1. The Certificate of Public Need Program in Virginia Peter Boswell, Director Division of Certificate of Public Need VDH Office of Licensure and Certification July 2015

2. Establishment of COPN Review Process The Code of Virginia at §32.1-102.1 through §32.1- 102.11 (The Code) Virginia Medical Care Facilities Certificate of Public Need Rules and Regulations 12VAC 5-220 (The Regulations) The State Medical Facilities Plan 12VAC 5-230 through 12VAC 5-360 (The SMFP)

3. Projects Requiring COPN Authorization A.General Hospitals, obstetrical services, neonatal special care services, general capital expenditures B.Open heart surgery, cardiac catheterization, ambulatory surgery centers, operating room additions, transplant services C.Psychiatric facilities, substance abuse treatment, mental retardation facilities D.Diagnostic imaging facilities and services E.Medical rehabilitation beds and services F.Radiation therapy, gamma knife surgery and linac based SRS, lithotripsy, diagnostic imaging equipment may be included in an application with radiation therapy G.Nursing home facilities and bed additions, nursing home capital expenditures

4. The 5 Virginia COPN Health Planning Regions and 22 Planning Districts

5. COPN Review Criteria and Standards – Required Considerations 1. Increase geographic access to needed services for residents 2. (i) the level of community support (ii) the availability of reasonable alternatives (iii) recommendation of the regional health planning agency (iv) any costs and benefits of the project (v) the financial accessibility of the project (vi) at the discretion of the Commissioner, any other factors as may be relevant to the determination of public need for a project;

6. Required Considerations 3. The extent to which the application is consistent with the State Medical Facilities Plan; 4. The extent to which the application fosters institutional competition that benefits the area to be served while improving access to essential health care services for all persons in the area to be served; 5. The relationship of the project to the existing health care system of the area to be served, including the utilization and efficiency of existing services or facilities;

7. Required Considerations 6. The feasibility of the project, including the financial benefits of the project to the applicant, the cost of construction, the availability of financial and human resources, and the cost of capital; 7. The extent to which the project provides improvements or innovations in the financing and delivery of health services, 8. In the case of a project proposed by or affecting a teaching hospital associated with a public institution of higher education or a medical school in the area to be served, (i)the unique research, training, and clinical mission of the teaching hospital or medical school, and (ii)any contribution the teaching hospital or medical school may provide in the delivery, innovation, and improvement of health care for citizens of the Commonwealth, including indigent or underserved populations.

8. Two SMFP Standards Applicable to Every Review Travel Time to Services o Mapping Software - Microsoft Streets & Trips Need for Additional Service Capacity o Population - Weldon Cooper Center for Public Service o Utilization of Existing Services – Virginia Health Information o Age Specific Use Rates - Nursing Home Patient Origin Survey o Cancer incidence rates - Statewide Cancer Registry

9. The Pre-Application Phase Receipt of a Letter of Intent from the applicant o 70 days prior to start of cycle Application received from the applicant o 40 days prior to start of cycle DCOPN (and HSANV, if in PD 8) reviews the submission for completeness and transmits follow-up questions to the applicant o 10 days following receipt of the application Responses received from the applicant o 5 days prior to the start of cycle

10. Application Review Phase Each 190-day review cycle begins on the 10 th of the month. Public Hearing Recommendation

11. Decision Phase IF uncontested COPN requests are recommended for approval by both the HSANV and the DCOPN, no Informal Fact Finding Conference is needed. Contested COPN Requests and/or those recommended for denial by either/both the HSANV and/or the DCOPN will be heard at an Informal Fact Finding Conference.

12. Request for Applications (RFA) Prospective determination of need for nursing home beds made by the State Applications can only be accepted for a specifically identified number of nursing home beds in specific Planning Districts

13. Request for Applications Need determined based on annual Statewide analysis using State Medical Facilities Plan criteria Once RFA is issued the Pre-review, Review and Decision phases are the same as in the basic review

14. Conditions State Health Commissioner has the authority to condition the issuance of a COPN on the applicant’s agreement to certain conditions: – Provision of indigent care – Facilitation of the development and operation of primary care services – Accept patients requiring specialized care

15. Conditions 655 Conditioned COPNs Issued 195 Conditioned COPNs Active 108 Conditioned COPNs not yet completed

16. Conditions 2013 $1.34 billion worth of care reported as provided in compliance with conditions $35.8 million in cash contributions to safety net providers made in compliance with conditions

17. Program Volume 2010 - 2014 Average 87 Letters of Intent per year Average 59 Applications per year Average 16 applications heard at 13 IFFCs per year Average 52 Decisions per year – 85.7% Approved – 14.3% Denied

18. Program Volume 2010 - 2014 Average annual value of all projects approved annually $434 million Average annual value of all projects denied annually $43 million

19. Program Revenue Fiscal Year 20102015 Application Fees $870,350 $764,573 FOIA Fees 12,691 7,917 Total $883,041 $772,490

20. Program Staffing 20102015 Director 1.0 0.5 Supervisor 1.0 0.5 Analysts 4.5 3.0 Adjudication Officer 1.0 1.0 Total FTEs 7.5 5.0

21. Questions?