Oregon Administrative Rules › Chapter 333 - OREGON HEALTH AUTHORITY, PUBLIC HEALTH DIVISION › Division 590 - DEMONSTRATION OF NEED FOR ACUTE INPATIENT BEDS AND FACILITIES › Section 333-590-0030 - Assumptions

Current through Register Vol. 63, No. 7, July 1, 2024
The following general assumptions are made with respect to the
				balance between bed capacity and anticipated future utilization. In specific
				cases, certain assumptions may or may not apply:
(1) The annual patient days needed by the
			 population of a health service area can be more confidently forecasted than the
			 demand at a single hospital or local market area.
(2) Hospital service area patient days can be
			 more confidently forecasted by isolating the trends in the area's population
			 from trends in the area's use-rate (annual patient days per 1,000 population).
			 The two trends can then be recombined by multiplication.
(3) Population-based acute inpatient
			 use-rates (annual patient days in nonfederal, nonspecialty, short-term Oregon
			 hospitals, divided by forecasted Oregon population) have declined for the past
			 ten years, and are likely to continue to decline for the next ten years:
(a) Within the area to be served by the
			 proposal, factors such as changing age structure of the population,
			 transportation patterns and locations of physician specialists, may modify this
			 effect, as may changes in the intensity or types of services delivered; and
			 documented commitments to develop other procompetitive initiatives such as
			 alternative delivery systems, selective contracting, successful competitive
			 bidding, and other market oriented changes;
(b) At the applicant's request, the division
			 may modify the general assumption that use-rate will decline. One basis for
			 such modification can be documentation (which the division can validate) by the
			 applicant that its facility does, or proposes to provide 30 percent or more of
			 its services to meet elective acute care needs (which cannot be met at existing
			 facilities in the hospital service area as defined in OAR
			 333-590-0050(1)) to individuals not residing within 50 miles by road in the case of
			 nonemergency acute services; or 25 miles by road in the case of emergency acute
			 services. In such a case, the applicant's population base for purposes of
			 calculating use-rate will take into account the number of persons from outside
			 the area to be served by the facility who are projected to use the
			 facility;
(c) At the request of the
			 applicant, the division may also modify the general assumption that use-rate
			 will decline if the applicant provides documentation (which the division can
			 validate) that its facility proposes to provide all or some of its services to
			 members, subscribers and enrollees of institutions, HMOs or health care plans.
			 In such cases, the population to be served by the facility will be considered
			 to be the members, subscribers and enrollees of such institutions, HMOs or
			 health care plans who reside in the facility's service area. In cases where the
			 applicant provides or proposes to provide only a portion of its services to
			 such members, subscribers and enrollees, the population to be served by the
			 proposal will be adjusted on a proportionate basis. Assumptions as to the
			 use-rate of such members, subscribers or enrollees will be based either on past
			 experience of the institution, HMO or health care plan or, in the case where no
			 past experience exists, on past experience of similar institutions, HMOs or
			 health care plans in the state;
(d)
			 At the request of the applicant, the division may also modify the general
			 assumption that use-rate will decline if the applicant documents that its
			 facility is either:
(A) A medical or other
			 health professions' school; or
(B)
			 A multidisciplinary clinic; or
(C)
			 A specialty center; or
(D) A
			 facility established or operated by a religious body or denomination to meet
			 the needs of members of such religious body or denomination for care and
			 treatment in accordance with their religious or ethical convictions, when these
			 religious and ethical convictions demonstrably preclude use of established
			 health care facilities in the area, and particular health care facilities
			 provided for the purpose of rendering health care to such members. Utilization
			 and beds at such facilities shall not be counted when considering the need for
			 services at other facilities in the hospital service area.
(e) In such cases as stipulated in paragraph
			 (d)(A), (B) (C) or (D) of this section, modification of the basic use-rate
			 assumption shall be based on documentation (which the division can validate) by
			 the applicant that a population different from or in addition to the hospital
			 service area population (as defined in OAR
			 333-590-0050(1)) is served or will be served by the facility, and that this population has
			 experienced trends in hospital use-rates which are different from those in the
			 applicant's health service area. The use-rate assumption shall be modified only
			 to the extent that the additional service area population or geographic area is
			 taken into account. For example, if an applicant demonstrates that it draws
			 patients from the entire state, then the use-rate would be assumed to decline
			 at the statewide historical rate of decline.