planning, children, foster
			 children, and eligible adults beginning October 1, 2019, for three (3) years.
			 The objective is to better coordinate the care, follow-up, and follow-through
			 for Medicaid recipients residing in any one of the seven (7) regions. Each
			 region will have a contracted entity responsible for the coordination of care
			 and services for Medicaid eligibles. Quality measures are key to the success of
			 the waiver.
4. ADPH, in
			 collaboration with the Alabama Department of Human Resources, implemented the
			 Alabama Unwed Pregnancy Prevention Program (AUPPP) in 2001 and the Family
			 Planning Teen Care Coordination Program in 2002. The AUPPP addresses adolescent
			 pregnancy and unwed pregnancy by providing funding support to community-based
			 projects, a statewide teen pregnancy prevention campaign, and media outreach.
			 The teen care coordination program provides medical social support to teens age
			 eighteen (18) and under receiving family planning services in local health
			 departments.
5. Other programs
			 implemented by ADPH that are affecting infant mortality include the Alabama
			 Child Death Review Program legislated in 1997, a campaign addressing
			 "back-to-sleep", a "safety for sleeping babies" brochure, and folic acid
			 outreach. According to the Alabama Child Death Review Program, approximately
			 eighty percent (80%) of infant deaths in Alabama are attributable to unsafe
			 sleeping conditions.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-2 - HEALTH PRIORITIES › Section 410-2-2-.05 - Diseases - Prevention And Management

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Preventable Diseases
(a) Vaccine Preventable Diseases (Measles,
			 Pertussis, HPV, Influenza, Shingles, etc.). With a more local and global
			 transient population, diseases are resurfacing due to a lack of, and failure to
			 immunize for childhood and seasonal diseases such as influenza.
1. Influenza Problem. Seasonal epidemics of
			 influenza occur every year in the United States, beginning in the fall.
			 Typically, the epidemics cause thousands to tens of thousands of deaths and
			 approximately 200,000 hospitalizations annually.
(i) Since the 1940s, a vaccine has been
			 available to prevent influenza; unfortunately, the vaccine is not used as much
			 as it should be. To prevent hospitalizations and deaths caused annually by the
			 influenza virus, the Centers for Disease Control and Prevention ("CDC") has
			 recommended that all U. S. Citizens more than six (6) months of age receive the
			 influenza vaccine.
(ii) The rate of
			 vaccination is low (25% - 45%).
(iii) The cost of vaccination is minimal ($10
			 - $18), depending on type (injection vs. nasal).
(iv) Side effects are minimal.
(v) Influenza causes children to miss school,
			 usually up to one week, which in some cases can cause parents to miss
			 work.
(vi) Recommendations:
(I) Consider adding the influenza vaccine to
			 the required immunization schedule outlined in Ala. Admin. Code r
			 420-6-1-.03.
(II) Vaccinating school aged children would
			 keep more kids in school and potentially save the state millions of
			 dollars.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-2 - HEALTH PRIORITIES › Section 410-2-2-.08 - Reserved

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(15).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.01 - Introduction

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter of the Alabama State Health Plan reviews the
				status of certain specialty health care services and the need for additional
				services to address the problems cited in the Priorities section of the Plan.
				Specialty Services are separately identified for ease of reference and to
				highlight their importance in the overall planning and regulatory
				responsibilities. The health care system in Alabama should not be burdened by
				an unnecessary duplication of expensive services.
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(4).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.03 - Cardiac Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Fixed-Based Cardiac Catheterization Laboratories
(a) Discussion
1. During the past four decades, an evolution
			 in cardiac catheterization has taken place. The role of the cardiac
			 catheterization laboratory has progressed from study of cardiac function and
			 anatomy for purposes of diagnosis to evaluation of candidates for surgery and
			 finally, to providing catheter-based, nonsurgical interventional treatment.
			 This progress has stimulated an increase in demand for cardiac catheterization
			 services.
2. From about 1982 to the
			 present, there has been an unprecedented proliferation of cardiac
			 catheterization services, which have now been expanded to a wider group of
			 patients and diseases. The increase in patients and laboratories has been
			 stimulated by the development of nonsurgical catheterization laboratory-based
			 therapeutic procedures for palliation of both stable and unstable ischemic
			 heart disease as well as selected valvular and congenital heart diseases,
			 arrhythmias, and other problems. Many noncardiac diagnostic and therapeutic
			 vascular procedures are now being performed in cardiac catheterization
			 laboratory settings, but this area is still evolving. As newer cardiac
			 diagnostic and treatment modalities are developed, it is highly likely that the
			 role of cardiac catheterization will continue to evolve. Certain cardiac
			 catheterization procedures are now offered in physicians' offices outside of
			 the usual hospital environment.
3.
			 Fixed-based cardiac catheterization services are the only acceptable method for
			 providing cardiac catheterization services to the people in Alabama.
4. For purposes of this section, a cardiac
			 catheterization "procedure equivalent" is defined as a unit of measure which
			 reflects the relative average length of time one patient spends in one session
			 in a cardiac catheterization laboratory. One procedure equivalent equals 1.5
			 hours utilization time.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.04 - Oncology - Radiation Therapy Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Discussion. Radiation therapy, surgery,
			 and medical oncology-chemotherapy combined are often the most effective
			 treatment for cancer. Specific planning for these modes of treatment is
			 necessary to insure proper cost and quality of care for the citizens of
			 Alabama. Surgery is often a "one-time" service and may or may not be offered
			 close to the patient's home. Radiation therapy and chemotherapy are generally
			 provided on a daily basis for an extended period of time, and so are often more
			 accessible if provided close to a patient's residence.
(2) Definition.
(a) "Radiation Therapy" is a clinical
			 specialty in which ionizing radiation is used for treatment of cancer. The
			 predominant form of radiation therapy involves an external source of radiation
			 focused on the diseased area.
(b)
			 "Oncology" is the discipline devoted to the delivery of specialized care to
			 those patients afflicted with cancer. The delivery of care to these patients
			 involves the diagnosis of cancer, the staging and determining the distribution
			 of cancer, and the treatment of cancer. Treatments involve coordination of care
			 often with radiation oncologists and surgeons. The primary modes of treatment
			 for these patients are hormonal therapy and immunotherapy.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.06 - Reserved

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(4).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.07 - Reserved

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(4).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.08 - New Technology

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Definition
(a) New technology is emerging
			 equipment (1) intended for use in the diagnosis and/or treatment of medical
			 conditions; (2) for which adequate data is not yet available to fully develop
			 State Health Plan criteria and standards on a technology-specific basis; and
			 (3) whose cost exceeds the thresholds established in §
									22-21-263,
Code of
			 Ala. 1975
. New technologies often involve costly capital
			 expenditures and significant increases in operational costs. Therefore,
			 adequate standards and criteria shall be established to determine need,
			 efficiency and appropriateness as required by §
									22-21-266,
Code of
			 Ala. 1975
.
(b)
			 Emerging equipment shall be considered new technology prior to and for eighteen
			 (18) months following its approval by the Food and Drug Administration (FDA).
			 After eighteen (18) months, equipment initially classified as new technology
			 shall be treated as any other major medical equipment (§
									22-21-263,
Code of
			 Ala. 1975
) acquisition; if technology-specific criteria are made a
			 part of the State Health Plan, they shall apply, and where no
			 technology-specific section exists, other pertinent statutory, regulatory and
			 State Health Plan provisions shall govern.
(c) New technology provisions do not apply to
			 the acquisition of equipment to be used solely for research.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.09 - Transplantation Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Definition. Transplantation is the process in which an organ or tissue from one
			 person is surgically implanted into another person to replace diseased,
			 damaged, or defective organs or tissue. For purposes of this section
			 transplantation services include kidney, heart, lung, liver, bone marrow, and
			 pancreas transplants.
(2) General.
			 Transplantation is a costly, specialized service due in part to the resources
			 required to operate such a service. Resources include donated organs or tissue,
			 medical transplant specialists, and other technical expertise. The availability
			 of these resources is limited and as such transplant services shall be limited
			 to ensure the quality, availability, and cost effectiveness of such services.
			 Studies have indicated that transplant centers and surgical teams with more
			 experience generally have fewer complications and higher survival
			 rates.
(3) Statistics. According to
			 The Organ Procurement & Transplantation Network (optn.org):
(a) As of April 2018, more than 114,000
			 people were on the national waiting list for organ transplant.
(b) In 2018 there were:
1. 17,566 deceased and living organ
			 donors;
2. 36,529 lifesaving organ
			 transplants;
3. 124,601
			 registrations on the waiting list as of May 8, 2019; and
4. 5,918 people who died while
			 waiting.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.10 - In Home Hospice Services

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Discussion
(a) Hospice care is a choice made to enhance
			 end of life. Hospice focuses on caring and comfort for patients and not
			 curative care. In most cases, care is provided in the patient's place of
			 residence. It is the intent of this section to address health planning concerns
			 relating to hospice services provided in the patient's place of residence. For
			 coverage of hospice services provided on an inpatient basis, please see Section
			 410-2-4-.15.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-3 - SPECIALTY SERVICES › Section 410-2-3-.11 - Air Ambulance

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Definition
(a) Fixed wing (FW) air ambulance
			 is the transportation by a fixed wing aircraft that is certified by the Federal
			 Aviation Administration (FAA) as a fixed wing air ambulance and the provision
			 of medically necessary services and supplies.
(b) Rotary Wing (RW) air ambulance is the
			 transportation by a helicopter that is certified by the FAA as a rotary wing
			 ambulance, including the provision of medically necessary supplies and
			 services.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.01 - Introduction

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter focuses on existing health care facilities and the
				need for additional facilities. Methodologies for many facilities, i.e.,
				general hospitals, nursing homes, specialty care assisted living facilities,
				rehabilitation, psychiatric and substance abuse, are specific in nature and
				project a finite number of beds needed. Swing beds, Long Term Acute Care
				Hospital beds, and Critical Care Access Hospital beds are allowed for hospitals
				which meet the criteria as specified in the appropriate Federal Directive. The
				home health methodology is based on upon a minimum level of
				utilization.
Author:
Statewide Health Coordinating Council
				  (SHCC)
Statutory Authority:
Code of Ala.
				  1975
, §
										22-21-260(4).
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.02 - Acute Care (Hospitals)

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 Introduction. In this section, the methodology for computing acute care bed
			 need will be described, and criteria for making adjustments to the computed bed
			 need will be discussed.
(a) Definition:
			 Hospital.
1. Defined as printed in Rules of
			 Alabama State Board of Health Division of Licensure and Certification Chapter
			 420-5-7 (effective August 26, 2013):
(i)
			 "Hospital" means a health institution planned, organized and maintained for
			 offering to the public, facilities and beds for use in the diagnosis and
			 treatment of patients requiring in-patient medical care, out-patient medical
			 care, or other care performed by or under the supervision of physicians due to
			 illness, disease, injury, deformity, abnormality, or pregnancy.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.03 - Nursing Homes

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definition.
			 A Nursing Home is a business entity engaged in providing housing, meals and
			 care to sick or disabled individuals who require medical care, nursing care, or
			 rehabilitative services on a daily or more frequent basis. Hospital swing beds
			 are included in Section
			 410-2-4-.09.
(2) Analysis of Existing Facilities
(a) As of October 2019, there were 232
			 licensed nursing homes, excluding state owned and operated facilities, totaling
			 27,383 beds operating in the state of Alabama. Average occupancy for the 228
			 facilities was approximately84.8% for Fiscal Year 2018. Currently, there are
			 approximately 32.9 beds per one thousand persons age 65 and older.
(b) Approximately 84.6 % of nursing home beds
			 in Alabama are occupied by persons age 65 and older. This aged population
			 represents 16.5% of the state's total population and is projected to increase
			 during the coming years.
(c)
			 Nursing homes provide various levels of care for those needing their services.
			 These include:
1. Short-term post hospital
			 care (PAC) for those who require specialized rehabilitation after their acute
			 care hospital episodes. Most of these PAC admissions return home.
2. Long term care for those with complex
			 chronic conditions requiring care and supervision unavailable in a home setting
			 through available supports and services.
3. Palliative care for hospice patients
			 unable to remain in a home environment.
4. Memory care in a secured environment for
			 those with complex chronic conditions requiring care and supervision
			 unavailable in a home setting through available supports and services and
			 suffering from Alzheimer's disease and other forms of dementia.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.05 - Assisted Living Facilities

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definition. Assisted living facilities
			 provide, or offer to provide, any combination of residence, health supervision,
			 and personal care to three (3) or more individuals in need of assistance with
			 daily living activities.
(2)
			 Existing Assisted Living Facilities. As of September 2019 there were 194
			 licensed assisted living facilities totaling 7,253 beds operating in the state
			 of Alabama, or approximately 8.7 beds per 1,000 persons age 65 and older.
			 Assisted living is available in Alabama on a private-pay basis only.
(3) Availability. The 194 licensed assisted
			 living facilities are concentrated in the more populated counties. Three (3)
			 counties contain 35% of the assisted living beds and ten (10) counties contain
			 65% of the assisted living beds. Forty-eight (48) of the sixty-seven (67)
			 counties have assisted living facilities and nineteen (19) counties have no
			 assisted living facilities.
(4)
			 Continuity
(a) Discussion. Assisted living
			 facilities should provide assistance appropriate to resident needs. To ensure
			 that comprehensive services are available and to be certain residents are at a
			 proper level of care, assisted living facilities should provide, or should have
			 agreements with health care providers to provide, a broad range of care. When
			 providing these services, transfer of residents and support services should be
			 provided as necessary.
(b)
			 Self-Help Program. Assisted living providers will be encouraged to provide a
			 level of assistance that would help and encourage the residents to be
			 self-sufficient for as long as possible before requiring a change to a more
			 dependent home.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.07 - Home Health

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definitions
(a) Home Health Agency. A home health agency
			 is an organization that is primarily engaged in providing skilled nursing
			 services and other therapeutic services. Services are provided on an
			 intermittent basis. Each visit must be less than four hours in duration. Any
			 visit made to or procedures performed on a patient at their home must only be
			 made upon a physician's written order. Home health providers shall provide at
			 least the following services, including, but not limited to, skilled nursing
			 care, personal care, physical therapy, speech therapy, medical social services,
			 and medical supplies services.
(b)
			 Home Health Care. Home health care is that component of a continuum of
			 comprehensive health care whereby intermittent health services are provided to
			 individuals and families in their places of residence for the purpose of
			 promoting, maintaining or restoring health, or of maximizing the level of
			 independence, while minimizing the effects of disability and illness, including
			 terminal illness. Services appropriate to the needs of the individual patient
			 and family are planned, coordinated, and made available by providers organized
			 for the delivery of home health care through the use of employed staff,
			 contractual arrangements, or a combination of employed staff and contractual
			 arrangements. There is no licensure requirement for home health agencies in
			 Alabama.
(c) Home Health Services.
			 Home health services are made available based upon patient care needs as
			 determined by an objective patient assessment administered by a
			 multidisciplinary team or a single health professional. Centralized
			 professional coordination and case management are included. These services are
			 provided under a plan of treatment certified by a physician that may include,
			 but are not limited to, appropriate service components, such as medical,
			 nursing, social work, respiratory therapy, physical therapy, occupational
			 therapy, speech therapy, nutrition, homemaker home health aide service, and
			 provision of medical equipment and supplies.
(d) Section
			 22-21-265, Code of Alabama, 1975,
			 allows an existing home health agency to accept referrals from a county which
			 is contiguous to a county in which the agency holds CON authority. Additional
			 restrictions are provided in statute.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.08 - Inpatient Physical Rehabilitation

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definition. Inpatient physical
			 rehabilitation services are those designed to be provided on an integrated
			 basis by a multidisciplinary rehabilitation team to restore the disabled
			 individual to the highest physical usefulness of which he is capable. These
			 services may be provided in a distinct part unit of a hospital, as defined in
			 the Medicare and Medicaid Guidelines, or in a free-standing rehabilitation
			 hospital.
(2) General.
			 Rehabilitation can be viewed as the third phase of the medical care continuum,
			 with the first being the prevention of illness, the second, the actual
			 treatment of disease, and the third, rehabilitation or a constructive system of
			 treatment designed to enable individuals to attain their highest degree of
			 functioning. In many cases, all three phases can occur simultaneously. For the
			 purposes of this section of the State Health Plan, only the need for and
			 inventory of inpatient rehabilitation beds will be addressed.
(3) Need Determination. The Statewide Health
			 Coordinating Council (SHCC) has determined that there is a need for 15
			 rehabilitation beds per 100,000 population for each region.
(4) Planning Policies
(a) Planning Policy. Regional occupancy for
			 the most recent reporting year should be at least seventy-five percent (75%)
			 before the SHCC considers any requests for plan adjustments for additional bed
			 capacity.
(b) Planning Policy.
			 Conversion of existing hospital beds to rehabilitation beds should be given
			 priority consideration over new construction when the conversion is
			 significantly less costly, and the existing structure can meet licensure and
			 certification requirements.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.09 - Swing Beds

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definition.
			 A swing bed is a licensed hospital bed that can be used for either a hospital
			 or skilled nursing home patient. A swing bed program is authorized in Alabama
			 to include hospitals that meet the criteria as specified in Federal laws and
			 regulations. In accordance with the appropriate directive and this State Health
			 Plan, a swing bed hospital must meet the following requirements:
(a) must meet the federal requirements
			 addressing the facility size, location, and utilization factors;
(b) must have a valid provider agreement
			 under Medicare;
(c) must meet the
			 discharge planning and social services standards applicable to participating
			 skilled nursing facilities;
(d)
			 must not have a waiver for 24-hour nursing coverage;
(e) must be granted a Certificate of Need by
			 the State Health Planning and Development Agency to provide skilled nursing
			 facility services;
(f) any provider
			 seeking to offer swing beds as a new service is limited to an initial allotment
			 of ten (10) beds;
(g) Subject to
			 the procedure provided in paragraph (2) below, each participating hospital is
			 limited to twenty-five (25) swing beds;
(h) the average length of stay for swing bed
			 patients must not exceed 30 days;
(i) beds authorized as swing beds will remain
			 licensed as general hospital beds and be included in the general acute care
			 inventory and bed need methodology;
(j) critical access hospitals shall be given
			 special consideration in any application for a Certificate of Need for swing
			 beds.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.10 - Psychiatric Care

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Background
(a) In the early 1990s, the Alabama
			 Department of Mental Health and Mental Retardation developed a psychiatric bed
			 need methodology that provided for an inventory of 37.1 beds per 100,000
			 population. Originally, the methodology was calculated using regions; however,
			 in 2003 it was changed to reflect a statewide need methodology. Although the
			 statewide need methodology was helpful in the early years to ensure access to
			 care, it resulted in an uneven distribution of psychiatric beds, with higher
			 concentrations of beds in some regions and shortages of psychiatric beds in
			 other regions of the state.
(b)
			 Over time, the number of psychiatric beds, both private beds and state beds,
			 has declined. States have transitioned funding for mental health services from
			 institutional care to community-based services, as state budgets have been cut
			 and as more is known about the benefits of providing care in a
			 non-institutional, community setting. Alabama mirrors these national trends, as
			 it has closed three state facilities and downsized from 4,000 beds in 2009 to
			 approximately 1,600 beds in 2017. In some areas, community-based services
			 include crisis stabilization and access to timely follow-up care. In other
			 areas, community resources may be limited, and those with psychiatric
			 emergencies often present to a general acute care hospital emergency room for
			 care; some of the more severely mentally ill remain for extended periods of
			 time in private psychiatric facilities, waiting on a state bed to become
			 available.
Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.11 - Substance Use

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Discussion
(a) The National Household Survey on Drug
			 Abuse (NHSDA) estimated 22.2 million Americans age twelve (12) or older in 2012
			 were classified with dependence on or use of either alcohol or illicit drugs, a
			 figure significantly higher than in 2000 - about 14.5 million. Most of these
			 persons (14.9 million) were dependent on or used alcohol only. Another 2.8
			 million were dependent on or used both alcohol and illicit drugs, while 4.5
			 million were dependent on or used illicit drugs but not alcohol. Persons age
			 eighteen (18) to twenty-five (25) had the highest rates of alcohol dependence
			 or use (14.8%). (Source:
www.samhsa.gov
)
(b) There are more deaths and disabilities
			 each year in the United States from Substance use than from any other cause.
			 One-quarter of all emergency room visits, one-third of all suicides, and more
			 than one half of all homicides and incidents of domestic violence are
			 alcohol-related. (Source:
www.ncadd.org
)
(c) Alcohol and drug use costs the American
			 economy an estimated $276 billion per year in lost productivity, health care
			 expenditures, crime, motor vehicle crashes and other conditions. (Source:
www.ncadd.org
)