New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter V - Medical Facilities › Subchapter C - State Hospital Code › Article 1 - General Provisions › Part 709 - Determination Of Public Need For Medical Facility Construction › Section 709.2 - Acute care facilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
					 methodology will be utilized in the evaluation of certificate of need
					 applications involving the construction or establishment of new or replacement
					 beds in an acute care hospital and the need for acute care facilities and
					 services. It is the intent of the State Hospital Review and Planning Council
					 that this methodology, when used in conjunction with the planning standards and
					 criteria set forth in Part 708 of this Title and section
					 709.1 of this Part, become a
					 statement of basic principles and planning/decisionmaking tools for guiding and
					 directing the development of hospital services throughout the State.
					 Additionally, it is intended that the methodology will provide potential
					 applicants with a framework to develop specific hospital feasability studies
					 submitted as a part of certificate of need applications while allowing health
					 systems agencies sufficient flexibility to consider the unique and special
					 characteristics of their respective areas in determining bed need. The
					 methodology is conceptually based on the application of uniform planning
					 objectives at the county and/or State level. Its purpose is to provide
					 guidance, to insure flexibility, and to assist the health systems agencies, the
					 Commissioner of Health and potential applicants in determining the future need
					 for acute care beds as consistent with the certificate of need program. The
					 goals and objectives of the methodology expressed in this section are expected
					 to insure that an adequate institutional bed supply is available for normal and
					 emergency needs. The methodology helps identify counties where the projection
					 of future acute care bed need implies a potential for excess capacity and where
					 significant issues of hospital access and viability may occur. The goals and
					 objectives of this methodology also are expected to result in minimizing the
					 need for costly inpatient care by encouraging the development and expansion of
					 more desirable lower cost alternatives, as well as insuring that high quality
					 care and an adequate institutional bed supply are available.
(b) For purposes of this methodology, the
					 base year shall be 1991 and the planning target year shall be 1996. The
					 planning area shall be the county.
(c) The methodology uses the following steps
					 to estimate the need for medical/surgical and pediatric beds in the planning
					 target year:
(1) The normative discharge
					 utilization rates by county of patient residence for males and females ages
					 0-9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and 85 and over are derived for
					 medical/surgical and pediatric services for the base year and the year five
					 years previous to the base year as set forth in paragraphs (d)(1) through (3)
					 of this section.
(2) The
					 population, males and females ages 0-9, 10-14, 15-19, 20-44, 45-64, 65- 74,
					 75-84 and 85 and over, is estimated by county for the base year, the year five
					 years previous to the base year and for the planning target year as set forth
					 in paragraph (d)(4) of this section.
(3) Normative discharge utilization rates per
					 1,000 population by county of patient residence and by peer groups of counties
					 for males and females ages 0- 9, 10-14, 15-19, 20-44, 45-64, 65-74, 75-84 and
					 85 and over are estimated for the planning target year as set forth in
					 paragraphs (d)(5) through (8) of this section.
(4) The number of expected discharges is
					 derived by multiplying the utilization rates by county for males and females
					 ages 0-9, 10-14, 15-19, 20-44, 45-64, 65- 74, 75-84 and 85 and over for the
					 planning target year by the estimated county population for the planning target
					 year divided by 1,000.
(5) Total
					 expected discharges by county of residence is the sum of the expected
					 discharges as set forth in paragraph (4) of this subdivision.
(6) To derive the estimated number of
					 discharges in the planning target year by county of hospitalization, the
					 estimated number of expected discharges for the planning target year by county
					 of residence is adjusted to reflect the migration of patients between counties
					 in the State and for patients migrating from other states to New York as set
					 forth in paragraphs (d)(9) and (10) of this section.
(7) Discharges in the planning target year,
					 by county of expected hospitalization, are distributed by diagnostic related
					 groups (DRG) and payor categories as set forth in paragraph (d)(11) of this
					 section.
(8) Actual average base
					 year length of stay for discharges in the county of hospitalization for each
					 DRG and payor group is compared to national experience in length of stay for
					 each DRG and payor group as set forth in paragraph (d)(12) of this section. The
					 lowest length of stay, either the national experience or the county actual
					 average base year length of stay for each DRG and payor group, is multiplied by
					 the expected number of discharges for that DRG and payor group to derive
					 expected days of hospitalization in the planning target year. Expected days of
					 hospitalization in the planning target year by DRG and payor groups are summed
					 to derive total expected days.
(9)
					 Days of care provided to adults and pediatric patients are separated from total
					 expected days of hospitalization in the planning target year as set forth in
					 paragraph (d)(13) of this section. Medical/surgical bed need is derived from
					 adult days and pediatric bed need is derived from pediatric days.
(10) Expected adult and pediatric days of
					 hospitalization in the planning target year are divided by 365 to derive
					 average daily census for each county.
(11) Estimated medical/surgical and pediatric
					 beds needed in the planning target year for each county are calculated by
					 dividing average daily census by the expected occupancy rate as set forth in
					 paragraph (d)(14) of this section.
(12) The estimates of public need for
					 medical/surgical and pediatric beds for the planning target year for each
					 county are adjusted, as set forth in paragraphs (d)(15), (16) and (17) of this
					 section, to reflect the use of these beds for alternate level of care patients
					 and other extraordinary disease occurrences which were not adequately reflected
					 in the historic use rate experience.