1. 1 COPN in Other States – Follow-up Information Presentation to COPN Workgroup Joe Hilbert Director of Governmental and Regulatory Affairs – Virginia Department of Health August 19, 2015

2. 2 Presentation Outline Three States that Eliminated COPN Wisconsin, Indiana, Pennsylvania States with COPN where there has been recent/current program review North Carolina, South Carolina, Kentucky, Georgia, Delaware, New York, Connecticut

3. 3 States That Eliminated COPN - Wisconsin Stopped administering its CON program for Nursing Homes in 2011. Authorizing statute was never repealed Variety of other policy tools used to control nursing home expenditures Medicaid moving all LTC services into Managed Care by 2017 Moratorium on new nursing home beds Monthly Licensed Bed Assessment “Hard cap” of 51,800 nursing home beds; 35,000 actual beds; Occupancy rate @80% Since the CON authorizing statute for nursing homes remains in effect, active administration of the CON program could be reinstituted if needed

4. 4 States that Eliminated COPN - Pennsylvania Allowed to sunset in 1996 It was determined that certain qualitative standards used in CON review should be retained in the form of licensure regulations Licensure regulations were promulgated for cardiac catheterization, open heart surgery, neonatal services and organ transplantation Required hospitals performing cardiac catheterization and open heart surgery to report data quarterly

5. 5 States that Eliminated COPN - Pennsylvania Following sunset, noticeable increase in outpatient facilities (e.g., ambulatory surgery facilities, imaging centers) Licensed ambulatory surgery facilities increased from 104 to 245 from 2000 to 2005 2005 Legislative Report – In 2002, 7 of 21 cardiac catheterization programs with open heart surgery that started after the sunset of CON were not meeting the American College of Cardiology/American Heart Association minimum proficiency volumes All programs approved under CON were meeting the volumes

6. 6 States that Eliminated COPN - Indiana CON was limited to Nursing Homes; allowed to sunset in 1999 2008 to 2014 - 42 new nursing homes; 12,000 excess beds occupancy rate @10% below the national average. 2014 study - 17 facilities then under construction would decrease occupancy another 4.4% and cost state ongoing $24 M per year in Medicaid expenditures 2015 - enacted 3-year moratorium on new nursing home construction with a number of exceptions

7. 7 North Carolina – Phased Repeal of CON (HB97 of 2015) Effective 1/1/16, CON will no longer apply to: Establishment of beds or change in bed capacity at Acute care hospitals, Inpatient psych hospitals, Inpatient rehab hospitals, Kidney disease treatment centers, ICFMRs, Chemical dependency treatment facilities Offering the following services Bone marrow transplant, burn intensive care, open heart surgery, solid organ transplant Acquisition of the following equipment Gamma knife, Heart-lung bypass machine, Lithotripter Construction, development, establishment, increase in the number, or relocation of an Operating Room or gastrointestinal endoscopy room in a licensed health service facility

8. 8 North Carolina – Phased Repeal of CON 8/1/17 – CON shall not apply to establishment of beds or change in bed capacity at: Diagnostic Centers, Ambulatory Surgical Facilities 1/1/19 – CON shall not apply to: Nursing homes, hospice facilities and programs, LTC hospitals, cardiac catheterization services and equipment, linear accelerator, MRI scanner, PET scanner, Simulator

9. 9 South Carolina - Recommendations of CON Review Panel (2012) Increase $ threshold for review of capital projects associated with patient care activities Eliminate $ threshold for diagnosis/treatment equipment, require accreditation of CT and MRI units as condition of registration Implement batching process for review of applications Require electronic filing of application Develop categories of projects eligible for expedited review Provide department access to additional data needed to review CON applications

10. 10 South Carolina – Pending Legislation (H.3250) Additional CON exemptions Establish $5M review threshold for health care facility capital expenditures Require annual review and update of State Health Plan Allow department to retain all fees for use of program Eliminate requirement for publication of notice, and require letter of intent “Loser Pays” provision concerning attorney’s fees and costs during contested cases and appeals Provide department access to Revenue and Fiscal Affairs Office data

11. 11 Kentucky - Certificate of Need Modernization: Core Principles and Request for Stakeholder Input (2014) Support evolution of care delivery Incentivize development of a full continuum of care Incentivize quality Improve access to care Improve value of care Promote adoption of efficient technology Exempt services for which CON is no longer necessary

12. 12 New York Administrative changes (2010) Increased dollar threshold for CON review Eliminated non-clinical projects (e.g. HVAC, parking decks) from CON review Implemented electronic CON application Public Health and Health Planning Council (2012) Retain CON for hospital beds, but reconsider within next 3-5 years Exempt providers participating in ACOs Update CON process for hospice Establish Regional Health Improvement Collaboratives

13. 13 New York Impact of Medicaid DSRIP Section 1115 Waiver (2015) Hospital bed need methodology old and in need of revision, but may wind up eliminating because DSRIP pulling beds out of system. Expecting a considerable increase in CON applications ($2B worth of capital projects associated with DSRIP restructuring, @250 applications) Specific DSRIP performance criteria is to right size acute care facilities and regroup facilities for outpatient care - related to desire to reduce avoidable hospitalizations

14. 14 Connecticut 2010 Revisions Simplify procedural requirements Focus oversight on preserving access to “safety net” services Improve CON criteria to address the financial stability of the health care delivery system and enhance quality of patient care 2013 - added impact on Medicaid to CON review criteria 2015 - added CON review criteria related to hospital conversions/acquisitions Hired independent monitor to perform a “market impact review” for proposals involving purchasers with net worth of $1.5 Billion or more

15. 15 Connecticut – Integration of Health Planning and CON State Health Assessment - overview of the social, economic, physical well-being and mental health of the state’s population. State Health Improvement Plan - roadmap for promoting and advancing population health through prevention and risk reduction. Facilities and Services Plan – CON review standards and guidelines State Health Care Facilities and Services Plan - examines how access and services within the health care system affect a community’s health, particularly among at-risk and vulnerable populations

16. 16 Georgia Commission on the Efficacy of the Certificate of Need Program (2006) - Recommendations Increase fine for failure to obtain a CON Allow conditional CONs Licensure standards at clinical service level Increase review timeframe for initial decision to 120 days Exempt relocation of an existing facility within a limited distance Exempt short stay general hospital beds, cardiac catheterization, Continuing Care Retirement Communities, and traumatic brain injury facilities Eliminate exemption for Ambulatory Surgery Centers Maintain CON for Positron Emission Tomography

17. 17 Evaluation of Delaware’s Certificate of Public Review Program (2008) - Recommendations Devise plan for a fully coordinated and comprehensive health planning process If CPR is to continue, devise mechanism for determining system costs (lowering thresholds for CPR is one way to move toward this goal) If CPR is discontinued, devise mechanism for assuring consumer access to medical health care “goods” and consider that some procedures should be rendered in high-volume environment If CPR is maintained, consider extending CPR to services, not facilities and technology, and add assisted living as a reviewed service

18. 18 Questions? Comments?