Opinion ID: 2014857
Heading Depth: 1
Heading Rank: 6

Heading: Least Costly of Alternatives

Text: The district court found, inter alia, that Gramercy had not met its burden in establishing that its proposed facility is the most cost-efficient alternative. This finding is amply supported by the record. Section 005.02A2 states in relevant part: The applicant must demonstrate that the proposed project is the least costly of the alternatives for meeting the need established under part 005.01A above, or if it is not the least costly, that it is the most effective alternative for meeting such need. In determining which alternative is the least costly, consideration shall include (but without limitation to) the following: the total cost of the project: charges to all consumers and payers, including government reimbursement programs; the effect of the proposed means of financing on consumers and payers considered as a whole; and, in the case of construction projects (including remodeling), the design, methods, and materials of construction and the long-term energy costs for the project. In its order, the district court stated: The record reflects that Gramercy's proposed facility will have nursing stations on separate floors which is unusual because the typical long-term care facility incorporates a one-story design. Evidence suggests that such a design will not be the most cost efficient.... The Appellant Gramercy emphasis [sic] that a multi-story design was the most efficient for purposes of the actual building site of the proposed structure. Appellant's brief at 36. However, the issue is not what is the best design for that particular building site but rather what is the best alternative for the community. While a multi-story design may be the best plan for that site, it is not a justification for granting a certificate when a more efficient facility could exist at another site. As a result, the Appellant Gramercy has not met its burden to establish that the proposed facility is the most cost efficient alternative. There is sufficient competent evidence in this record to support the district court's findings. At the hearing before the Review Committee, Laucomer remarked on Gramercy's two story addition for the skilled nursing beds and stated that there could be more efficient ways ... of providing care for sixty beds. Laucomer stated that the cost of the project for Gramercy's proposed two-story addition would be more expensive than a one-story design on a square-foot basis. Laucomer further testified that Gramercy's proposed addition would not be as efficient as a one-story design, because Gramercy's proposed multistory design would require duplication of and provision for certain items that a single-story design would not, including multiple nursing stations and an elevator. The district court did not err in concluding that Gramercy's proposed addition was not the least costly of alternatives, and therefore, Gramercy failed to meet the criteria for a CON on this basis.