Alabama Administrative Code › Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY › Chapter 410-2-4 - FACILITIES › Section 410-2-4-.04 - Limited Care Facilities - Specialty Care Assisted Living Facilities

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Definition.
			 Specialty Care Assisted Living Facilities ("SCALFs") are intermediate care
			 facilities which provide residents with increased care and/or supervision
			 designed to address the residents' special needs due to the onset of dementia,
			 Alzheimer's disease or similar cognitive impairment in addition to assistance
			 with normal daily activities including, but not limited to, restriction of
			 egress for residents where appropriate and necessary to protect the resident
			 and which require a license from the Alabama Department of Public Health as a
			 Specialty Care Assisted Living Facility pursuant to Ala. Admin. Code r
			 420-5-20, et seq.
(2) Specialty
			 Care Assisted Living Facility Bed Need Methodology
(a) Purpose. The purpose of this specialty
			 care assisted living facility bed need methodology is to identify, by county,
			 the number of beds needed to assure the continued availability, accessibility,
			 and affordability of quality care for residents of Alabama.
(b) General. Only the SHCC, with the
			 Governor's final approval, can make changes to this methodology except that the
			 SHPDA staff shall annually update bed need projections and inventories to
			 reflect more current population and utilization statistics. Adjustments are
			 addressed in paragraph (e).
(c)
			 Basic Methodology. Considering the availability of more home and
			 community-based services for the elderly in Alabama, there should be a minimum
			 of six (6) beds per 1,000 population age 65 and older for each county.
The bed need formula is as follows:
(6 beds per thousand) x (population age 65 and older/1,000) =
				Projected Bed Need
(d)
			 Planning Policies
1. Projects to develop
			 specialty care assisted living facilities or units in areas where there exist
			 medically underserved, low income, or minority populations should be given
			 priority over projects not being developed in these critical areas when the
			 project to develop specialty care assisted living facilities in areas where
			 there exists medically underserved, low income or minority populations is not
			 more costly to develop than other like projects.
2. Bed need projections will be based on a
			 three-year planning horizon.
3.
			 Planning will be on a county wide basis.
4. Subject to SHCC adjustments, no beds will
			 be added in any county where that county's projected ratio exceeds six (6) beds
			 per 1,000 population age 65 and older, except in the case of any county meeting
			 the conditions delineated in sections (d) 6 - 8 below.
5. When any specialty care assisted living
			 facility relinquishes its license to operate, either voluntarily or
			 involuntarily other than by a Certificate of Need approved transfer, or by
			 obtaining title by a foreclosure as specified in the opinion rendered by the
			 Alabama Attorney General, November 17, 1980, the beds authorized for use at
			 that facility shall be returned to inventory. The new bed need requirement in
			 the county where the facility was located will be that number which will bring
			 the county ratio up to six (6) beds per 1,000 population age 65 and older,
			 except in the case of any county meeting the conditions delineated in sections
			 (d) 6 - 8 below.
6. Applicants for
			 adjustments have provided evidence to the SHCC that certain counties in the
			 state have a patient base drawn from multiple additional counties for several
			 reasons, including but not limited to: the location of other family members;
			 the difficulties in constructing and operating a financially viable SCALF in
			 rural areas; the location of other medical providers; and the creation of
			 multi-level senior living developments allowing for "aging in place." The SHCC
			 recognizes that an alternative means of assessing need for certain counties is
			 necessary. Any county with a projected population, age 65 and older, of 20,000
			 or more qualifies for an alternative need projection which shall account for
			 both the projected need and the existing CON authorized bed capacity of that
			 county, and all counties contiguous to that county. The sum of the authorized
			 bed capacity of the target county and all contiguous counties shall be
			 subtracted from the sum of the projected need for the target county and all
			 contiguous counties. This projected net need shall be compared to the projected
			 net need determined under the methodology in section (2)(c) above. The larger
			 of the two projected net need values shall be the need for the target county
			 and shall be reflected on any Statistical Update published by SHPDA.
7. Additional need may be shown in situations
			 involving a sustained high occupancy rate either for a county or for a single
			 facility. An applicant may apply for additional beds, and thus the
			 establishment of need above and beyond the standard methodology utilizing one
			 of the following two policies. Once additional beds have been applied for under
			 one of the policies, that applicant shall not qualify to apply for additional
			 beds under either of these policies unless and until the established time
			 limits listed below have passed. All CON authorized SCALF beds shall be
			 included in consideration of occupancy rate and bed need.
(i) If the occupancy rate for a county is
			 greater than 92% utilizing the census data in the most recent full year "Annual
			 Report(s) for Specialty Care Assisted Living Facilities (Form SCALF-1)"
			 published by or filed with SHPDA, an additional need of the greater of either
			 ten percent (10%) of the current total CON Authorized bed capacity of that
			 county or sixteen (16) total beds may be approved for either the creation of a
			 new facility or for the expansion of existing facilities within that county.
			 However, due to the priority of providing the most costeffective health care
			 services available, a new facility created under this policy shall only be
			 allowed through the conversion of existing beds at an Assisted Living Facility
			 currently in possession of a regular, non-probationary license from the Alabama
			 Department of Public Health. Once additional need has been shown under this
			 policy, no new need shall be shown in that county based upon this rule for
			 twenty-four (24) months following issuance of the initial CON, to allow for the
			 impact of those beds in that county to be analyzed. Should the initial
			 applicant for beds in a county not apply for the total number of beds allowed
			 to be created under this rule, the remaining beds are available to be applied
			 for by other providers in the county meeting the conditions listed in this
			 rule.
(ii) If the occupancy rate
			 for a single facility is greater than 92% utilizing the census data in the last
			 two (2) most recent full year "Annual report(s) for Specialty Care Assisted
			 Living Facilities (Form SCALF-1)" published by or filed with SHPDA,
			 irrespective of the total occupancy rate of the county over that time period,
			 up to sixteen (16) additional beds may be approved for the expansion of that
			 facility only. Once additional beds have been approved under this policy, no
			 new beds shall be approved for that facility for twenty-four (24) months
			 following issuance of the CON to allow for the impact of those beds at that
			 facility to be analyzed.
8. No application for the establishment of a
			 new, freestanding SCALF shall be approved for fewer than sixteen (16) beds, to
			 allow for the financial feasibility and viability of a project. Need may be
			 adjusted by the Agency for any county currently showing a need of more than
			 zero (0) but fewer than sixteen (16) total beds to a total need of sixteen (16)
			 new beds, but only in the consideration of an application for the construction
			 of a new facility in that county. Need shall not be adjusted in consideration
			 of an application involving the expansion of a currently authorized and
			 licensed SCALF or for the conversion of beds at an existing Assisted Living
			 Facility.
9. Any CON Application
			 filed by a licensed SCALF shall not be deemed complete until, and unless:
(i) The applicant has submitted all survey
			 information requested by SHPDA prior to the application date; and
(ii) The SHPDA Executive Director determines
			 that the survey information is complete.
10. No licensed SCALF filing an intervention
			 notice or statement in opposition in any CON proceeding may cite or otherwise
			 seek consideration by SHPDA of such facility's utilization data until, and
			 unless:
(i) The intervenor or opponent has
			 submitted all survey information requested by SHPDA prior to the application
			 date; and
(ii) The SHPDA Executive
			 Director determines that the survey information is complete.
(e) Adjustments. The bed
			 need, as determined by the methodology, is subject to adjustments by the SHCC.
			 The specialty care assisted living facility bed need may need to be adjusted by
			 the SHCC if an applicant can prove that the identified needs of a targeted
			 population are not being met by existing specialty care assisted living
			 facilities in the county of the targeted population.
(f) Notwithstanding the foregoing, any
			 application for Certificate of Need for specialty care assisted living facility
			 beds for which a proper letter of intent was duly filed with SHPDA prior to the
			 adoption of the bed need methodology shall not be bound by this bed need
			 methodology.
(g) The determination
			 of need for specialty care assisted living facility beds shall not be linked to
			 the number of existing assisted living beds in the county.
(h) In order to determine if this methodology
			 and related planning policies accurately reflect the need for SCALF beds in the
			 state, the SHCC requires additional information to determine the county of
			 residence prior to admission to each SCALF. The SHCC requests that the Health
			 Care Information and Data Advisory Council add a section to the "Annual Report
			 for Specialty Care Assisted Living Facilities (Form SCALF-1)" reporting the
			 county of residence for patients admitted to each SCALF. After the Annual
			 Report is modified by the Health Care Information and Data Advisory Council,
			 the SHCC shall use the information collected to review this methodology at the
			 end of the third mandatory reporting period to determine if additional
			 revisions to this methodology are required to better reflect both the existing
			 utilization of SCALF services and the potential need for additional SCALF beds.
For a listing of Specialty Care Assisted Living Facilities or
				the most current statistical need projections in Alabama contact the Data
				Division as follows:
MAILING ADDRESS
(U. S. Postal Service)
STREET ADDRESS
Commercial Carrier)
PO BOX 303025
MONTGOMERY, AL 36130-3025
100 NORTH UNION STREET, SUITE 870
MONTGOMERY, AL 36104
TELEPHONE:
(334) 242-4103
FAX:
(334) 242-4113
EMAIL:
data.submit@shpda.alabama.gov
WEBSITE:
http://www.shpda.alabama.gov