N.Y. Comp. Codes R. & Regs. Tit. 10 § 709.5 - Ambulatory surgery services
(a)
This methodology will be utilized to evaluate certificate of need applications
involving the construction or establishment of new ambulatory surgery centers
or services or extension clinics of existing centers. 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 section
709.1(a) of this
Part, become a statement of basic principles and planning/decisionmaking tools
for guiding and directing the development of ambulatory surgery services and
facilities throughout the State. This methodology is intended to promote the
development of ambulatory surgery programs as a cost-effective alternative to
inpatient surgery where appropriate. It is also intended that this methodology
will provide potential applicants with sufficient flexibility to consider the
unique characteristics of their prospective projects in determining
need.
(b) Terms defined.
(1) Ambulatory surgery service, as set forth
in section
755.1 of this Title, is a service
organized to provide those surgical procedures which need to be performed for
safety reasons in an operating room on anesthetized patients requiring a stay
of less than 24 hours. A list of procedures appropriate for ambulatory surgery
is set forth in section
86-4.40 of this Title. Ambulatory
surgery services may be provided in a free-standing ambulatory surgery facility
or a hospital-based ambulatory surgery facility. Ambulatory surgery facilities
may be either single or multi-specialty.
(2) Hospital-based ambulatory surgery
services, as set forth in section
405.20(d) of this
Title, may be located at the same site as the hospital (on-site) or apart from
the hospital (off- site).
(3)
Free-standing ambulatory surgery services and facilities are certified to
operate as diagnostic and treatment centers as set forth in section
600.8 of this Title.
(4) Extension clinic shall mean an extension
clinic as defined in section
401.1 of this Title.
(c) Minimum requirements for
ambulatory surgery services and facilities. Applicants for free-standing
ambulatory surgery services or applicants for hospital-based off-site
ambulatory surgery facilities must meet the following minimum requirements:
(1) all facilities must meet the minimum
operating standards of free-standing ambulatory surgery services under article
28 of the Public Health Law as set forth in Part 755 of this Title;
and
(2) all facilities must meet
the minimum construction standards of a diagnostic and treatment center under
article 28 of the Public Health Law as set forth in section 715.16 of this
Title.
(d) Determination
of public need in certificate of need applications. Factors to be considered in
determining the public need for ambulatory surgery services and facilities
shall include, but not be limited to, the following factors:
(1) written documentation that the proposed
capacity of the ambulatory surgery service or facility will be utilized
sufficiently to be financially feasible as demonstrated by a three-year
analysis of projected costs and revenues associated with the program. Written
documentation of financial feasibility shall also include, but not be limited
to, an analysis of expected demand for ambulatory surgery services and an
explanation of how current and expected patient referral and use patterns will
make the project financially feasible;
(2) written documentation that the proposed
service or facility will enhance access to services by patients, including
members of medically underserved groups which have traditionally experienced
difficulties in obtaining equal access to health service (for example, low
income persons, racial and ethnic minorities, women and handicapped persons)
and/or rural populations;
(3)
written documentation that the facility's hours of operation and admission
policies will promote the availability of services to those in need of such
services regardless of their ability to pay. This shall include, but not be
limited to, a written policy to provide charity care and to promote access to
services regardless of an individual's ability to pay. Charity care shall mean
care provided at no charge or reduced charge for the services the facility is
certified to provide to patients who are unable to pay full charges, are not
eligible for covered benefits under title XVIII or XIX of the Social Security
Act or are not covered by private insurance; and
(4) written documentation of the facility's
willingness and ability to safely serve ambulatory surgery patients including,
but not limited to, such factors as control of infection, quality assessment
and improvement, patient transfer, emergency care, credentialing and medical
recordkeeping as set forth in Part 755 of this Title.
(e) Public need for a proposed facility shall
be deemed to exist when review and consideration of evidence concerning each of
the factors set forth in subdivision (d) of this section results in an
affirmative finding.
(f)
Determination of need for ambulatory surgery services in a health maintenance
organization (HMO). Notwithstanding anything to the contrary in this section,
the addition of ambulatory surgery services to be provided directly to a
HMO-enrolled population shall be approved when the HMO can demonstrate to the
satisfaction of the commissioner that the provision of services shall be
cost-effective and accessible to plan enrollees.
Notes
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