State medical facilities plan

              2013
NORTH CAROLINA
2013 STATE MEDICAL FACILITIES PLAN
Effective January 1, 2013
Prepared by the
North Carolina Department of Health and Human Services
Division of Health Service Regulation
Medical Facilities Planning Branch
Under the direction of the
North Carolina State Health Coordinating Council
For information contact the
North Carolina Division of Health Service Regulation
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
www.ncdhhs.gov/dhsr/ncsmfp/index.html
(919) 855 - 3865 Telephone Number
(919) 715 - 4413 FAX Number
The North Carolina Department of Health and Human Services does not
discriminate on the basis of race, color, national origin, sex, religion, age
or disability in employment or the provision of services.
The 2013 State Medical Facilities Plan
is dedicated to the memory of:
Representative William L. Wainwright
Your kindness, devotion and endless support
will always be remembered.
Representative William L. Wainwright began his political life
in 1991 and for the next 22 years he represented N.C. House
District 12. He was in his eleventh term in the N.C. House of
Representatives representing Craven and Lenoir counties when
his life ended. From 2001 to 2004 he was chairman of the
Legislative Black Caucus, and the Joint Legislative Commission
on Department of Transportation Disadvantaged Minority-Owned
and Women-Owned Businesses. He also was the former House
Finance Committee chairman. In January 2007, Representative
Wainwright was elected by his peers as Speaker pro tempore of the
House. He served in that capacity for four years. He was the first
African American to serve in that post since the Reconstruction.
He became House deputy minority leader in 2011.
In addition to his political work, he was an ordained minister, and
from 1985-1993 served as pastor of Piney Grove African Methodist Episcopal Zion church, and
since 1993 was a presiding elder of New Bern District of North Carolina conference of the AME
Zion Church.
Representative Wainwright was appointed to State Health Coordinating Council on July 14, 1998
and appointed as SHCC chairman in March 2010. He was in full support of a statewide need
determination for a linear accelerator that was part of a demonstration project for a model prostate
cancer center focused on outreach to and treatment of men with prostate cancer, particularly African
American men. During his tenure as chairman, he clarified operating procedures for the SHCC, a
Pediatric Operating Room Workgroup convened and made recommendations to the SHCC, Policy
AC-3 and Policy AC-5 were revised, the methodology for projecting need for heart-lung bypass
machines was removed from the Plan, and the standard methodology for Acute Care beds was
revised. He was always supportive of staff, fellow SHCC members and the SMFP process.
Representative Wainwright was a dedicated public servant who stood on principles representing
his local constituents without ignoring the greater good. He was driven to helping people and was
instrumental in moving legislation forward to the benefit of many. His negotiating skills allowed him
to be known as a powerful speaker in the pulpit and on the House floor. Representative Wainwright
will be missed by all whose lives he touched.
1947 – 2012
TABLE OF CONTENTS
Background
Chapter 1 Overview of the North Carolina 2013 State Medical Facilities Plan
Chapter 2 Amendments and Revisions to the State Medical Facilities Plan
Chapter 3 Certificate of Need Review Categories and Schedule
Chapter 4 Statement of Policies:
Acute Care Hospitals
Nursing Care Facilities
Adult Care Homes
Home Health Services
End-Stage Renal Disease Dialysis Services
Mental Health, Developmental Disabilities, and
Substance Abuse (General)
Psychiatric Inpatient Services Facilities
Intermediate Care Facilities for Individuals with Intellectual Disabilities
(formerly Intermediate Care Facilities for the Mentally Retarded)
All Health Services
Acute Care Facilities and Services
Chapter 5 Acute Care Hospital Beds
Chapter 6 Operating Rooms
Chapter 7 Other Acute Care Services
Open Heart Surgery Services
Burn Intensive Care Services
Transplantation Services
Chapter 8 Inpatient Rehabilitation Services
Technology and Equipment
Chapter 9 Technology and Equipment
Lithotripsy
Gamma Knife
Linear Accelerators
Positron Emission Tomography Scanner
Magnetic Resonance Imaging
Cardiac Catheterization Equipment
Long-Term Care Facilities and Services
Chapter 10 Nursing Care Facilities
Chapter 11 Adult Care Homes
Chapter 12 Home Health Services
Chapter 13 Hospice Services
Chapter 14 End-Stage Renal Disease Dialysis Facilities
Chapter 15 Psychiatric Inpatient Services
Chapter 16 Substance Abuse Inpatient and Residential Services
(Chemical Dependency Treatment Beds)
Chapter 17 Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
(formerly Intermediate Care Facilities for the Mentally Retarded (ICF/MR))
Appendices
Appendix A: North Carolina Health Service Areas
Appendix B: Partial Listing of Medical Facilities Planning Acronyms/Terms
Appendix C: List of Contiguous Counties
Appendix D: North Carolina Certificate of Need Statute
Appendix E: Regulation of Detoxification Services Provided in
Hospitals Licensed under Article 5, Chapter 131E,
of the General Statutes
Appendix F: Academic Medical Center Teaching Hospitals
Appendix G: Critical Access Hospitals
DISCLAIMER
The North Carolina 2013 State Medical Facilities Plan is subject to revision throughout the
year. Notices containing updates and changes will be posted on the North Carolina Division
of Health Service Regulation web page at http://www.ncdhhs.gov/dhsr/ncsmfp/index.html as
they are approved. Check our web site for updates.
Chapter 1:
Overview of the North Carolina 2013 State Medical Facilities Plan
CHAPTER 1
OVERVIEW OF THE NORTH CAROLINA 2013 STATE MEDICAL FACILITIES
PLAN
Purpose
The North Carolina 2013 State Medical Facilities Plan (“Plan”) was developed by the
North Carolina Department of Health and Human Services, Division of Health Service
Regulation, under the direction of the North Carolina State Health Coordinating Council
(SHCC), pursuant to G.S. §131E-177. The major objective of the Plan is to provide individuals,
institutions, state and local government agencies, and community leadership with policies and
projections of need to guide local planning for specific health care facilities and services.
Projections of need are provided for the following types of facilities and services:
 acute care hospitals
 adult care facilities
 end-stage renal disease dialysis facilities
 hospice home care and hospice inpatient beds
 inpatient rehabilitation facilities
 intermediate care facilities for individuals with intellectual disabilities
(formerly intermediate care facilities for the mentally retarded)
 Medicare-certified home health agencies
 nursing care facilities
 operating rooms
 other acute care services
 psychiatric hospital units and specialty hospitals
 substance abuse hospital units, specialty hospitals,
and residential facilities
 technology and equipment services
Chapters dealing with specific facility/service categories contain summaries of the supply
and the utilization of each type of facility or service, a description of any changes in the
projection method and policies from the previous planning year, a description of the projection
method, and other data relevant to the projections of need.
The projections of need for the various facilities and services are used in conjunction with
other statutes and rules in reviewing certificate of need applications for establishment, expansion,
or conversion of health care facilities and services. All parties interested in health care facility
and health services planning should consider this Plan a key resource.
Basic Principles Governing the Development of this Plan
1. Safety and Quality Basic Principle
The State of North Carolina recognizes the importance of systematic and ongoing
improvement in the quality of health services. Citizens of North Carolina rightfully expect
health services to be safe and efficient. To warrant public trust in the regulation of health
services, monitoring of safety and quality using established and independently verifiable metrics
will be an integral part of the formulation and application of the North Carolina State Medical
Facilities Plan.
Scientific quantification of quality and safety is rapidly evolving. Emerging measures of
quality address both favorable clinical outcomes and patient satisfaction, while safety measures
focus on the elimination of practices that contribute to avoidable injury or death and the adoption
of practices that promote and ensure safety. The SHCC recognizes that while safety, clinical
outcomes, and satisfaction may be conceptually separable, they are often interconnected in
practice. The North Carolina State Medical Facilities Plan should maximize all three elements.
Where practicalities require balancing of these elements, priority should be given to safety,
followed by clinical outcomes, followed by satisfaction.
The appropriate measures for quality and safety should be specific to the type of facility
or service regulated. Clinical outcome and safety measures should be evidence-based and
objective. Patient satisfaction measures should be quantifiable. In all cases, metrics should be
standardized and widely reported and preference should be given to those metrics reported on a
national level. The SHCC recognizes that metrics meeting these criteria are currently better
established for some services than for others. Furthermore, experience and research as well as
regulation at the federal level will continue to identify new measures that may be incorporated
into the standards applicable to quality and safety. As experience with the application of quality
and safety metrics grows, the SHCC should regularly review policies and need methodologies
and revise them as needed to address any persistent and significant deficiencies in safety and
quality in a particular service area.
2. Access Basic Principle
Equitable access to timely, clinically appropriate and high quality health care for all the
people of North Carolina is a foundational principle for the formulation and application of the
North Carolina State Medical Facilities Plan. Barriers to access include, but are not limited to:
geography, low income, limited or no insurance coverage, disability, age, race, ethnicity, culture,
language, education and health literacy. Individuals whose access to needed health services is
impeded by any of these barriers are medically underserved. The formulation and
implementation of the North Carolina State Medical Facilities Plan seeks to reduce all of these
types of barriers to timely and appropriate access. The first priority is to ameliorate economic
barriers and the second priority is to mitigate time and distance barriers.
The impact of economic barriers is twofold. First, individuals without insurance, with
insufficient insurance, or without sufficient funds to purchase their own health care will often
require public funding to support access to regulated services. Second, the preferential selection
by providers of well funded patients may undermine the advantages that can accrue to the public
from market competition in health care. A competitive marketplace should favor providers that
deliver the highest quality and best value care, but only in the circumstances where all
competitors deliver like services to similar populations.
The SHCC assigns the highest priority to a need methodology that favors providers
delivering services to a patient population representative of all payer types in need of those
services in the service area. Comparisons of value and quality are most likely to be valid when
services are provided to like populations. Incentives for quality and process improvement,
resource maximization, and innovation are most effective when providers deliver services to a
similar and representative mixture of patients.
Access barriers of time and distance are especially critical to rural areas and small
communities. However, urban populations can experience similar access barriers. The SHCC
recognizes that some essential, but unprofitable, medical services may require support by
revenues gained from profitable services or other sources. The SHCC also recognizes a trend to
the delivery of some services in more accessible, less complex, and less costly settings.
Whenever verifiable data for outcome, satisfaction, safety, and costs for the delivery of such
services to representative patient populations justify, the SHCC will balance the advantages of
such ambulatory facilities with the needs for financial support of medically necessary but
unprofitable care.
The needs of rural and small communities that are distant from comprehensive urban
medical facilities merit special consideration. In rural and small communities selective
competition that disproportionately captures profitable services may threaten the viability of sole
providers of comprehensive care and emergency services. For this reason methodologies that
balance value, quality, and access in urban and rural areas may differ quantitatively. The SHCC
planning process will promote access to an appropriate spectrum of health services at a local
level, whenever feasible under prevailing quality and value standards.
3. Value Basic Principle
The SHCC defines health care value as the maximum health care benefit per dollar
expended. Disparity between demand growth and funding constraints for health care services
increases the need for affordability and value in health services. Maximizing the health benefit
for the entire population of North Carolina that is achieved by expenditures for services regulated
by the State Medical Facilities Plan will be a key principle in the formulation and
implementation of SHCC recommendations for the State Medical Facilities Plan.
Measurement of the cost component of the value equation is often easier than
measurement of benefit. Cost per unit of service is an appropriate metric when comparing
providers of like services for like populations. The cost basis for some providers may be inflated
by disproportionate care to indigent and underfunded patients. In such cases the SHCC
encourages the adjustment of cost measures to reflect such disparity, but only to the extent such
expenditures can be measured according to an established, state-wide standard that is uniformly
reported and verifiable. Measurement of benefit is more challenging. Standardized safety and
quality measures, when available, can be important factors in achieving improved value in the
provision of health services. Prevention, early detection and early intervention are important
means for increasing the total population benefit for health expenditures. Development of new
technology has the potential to add value by improving outcome and enhancing early detection.
Capital costs of such new technology may be greater but justified by the added population
benefit. At the same time overutilization of more costly and/or highly specialized, low-volume
services without evidence-based medical indications may contribute to escalating health costs
without commensurate population-based health benefit. The SHCC favors methodologies which
encourage technological advances for proven and affordable benefit and appropriate utilization
for evidence-based indications when available. The SHCC also recognizes the importance of
primary care and health education in promoting affordable health care and best utilization of
scarce and expensive health resources. Unfortunately, technologically sophisticated and costly
services that benefit small numbers of patients may be more readily pursued than simple and less
costly detection and prevention measures that benefit the broader population. In the pursuit of
maximum population-based health care value, the SHCC recognizes the potential adverse impact
for growth of regulated services to supplant services of broad benefit to the larger population.
Long-term enhancement of health care value will result from a State Medical Facilities
Plan that promotes a balance of competition and collaboration and encourages innovation in
health care delivery. The SHCC encourages the development of value-driven health care by
promoting collaborative efforts to create common resources such as shared health databases,
purchasing cooperatives, and shared information management, and by promoting coordinated
services that reduce duplicative and conflicting care. The SHCC also recognizes the importance
of balanced competition and market advantage in order to encourage innovation, in so far as
those innovations improve safety, quality, access, and value in health care delivery.
The State Health Planning Process
Throughout the development of the North Carolina State Medical Facilities Plan there are
opportunities for public review and comment. Sections of the Plan, including the policies and
methods for projecting need, are developed with the assistance of committees of the North
Carolina State Health Coordinating Council. The committees submit their recommendations to
the Council for approval. A Proposed Plan is assembled and made available to the public.
Public hearings on the Proposed Plan are held throughout the State during the summer.
Comments and petitions received during this period are considered by the Council and, upon
incorporation of all changes approved by the Council, a final draft of the Plan is presented to the
Governor for review and approval. With the Governor’s approval, the State Medical Facilities
Plan becomes the official document for health facility and health service planning in North
Carolina for the specified calendar year.
Other Publications
Information concerning publications or the availability of other data related to the health
planning process may be obtained by contacting the North Carolina Division of Health Service
Regulation, Medical Facilities Planning Branch.
North Carolina Division of Health Service Regulation
Medical Facilities Planning Branch
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
Telephone Number: (919) 855-3865
FAX Number: (919) 715-4413
NOTE
Determinations of need for services and facilities in this Plan do not imply an intent on the
part of the North Carolina Department of Health and Human Services, Division of Medical
Assistance to participate in the reimbursement of the cost of care of patients using services
and facilities developed in response to this need.
North Carolina State Health Coordinating Council Members,
Committee Membership, and Staff
Members: Representing: From:
Jerry Parks, Chairman Association of Local Health Directors Edenton
Donald Beaver Health Care Facilities Association Hickory
Bill Bedsole At-Large Washington
Greg Beier At-Large Winston-Salem
Don Bradley, MD Health Insurance Industry Durham
Richard Bruch, MD Medical Society Durham
Dennis Clements, III, MD Academic Medical Centers Durham
Johnnie Farmer County Commissioners Association Aulander
Anthony Foriest N.C. Senate Graham
Sandra Greene, DrPH At-Large Chapel Hill
Ted Griffin Business and Industry Durham
Harold Hart Business and Industry Siler City
Laurence Hinsdale At-Large Concord
Daniel Hoffmann Veterans Administration Durham
John Holt, Jr., MD At-Large Raleigh
Eric Janis, MD At-Large Smithfield
Brenda Latham-Sadler, MD At-Large Winston-Salem
Tim Ludwig At-Large New Bern
Leslie Marshall, MD At-Large Raleigh
Zach Miller Long-Term Care Facilities Association Wilmington
Michael Nagowski At-Large Fayetteville
Charles Niemeyer, MD At-Large Gastonia
Prashant Patel, MD At-Large Cary
Thomas Pulliam, MD At-Large Lewisville
Pam Tidwell Home Care Association Asheville
Deborah Teasley, PhD Area Health Education Centers Fayetteville
Christopher Ullrich, MD At-Large Charlotte
John Young Hospital Association Kings Mountain
Committees and Staff Members
Acute Care Services Committee
Planning for acute care beds, operating rooms, open heart surgery services, burn intensive
care services, transplantation services [bone marrow transplants and solid organ transplants], and
inpatient rehabilitation services:
Sandra Greene, DrPH, (Chair); Greg Beier, (Vice Chair); Bill Bedsole; Don Bradley, MD;
Brenda Latham-Sadler, MD; Leslie Marshall, MD; Michael Nagowski; Prashant Patel, MD;
John Young
Staffed by: Dr. Carol Potter
Long-Term and Behavioral Health Committee
Planning for nursing care facilities, adult care homes, home health services, hospice
services, end-stage renal disease dialysis facilities, psychiatric inpatient facilities, substance
abuse inpatient and residential services (chemical dependency treatment beds), and intermediate
care facilities for individuals with intellectual disabilities:
Donald Beaver; Johnnie Farmer; Anthony Foriest; Ted Griffin; Charles Niemeyer, MD; Zach
Miller; Thomas Pulliam, MD; Pam Tidwell
Staffed by: Elizabeth Brown, and Selena Youmans
Technology and Equipment Committee
Planning for lithotripsy, gamma knife, linear accelerators, positron emission tomography
scanners, magnetic resonance imaging scanners, and cardiac catheterization/angioplasty
equipment:
Christopher Ullrich, MD, (Chair); Richard Bruch, MD; Dennis Clements III, MD; Harold Hart;
Laurence Hinsdale; Daniel Hoffmann; John Holt, MD; Eric Janis, MD; Tim Ludwig; Deborah
Teasley, PhD
Staffed by: Shelley Carraway
Medical Facilities Planning Branch Staff
Nadine Pfeiffer, Planning Branch Manager
Elizabeth Brown, Planner
Shelley Carraway, Planner
Carol Potter, Planner
Erin Glendening, Technology Support Analyst
Kelli Fisk, Administrative Assistant
Division of Health Service Regulation
Drexdal Pratt, Director
Jim Keene, Consultant
Tom Elkins, Consultant
Chapter 2:
Amendments and Revisions to the State Medical Facilities Plan
CHAPTER 2
AMENDMENTS AND REVISIONS TO THE STATE MEDICAL FACILITIES PLAN
Amendment of Approved Plans
After the North Carolina State Medical Facilities Plan has been signed by the Governor,
it will be amended only as necessary to correct errors or to respond to statutory changes,
amounts of legislative appropriations or judicial decisions. The North Carolina State Health
Coordinating Council will conduct a public hearing on proposed amendments and will
recommend changes it deems appropriate for the Governor's approval.
NOTE: Need determinations as shown in this document may be increased or decreased during
the year pursuant to Policy GEN-2 (See Chapter 4).
Petitions to Revise the Next State Medical Facilities Plan
Anyone who finds that the North Carolina State Medical Facilities Plan policies or
methodologies, or the results of their application, are inappropriate may petition for changes or
revisions. Such petitions are of two general types: those requesting changes in basic policies
and methodologies, and those requesting adjustments to the need projections.
Petitions for Changes in Basic Policies and Methodologies
People who wish to recommend changes that may have a statewide effect are asked to
contact the Medical Facilities Planning Branch staff as early in the year as possible, and to
submit petitions no later than March 6, 2013. Changes with the potential for a statewide effect
are the addition, deletion, and revision of policies or projection methodologies. These types of
changes will need to be considered in the first four months of the calendar year as the North
Carolina Proposed State Medical Facilities Plan" (explained below) is being developed.
Instructions for Writing Petitions for Changes in Basic Policies and Methodologies
At a minimum, each written petition requesting a change in basic policies and
methodologies used in the North Carolina State Medical Facilities Plan should contain:
1. Name, address, email address and phone number of petitioner.
2. Statement of the requested change, citing the policy or planning
methodology in the North Carolina State Medical Facilities Plan for which
the change is proposed.
3. Reasons for the proposed change to include:
a. A statement of the adverse effects on the providers or consumers of
health services that are likely to ensue if the change is not made, and
b. A statement of alternatives to the proposed change that were
considered and found not feasible.
4. Evidence that the proposed change would not result in unnecessary
duplication of health resources in the area.
5. Evidence that the requested change is consistent with the three Basic
Principles governing the development of the North Carolina State Medical
Facilities Plan: Safety and Quality, Access, and Value.
Each written petition must be clearly labeled “Petition” and one copy of each petition
must be received by the North Carolina Division of Health Service Regulation’s Medical
Facilities Planning Branch by 5:00 p.m. on March 6, 2013. Petitions must be submitted by e-mail,
fax, mail or hand delivery.
E-Mail: DHSR.SMFP.Petitions-Comments@dhhs.nc.gov
Fax: 919-715-4413
Mail: North Carolina Division of Health Service Regulation
Medical Facilities Planning Branch
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
The office location and address for hand delivery and use of delivery services:
809 Ruggles Drive
Raleigh, North Carolina 27603
Response to Petitions for Changes in Basic Policies and Methodologies
The process for response to such petitions is as follows:
1. Staff, in reviewing the proposed change, may request additional
information and opinions from the petitioner or any other people or
organizations who may be affected by the proposed change.
2. The petition and other information will be made available to the members
of the appropriate committee of the North Carolina State Health
Coordinating Council.
3. The petition will be considered by the appropriate committee of the North
Carolina State Health Coordinating Council and the committee will make
recommendations to the North Carolina State Health Coordinating Council
regarding disposition of the petition.
4. The North Carolina State Health Coordinating Council will consider the
committee’s recommendations and make decisions regarding whether or
not to incorporate the changes into the Proposed North Carolina State
Medical Facilities Plan.
Petitioners will receive written notification of times and places of meetings at which their
petitions will be discussed. Disposition of all petitions for changes in basic policies and
methodologies in the North Carolina State Medical Facilities Plan will be made no later than the
final Council meeting of the calendar year.
Petitions for Adjustments to Need Determinations
A North Carolina Proposed State Medical Facilities Plan is adopted annually by the
North Carolina State Health Coordinating Council, and is made available for review by
interested parties during an annual "Public Review and Comment Period." During this period,
regional public hearings are held to receive oral/written comments and written petitions. The
Public Review and Comment Period for consideration of each North Carolina Proposed State
Medical Facilities Plan is determined annually and dates are available from the Medical
Facilities Planning Branch and published in the North Carolina State Medical Facilities Plan.
People who believe that unique or special attributes of a particular geographic area or
institution give rise to resource requirements that differ from those provided by application of the
standard planning procedures and policies may submit a written petition requesting an
adjustment be made to the need determination given in the North Carolina Proposed State
Medical Facilities Plan. These petitions should be delivered to the Medical Facilities Planning
Branch as early in the Public Review and Comment Period as possible, but no later than the last
day of this period. Requirements for petitions to change need determinations in the North
Carolina Proposed State Medical Facilities Plan are given below.
Instructions for Writing Petitions for Adjustments to Need Determinations
At a minimum, each written petition requesting an adjustment to a need determination in
the North Carolina Proposed State Medical Facilities Plan should contain:
1. Name, address, email address and phone number of petitioner.
2. A statement of the requested adjustment, citing the provision or need
determination in the North Carolina Proposed State Medical Facilities
Plan for which the adjustment is proposed.
3. Reasons for the proposed adjustment, including:
a. Statement of the adverse effects on the population of the
affected area that are likely to ensue if the adjustment is not
made, and
b. A statement of alternatives to the proposed adjustment that
were considered and found not feasible.
4. Evidence that health service development permitted by the proposed
adjustment would not result in unnecessary duplication of health
resources in the area.
5. Evidence that the requested adjustment is consistent with the three Basic
Principles governing the development of the North Carolina State
Medical Facilities Plan: Safety and Quality, Access and Value.
Petitioners should use the same service area definitions as provided in the program
chapters of the North Carolina Proposed State Medical Facilities Plan.
Petitioners should also be aware that the Medical Facilities Planning staff, in reviewing
the proposed adjustment, may request additional information and opinions from the petitioner or
any other people and organizations who may be affected by the proposed adjustment.
Each written petition must be clearly labeled “Petition” and one copy of each petition
must be received by the Medical Facilities Planning Branch by 5:00 p.m. on July 31, 2013.
Petitions must be submitted by e-mail, fax, mail or hand delivery.
E-Mail: DHSR.SMFP.Petitions-Comments@dhhs.nc.gov
Fax: 919-715-4413
Mail: North Carolina Division of Health Service Regulation
Medical Facilities Planning Branch
2714 Mail Service Center
Raleigh, North Carolina 27699-2714
The office location and address for hand delivery and use of delivery services:
809 Ruggles Drive
Raleigh, North Carolina 27603
Response to Petitions for Adjustments to Need Determinations
The process for response to these petitions by the North Carolina Division of Health
Service Regulation and the North Carolina State Health Coordinating Council is as follows:
1. Preparation of an agency report. Staff may request additional information
from the petitioner.
2. Consideration of the petition and the agency report by the appropriate
committee of the North Carolina State Health Coordinating Council.
3. Committee submits its recommendations to the North Carolina State
Health Coordinating Council regarding disposition of the petition.
4. Consideration of the committee recommendations by the North Carolina
State Health Coordinating Council and decisions regarding whether or
not to incorporate the recommended adjustments in the final draft of the
North Carolina State Medical Facilities Plan to be forwarded to the
Governor.
Petitioners will receive written notification of times and places of meetings at which their
petitions will be discussed. Disposition of all petitions for adjustments to need determinations in
the North Carolina State Medical Facilities Plan will be made no later than the date of the final
Council meeting of the calendar year.
Scheduled State Health Coordinating Council Meetings and Committee Meetings
Any changes to Council, Committee, Work Group and Public Hearing meeting dates, times and
locations will be posted on the meeting information web page at:
www.ncdhhs.gov/dhsr/mfp/meetings.html
North Carolina State Health Coordinating Council
March 6, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building
May 29, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
October 2, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Directions to the Brown Building can be found at:
www.ncdhhs.gov/dhsr/brown.html
The Council will conduct a public hearing on statewide issues related to development of the
North Carolina Proposed 2014 State Medical Facilities Plan immediately following the
business meeting on March 6, 2013.
Acute Care Services Committee
April 10, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
May 8, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
September 18, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Long-Term and Behavioral Health Committee
April 17, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
May 3, 2013 Dorothea Dix Campus 10:00 a.m.
(Friday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
September 11, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Technology and Equipment Committee
April 3, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
April 24, 2013 Dorothea Dix Campus 10:00 a.m.
(Wednesday) 801 Biggs Drive – Raleigh, N.C.
Brown Building Room 104
September 20, 2013 Dorothea Dix Campus 10:00 a.m.
(Friday) 801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Deadlines for Petitions and Comments, and Public Hearing Schedule
The deadline for receipt by the Medical Facilities Planning Branch (MFPB) of petitions, written
comments and written comments on petitions and comments is 5:00 p.m. on dates listed below.
March 6, 2013 The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2014 State Medical Facilities
Plan (SMFP) immediately following the business meeting.
March 22, 2013 Deadline for receipt by the MFPB of any written comments regarding
petitions or comments submitted by the March 6th deadline on statewide
issues related to development of the North Carolina Proposed 2014 State
Medical Facilities Plan.
2013 Schedule for Public Hearings on the N.C. Proposed 2014 SMFP
(all hearings begin at 1:30 p.m.)
July 12, 2013 Asheville Mountain Area Health Education Center
July 16, 2013 Wilmington New Hanover Regional Medical Center
July 19, 2013 Greensboro Moses Cone Health System
July 23, 2013 Greenville Pitt County Office Building
July 26, 2013 Charlotte Carolinas College of Health Sciences
July 31, 2013 Raleigh Dorothea Dix Campus – Brown Building
July 31, 2013 Deadline for receipt by MFPB of petitions for adjustments to need
determinations and other written comments regarding the North
Carolina Proposed 2014 State Medical Facilities Plan.
August 16, 2013 Deadline for receipt by the MFPB of any written comments on petitions
or comments submitted by the July 31st deadline regarding adjusted
need determinations or other issues arising from the North Carolina
Proposed 2014 State Medical Facilities Plan.
Chapter 3:
Certificate of Need Review Categories and Schedule
CHAPTER 3
CERTIFICATE OF NEED REVIEW CATEGORIES AND SCHEDULE
Certificates of need are required prior to the development of new institutional health
services identified as needed in the North Carolina State Medical Facilities Plan. The Certificate
of Need Section shall determine the appropriate review category or categories in which an
application shall be submitted pursuant to 10A NCAC 14C .0202. For proposals which include
more than one category, an applicant must contact the Certificate of Need Section prior to
submittal of the application for a determination regarding the appropriate review category or
categories and the applicable review period in which the proposal must be submitted.
The categories are as follows:
Category A
Proposals submitted by acute care hospitals, except those proposals included in Categories B
through M.
Category B
Proposals for:
o new nursing facilities or new nursing facility beds;
o new adult care home facilities or new adult care home beds; and
o new continuing care retirement communities applying for exemption under Policy NH-2
or Policy LTC-1.
Category C
Proposals for:
o new psychiatric facilities and new psychiatric beds;
o new intermediate care facilities for individuals with intellectual disabilities and new
ICF/IID beds;
o new substance abuse and chemical dependency treatment facilities and substance abuse
and chemical dependency treatment beds; and
o transfer of nursing care beds from state psychiatric hospitals to local communities
pursuant to Policy NH-5, psychiatric beds from state psychiatric hospitals to community
facilities pursuant to Policy PSY-1, and ICF/IID beds from state developmental centers to
community facilities pursuant to Chapter 858 of the 1983 Session Laws or Policy
ICF/MR-2.
Category D
Proposals for:
o new dialysis stations in response to the “County Need” or “Facility Need”
methodologies; and
o relocation of existing certified dialysis stations to another county pursuant to Policy
ESRD-2.
Category E
Proposals for:
o new inpatient rehabilitation facilities or new inpatient rehabilitation beds;
o new licensed ambulatory surgical facilities;
o new operating rooms; and
o relocation of existing operating rooms, as defined in G.S. 131E-176(18c), with the
exception of the relocation of an entire existing licensed ambulatory surgical facility
within the same county which is included in Category I.
Category F
Proposals for:
o new Medicare-certified home health agencies or home health offices;
o new hospices or hospice offices;
o new hospice inpatient facility beds; and
o new hospice residential care facility beds.
Category G
Proposals for:
o conversion of acute care beds to nursing care beds under Policy NH-1; and
o conversion of acute care beds to long-term care hospital beds.
Category H
Proposals for:
o bone marrow transplantation services;
o burn intensive care services;
o neonatal intensive care services;
o open heart surgery services;
o solid organ transplantation services;
o cardiac catheterization equipment;
o heart-lung bypass machines;
o gamma knives;
o lithotripters;
o fixed site magnetic resonance imaging scanners;
o positron emission tomography scanners
o linear accelerators;
o simulators;
o major medical equipment as defined in G.S. 131E-176(14o); and
o diagnostic centers as defined in G.S. 131E-176(7a).
Category I
Proposals for:
o changes of scope and cost overruns;
o expansions of existing continuing care retirement communities which are licensed by the
Department of Insurance at the date the application is filed and are applying under Policy
NH-2 or Policy LTC-1 for exemption from need determinations in Chapter 10: Nursing
Care Facilities or Chapter 11: Adult Care Homes;
o relocation within the same county of an entire existing health service facility (excluding
acute care hospitals);
o relocation within the same county of existing licensed nursing facility beds, existing
licensed adult care home beds, or existing certified dialysis stations;
o transfer of continuing care retirement community beds pursuant to Policy NH-7;
o reallocation of beds or services pursuant to Policy Gen-1;
o Category A or Policy AC-3 projects submitted by Academic Medical Center Teaching
Hospitals designated prior to January 1, 1990;
o acquisition of replacement equipment that does not result in an increase in the inventory
of the equipment; and
o projects not included in Categories A through H or Categories J through M.
Category J
Proposals for:
o demonstration projects;
o statewide burn intensive care services need determinations;
o relocation of existing adult care home or nursing facility beds pursuant to Policy NH-4,
NH-6 or LTC-2 to a different county which does not have a need determination for
additional beds; and
o any new institutional health service, as defined in G.S. 131E-176(16), that is proposed to
be developed or offered in Gates, Graham and Hyde counties, with the exception of
proposals in Categories B, D or I.
Category K
Proposals for:
o new or additional acute care beds in the acute care service area;
o relocation of existing licensed acute care beds to a different site within the same acute
care service area, except proposals included in Category J; and
o new long-term care hospital beds.
Category L
Proposals for new mobile magnetic resonance imaging scanners.
Category M
Proposals for:
o new or additional gastrointestinal endoscopy rooms as defined in G.S. 131E-176(7d); and
o relocation of existing gastrointestinal endoscopy rooms as set forth in G.S. 131E-
176(16)u, with the exception of the relocation of an entire existing licensed ambulatory
surgical facility within the same county which is included in Category I.
Review Dates
Table 3A shows the review schedule, by category, for certificate of need applications
requiring review. However, a service, facility, or equipment for which a need determination is
identified in the North Carolina State Medical Facilities Plan will have only one scheduled
review date and one corresponding application filing deadline in the calendar year, even though
the table shows multiple review dates for the broad category. In order to determine the
designated filing deadline for a specific need determination in the North Carolina State Medical
Facilities Plan, an applicant must refer to the applicable need determination table for that service
in the related chapter in the Plan. Applications for certificates of need for new institutional
health services not specified in other chapters of the Plan shall be reviewed pursuant to the
following review schedule, with the exception that no reviews are scheduled if the need
determination is zero. Need determinations for additional dialysis stations pursuant to the
“county need” or “facility need” methodologies shall be reviewed in accordance with the
provisions of Chapter 14.
In order to give the Certificate of Need Section sufficient time to provide public
notice of review and public notice of public hearings as required by G.S. 131E-185, the
deadline for filing certificate of need applications is 5:30 p.m. on the 15th day of the month
preceding the “CON Beginning Review Date.” In instances when the 15th day of the month
falls on a weekend or holiday, the filing deadline is 5:30 p.m. on the next business day. The
filing deadline is absolute and applications received after the deadline shall not be reviewed
in that review period. Applicants are strongly encouraged to complete all materials at least
one day prior to the filing deadline and to submit material early on the “Certificate of Need
Application Due Date.”
Table 3A: 2013 Certificate of Need Review Schedule
CON Beginning
Review Date
Health Service Area
I, II, III
Health Service Area
IV, V, VI
January 1, 2013 -- --
February 1, 2013 A, B, C, G, H, I --
March 1, 2013 -- A, B, C, E, G, H, I
April 1, 2013 C, D, E, F, H, I, K(1), M(1) D
May 1, 2013 -- C, E, F, H, I, K(4), M(4)
June 1, 2013 A, B, C, F, H, I --
July 1, 2013 J A, B, C, E, H, I, J, K(5), M(5)
August 1, 2013 B, C, E, F, H, I, K(2), M(2) --
September 1, 2013 -- B, C, F, H, I
October 1, 2013 A, C, D, F, H, I D
November 1, 2013 B, C, E, H, I, L, K(3), M(3) --
December 1, 2013 -- A, B, C, E, F, H, I, L, K(6), M(6)
(1) HSA I only.
(2) HSA II only.
(3) HSA III only.
(4) HSA IV only.
(5) HSA V only.
(6) HSA VI only.
For further information about specific schedules, timetables, and certificate of need
application forms, contact:
North Carolina Division of Health Service Regulation
Certificate of Need Section
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
Phone: (919) 855-3873
Chapter 4:
Statement of Policies:
• Acute Care Hospitals
• Nursing Care Facilities
• Adult Care Homes
• Home Health Services
• End-Stage Renal Disease Dialysis Services
• Mental Health, Developmental Disabilities,
and Substance Abuse (General)
• Psychiatric Inpatient Services Facilities
• Intermediate Care Facilities for Individuals with Intellectual
Disabilities (formerly Intermediate Care Facilities for the
Mentally Retarded)
• All Health Services
CHAPTER 4
STATEMENT OF POLICIES
Summary of Policy Changes for 2013
There were no substantive policy changes incorporated into the North Carolina 2013
State Medical Facilities Plan.
Throughout Chapter 4, references to dates have been advanced by one year, as
appropriate.
POLICIES APPLICABLE TO ACUTE CARE HOSPITALS (AC)
POLICY AC-1: USE OF LICENSED BED CAPACITY DATA FOR PLANNING
PURPOSES
For planning purposes, the number of licensed beds shall be determined by the Division
of Health Service Regulation in accordance with standards found in 10A NCAC 13B - Section
.6200 and Section .3102 (d).
Licensed bed capacity of each hospital is used for planning purposes. It is the hospital's
responsibility to notify the Division of Health Service Regulation promptly when any of the
space allocated to its licensed bed capacity is converted to another use, including purposes not
directly related to health care.
POLICY AC-3: EXEMPTION FROM PLAN PROVISIONS FOR CERTAIN
ACADEMIC MEDICAL CENTER TEACHING HOSPITAL PROJECTS
Projects for which certificates of need are sought by academic medical center teaching
hospitals may qualify for exemption from the need determinations of this document. The
Medical Facilities Planning Branch shall designate as an Academic Medical Center Teaching
Hospital any facility whose application for such designation demonstrates the following
characteristics of the hospital:
1. Serves as a primary teaching site for a school of medicine and at least one
other health professional school, providing undergraduate, graduate and
postgraduate education.
2. Houses extensive basic medical science and clinical research programs,
patients and equipment.
3. Serves the treatment needs of patients from a broad geographic area
through multiple medical specialties.
Exemption from the provisions of need determinations of the North Carolina State
Medical Facilities Plan shall be granted to projects submitted by Academic Medical Center
Teaching Hospitals designated prior to January 1, 1990 provided the projects are necessary to
meet one of the following unique academic medical needs:
1. Necessary to complement a specified and approved expansion of the
number or types of students, residents or faculty that are specifically
required for an expansion of students or residents, as certified by the head
of the relevant associated professional school; the applicant shall provide
documentation that the project is consistent with any relevant standards,
recommendations, or guidance from specialty education accrediting
bodies; or
2. With respect to the acquisition of equipment, is necessary to accommodate
the recruitment or retention of a full-time faculty member who will devote
a majority of his or her time to the combined activities of teaching
(including teaching within the clinical setting), research, administrative or
other academic responsibilities within the academic medical center
teaching hospital or medical school; or
3. Necessary to accommodate patients, staff or equipment for a specified and
approved expansion of research activities, as certified by the head of the
entity sponsoring the research; and including, to the extent applicable,
documentation pertaining to grants, funding, accrediting or other
requirements, and any proposed clinical application of the asset; or
4. Necessary to accommodate changes in requirements of specialty education
accrediting bodies, as evidenced by copies of documents issued by such
bodies.
A project submitted by an Academic Medical Center Teaching Hospital under this policy
that meets one of the above conditions shall demonstrate that the Academic Medical Center
Teaching Hospital’s teaching or research need for the proposed project cannot be achieved
effectively at any non-Academic Medical Center Teaching Hospital provider which currently
offers and has capacity within the service for which the exemption is requested and which is
within 20 miles of the Academic Medical Center Teaching Hospital.
The Academic Medical Center Teaching Hospital shall include in its application an
analysis of the cost, benefits and feasibility of engaging that provider in a collaborative effort
that achieves the academic goals of the project as compared with the certificate of need
application proposal. The Academic Medical Center Teaching Hospital shall also provide a
summary of a discussion or documentation of its attempt to engage the provider in discussion
regarding its analysis and conclusions.
The Academic Medical Center Teaching Hospital shall include in its application a
discussion of any similar assets within 20 miles that are under the control of the applicant or the
associated professional school and the feasibility of using those assets to meet the unique
teaching or research needs of the Academic Medical Center Teaching Hospital.
For each of the first five years of operation the approved applicant shall submit to the
Certificate of Need Section a detailed description of how the project achieves the academic
requirements of the appropriate section(s) of Policy AC-3, paragraph 2 [items 1 through 4] as
proposed in the certificate of need application.
Applicants who are approved for Policy AC-3 projects after January 1, 2012 shall report
those Policy AC-3 assets (including beds, operating rooms and equipment) on the appropriate
annual license renewal application or registration form for the asset. The information to be
reported for the Policy AC-3 assets shall include: (a) inventory or number of units of AC-3
Certificate of Need-approved assets (including all beds, operating rooms and equipment); (b) the
annual volume of days, cases or procedures performed for the reporting year on the Policy AC-3
approved asset; and (c) the patient origin by county. Neither the assets under (a) above nor the
utilization from (b) above shall be used in the annual State Medical Facilities Plan need
determination formulas, but both the assets and the utilization will be available for informational
purposes to users of the State Medical Facilities Plan.
This policy does not apply to a proposed project or the portion thereof that is based solely
upon the inability of the State Medical Facilities Plan methodology to accurately project need for
the proposed service(s), due to documented differences in patient treatment times that are
attributed to education or research components in the delivery of patient care or to differences in
patient acuity or case mix that are related to the applicant’s academic mission. However, the
applicant may submit a petition pursuant to the State Medical Facilities Plan Petitions for
Adjustments to Need Determinations process to meet that need or portion thereof.
Policy AC-3 projects are required to materially comply with representations made in the
certificate of need application regarding academic based need. If an asset originally developed
or acquired pursuant to Policy AC-3 is no longer used for research and/or teaching, the
Academic Medical Center Teaching Hospital shall surrender the certificate of need.
POLICY AC-4: RECONVERSION TO ACUTE CARE
Facilities that have redistributed beds from acute care bed capacity to psychiatric,
rehabilitation, nursing care, or long-term care hospital use, shall obtain a certificate of need to
convert this capacity back to acute care. Applicants proposing to reconvert psychiatric,
rehabilitation, nursing care, or long-term care hospital beds back to acute care beds shall
demonstrate that the hospital’s average annual utilization of licensed acute care beds as
calculated using the most recent Truven Health Analytics Days of Care as provided to the
Medical Facilities Planning Branch by The Cecil G. Sheps Center for Health Services Research
at the University of North Carolina at Chapel Hill, is equal to or greater than the target
occupancies shown below, but shall not be evaluated against the acute care bed need
determinations shown in Chapter 5 of the North Carolina State Medical Facilities Plan. In
determining utilization rates and average daily census, only acute care bed “days of care” are
counted.
Facility Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
1 – 99 66.7%
100 – 200 71.4%
Greater than 200 75.2%
POLICY AC-5: REPLACEMENT OF ACUTE CARE BED CAPACITY
Proposals for either partial or total replacement of acute care beds (i.e., construction of
new space for existing acute care beds) shall be evaluated against the utilization of the total
number of acute care beds in the applicant’s hospital in relation to utilization targets found
below. For hospitals not designated by the Centers for Medicare & Medicaid Services as
Critical Access Hospitals, in determining utilization of acute care beds, only acute care bed
“days of care” shall be counted. For hospitals designated by the Centers for Medicare &
Medicaid Services as Critical Access Hospitals, in determining utilization of acute care beds,
only acute care bed “days of care” and swing bed days (i.e., nursing facility days of care) shall
be counted in determining utilization of acute care beds. Any hospital proposing replacement of
acute care beds must clearly demonstrate the need for maintaining the acute care bed capacity
proposed within the application. Additionally, if the hospital is a Critical Access Hospital and
swing bed days are proposed to be counted in determining utilization of acute care beds, the
hospital shall also propose to remain a Critical Access Hospital and must demonstrate the need
for maintaining the swing bed capacity proposed within the application. If the Critical Access
Hospital does not propose to remain a Critical Access Hospital, only acute care bed “days of
care” shall be counted in determining utilization of acute care beds and the hospital must clearly
demonstrate the need for maintaining the acute care bed capacity proposed within the
application.
Facility Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
1 – 99 66.7%
100 – 200 71.4%
Greater than 200 75.2%
POLICY AC-6: HEART-LUNG BYPASS MACHINES FOR EMERGENCY
COVERAGE
To protect cardiac surgery patients, who may require emergency procedures while
scheduled procedures are under way, a need is determined for one additional heart-lung bypass
machine whenever a hospital is operating an open heart surgery program with only one heart-lung
bypass machine. The additional machine is to be used to assure appropriate coverage for
emergencies and in no instance shall this machine be scheduled for use at the same time as the
machine used to support scheduled open heart surgery procedures. A certificate of need
application for a machine acquired in accordance with this provision shall be exempt from
compliance with the performance standards set forth in 10A NCAC 14C .1703.
POLICIES APPLICABLE TO NURSING CARE FACILITIES (NH)
POLICY NH-1: PROVISION OF HOSPITAL-BASED NURSING CARE
A certificate of need may be issued to a hospital which is licensed under G.S. 131E,
Article 5, and which meets the conditions set forth below and in 10A NCAC 14C .1100, to
convert up to 10 beds from its licensed acute care bed capacity for use as hospital-based nursing
care beds without regard to determinations of need in Chapter 10: Nursing Care Facilities, if the
hospital:
1. is located in a county which was designated as non-metropolitan by the
U.S. Office of Management and Budget on January 1, 2013; and
2. on January 1, , 2013, had a licensed acute care bed capacity of 150 beds or
less.
The certificate of need shall remain in force as long as the North Carolina Department of
Health and Human Services determines that the hospital is meeting the conditions outlined in
this policy.
"Hospital-based nursing care" is defined as nursing care provided to a patient who has
been directly discharged from an acute care bed and cannot be immediately placed in a licensed
nursing facility because of the unavailability of a bed appropriate for the individual's needs.
Nursing care beds developed under this policy are intended to provide placement for
residents only when placement in other nursing care beds is unavailable in the geographic area.
Hospitals which develop nursing care beds under this policy shall discharge patients to other
nursing facilities with available beds in the geographic area as soon as possible where
appropriate and permissible under applicable law. Necessary documentation, including copies of
physician referral forms (FL 2) on all patients in hospital-based nursing units, shall be made
available for review upon request by duly authorized representatives of licensed nursing
facilities.
For purposes of this policy, beds in hospital-based nursing care shall be certified as a
"distinct part" as defined by the Centers for Medicare & Medicaid Services. Nursing care beds
in a "distinct part" shall be converted from the existing licensed acute care bed capacity of the
hospital and shall not be reconverted to any other category or type of bed without a certificate of
need.
An application for a certificate of need for reconverting beds to acute care shall be
evaluated against the hospital's service needs utilizing target occupancies shown in Policy AC-4,
without regard to the acute care bed need shown in Chapter 5: Acute Care Hospital Beds. A
certificate of need issued for a hospital-based nursing care unit shall remain in force as long as
the following conditions are met:
1. The nursing care beds shall be certified for participation in the Title XVIII
(Medicare) and Title XIX (Medicaid) programs;
2. The hospital discharges residents to other nursing facilities in the
geographic area with available beds when such discharge is appropriate
and permissible under applicable law;
3. Patients admitted shall have been acutely ill inpatients of an acute hospital
or its satellites immediately preceding placement in the nursing care unit.
The granting of beds for hospital-based nursing care shall not allow a hospital to convert
additional beds without first obtaining a certificate of need. Where any hospital, or the parent
corporation or entity of such hospital, any subsidiary corporation or entity of such hospital, or
any corporation or entity related to or affiliated with such hospital by common ownership,
control or management:
1. Applies for and receives a certificate of need for nursing care bed need
determinations in Chapter 10 of the North Carolina State Medical
Facilities Plan, or
2. Currently has nursing home beds licensed as a part of the hospital under
G.S. 131E, Article 5, or
3. Currently operates nursing care beds under the Federal Swing Bed
Program (P.L. 96-499),
such hospital shall not be eligible to apply for a certificate of need for hospital-based nursing
care beds under this policy. Hospitals designated by the State of North Carolina as Critical
Access Hospitals pursuant to section 1820 (f) of the Social Security Act, as amended, which
have not been allocated nursing care beds under provisions of G.S. 131E 175-190, may apply to
develop beds under this policy. However, such hospitals shall not develop nursing care beds
both to meet needs determined in Chapter 10 of the North Carolina State Medical Facilities Plan
and this policy.
Beds certified as a "distinct part" under this policy shall be counted in the inventory of
existing nursing care beds and used in the calculation of unmet nursing care bed need for the
general population of a planning area.
Applications for certificates of need pursuant to this policy shall be accepted only for the
February 1 review cycle for Health Service Areas I, II and III, and for the March 1 review cycle
for Health Service Areas IV, V and VI. Nursing care beds awarded under this policy shall be
deducted from need determinations for the county as shown in Chapter 10: Nursing Care
Facilities.
Continuation of this policy shall be reviewed and approved by the North Carolina
Department of Health and Human Services annually. Certificates of need issued under policies
analogous to this policy in the North Carolina State Medical Facilities Plans subsequent to the
1986 Plan are automatically amended to conform with the provisions of this policy at the
effective date of this policy.
The North Carolina Department of Health and Human Services shall monitor this
program and ensure that patients affected by this policy are receiving services as indicated by
their care plan, and that conditions under which the certificate of need was granted are being
met.
POLICY NH-2: PLAN EXEMPTION FOR CONTINUING CARE RETIREMENT
COMMUNITIES
Qualified continuing care retirement communities may include from the outset, or add or
convert bed capacity for nursing care without regard to the nursing care bed need shown in
Chapter 10: Nursing Care Facilities. To qualify for such exemption, applications for certificates
of need shall show that the proposed nursing care bed capacity:
1. Will only be developed concurrently with, or subsequent to, construction
on the same site of facilities for both of the following levels of care:
a. independent living accommodations (apartments and homes) for
people who are able to carry out normal activities of daily living
without assistance; such accommodations may be in the form of
apartments, flats, houses, cottages, and rooms;
b. licensed adult care home beds for use by people who, because of
age or disability require some personal services, incidental medical
services, and room and board to assure their safety and comfort.
2. Will be used exclusively to meet the needs of people with whom the
facility has continuing care contracts (in compliance with the North
Carolina Department of Insurance statutes and rules) who have lived in a
non-nursing unit of the continuing care retirement community for a period
of at least 30 days. Exceptions shall be allowed when one spouse or
sibling is admitted to the nursing unit at the time the other spouse or
sibling moves into a non-nursing unit, or when the medical condition
requiring nursing care was not known to exist or be imminent when the
individual became a party to the continuing care contract.
3. Reflects the number of nursing care beds required to meet the current or
projected needs of residents with whom the facility has an agreement to
provide continuing care, after making use of all feasible alternatives to
institutional nursing care.
4. Will not be certified for participation in the Medicaid program.
One half of the nursing care beds developed under this exemption shall be excluded from
the inventory used to project nursing care bed need for the general population. Certificates of
need issued under policies analogous to this policy in the North Carolina State Medical Facilities
Plans subsequent to the 1985 State Medical Facilities Plan are automatically amended to
conform with the provisions of this policy at the effective date of this policy. Certificates of
need awarded pursuant to the provisions of Chapter 920, Session Laws 1983 or Chapter 445,
Session Laws 1985 shall not be amended.
POLICY NH-3: DETERMINATION OF NEED FOR ADDITIONAL NURSING
CARE BEDS IN SINGLE PROVIDER COUNTIES
When a nursing care facility with fewer than 80 nursing care beds is the only nursing care
facility within a county, it may apply for a certificate of need for additional nursing care beds in
order to bring the minimum number of nursing care beds available within the county to no more
than 80 nursing care beds without regard to the nursing care bed need determination for that
county as listed in Chapter 10: Nursing Care Facilities.
POLICY NH-4: RELOCATION OF CERTAIN NURSING FACILITY BEDS
A certificate of need to relocate existing licensed nursing facility beds to another
county(ies) may be issued to a facility licensed as a nursing facility under G.S. Chapter 131E,
Article 6, Part 1, provided that the conditions set forth below and in 10A NCAC 14C .1100 and
the review criteria in G.S. 131E-183(a) are met. A facility applying for a certificate of need to
relocate nursing facility beds shall demonstrate that:
1. It is a non-profit nursing facility supported by and directly affiliated with a
particular religion and that it is the only nursing facility in North Carolina
supported by and affiliated with that religion;
2. The primary purpose for the nursing facility’s existence is to provide long-term
care to followers of the specified religion in an environment which
emphasizes religious customs, ceremonies, and practices;
3. Relocation of the nursing facility beds to one or more sites is necessary to
more effectively provide nursing care to followers of the specified religion
in an environment which emphasizes religious customs, ceremonies, and
practices;
4. The nursing facility is expected to serve followers of the specified religion
from a multi-county area; and
5. The needs of the population presently served shall be met adequately
pursuant to G.S. 131E-183.
Exemption from the need determinations in Chapter 10: Nursing Care Facilities shall be
granted to a nursing facility for purposes of relocating existing licensed nursing care beds to
another county provided that it complies with all of the criteria listed in Subparts 1 through 5
above.
Any certificate of need issued under this policy shall be subject to the following conditions:
1. The nursing facility shall relocate beds in at least two stages over a period
of at least six months or such shorter period of time as is necessary to
transfer residents desiring to transfer to the new facility and otherwise
make discharge arrangements acceptable to residents not desiring to
transfer to the new facility; and
2. The nursing facility shall provide a letter to the Nursing Home Licensure
and Certification Section, on or before the date that the first group of beds
are relocated, irrevocably committing the facility to relocate all of the
nursing facility beds for which it has a certificate of need to relocate; and
3. Subsequent to providing the letter to the Nursing Home Licensure and
Certification Section described in Subsection 2 above, the nursing facility
shall accept no new patients in the beds which are being relocated, except
new patients who, prior to admission, indicate their desire to transfer to
the facility’s new location(s).
POLICY NH-5: TRANSFER OF NURSING FACILITY BEDS FROM STATE
PSYCHIATRIC HOSPITAL NURSING FACILITIES TO COMMUNITY
FACILITIES
Beds in state psychiatric hospitals that are certified as nursing facility beds may be
relocated to licensed nursing facilities. However, before nursing facility beds are transferred out
of the state psychiatric hospitals, services shall be available in the community. State psychiatric
hospital nursing facility beds that are relocated to licensed nursing facilities shall be closed
within 90 days following the date the transferred beds become operational in the community.
Licensed nursing facilities proposing to operate transferred nursing facility beds shall
commit to serve the type of residents who are normally placed in nursing facility beds at the state
psychiatric hospitals. To help ensure that relocated nursing facility beds will serve those people
who would have been served by state psychiatric hospitals in nursing facility beds, a certificate
of need application to transfer nursing facility beds from a state hospital shall include a written
memorandum of agreement between the director of the applicable state psychiatric hospital; the
director of the North Carolina Division of State Operated Healthcare Facilities; the secretary of
the North Carolina Department of Health and Human Services; and the person submitting the
proposal.
This policy does not allow the development of new nursing care beds. Nursing care beds
transferred from state psychiatric hospitals to the community pursuant to Policy NH-5 shall be
excluded from the inventory.
POLICY NH-6: RELOCATION OF NURSING FACILITY BEDS
Relocations of existing licensed nursing facility beds are allowed only within the host
county and to contiguous counties currently served by the facility, except as provided in Policies
NH-4, NH-5 and NH-7. Certificate of need applicants proposing to relocate licensed nursing
facility beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
licensed nursing facility beds in the county that would be losing nursing
facility beds as a result of the proposed project, as reflected in the North
Carolina State Medical Facilities Plan in effect at the time the certificate
of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed
nursing facility beds in the county that would gain nursing facility beds as
a result of the proposed project, as reflected in the North Carolina State
Medical Facilities Plan in effect at the time the certificate of need review
begins.
POLICY NH-7: TRANSFER OF CONTINUING CARE RETIREMENT
COMMUNITY BEDS
A certificate of need to relocate existing licensed nursing beds to another county or
counties may be issued to a facility licensed as a nursing facility under G.S. Chapter 131E,
Article 6, Part 1 without regard to the nursing care bed need shown in Chapter 10, provided that
the following conditions are met:
1. Any certificate of need application filed pursuant to this policy must
satisfy:
a. the regulatory review criteria in 10A NCAC 14C .1100, except the
performance standards in 10A NCAC 14C .1102(a) and (b); and
b. the review criteria in G.S. 131E-183(a).
2. The nursing facility receiving the beds (“the receiving facility”) must:
a. be part of a not-for-profit continuing care retirement community
(CCRC);
b. be part of a CCRC which is affiliated through ownership,
governance, or leasehold with a not-for-profit organization which
provides long-term care to residents;
c. provide CCRC services to residents from multiple counties in
addition to the county in which the facility is located; and
d. use the transferred beds exclusively to meet the needs of people
either eligible for Medicaid or eligible for Medicaid within 45 days
of admission to the nursing facility bed with whom the facility has
continuing care contracts (in compliance with the North Carolina
Department of Insurance statutes and rules) who have lived in a
non-nursing unit of the continuing care retirement community for a
period of at least 30 days.
3. The nursing facility transferring the beds (“the transferring facility”) must
be a CCRC affiliated through ownership, governance or leasehold with the
same not-for-profit organization as the receiving facility.
4. The transferred beds shall not have been originally approved through the
certificate of need process on or after January 1, 1976 and shall have been
eligible prior to January 1, 1976 to be certified for Medicaid.
5. No more than five beds may be transferred to any single nursing facility
pursuant to this policy during any consecutive three-year period.
6. Certificate of need applicants proposing to relocate licensed nursing
facility beds under this policy shall demonstrate that the proposal will not
result in a deficit in the number of licensed nursing facility beds in the
county that would be losing nursing facility beds as a result of the
proposed project, as reflected in the North Carolina State Medical
Facilities Plan in effect at the time the certificate of need review begins.
7. Nursing facility beds relocated under this policy shall be counted in the
planning inventory of the receiving county.
POLICY NH-8: INNOVATIONS IN NURSING FACILITY DESIGN
Certificate of need applicants proposing new nursing facilities, replacement nursing
facilities, and projects associated with the expansion and/or renovation of existing nursing
facilities shall pursue innovative approaches in care practices, work place practices and
environmental design that address quality of care and quality of life needs of the residents.
These plans could include innovative design elements that encourage less institutional, more
home-like settings, privacy, autonomy and resident choice, among others.
POLICIES APPLICABLE TO ADULT CARE HOMES
POLICY LTC-1: PLAN EXEMPTION FOR CONTINUING CARE RETIREMENT
COMMUNITIES – Adult Care Home Beds
Qualified continuing care retirement communities may include from the outset, or add or
convert bed capacity for adult care without regard to the adult care home bed need shown in
Chapter 11: Adult Care Homes. To qualify for such exemption, applications for certificates of
need shall show that the proposed adult care home bed capacity:
1. Will only be developed concurrently with, or subsequent to, construction
on the same site of independent living accommodations (apartments and
homes) for people who are able to carry out normal activities of daily
living without assistance; such accommodations may be in the form of
apartments, flats, houses, cottages, and rooms.
2. Will provide for the provision of nursing services, medical services, or
other health related services as required for licensure by the North
Carolina Department of Insurance.
3. Will be used exclusively to meet the needs of people with whom the
facility has continuing care contracts (in compliance with the North
Carolina Department of Insurance statutes and rules) who have lived in a
non-nursing or adult care unit of the continuing care retirement
community for a period of at least 30 days. Exceptions shall be allowed
when one spouse or sibling is admitted to the adult care home unit at the
time the other spouse or sibling moves into a non-nursing or adult care
unit, or when the medical condition requiring nursing or adult care home
care was not known to exist or be imminent when the individual became a
party to the continuing care contract.
4. Reflects the number of adult care home beds required to meet the current
or projected needs of residents with whom the facility has an agreement to
provide continuing care, after making use of all feasible alternatives to
institutional adult care home care.
5. Will not participate in the Medicaid program or serve State-County
Special Assistance recipients.
One half of the adult care home beds developed under this exemption shall be excluded
from the inventory used to project adult care home bed need for the general population.
Certificates of need issued under policies analogous to this policy in the North Carolina State
Medical Facilities Plans subsequent to the North Carolina 2002 State Medical Facilities Plan are
automatically amended to conform with the provisions of this policy at the effective date of this
policy.
POLICY LTC-2: RELOCATION OF ADULT CARE HOME BEDS
Relocations of existing licensed adult care home beds are allowed only within the host
county and to contiguous counties currently served by the facility. Certificate of need applicants
proposing to relocate licensed adult care home beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
licensed adult care home beds in the county that would be losing adult
care home beds as a result of the proposed project, as reflected in the
North Carolina State Medical Facilities Plan in effect at the time the
certificate of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed adult
care home beds in the county that would gain adult care home beds as a
result of the proposed project, as reflected in the North Carolina State
Medical Facilities Plan in effect at the time the certificate of need review
begins.
POLICIES APPLICABLE TO HOME HEALTH SERVICES (HH)
POLICY HH-3: NEED DETERMINATION FOR MEDICARE-CERTIFIED HOME
HEALTH AGENCY IN A COUNTY
When a county has no Medicare-certified home health agency office physically located
within the county’s borders, and the county has a population of more than 20,000 people; or, if
the county has a population of less than 20,000 people and there is not an existing Medicare-certified
home health agency office located in a North Carolina county within 20 miles, need for
a new Medicare-certified home health agency office in the county is thereby established through
this policy. The “need determination” shall be reflected in the next annual North Carolina State
Medical Facilities Plan that is published following determination that a county meets the criteria
indicated above. (Population is based on population estimates/projections from the North
Carolina Office of State Budget and Management for the plan year in which the need
determination would be made excluding active duty military for any county with more than 500
active duty military personnel. The measurement of 20 miles will be in a straight line from the
closest point on the county line of the county in which an existing agency office is located to the
county seat of the county in which there is no agency.)
POLICIES RELATED TO END-STAGE RENAL DISEASE DIALYSIS SERVICES
(ESRD)
POLICY ESRD-2: RELOCATION OF DIALYSIS STATIONS
Relocations of existing dialysis stations are allowed only within the host county and to
contiguous counties currently served by the facility. Certificate of need applicants proposing to
relocate dialysis stations to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of
dialysis stations in the county that would be losing stations as a result of
the proposed project, as reflected in the most recent North Carolina
Semiannual Dialysis Report, and
2. Demonstrate that the proposal shall not result in a surplus of dialysis
stations in the county that would gain stations as a result of the proposed
project, as reflected in the most recent North Carolina Semiannual
Dialysis Report.
GENERAL POLICY APPLICABLE TO ALL MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE FACILITIES (MH)
POLICY MH-1: LINKAGES BETWEEN TREATMENT SETTINGS
An applicant for a certificate of need for psychiatric, substance abuse, or Intermediate
Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) beds shall document that
the affected local management entity-managed care organization has been contacted and invited
to comment on the proposed services.
POLICIES APPLICABLE TO PSYCHIATRIC INPATIENT SERVICES FACILITIES
(PSY)
POLICY PSY-1: TRANSFER OF BEDS FROM STATE PSYCHIATRIC
HOSPITALS TO COMMUNITY FACILITIES
Beds in the state psychiatric hospitals used to serve short-term psychiatric patients may
be relocated to community facilities through the certificate of need process. However, before
beds are transferred out of the state psychiatric hospitals, services and programs shall be
available in the community. State psychiatric hospital beds that are relocated to community
facilities shall be closed within 90 days following the date the transferred beds become
operational in the community.
Facilities proposing to operate transferred beds shall submit an application to the
Certificate of Need Section of the North Carolina Department of Health and Human Services and
commit to serve the type of short-term patients normally placed at the state psychiatric hospitals.
To help ensure that relocated beds will serve those people who would have been served by the
state psychiatric hospitals, a proposal to transfer beds from a state hospital shall include a written
memorandum of agreement between the local management entity-managed care organization
serving the county where the beds are to be located, the secretary of the North Carolina
Department of Health and Human Services, and the person submitting the proposal.
POLICIES APPLICABLE TO INTERMEDIATE CARE FACILITIES FOR
INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICF/IID) (formerly
Intermediate Care Facilities for the Mentally Retarded (ICF/MR))
POLICY ICF/IID-1: TRANSFER OF ICF/IID BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES FOR MEDICALLY
FRAGILE CHILDREN
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) beds
in state operated developmental centers may be relocated to community facilities through the
certificate of need process for the establishment of community ICF/IID facilities to serve
children ages birth through six years who have severe to profound developmental disabilities and
are medically fragile. This policy allows for the relocation or transfer of beds only and does not
provide for transfer of residents with the beds. State operated developmental center ICF/IID
beds that are relocated to community facilities shall be closed upon licensure of the transferred
beds.
Facilities proposing to operate transferred beds shall submit an application to the
Certificate of Need Section demonstrating a commitment to serve children ages birth through six
years who have severe to profound developmental disabilities and are medically fragile. To help
ensure the relocated beds will serve these residents such proposal shall include a written
agreement with the following representatives: director of the local management entity/managed
care organization serving the county where the group home is to be located; the director of the
applicable state operated developmental center; the director of the North Carolina Division of
State Operated Healthcare Facilities; the secretary of the North Carolina Department of Health
and Human Services and the operator of the group home.
POLICY ICF/IID-2: TRANSFER OF ICF/IID BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES FOR
INDIVIDUALS WHO CURRENTLY OCCUPY THE BEDS
Existing certified Intermediate Care Facilities for Individuals with Intellectual
Disabilities (ICF/IID) beds in state operated developmental centers may be transferred through
the certificate of need process to establish ICF/IID group homes in the community to serve
people with complex behavioral challenges and/or medical conditions for whom a community
ICF/IID placement is appropriate, as determined by the individual’s treatment team and with the
individual/guardian being in favor of the placement. This policy requires the transfer of the
individuals who currently occupy the ICF/IID beds in the developmental center to the
community facility when the beds are transferred. The beds in the state operated developmental
center shall be closed upon certification of the transferred ICF/IID beds in the community
facility. Providers proposing to develop transferred ICF/IID beds, as those beds are described in
this policy, shall submit an application to the Certificate of Need Section that demonstrates their
clinical experience in treating individuals with complex behavioral challenges or medical
conditions in a residential ICF/IID setting. To ensure the transferred beds will be used to serve
these individuals, a written agreement between the following parties shall be obtained prior to
development of the group home: director of the local management entity-managed care
organization serving the county where the group home is to be located, the director of the
applicable developmental center, the director of the North Carolina Division of State Operated
Healthcare Facilities, the secretary of the North Carolina Department of Health and Human
Services and the operator of the group home.
POLICIES APPLICABLE TO ALL HEALTH SERVICES (GEN)
The policy statements below apply to all health services including acute care (hospitals,
ambulatory surgical facilities, operating rooms, rehabilitation facilities, and technology); long-term
care (nursing homes, adult care homes, Medicare-certified home health agencies, end-stage
renal disease services and hospice services); mental health (psychiatric facilities, substance
abuse facilities, and ICF/IID ) and services and equipment including bone marrow
transplantation services, burn intensive care services, neonatal intensive care services, open heart
surgery services, solid organ transplantation services, cardiac catheterization equipment, heart-lung
bypass machines, gamma knives, linear accelerators, lithotripters, magnetic resonance
imaging scanners, positron emission tomography scanners, simulators, major medical equipment
as defined in G.S. 131E-176(14o), and diagnostic centers as defined in G.S. 131E-176(7a).
POLICY GEN-1: REALLOCATIONS
1. Reallocations shall be made only to the extent that the methodologies used
in this Plan to make need determinations indicate that need exists after the
inventories are revised and the need determinations are recalculated.
2. Beds or services which are reallocated once in accordance with this policy
shall not be reallocated again. Rather, the Medical Facilities Planning
Branch shall make any necessary changes in the next annual North
Carolina State Medical Facilities Plan.
3. Dialysis stations that are withdrawn, relinquished, not applied for,
decertified, denied, appealed, or pending the expiration of the 30-day
appeal period shall not be reallocated. Instead, any necessary
redetermination of need shall be made in the next scheduled publication of
the North Carolina Semiannual Dialysis Report.
4. Appeals of Certificate of Need Decisions on Applications
Need determinations of beds or services for which the Certificate of Need
Section decision to approve or deny the application has been appealed
shall not be reallocated until the appeal is resolved.
a. Appeals resolved prior to August 17:
If such an appeal is resolved in the calendar year prior to August
17, the beds or services shall not be reallocated by the Certificate
of Need Section; rather the Medical Facilities Planning Branch
shall make the necessary changes in the next annual North
Carolina State Medical Facilities Plan except for dialysis stations
which shall be processed pursuant to Item 3.
b. Appeals resolved on or after August 17:
If such an appeal is resolved on or after August 17 in the calendar
year, the beds or services, except for dialysis stations, shall be
made available for a review period to be determined by the
Certificate of Need Section, but beginning no earlier than 60 days
from the date that the appeal is resolved. Notice shall be mailed by
the Certificate of Need Section to all people on the mailing list for
the North Carolina State Medical Facilities Plan, no less than 45
days prior to the due date for receipt of new applications.
5. Withdrawals and Relinquishments
Except for dialysis stations, a need determination for which a certificate of
need is issued, but is subsequently withdrawn or relinquished, is available
for a review period to be determined by the Certificate of Need Section,
but beginning no earlier than 60 days from:
a. the last date on which an appeal of the notice of intent to withdraw
the certificate could be filed if no appeal is filed,
b. the date on which an appeal of the withdrawal is finally resolved
against the holder, or
c. the date that the Certificate of Need Section receives from the
holder of the certificate of need notice that the certificate has been
voluntarily relinquished.
Notice of the scheduled review period for the reallocated services or beds
shall be mailed by the Certificate of Need Section to all people on the
mailing list for the North Carolina State Medical Facilities Plan, no less
than 45 days prior to the due date for submittal of the new applications.
6. Need Determinations for which No Applications are Received
a. Services or beds with scheduled review in the calendar year on or
before September 1: The Certificate of Need Section shall not
reallocate the services or beds in this category for which no
applications were received, because the Medical Facilities
Planning Branch will have sufficient time to make any necessary
changes in the determinations of need for these services or beds in
the next annual North Carolina State Medical Facilities Plan,
except for dialysis stations.
b. Services or beds with scheduled review in the calendar year after
September 1: Except for dialysis stations, a need determination in
this category for which no application has been received by the last
due date for submittal of applications shall be available to be
applied for in the second Category I review period in the next
calendar year for the applicable Health Service Area. Notice of the
scheduled review period for the reallocated beds or services shall
be mailed by the Certificate of Need Section to all people on the
mailing list for the North Carolina State Medical Facilities Plan, no
less than 45 days prior to the due date for submittal of new
applications.
7. Need Determinations not Awarded because Application Disapproved
a. Disapproval in the calendar year prior to August 17:
Need determinations or portions of such need for which
applications were submitted but disapproved by the Certificate of
Need Section before August 17, shall not be reallocated by the
Certificate of Need Section. Instead the Medical Facilities
Planning Branch shall make the necessary changes in the next
annual North Carolina State Medical Facilities Plan if no appeal is
filed, except for dialysis stations.
b. Disapproval in the calendar year on or after August 17:
Need determinations or portions of such need for which
applications were submitted but disapproved by the Certificate of
Need Section on or after August 17, shall be reallocated by the
Certificate of Need Section, except for dialysis stations. A need in
this category shall be available for a review period to be
determined by the Certificate of Need Section but beginning no
earlier than 95 days from the date the application was disapproved,
if no appeal is filed. Notice of the scheduled review period for the
reallocation shall be mailed by the Certificate of Need Section to
all people on the mailing list for the North Carolina State Medical
Facilities Plan no less than 80 days prior to the due date for
submittal of the new applications.
8. Reallocation of Decertified Intermediate Care Facilities for Individuals
with Intellectual Disabilities (ICF/IID) Beds
If an ICF/IID facility’s Medicaid certification is relinquished or revoked,
the ICF/IID beds in the facility may be reallocated by the North Carolina
Department of Health and Human Services, Division of Health Service
Regulation, Medical Facilities Planning Branch after consideration of
recommendations from the North Carolina Division of Mental Health,
Developmental Disabilities, and Substance Abuse Services. The North
Carolina Department of Health and Human Services, Division of Health
Service Regulation, Certificate of Need Section shall schedule reviews of
applications for any reallocated beds pursuant to Section (5) of this policy.
POLICY GEN-2: CHANGES IN NEED DETERMINATIONS
1. The need determinations adopted in this document or in the Dialysis
Reports shall be revised continuously throughout the calendar year to
reflect all changes in the inventories of:
a. the health services listed at G.S. 131E-176 (16)f;
b. health service facilities;
c. health service facility beds;
d. dialysis stations;
e. the equipment listed at G.S. 131E-176 (16)f1;
f. mobile medical equipment; and
g. operating rooms as defined in Chapter 6;
as those changes are reported to the Medical Facilities Planning Branch.
However, need determinations in this document shall not be reduced if the
relevant inventory is adjusted upward 60 days or less prior to the
applicable “Certificate of Need Application Due Date.”
2. Inventories shall be updated to reflect:
a. decertification of Medicare-certified home health agencies or
offices, ICF/IID and dialysis stations;
b. delicensure of health service facilities and health service facility
beds;
c. demolition, destruction, or decommissioning of equipment as listed
at G.S. 131E-176(16)f1 and s;
d. elimination or reduction of a health service as listed at G.S. 131E-
176(16)f;
e. addition or reduction in operating rooms as defined in Chapter 6;
f. psychiatric beds licensed pursuant to G.S. 131E-184(c);
g. certificates of need awarded, relinquished, or withdrawn,
subsequent to the preparation of the inventories in the North
Carolina State Medical Facilities Plan;
h. corrections of errors in the inventory as reported to the Medical
Facilities Planning Branch.
3. Any person who is interested in applying for a new institutional health
service for which a need determination is made in this document may
obtain information about updated inventories and need determinations
from the Medical Facilities Planning Branch.
4. Need determinations resulting from changes in inventory shall be
available for a review period to be determined by the Certificate of Need
Section, but beginning no earlier than 60 days from the date of the action
identified in Subsection (2), except for dialysis stations which shall be
determined by the Medical Facilities Planning Branch and published in the
next North Carolina Semiannual Dialysis Report. Notice of the scheduled
review period for the need determination shall be mailed by the Certificate
of Need Section to all people on the mailing list for the North Carolina
State Medical Facilities Plan no less than 45 days prior to the due date for
submittal of the new applications.
POLICY GEN-3: BASIC PRINCIPLES
A certificate of need applicant applying to develop or offer a new institutional health
service for which there is a need determination in the North Carolina State Medical Facilities
Plan shall demonstrate how the project will promote safety and quality in the delivery of health
care services while promoting equitable access and maximizing healthcare value for resources
expended. A certificate of need applicant shall document its plans for providing access to
services for patients with limited financial resources and demonstrate the availability of capacity
to provide these services. A certificate of need applicant shall also document how its projected
volumes incorporate these concepts in meeting the need identified in the State Medical Facilities
Plan as well as addressing the needs of all residents in the proposed service area.
POLICY GEN-4: ENERGY EFFICIENCY AND SUSTAINABILITY FOR HEALTH
SERVICE FACILITIES
Any person proposing a capital expenditure greater than $2 million to develop, replace,
renovate or add to a health service facility pursuant to G.S. 131E-178 shall include in its
certificate of need application a written statement describing the project’s plan to assure
improved energy efficiency and water conservation.
In approving a certificate of need proposing an expenditure greater than $5 million to
develop, replace, renovate or add to a health service facility pursuant to G.S. 131E-178, the
Certificate of Need Section shall impose a condition requiring the applicant to develop and
implement an Energy Efficiency and Sustainability Plan for the project that conforms to or
exceeds energy efficiency and water conservation standards incorporated in the latest editions of
the North Carolina State Building Codes. The plan must be consistent with the applicant’s
representation in the written statement as described in paragraph one of Policy GEN-4.
Any person awarded a certificate of need for a project or an exemption from review
pursuant to G.S. 131E-184 are required to submit a plan for energy efficiency and water
conservation that conforms to the rules, codes and standards implemented by the Construction
Section of the Division of Health Service Regulation. The plan must be consistent with the
applicant’s representation in the written statement as described in paragraph one of Policy GEN-
4. The plan shall not adversely affect patient or resident health, safety or infection control.
Chapter 5:
Acute Care Hospital Beds
CHAPTER 5
ACUTE CARE HOSPITAL BEDS
Summary of Bed Supply and Utilization
As of fall 2012, there are 113 licensed acute care hospitals and 20,799 licensed acute care
beds in North Carolina. Data provided by Truven Health Analytics, formerly known as
Thomson Reuters, indicated that 4,418,818 days of care were provided to patients in those
hospitals during 2011, which represents an average annual occupancy rate of 58.25 percent.
These numbers exclude beds in service for substance abuse, psychiatry, rehabilitation, hospice,
and long-term care. In addition, across the state acute care bed capacity is expected to increase
in certain markets by 745 pending beds and to decrease in other markets by 185 beds, for a net
increase of 560 beds.
It is important to note that not all licensed beds were in service throughout the year.
Some beds were permanently idled, while others were temporarily taken out of service due to
staff shortages or to accommodate renovation projects.
Changes from the Previous Plan
For the 2013 State Medical Facilities Plan and subsequent Plans, the governor has
designated Hoke County as a single-county service area for the Acute Care Bed Need
methodology. Further, the determination of need in the 2013 State Medical Facilities Plan and
subsequent Plans will show no need for additional acute care hospital beds in Cumberland
County and Hoke County until one of the approved hospitals is licensed in Hoke County.
Information about these determinations can be found in the governor’s approval letter preceding
the Table of Contents.
No other substantive changes to the Acute Care Bed Need methodology, except for
language added to Step 8 to clarify need determination thresholds, have been incorporated into
the North Carolina 2013 State Medical Facilities Plan. The inventory has been updated and
references to dates have been advanced by one year as appropriate.
Basic Principles
A. Acute Care Hospital Goals
1. To facilitate continuing improvement in the state’s acute care
services. Advances in medical practice frequently entail the development
of new services, new facilities or both. The policy of the state is to
encourage their development when cost effective and essential to assure
reasonable accessibility to services.
2. To expand the availability of appropriate, adequate acute care service
to the people of North Carolina. Our improving highways and
transportation systems have brought acute care services within reasonable
geographic reach of all North Carolinians, but not within financial reach.
Despite the expansion of the state’s Medicaid Program, in 2004 17.5
percent of North Carolinians under the age of 65 were uninsured for a full
year, according to a study by the Cecil G. Sheps Center for Health
Services Research, at the University of North Carolina at Chapel Hill.
3. To protect the resource that the state’s acute care hospitals represent.
The acute care hospitals are the providers of essential health care services,
the state’s third largest employer, the largest single investment of public
funds in many communities, magnets for physicians deciding where to
practice, and building blocks in the economic development of their
communities. North Carolina must safeguard the future of its hospitals.
Even so, it is not the state’s policy to guarantee the survival and continued
operation of all the state’s hospitals, or even any one of them. In a
dynamic, fast-changing environment, which is moving away from
inpatient hospital services, the survival and future activities of hospitals
will be a function of many factors beyond the realm of state policy.
The state can, however, facilitate the survival of its hospitals and promote
the development of needed health care services, acute and non-acute, by
encouraging hospitals to convert unused acute care inpatient facilities to
new purposes, to collaborate with other health care providers, and to
develop health care delivery networks.
4. To encourage the substitution of less expensive for more expensive
services whenever feasible and appropriate. The state supports
continued and expanded use of programs which have demonstrated their
capacity to reduce both the number and length of hospital admissions,
including:
a. Development of health care delivery networks;
b. Increased use of ambulatory surgery;
c. Outpatient diagnostic studies;
d. Preadmission testing;
e. Preadmission certification;
f. Programs to reduce admission and readmission rates;
g. Timely scheduling of admissions;
h. Effective utilization review;
i. Discharge planning;
j. Appropriate use of alternative services such as home health
services, hospice, adult care homes, nursing homes; and
k. Initiating new, or maximizing existing, preventive health services.
5. To assure that substantial capital expenditures for the construction or
renovation of health care facilities are based on demonstrated need.
6. To assure that applicants proposing to expand or replace acute care
beds should provide careful analysis of what they have done to
promote cost-effective alternatives to inpatient care and to reduce
average length of stay.
B. Use of Swing Beds
The North Carolina Department of Health and Human Services supports the use of
"swing beds" in providing long-term nursing care services in rural acute care hospitals.
Section 1883 of the Social Security Act provides that certain small rural hospitals may
use their inpatient facilities to furnish skilled nursing facility (SNF) services to Medicare and
Medicaid beneficiaries and intermediate care facility (ICF) services to Medicaid beneficiaries.
Hospitals wishing to receive swing bed certification for Medicare patients must meet the
eligibility criteria outlined in the law which include:
1. Have a certificate of need, or a letter from the Certificate of Need Section
indicating that no certificate of need review is required to provide "swing
bed" services; and
2. Have a current valid Medicare provider agreement; and
3. Be located in an area of the state not designated as "urbanized" by the
most recent official census; and
4. Have fewer than 100 hospital beds, excluding beds for newborns and beds
in intensive type inpatient units; and
5. Not have in effect a 24-hour nursing waiver granted under 42 CFR
488.54(c); and
6. Not have had a swing bed approval terminated within the two years
previous to application; and
7. Meet the Swing Bed Conditions of Participation (see 42 CFR 482.66) on
Resident Rights; Admission, Transfer, and Discharge Rights; Resident
Behavior and Facility Practices; Patient Activities; Social Services;
Discharge Planning; Specialized Rehabilitative Services; and Dental
Services.
A certificate of need is not required if capital expenditures associated with the swing bed service
do not exceed $2 million, and there is no change in bed capacity.
Sources of Data
Inventory of Acute Care Beds:
The inventory of hospital facilities is maintained through the hospitals' response to a state
law that requires each facility to notify the North Carolina Department of Health and
Human Services and receive appropriate approvals before construction, alterations or
additions to existing buildings or any changes in bed capacities. Bed counts are revised
in the state's inventory as changes are reported and approved.
Days of Care and Patient Origin Data for the Bed Need Methodology:
The data source for annual days of care used in the methodology is Truven Health
Analytics, a collector of hospital patient discharge information. The general acute care
days of care by facility and data on patients’ county of residence were provided by the
Sheps Center based on the Truven Health Analytics data. (Note: The determination of
whether a patient record was categorized as an “acute care/general discharge” was
determined by the revenue code(s) for accommodation type, as submitted to Truven
Health Analytics by facilities on the UB-92 form. Included in Column F, “Truven Health
Analytics 2011 Acute Care Days” are records with revenue codes signifying an acute
care/general accommodation type. Likewise, any records that are coded as substance
abuse, psychiatric, or rehabilitation discharges are excluded from these figures.)
Basic Assumptions of the Methodology
 Target occupancies of hospitals should encourage efficiency of operation,
and vary with average daily census:
Average Daily Census
Target Occupancy of
Licensed Acute Care Beds
ADC 1-99 66.7%
ADC 100-200 71.4%
ADC>200 and <=400 75.2%
ADC>400: 78.0%
 In determining utilization rates and average daily census, only acute care
bed “days of care” are counted.
 If a hospital has received approval to increase or decrease acute care bed
capacity, this change is incorporated into the anticipated bed capacity
regardless of the licensure status of the beds.
Application of the Methodology
Step 1
Counties that have at least one licensed acute care hospital are single county acute care
bed service areas unless the county is grouped with a county lacking a licensed acute care
hospital. When a county that has at least one licensed acute care hospital is grouped with a
county lacking a licensed acute care hospital, a multicounty acute care bed service area is
created.
All counties lacking a licensed acute care hospital are grouped with either one or two
counties, each of which has at least one licensed acute care hospital. A multicounty acute care
bed service area may consist of multiple counties lacking a licensed acute care hospital that are
grouped with either one or two counties, each of which has at least one licensed acute care
hospital.
The three most recent years of available acute care days patient origin data are combined
and used to create the multicounty acute care bed service areas. These data are updated and
reviewed every three years. The multicounty acute care bed service areas are then updated, as
indicated by the data. The first update occurred in the North Carolina 2011 State Medical
Facilities Plan. The following decision rules are used to determine multicounty acute care bed
service area groupings.
1. Counties lacking a licensed acute care hospital are grouped with the single
county where the largest proportion of patients received inpatient acute
care services, as measured by acute inpatient days, unless:
a. Two counties with licensed acute care hospitals each provided
inpatient acute care services to at least 35 percent of the residents
who received inpatient acute care services, as measured by acute
inpatient days.
2. If 1.a. is true, then the county lacking a licensed acute care hospital is
grouped with both the counties which provided inpatient acute care
services to at least 35 percent of the residents who received inpatient acute
care services, as measured by acute inpatient days.
A county lacking a licensed acute care hospital becomes a single county acute care bed
service area upon licensure of an acute care hospital in that county. If a certificate of need is
issued for development of an acute care hospital in a county lacking an acute care hospital, the
acute care beds for which the certificate of need has been issued will be included in the inventory
of beds in that county’s multicounty acute care bed service area until those beds are licensed.
The governor designated Hoke County as a single-county service area for the 2013 State Medical
Facilities Plan and subsequent Plans.
An acute care bed’s service area is the acute care bed planning area in which the bed is
located. The acute care bed planning areas are the single and multicounty groupings shown in
Figure 5.1.
Step 2 (Columns D and E)
Determine the number of acute care beds in the inventory by totaling:
(Column D)
a. the number of licensed acute care beds at each hospital;
(Column E)
b. the number of acute care beds for which certificates of need have been
issued, but for which changes in the license have not yet been made (i.e.,
additions, reductions, and relocations); and
c. the number of acute care beds for which a need determination in the North
Carolina State Medical Facilities Plan is pending review or appeal.
Step 3 (Column F)
Determine the total number of acute inpatient days of care provided by each hospital
based on the data contained in the above referenced report for Federal Fiscal Year 2011. (Please
see note in “Sources of Data” regarding identification of general acute days of care.)
Step 4 (Columns G and H)
Calculate the projected inpatient days of care in Federal Fiscal Year 2015 as follows:
a. For each county, determine the total annual number of acute inpatient days
of care provided in North Carolina acute care hospitals during each of the
last five federal fiscal years based on data provided by the Sheps Center.
b. For each county, calculate the difference in the number of acute inpatient
days of care provided from year to year.
c. For each county, for each of the last four years, determine the percentage
change from the previous year by dividing the calculated difference in
acute inpatient days by the total number of acute inpatient days provided
during the previous year. (Example: (YR 2011 – YR 2010) / YR 2010; etc.)
(Column G)
d. For each county, total the annual percentages of change and divide by four
to determine the average annual historical percentage change for each
county. For positive annual percentages of change, add 1 and this
becomes the County Growth Rate Multiplier. For negative annual
percentages of change, subtract 1. If the County Growth Rate Multiplier
is negative, Truven Health Analytics 2011 Acute Care Days are carried
forward unchanged to Column H.
e. For each county with a positive County Growth Rate Multiplier, calculate
the compounded growth factor projected for the next four years by using
the average annual historical percentage change (from d. above) in the
first year and compounding the change each year thereafter at the same
rate.
(Column H)
f. For each hospital, multiply the acute inpatient days of care from Column F
by the compounded county growth factor to project the number of acute
inpatient days of care to be provided in Federal Fiscal Year 2015 at each
hospital.
Step 5 (Column I)
Calculate the projected midnight average daily census for each hospital in Federal Fiscal
Year 2015 by dividing the projected number of acute inpatient days of care provided at the
hospital (from Column H) by 365 days.
Step 6 (Column J)
Multiply each hospital's projected midnight average daily census from Step 5 (Column I)
by the appropriate target occupancy factor below:
Average Daily Census Occupancy Factor
Average Daily Census less than 100 1.50
Average Daily Census 100-200 1.40
Average Daily Census greater than 200 and <=400 1.33
Average Daily Census greater than 400 1.28
Step 7 (Column K)
Determine the surplus or deficit of beds for each hospital by subtracting the inventory of
beds in Step 2 (Column D plus Column E) from the number of beds generated in Step 6 (Column
J). (Note: Deficits will appear as positive numbers; surpluses, as negative numbers.)
Step 8 (Column L)
The number of acute care beds needed in a service area is determined as follows:
a. The threshold for a need determination for additional acute care beds is a
projected deficit of 20 or more beds, or a projected deficit which equals or
exceeds 10 percent of the total bed inventory for hospitals under common
ownership.
b. The threshold is applied individually to each hospital, and a need
determination is generated irrespective of surpluses at other hospitals in
the service area, unless there are other hospitals in the service area under
common ownership.
c. If two or more hospitals in the same service area are under common
ownership, total the surpluses and deficits of beds for those hospitals to
determine the surplus or deficit of beds for each owner of multiple
hospitals in the service area.
d. When the deficit of total acute care beds in the service area for any facility
or owner equals or exceeds 20 beds or 10 percent of the inventory of acute
care beds for that facility or owner, the deficits of all facilities and owners
in the service area will be summed to determine the number of acute care
beds needed in the service area.
Qualified Applicants
Any qualified applicant may apply for a certificate of need to acquire the needed acute
care beds. A person is a qualified applicant if he or she proposes to operate the additional acute
care beds in a hospital that will provide:
1. a 24-hour emergency services department,
2. inpatient medical services to both surgical and non-surgical patients, and
3. if proposing a new licensed hospital, medical and surgical services on a daily
basis within at least five of the major diagnostic categories as recognized by the
Centers for Medicare and Medicaid Services (CMS) as follows:
MDC 1: Diseases and disorders of the nervous system
MDC 2: Diseases and disorders of the eye
MDC 3: Diseases and disorders of the ear, nose, mouth and throat
MDC 4: Diseases and disorders of the respiratory system
MDC 5: Diseases and disorders of the circulatory system
MDC 6: Diseases and disorders of the digestive system
MDC 7: Diseases and disorders of the hepatobiliary system and pancreas
MDC 8: Diseases and disorders of the musculoskeletal system and
connective tissue
MDC 9: Diseases and disorders of the skin, subcutaneous tissue and
breast
MDC 10: Endocrine, nutritional and metabolic diseases and disorders
MDC 11: Diseases and disorders of the kidney and urinary tract
MDC 12: Diseases and disorders of the male reproductive system
MDC 13: Diseases and disorders of the female reproductive system
MDC 14: Pregnancy, childbirth and the puerperium
MDC 15: Newborns/other neonates with conditions originating in the
perinatal period
MDC 16: Diseases and disorders of the blood and blood-forming
organs and immunological disorders
MDC 17: Myeloproliferative diseases and disorders and poorly
differentiated neoplasms
MDC 18: Infectious and parasitic diseases
MDC 19: Mental diseases and disorders
MDC 20: Alcohol/drug use and alcohol/drug-induced organic mental
disorders
MDC 21: Injury, poisoning and toxic effects of drugs
MDC 22: Burns
MDC 23: Factors influencing health status and other contacts with
health services
MDC 24: Multiple significant trauma
MDC 25: Human immunodeficiency virus infections
CHEROKEE
SWAIN
JACKSON
GRAHAM
CHATHAM
POLK
BUNCOMBE
MADISON
ASHE
WATAUGA WILKES YADKIN
DAVIE
ROWAN
STOKES
FORSYTH
GUILFORD
ROCKINGHAM
CASWELL
RANDOLPH
DAVIDSON
COLUMBUS
ONSLOW
MOORE
HOKE
LEE
HARNETT
SCOTLAND
BLADEN
SAMPSON DUPLIN
WILSON
WAYNE
LENOIR
GREENE
CARTERET
UNION ANSON
CABARRUS
STANLY
RICHMOND
CRAVEN
JONES
PITT BEAUFORT
WASHINGTON
TYRRELL
DARE
MARTIN
EDGECOMBE
BERTIE
GATES NORTHAMPTON
HERTFORD
WARREN
FRANKLIN
WAKE
PERSON
VANCE
MCDOWELL BURKE
CALDWELL
MITCHELL
YANCEY
LINCOLN
GASTON
RUTHERFORD
CLEVELAND
MACON
CLAY
TRANSYL V ANIA
AVERY
CATAWBA
HYDE
BRUNSWICK
MONTGOMERY
ALEXANDER
ALLEGHANY
HENDERSON
CURRITUCK
PASQUOTANK
PERQUIM.
CAMDEN
CHOWAN
PAMLICO
NEW
HANOVER
SURRY
IREDELL
HAYWOOD
GRANVILLE
HALIFAX
NASH
JOHNSTON
DURHAM
ORANGE
ALAMANCE
CUMBERLAND
ROBESON
PENDER
MECKLENBURG
JACKSON
AHAM GR GRAHAM
BEAUFOR
HYDE
T
GATES
HERTFORD
PITT
HYDE
BUNCOMBE
GATES
PASQUOTANK
Figure 5.1: Acute Care Bed Service Areas
Shaded counties are multicounty acute care bed service areas,
consisting of a county with one or more hospitals and a nearby
county or counties without an acute care hospital.
For multicounty service areas, the asterisk designates the
county with at least one hospital.
Hospital Multicounty Service Area Color Code
Duke University Hospital, Durham Regional Hospital, North Carolina Specialty Hospital Durham, Caswell
Murphy Medical Center Cherokee, Clay
Mission Hospitals Buncombe, Graham, Madison, Yancey
MedWest Harris Jackson, Graham
Maria Parham Medical Center Vance, Warren
Our Community Hospital and Halifax Regional Medical Center Halifax, Northampton
Vidant Medical Center Pitt, Greene, Hyde
CarolinaEast Medical Center Craven, Jones, Pamlico
Vidant Pungo Hospital and Vidant Beaufort Hospital Beaufort, Hyde
Vidant Roanoke-Chowan Hospital Hertford, Gates
Vidant Chowan Hospital Chowan, Tyrrell
Albemarle Health: A Vidant Partner in Health Pasquotank, Camden, Currituck, Gates, Perquimans
Table 5A: Acute Care Bed Need Projections
Service Area Facility Name
License
Number
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Truven
Health
Analytics 2011
Acute Care
Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2011 Days, if
negative growth)
2015
Projected
Average
Daily
Census
(ADC)
2015 Beds
Adjusted
for Target
Occupancy
Projected
2015 Deficit
or Surplus
(surplus
shows as
a "-")
2015 Need
Determination
Using the
Standard
Methodology
2011 Utilization Data from Truven Health Analytics, formerly Thomson Reuters, compiled by the Cecil B. Sheps Center for Health Services Research
Target Occupancy Rates: ADC 1-99: 66.7%, ADC 100-200: 71.4%, ADC > 200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50, ADC 100-200: 1.40, ADC > 200 and <=400: 1.33, ADC >400: 1.28
A B C D E F G H I J K L
Alamance H0272 Alamance Regional Medical Center 182 0 44,831 1.0075 46,191 127 177 -5
Total for Alamance 182 0 0
Alexander H0274 Alexander Hospital 25 0 0 0 0 0 -25
Total for Alexander 25 0 0
Alleghany H0108 Alleghany Memorial Hospital 41 0 2,486 1.0166 2,655 7 11 -30
Total for Alleghany 41 0 0
Anson H0082 Anson Community Hospital 52 0 2,416 -1.1754 2,416 7 10 -42
Total for Anson 52 0 0
Ashe H0099 Ashe Memorial Hospital 76 0 5,169 1.0062 5,298 15 22 -54
Total for Ashe 76 0 0
Avery H0037 Charles A. Cannon, Jr. Memorial Hospital 30 0 5,216 -1.0309 5,216 14 21 -9
Total for Avery 30 0 0
Beaufort H0188 Vidant Beaufort Hospital* 120 0 7,103 -1.0804 7,103 19 29 -91
Beaufort H0002 Vidant Pungo Hospital 39 0 2,082 -1.0804 2,082 6 9 -30
Total for Beaufort/Hyde 159 0 0
Bertie H0268 Vidant Bertie Hospital 6 0 1,617 1.0096 1,680 5 7 1
Total for Bertie 6 0 1
Bladen H0154 Cape Fear Valley-Bladen County Hospital 48 0 3,803 -1.0399 3,803 10 16 -32
Total for Bladen 48 0 0
Brunswick H0250 Brunswick Novant Medical Center 74 0 11,417 -1.0035 11,417 31 47 -27
Brunswick H0150 J. Arthur Dosher Memorial Hospital 36 -11 4,208 -1.0035 4,208 12 17 -8
Total for Brunswick 110 -11 0
Buncombe H0036 Memorial Mission Hospital 673 60 183,403 1.0017 184,653 506 648 -85
Total for Buncombe/Graham/Madison/Yancey 673 60 0
Burke H0062 Grace Hospital 162 0 15,943 -1.0651 15,943 44 66 -96
Burke H0091 Valdese General Hospital 131 0 8,364 -1.0651 8,364 23 34 -97
Total for Burke 293 0 0
Projections based on four-year average county-specific growth rates, compounded annually over the next four years. Acute Care
Days data from 2007, 2008, 2009, 2010 and 2011 were used to generate four-year growth rate.
(ADC= Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Service Area Facility Name
License
Number
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Truven
Health
Analytics 2011
Acute Care
Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2011 Days, if
negative growth)
2015
Projected
Average
Daily
Census
(ADC)
2015 Beds
Adjusted
for Target
Occupancy
Projected
2015 Deficit
or Surplus
(surplus
shows as
a "-")
2015 Need
Determination
Using the
Standard
Methodology
2011 Utilization Data from Truven Health Analytics, formerly Thomson Reuters, compiled by the Cecil B. Sheps Center for Health Services Research
Target Occupancy Rates: ADC 1-99: 66.7%, ADC 100-200: 71.4%, ADC > 200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50, ADC 100-200: 1.40, ADC > 200 and <=400: 1.33, ADC >400: 1.28
A B C D E F G H I J K L
Cabarrus H0031 Carolinas Medical Center-NorthEast 447 0 99,388 1.0033 100,706 276 367 -80
Total for Cabarrus 447 0 0
Caldwell H0061 Caldwell Memorial Hospital 110 0 17,402 1.039 20,280 56 83 -27
Total for Caldwell 110 0 0
Carteret H0222 Carteret General Hospital 135 0 23,360 -1.0522 23,360 64 96 -39
Total for Carteret 135 0 0
Catawba H0223 Catawba Valley Medical Center 200 0 33,935 -1.0435 33,935 93 139 -61
Catawba H0053 Frye Regional Medical Center 209 0 39,472 -1.0435 39,472 108 151 -58
Total for Catawba 409 0 0
Chatham H0007 Chatham Hospital 25 0 2,466 -1.0234 2,466 7 10 -15
Total for Chatham 25 0 0
Cherokee H0239 Murphy Medical Center 57 0 8,309 1.0138 8,777 24 36 -21
Total for Cherokee/Clay 57 0 0
Chowan H0063 Vidant Chowan Hospital* 49 0 6,388 -1.0072 6,388 18 26 -23
Total for Chowan/Tyrell 49 0 0
Cleveland H0024 Cleveland Regional Medical Center 241 0 33,117 -1.0273 33,117 91 136 -105
Cleveland H0113 Kings Mountain Hospital 72 -25 6,382 -1.0273 6,382 17 26 -21
Total for Cleveland 313 -25 0
Columbus H0045 Columbus Regional Healthcare System 154 0 22,934 -1.0276 22,934 63 94 -60
Total for Columbus 154 0 0
Craven H0201 CarolinaEast Medical Center 307 0 55,036 -1.0835 55,036 151 211 -96
Total for Craven/Jones/Pamlico 307 0 0
Cumberland H0213 Cape Fear Valley Medical Center 490 65 170,143 1.0565 211,979 581 743 188
Total for Cumberland 490 65 188**
Dare H0273 The Outer Banks Hospital* 21 0 3,234 -1.0273 3,234 9 13 -8
Total for Dare 21 0 0
Davidson H0027 Lexington Medical Center 94 0 9,947 -1.057 9,947 27 41 -53
Projections based on four-year average county-specific growth rates, compounded annually over the next four years. Acute Care
Days data from 2007, 2008, 2009, 2010 and 2011 were used to generate four-year growth rate.
(ADC= Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Service Area Facility Name
License
Number
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Truven
Health
Analytics 2011
Acute Care
Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2011 Days, if
negative growth)
2015
Projected
Average
Daily
Census
(ADC)
2015 Beds
Adjusted
for Target
Occupancy
Projected
2015 Deficit
or Surplus
(surplus
shows as
a "-")
2015 Need
Determination
Using the
Standard
Methodology
2011 Utilization Data from Truven Health Analytics, formerly Thomson Reuters, compiled by the Cecil B. Sheps Center for Health Services Research
Target Occupancy Rates: ADC 1-99: 66.7%, ADC 100-200: 71.4%, ADC > 200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50, ADC 100-200: 1.40, ADC > 200 and <=400: 1.33, ADC >400: 1.28
A B C D E F G H I J K L
Davidson H0112 Thomasville Medical Center 101 0 9,861 -1.057 9,861 27 41 -60
Total for Davidson 195 0 0
Davie H0171 Davie County Hospital 81 -31 499 -1.1854 499 1 2 -48
Total for Davie 81 -31 0
Duplin H0166 Vidant Duplin Hospital* 56 0 7,614 -1.093 7,614 21 31 -25
Total for Duplin 56 0 0
Durham H0015 Duke University Hospital*** 924 0 240,909 1.0015 242,358 664 850 -74
Durham H0233 Durham Regional Hospital 316 0 57,842 1.0015 58,190 159 223 -93
Duke/Durham Regional Hospital Total 1,240 0 298,751 300,548 823 1,073 -167
Durham H0075 North Carolina Specialty Hospital 18 0 3,866 1.0015 3,889 11 16 -2
Total for Durham/Caswell 1,258 0 0
Edgecombe H0258 Vidant Edgecombe Hospital 101 0 14,635 1.0125 15,381 42 63 -38
Total for Edgecombe 101 0 0
Forsyth H0209 Forsyth Memorial Hospital 823 10 203,122 1.0021 204,834 561 718 -115
Forsyth H0229 Medical Park Hospital 22 -10 2,783 1.0021 2,806 8 12 0
Forsyth/Medical Park Hospital Total 845 0 205,905 207,640 569 730 -115
Forsyth H0011 North Carolina Baptist Hospital 802 0 224,870 1.0021 226,765 621 795 -7
Total for Forsyth 1,647 0 0
Franklin H0261 Franklin Regional Medical Center 70 0 3,500 -1.2791 3,500 10 14 -56
Total for Franklin 70 0 0
Gaston H0105 Gaston Memorial Hospital 372 0 80,843 -1.0203 80,843 221 295 -77
Total for Gaston 372 0 0
Granville H0098 Granville Health System 62 0 9,070 1.058 11,364 31 47 -15
Total for Granville 62 0 0
Guilford H0159 Cone Health 777 0 194,144 -1.0077 194,144 532 681 -96
Guilford H0052 High Point Regional Health System 307 0 62,484 -1.0077 62,484 171 240 -67
Total for Guilford 1,084 0 0
Projections based on four-year average county-specific growth rates, compounded annually over the next four years. Acute Care
Days data from 2007, 2008, 2009, 2010 and 2011 were used to generate four-year growth rate.
(ADC= Average Daily Census)
Table 5A: Acute Care Bed Need Projections
Service Area Facility Name
License
Number
Licensed
Acute Care
Beds
Adjustments
for CONs/
Previous Need
Truven
Health
Analytics 2011
Acute Care
Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2011 Days, if
negative growth)
2015
Projected
Average
Daily
Census
(ADC)
2015 Beds
Adjusted
for Target
Occupancy
Projected
2015 Deficit
or Surplus
(surplus
shows as
a "-")
2015 Need
Determination
Using the
Standard
Methodology
2011 Utilization Data from Truven Health Analytics, formerly Thomson Reuters, compiled by the Cecil B. Sheps Center for Health Services Research
Target Occupancy Rates: ADC 1-99: 66.7%, ADC 100-200: 71.4%, ADC > 200 and <=400: 75.2%, ADC>400: 78%
Target Occupancy Factors: ADC 1-99: 1.50, ADC 100-200: 1.40, ADC > 200 and <=400: 1.33, ADC >400: 1.28
A B C D E F G H I J K L
Halifax H0230 Halifax Regional Medical Center 184 0 27,305 -1.0468 27,305 75 112 -72
Halifax H0004 Our Community Hospital* 20 0 82 -1.0468 82 0 0 -20
Total for Halifax/Northampton 204 0 0
Harnett H0224 Betsy Johnson Regional Hospital 101 0 25,186 -1.0303 25,186 69 104 3
Harnett Harnett Health System Central Campus 0 50 0 -1.0303 0 0 0 -50
Betsy Johnson/Harnett Health System Total 101 50 25,186 25,186 69 104 -47
Harnett Good Hope Hospital (closed eff. 4/11/06) 0 34 0 -1.0303 0 0 0 -34
Total for Harnett 101 84 0
Haywood H0025 MedWest Haywood* 153 0 16,196 -1.0564 16,196 44 67 -86
Total for Haywood 153 0 0
Henderson H0161 Margaret R