1. the future of CON in SC

2. controversial issues last session  Loser pays  Equipment threshold  Behavioral health bed conversion  Bamberg issue  CON exemptions  Grandfathering

3. legislative attitude toward CON  CON fights are public  Why doesn’t free market apply?  Which legislator can explain a bill on the floor?

4. next session  Repeal effort?  Reform effort?  United or split?

5. 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

6. what else defines when CON is required?  Regulation 61-15  State Health Plan Regulation 61-15:  Establishes capital expenditure threshold  Establishes medical equipment expenditure threshold  Defines total project cost

7. regulation 61-15 Also provides details of the process:  Specifies when written determinations of exemptions and non-applicability are required and what is required  Creates timelines and processes for public notification  Specifies contents and format of CON application  Creates timelines for additional information  Process for relative importance project review criteria  Review time frames, notification of affected person, and public hearings  Periodic reporting requirements

8. south carolina health plan / general contents  Projections of need for additional healthcare facilities, beds, health services & equipment  Standards for distribution of healthcare facilities, beds, health services & equipment  Project review criteria

9. specific facilities, beds, health services and equipment in south carolina health plan  Inpatient health facilities and beds  Acute care hospital  CAH  LTAC, PLTAC  Psychiatric hospitals and psychiatric beds  Rehab hospitals and rehab beds  Residential treatment facilities for children, adolescents  Long term care facilities and beds

10. specific facilities, beds, health services and equipment in south carolina health plan  Health services connected with hospitals: obstetrical and neonatal pediatric cardiac cath open heart freestanding emergency services  Other health services and equipment: PET PET/CT PEM linear accelerator ASC inpatient hospice home health agencies

11. who responded? (n=47 respondents)

12. is it important to maintain CON? (n=47 respondents)

13. should the CON law be? (n=39 respondents)

14. limited or broad by type (n=40 respondents)

15. lf limited, when should it be required? New general acute hospital19(100%) New specialty hospital (psych, rehab, single service such as cardio, ortho, etc.) 18(95%) New ASC17(89%) New services not previously offered8(42%) Purchases (or lease) of new major medical equipment not previously owned 7(37%) Expansion of existing services offered at a facility3(16%) (n=19 respondents)

16. if broad, when should it be required for facilities? (n=19 respondents) Facilities Acute Care Beds18(95%) Psychiatric Beds15(79%) Ambulatory Surgery Center-Single Specialty15(79%) Ambulatory Surgery Center-Multi Specialty15(79%) LTAC Beds14(74%) Nursing Home Beds14(74%) Rehabilitation Beds14(74%) In-Patient Hospice Beds13(68%) Alcohol and Drug Abuse7(37%) Residential Treatment/Intermediate Care Facility5(26%) Medical Office Building2(11%) Residential Care/Assisted Living2(11%)

17. if broad, when should it be required for equipment? (n=12 respondents) Equipment PET Scanners12(100%) PET/CT12(100%) MRI Scanners9(75%) Gamma Knives9(75%) Emerging Technology8(67%) CT Scanners7(58%) Mobile High Tech6(50%) Lithotripsy4(33%) Ultra Sound1(8%)

18. if broad, when should it be required for services? (n=16 respondents) Services Open Heart15(94%) Linear Accelerator13(81%) Therapeutic Cath13(81%) Organ Transplant13(81%) Neonatal Services (Level III and Level IV)11(69%) Burn Care9(56%) Home Health9(56%) Diagnostic Cardiac Cath9(56%) Obstetrical8(50%) Air Ambulance7(44%) Subacute Care6(38%)

19. if broad, should SC have a capital threshold? If yes, which range seems appropriate?

20. if broad, should SC have an equipment threshold? If yes, which range seems appropriate?