Certificate of Need: Environmental Scan

What defines when a CON is required in 2015?  CON state law  DHEC Regulation  DHEC State Health Plan

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)

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

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

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

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

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

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

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

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

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

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