Certificate of Need: Environmental Scan

1. Certificate of Need: Environmental Scan

2. What defines when a CON is required in 2015? • CON state law • DHEC Regulation 61-15 • DHEC State Health Plan

3. When is a CON required in 2015: • Construction of a new healthcare facility • Adding beds or a change in a license • Capital expenditure for adding or expanding a health facility or health service with standards in the State Health Plan • Capital expenditure in excess of regulation ($2 million) • Purchase of equipment in excess of regulation ($600,000)

4. When is a CON not required in 2015: • Equipment or service used strictly for research • Physician offices • Facilities operated by state or federal government • Dialysis centers • Replacement of like equipment • Certain medical projects & services • Urgent care centers, MOB, MRI • Certain non-medical projects • HVAC, Parking garage, computer system

5. Specific facilities, beds, health services & equipment in DHEC State Health Plan: • Projections of need for additional healthcare facilities, beds, health services & equipment • Inpatient health facilities and beds: • Acute care hospital • LTAC, PLTAC • Psychiatric hospitals and psychiatric beds • Rehab hospitals and rehab beds • Residential treatment facilities for children, adolescents • Nursing homes and beds

6. Specific facilities, beds, health services and equipment in DHEC State Health Plan • Health services connected with hospitals: • Obstetrical and neonatal • Pediatric • Cardiac cath labs • Open heart • Freestanding emergency services • Other health services and equipment: • PET • PET/CT • PEM • Linear accelerator • ASC • Inpatient hospice • Home health agencies* • Project review criteria for each segment

7. CON components in state law • Definitions • When CON’s required • When CON’s not required • Health planning committee & state health plan • Use of project review criteria • Public notification in newspaper • Review procedure and contested cases • Prohibited communication during review • Use of ALC and Court of Appeals • Limitations on CON

8. When is a CON required in July 2016: • Construction of a new healthcare facility • Purchase of new & emerging technology • Providing a new health service not previously provided • Expansion of an existing health service beyond 1 mile of where it is currently located • Capital expenditure greater than $5 million Current H.3250

9. When is a CON not required in July 2016: • Purchase of research equipment • Physician offices • Replacement of like equipment • Expansion of beds in acute care, rehab, psych or nursing homes • Expansion of existing services & equipment within 1 mile of where located & for which a CON was previously awarded Current H.3250

10. Other changes in July 2016: • Elimination of Health Planning Committee • SHP updated annually • SHP & CON application online • Shortens review & appeals process • Grandfather clause < $7 million • Sunset in 2017 Current H.3250

11. Who favors CON: • Hospitals • Imaging centers • Oncology groups • Home Health agencies • Nursing homes • Select Physician practices • Ambulatory Surgical Centers

12. Who is tired of CON? FTC The Governor SC State House Allan Stalvey

13. The CON Environment today: • 36 states have a CON program- great variability • CON states have fewer hospital beds & imaging services • PA (1999) & Wisconsin (2011) were last states to repeal • Both Georgia & NC have proposed repeal • Healthcare delivery is changing rapidly: • Cost & Quality • Convenience • Reimbursement • Continuum