(1)
Purpose and scope.
a. These
standards are measures of criteria found in Iowa Code section
10A.714(1)
"a" through "g." Criteria that are measured
by a standard are cited in parentheses following each standard.
b. Certificate of need applications that are
to be evaluated against these standards include applications to:
(1) Construct, develop, offer new, modernize, replace,
renovate, or relocate intermediate care or skilled nursing care beds in nursing
homes or hospitals.
(2) Expand bed
capacity in intermediate care or skilled nursing care facilities or designated
units in hospitals.
(2)
Definitions.
"Intermediate care facility" or
"ICF" means any institution, place, building, or agency
providing for a period exceeding 24 consecutive hours accommodation, board, and
nursing services, the need for which is certified by a physician, to three or
more individuals, not related to the administrator or owner thereof within the
third degree of consanguinity, who by reason of illness, disease, or physical
or mental infirmity require nursing services that can be provided only under
the direction of a registered nurse or a licensed practical nurse.
"Rural counties" means all counties not
designated by the U.S. Census as SMA (Standard Metropolitan Area)
counties.
"Skilled nursing facility" or
"SNF" means any institution, place, building, or agency
providing for a period exceeding 24 consecutive hours accommodation, board, and
nursing services, the need for which is certified by a physician, to three or
more individuals not related to the administrator or owner thereof within the
third degree of consanguinity who by reason of illness, disease, or physical or
mental infirmity require continuous nursing care services and related medical
services, but do not require hospital care. The nursing care services provided
must be under the direction of a registered nurse on a 24-hour-per-day
basis.
"Urban counties" means those counties
designated by the U.S. Census as SMA (Standard Metropolitan Area)
counties.
(3)
Availability and need. (Iowa Code section
10A.714(1)
"c," "d," "e," "g," "h")
a.
The following formula shall be used as a means of projecting the approximate
number of intermediate and skilled nursing care beds needed to serve the
projected population five years into the future:
(1) Rural counties:
[. 09(65 + population) + .0015 (64 - population)] x 110%
equals total long-term care bed need Combined SNF and ICF bed need equals 2/3
(total long-term care bed need)
Assumed RCF bed need equals 1/3 (total long-term care bed
need).
(2) Urban counties:
[. 07(65 + population) + .0015 (64 - population)] x 110%
equals total long-term care bed need Combined SNF and ICF bed need equals 2/3
(total long-term care bed need)
Assumed RCF bed need equals 1/3 (total long-term care bed
need).
(3) Economic
development authority population projections are adopted for use in the
determination of long-term care bed need.
(4) The department of inspections, appeals, and
licensing will calculate long-term care bed need figures annually, using
population projections five years into the future.
b. For purposes of comparing "need" to
"existing" beds in a given county, the following shall be considered in the
calculation of "existing" beds:
(1) ICF and
SNF beds licensed at freestanding facilities in the county.
(2) Additional ICF and SNF beds previously approved
through certificate of need but not yet licensed.
(3) ICF and SNF beds in designated units in hospitals
in the county.
c. The
statistical calculation of bed need shall serve as a guideline for the health
facilities council in reviewing need for the proposed long-term care beds.
Other factors that may be considered by the council include, but are not
limited to:
(1) The availability and
utilization of other ICF and SNF services in the county, or within the
applicant's service area.
(2) The
availability and utilization of other long-term care services in nearby
hospitals, such as skilled care available through the swing bed
program.
(3) The availability of
supportive living arrangements that may or may not be licensed as residential
care facilities (RCF).
(4) The
availability of home health and other in-home services.
(5) The availability of other services to the
elderly.
(6) The availability of
ICF and SNF services in neighboring counties.
(7) Utilization by out-of-state residents of
facilities in counties bordering other states, where the applicant provides
evidence that in-migration of long-term care patients exceeds out-migration to
the bordering state.
(8) Programs
and services directed at special populations whose needs cannot otherwise be
met, or whose needs cannot be met cost-effectively at other
facilities.
d. In
documenting need for a project, the applicant shall identify the service area
and target population, including a description of the methodology used by the
applicant in determining need for the requested beds and the expected sources
of referrals. The applicant shall document that the number of beds requested is
appropriate to address the identified need. The applicant shall also identify
how the target population is currently being cared for, and what hardship is
being experienced by the absence of the proposed beds.
(4)
Quality. (Iowa Code
section 10A.714(1)
"i," "k") The applicant shall document that the applicant has
contacted the health and safety division of the department of inspections,
appeals, and licensing to conform with physical standards, staffing
requirements, and other licensing requirements to assess the potential for
provision of quality care at the facility. When necessary, the applicant shall
attempt to arrange an on-site visit to the facility to determine compliance
with physical requirements, and shall provide documentation of this site visit
or attempts to arrange such a site visit.
(5)
Continuity. (Iowa Code section
10A.714(1)
"g," "h," "k")
a. The
applicant shall document the relationship of the facility's proposed services
to other health and long-term care services in the community such as physician
and hospital services, habilitation, rehabilitation, transportation or other
services. The facility should be capable of providing or arranging for the
provision of a continuum of long-term care services.
b. The facility should be capable of providing or
arranging for the provision of a comprehensive program of coordinated patient
services. The applicant shall provide evidence of contracts for services,
appropriate staffing patterns and ratios, and licensure of personnel as
necessary.
(6)
Accessibility and acceptability. (Iowa Code section
10A.714(1)
"c," "d")
a. Population
subgroups that have traditionally been underserved, such as adolescents, the
elderly, women, racial minorities, mentally ill, intellectually disabled, and
developmentally disabled should be considered when planning for or reviewing
long-term care facilities.
b. The
applicant shall document to what extent Medicaid patients will be served by the
proposed beds, using past Medicaid utilization as an indicator or, in the case
of a new facility, projecting anticipated Medicaid
utilization.
(7)
Costs and financial feasibility. (Iowa Code section
10A.714(1)
"e," "f," "i," "p")
a. The
applicant shall identify capital and operating costs associated with the
project, identify sources of funding to cover those costs, and demonstrate that
the project is financially feasible.
b. Construction costs shall be in line with
construction costs of other similar projects.
c. The applicant shall provide budgets for the first
three years of operation, including documentation of all assumptions used. The
budget shall include anticipated sources of revenue, including the percentage
of revenue from private pay, Medicaid, Medicare and other patient
revenues.
d. Proposed charges per
patient day should be justifiable when compared to current charges of other
similarly licensed facilities in the applicant's service area, or other similar
facilities elsewhere in the state. If charges are significantly higher or
lower, the applicant shall provide a description of proposed programs or
services that explain the difference in charges.
