2016
NORTH CAROLINA 2016
STATE MEDICAL FACILITIES PLAN
Effective January 1, 2016
Prepared by the
North Carolina Department of Health and Human Services
Division of Health Service Regulation
Healthcare Planning and Certificate of Need Section
Under the direction of the
North Carolina State Health Coordinating Council
For information contact the
North Carolina Division of Health Service Regulation
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
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.
NOTE: Data used in the North Carolina 2016 State Medical
Facilities Plan was last updated October 9, 2015.
PAT MCCRORY
GovERNOR
Christopher G. Ullrich, M.D.
STATE oF NoRTH CAROLINA
OFFICE OF THE GovERNOR
April 29, 2016
North Carolina State Health Coordinating Council
2704 Mail Service Center
Raleigh, NC 27699-2704
Dear Dr. Ullrich:
In accordance with the North Carolina State Health Coordinating Council's recommendation to
amend the North Carolina 2016 State Medical Facilities Plan, I hereby approve the proposed
amendment to correct the tables in Chapter 6. The amendment eliminates the projected need for
one operating room in Rowan County.
Sincerely,
~m.~
cc: Richard 0. Brajer, Secretary, Department of Health and Human Services
Mark Payne, Assistant Secretary, Division of Audit and Health Service Regulation
20301 MAIL SERVICE CENTER • RALEIGH, NC 27699-0301 • TELEPHONE: 919-814-2000
WWW .GOVERNOR.STATE.NC.US
North Carolina Department of Health and Human Services
Division of Health Service Regulation
Pat McCrory Richard O. Brajer
Governor Secretary DHHS Drexdal Pratt
Division Director
Office of the Director
http://www.ncdhhs.gov/dhsr/
Phone: 919-855-3750 / Fax: 919-733-2757
Location: 809 Ruggles Drive  Dorothea Dix Hospital Campus  Raleigh, N.C. 27603
Mailing Address: 2701 Mail Service Center • Raleigh, North Carolina 27699-2701
An Equal Opportunity / Affirmative Action Employer
November 2, 2015
The Honorable Pat McCrory, Governor
State of North Carolina
20301 Mail Service Center
Raleigh, NC 27699-0301
Dear Governor McCrory:
On behalf of the North Carolina State Health Coordinating Council, I am pleased to forward our recommendations
for the North Carolina 2016 State Medical Facilities Plan. This Plan is the culmination of a year’s work by the
council, its committees and Healthcare Planning staff.
The council has devoted a significant amount of time to the review and discussion of a variety of issues prior to
making its recommendations for the upcoming year. The Proposed Plan was disseminated broadly and examined in
six public hearings held across the state, and any petitions and comments received during this year-long process
were duly considered.
This final document represents the council’s recommendations regarding health care needs to be addressed in the
2016 certificate of need reviews.
Sincerely,
Christopher G. Ullrich, M.D., Chairman
N.C. State Health Coordinating Council
CGU:kf
Enclosure
cc: Richard Brajer, DHHS Secretary
Drexdal Pratt, Division Director
I hereby approve the North Carolina 2016 State Medical Facilities Plan effective January 1, 2016.
I ). - l G'- I~-
Date
TABLE OF CONTENTS
Background
Chapter 1 Overview of the North Carolina 2016 State Medical Facilities Plan 1
Chapter 2 Amendments and Revisions to the State Medical Facilities Plan 7
Chapter 3 Certificate of Need Review Categories and Schedule 15
Chapter 4 Statement of Policies: 21
Acute Care Hospitals 21
Technology and Equipment 24
Nursing Care Facilities 25
Adult Care Homes 31
Home Health Services 32
End-Stage Renal Disease Dialysis Services 33
Mental Health, Developmental Disabilities, and 33
Substance Abuse (General)
Psychiatric Inpatient Services Facilities 34
Intermediate Care Facilities for Individuals with Intellectual Disabilities 34
All Health Services 35
Acute Care Facilities and Services
Chapter 5 Acute Care Hospital Beds 41
Chapter 6 Operating Rooms 61
Chapter 7 Other Acute Care Services 103
Open Heart Surgery Services 103
Burn Intensive Care Services 106
Transplantation Services 109
Chapter 8 Inpatient Rehabilitation Services 115
Technology and Equipment
Chapter 9 Technology and Equipment 121
Lithotripsy 122
Gamma Knife 130
Linear Accelerators 132
Positron Emission Tomography Scanner 145
Magnetic Resonance Imaging 153
Cardiac Catheterization Equipment 179
Long-Term Care Facilities and Services
Chapter 10 Nursing Care Facilities 197
Chapter 11 Adult Care Homes 223
Chapter 12 Home Health Services 257
Chapter 13 Hospice Services 323
Chapter 14 End-Stage Renal Disease Dialysis Facilities 371
Chapter 15 Psychiatric Inpatient Services 377
Chapter 16 Substance Abuse Inpatient and Residential Services 387
(Chemical Dependency Treatment Beds)
Chapter 17 Intermediate Care Facilities for Individuals with 395
Intellectual Disabilities (ICF/IID)
Appendices
Appendix A: North Carolina Health Service Areas 411
Appendix B: Partial Listing of Healthcare Planning Acronyms/Terms 412
Appendix C: List of Contiguous Counties 414
Appendix D: North Carolina Certificate of Need Statute 418
Appendix E: Regulation of Detoxification Services Provided in 441
Hospitals Licensed under Article 5, Chapter 131E,
of the General Statutes
Appendix F: Academic Medical Center Teaching Hospitals 442
Appendix G: Critical Access Hospitals 443
DISCLAIMER
The North Carolina 2016 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://www2.ncdhhs.gov/dhsr/ncsmfp/index.html as they are
approved. Check the web site for updates.
Chapter 1:
Overview of the North Carolina 2016 State Medical Facilities Plan
CHAPTER 1
OVERVIEW OF THE NORTH CAROLINA 2016 STATE
MEDICAL FACILITIES PLAN
Purpose
The North Carolina 2016 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
 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, Healthcare
Planning and Certificate of Need Section.
North Carolina Division of Health Service Regulation
Healthcare Planning and Certificate of Need Section
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
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
Members: Representing: From:
Christopher Ullrich, MD, Chairman At-Large Charlotte
Stephen Lawler, Vice-chairman Hospitals Greenville
Trey Adams Small Business & Industry Raleigh
Richard Akers, MD At-Large Gastonia
Christina Apperson At-Large Raleigh
Donald Beaver Nursing Homes Conover
Peter Brunnick Hospice Charlotte
James Burgin County Government (Rural) Angier
Stephen DeBiasi At-Large Wilmington
Mark Ellis, MD At-Large Charlotte
Sandra Greene, DrPH At-Large Chapel Hill
Ralph Hise N.C. Senate Spruce Pine
Kelly Hollis Large Business & Industry Raleigh
Kurt Jakusz Home Care Facilities Asheville
Donny Lambeth N.C. House of Representatives Winston-Salem
Kenneth Lewis Health Insurance Industry Pinehurst
Robert McBride, MD At-Large Charlotte
Denise Michaud Local Health Director Lenoir
Jeffrey Moore, MD At-Large Morehead City
Jaylan Parikh, MD At-Large Dunn
Prashant Patel, MD Physician Cary
Thomas Pulliam, MD At-Large Southern Pines
Gloria Whisenhunt County Government (Urban) Winston-Salem
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), Christina Apperson, Mark Ellis, MD, Representative Donny Lambeth,
Stephen Lawler, Kenneth Lewis, Robert McBride, MD
Staffed by: Amy Craddock, PhD
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:
T.J. Pulliam, MD, (Chair), Don Beaver, Peter Brunnick, James Burgin, Stephen DeBiasi, Kurt Jakusz,
Denise Michaud, Jaylan Parikh, MD, Gloria Whisenhunt
Staffed by: Elizabeth Brown, Paige Bennett and Amy Craddock, PhD
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), Trey Adams, Richard Akers, MD, Senator Ralph Hise, Kelly Hollis,
Jeffrey Moore, MD, Prashant Patel, MD
Staffed by: Paige Bennett
Healthcare Planning Staff
Shelley Carraway, Chief
Paige Bennett, Planner
Elizabeth Brown, Planner
Amy Craddock, PhD, Planner
Tom Dickson, PhD, Database Manager
Kelli Fisk, Administrative Assistant
Division of Health Service Regulation
Drexdal Pratt, Director
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 Healthcare
Planning and Certificate of Need Section staff as early in the year as possible, and to submit petitions no
later than March 2, 2016. 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 "Proposed North Carolina 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, Healthcare Planning by 5:00 p.m. on
March 2, 2016. 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
Healthcare Planning
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
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 Healthcare Planning 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 Healthcare Planning 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 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 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 Healthcare 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 Healthcare Planning by 5:00 p.m. on July 28, 2016. 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
Healthcare Planning
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
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:
http://www2.ncdhhs.gov/dhsr/mfp/meetings.html
North Carolina State Health Coordinating Council
(All meetings begin at 10:00 a.m.)
March 2, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh NC
Brown Building Room 104
May 25, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh NC
Brown Building Room 104
September 7, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh NC
Brown Building Room 104
October 5, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh NC
Brown Building Room 104
Directions to the Brown Building can be found at:
http://www2.ncdhhs.gov/dhsr/brown.html
The Council will conduct a public hearing on statewide issues related to development of the North
Carolina Proposed 2017 State Medical Facilities Plan immediately following the business meeting
on March 2, 2016.
Committee Meetings for 2016
(All meetings begin at 10:00 a.m.)
Acute Care Services Committee
April 12, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
May 3, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
September 13, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Long-Term and Behavioral Health Committee
April 8, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
May 6, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
September 9, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Technology and Equipment Committee
March 30, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
April 27, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
September 14, 2016 Dorothea Dix Campus
801 Biggs Drive – Raleigh, N.C.
Brown Building – Room 104
Deadlines for Petitions and Comments, and Public Hearing Schedule
The deadline for receipt by Healthcare Planning of petitions, written comments and written comments on
petitions and comments is 5:00 p.m. on dates listed below.
March 2, 2016 The Council will conduct a Public Hearing on statewide issues related to
Development of the North Carolina Proposed 2017 State Medical Facilities Plan
(SMFP) immediatley following the business meeting.
March 18, 2016 Deadline for receipt by Healthcare Planning of any written comments regarding
petitions or comments submitted by the March 2nd deadline on statewide issues
related to development of the North Carolina Proposed 2017 State Medical
Facilities Plan.
2016 Schedule for Public Hearings on the N.C. Proposed 2017 SMFP
(All hearings begin at 1:30 p.m.)
July 12, 2016 Greensboro The Women’s Hospital
July 15, 2016 Asheville Mountain Area Health Education Center
July 19, 2016 Greenville Pitt County Office Building
July 22, 2016 Wilmington New Hanover County - Main Library
July 25, 2016 Concord CMC - NorthEast
July 28, 2016 Raleigh Dorothea Dix Campus – Brown Building
July 28, 2016 Deadline for receipt by Healthcare Planning of petitions for adjustments
to need determinations and other written comments regarding the North
Carolina Proposed 2017 State Medical Facilities Plan.
August 12, 2016 Deadline for receipt by the Healthcare Planning of any written comments
on petitions or comments submitted by the July 28th deadline regarding
adjusted need determinations or other issues arising from the North
Carolina Proposed 2017 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. Certificate of Need 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
Certificate of Need 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 or 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;
o transfer of nursing facility beds from state psychiatric hospitals to local communities pursuant to
Policy NH-5;
o transfer of psychiatric beds from state psychiatric hospitals to community facilities pursuant to
Policy PSY-1; and
o transfer of ICF/IID beds from state developmental centers to community facilities pursuant to
Chapter 858 of the 1983 Session Laws, Policy ICF/IID-1, Policy ICF/IID-2 or Policy ICF/IID-3.
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);
o diagnostic centers as defined in G.S. 131E-176(7a);
o proposal to convert an existing or approved fixed PET scanner to mobile pursuant to Policy
TE-1; and
o proposal to acquire an intraoperative magnetic resonance scanner pursuant to Policy TE-2.
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 as of 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 acute care beds from one existing licensed hospital
to another existing licensed hospital or a different campus of the same existing licensed hospital;
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 as such 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 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 Yancey 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 to replace the entire hospital, develop a new hospital or to develop a new satellite
campus of an existing hospital, 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 Certificate of Need 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: 2016 Certificate of Need Review Schedule
CON Beginning
Review Date
Health Service Area
I, II, III
Health Service Area
IV, V, VI
January 1, 2016 -- --
February 1, 2016 A, B, C, G, H, I --
March 1, 2016 -- A, B, C, E, G, H, I
April 1, 2016 C, D, E, F, H, I, K(1), M(1) D
May 1, 2016 J C, E, F, H, I, J, K(4), M(4)
June 1, 2016 A, B, C, F, H, I --
July 1, 2016 J A, B, C, E, H, I, J, K(5), M(5)
August 1, 2016 B, C, E, F, H, I, K(2), M(2) --
September 1, 2016 -- B, C, F, H, I
October 1, 2106 A, C, D, F, H, I D
November 1, 2016 B, C, E, H, I, L, K(3), M(3) --
December 1, 2016 -- 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
2704 Mail Service Center
Raleigh, North Carolina 27699-2704
Phone: (919) 855-3873
Chapter 4:
Statement of Policies:
• 	 Acute Care Hospitals
• 	 Technology and Equipment
• 	 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
• 	 All Health Services
CHAPTER 4
STATEMENT OF POLICIES
Summary of Policy Changes for 2016
There is one new policy incorporated into the North Carolina 2016 State Medical Facilities Plan. Policy
TE-2: Intraoperative Magnetic Resonance Scanners has been added by a recommendation of the State
Health Coordinating Council. This policy will allow facilities that meet the outlined requirements to
apply for an intraoperative magnetic resonance scanner. Three policies, NH-6, LTC-2, and ESRD-2, for
consistency had similar, minor language changes in order to provide additional clarity in the existing
wording.
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 Healthcare Planning and
Certificate of Need Section 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 Certificate of Need 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 Healthcare Planning 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 TECHNOLOGY AND EQUIPMENT (TE)
Policy TE-1: Conversion of Fixed Pet Scanners to Mobile Pet Scanners
Facilities with an existing or approved fixed PET scanner may apply for a Certificate of Need (CON) to
convert the existing or approved fixed PET scanner to a mobile PET scanner if the applicant(s)
demonstrates in the CON application that the converted mobile PET scanner:
1. Shall continue to operate as a mobile PET scanner at the facility, including satellite campuses,
where the fixed PET scanner is located or was approved to be located.
2. Shall be moved at least weekly to provide services at two or more host facilities1.
3. Shall not serve any mobile host site that is not owned by the PET certificate holder or an entity
related to the PET certificate holder such as a parent or subsidiary that is located in the county
where any existing or approved fixed PET scanner is located, except as required by subpart (1).
There will be one certificate of need application filing opportunity each calendar year.
1 The council recommended the revision of the current East and West service areas to a statewide
service area to allow flexibility in servicing mobile PET sites.
Policy TE-2: Intraoperative Magnetic Resonance Scanners
Qualified applicants may apply for an intraoperative Magnetic Resonance Scanner (iMRI) to be used in
an operating room suite.
To qualify, the health service facility proposing to acquire the iMRI scanner shall demonstrate in its
certificate of need application that it is a licensed acute care hospital which:
1. Performed at least 500 inpatient neurosurgical cases during the 12 months
immediately preceding the submission of the application; and
2. Has at least two neurosurgeons that perform intracranial surgeries currently on its
Active Medical Staff; and
3. Is located in a metropolitan statistical area as defined by the US Census Bureau
with at least 350,000 residents.
The iMRI scanner shall not be used for outpatients and may not be replaced with a conventional MRI
scanner.
The performance standards in 10A NCAC 14C .2703 would not be applicable.
Intraoperative procedures and inpatient procedures performed on the iMRI shall be reported separately
on the hospital license renewal application.
These scanners shall not be counted in the inventory of fixed MRI scanners; the procedures performed on
the iMRI will not be used in calculating the need methodology and will be reported in a separate table in
Chapter 9.
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, 2016; and
2. on January 1, 2016, 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 to 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 to 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, except as provided in Policies NH-4, NH-5 and NH-7. Certificate of need applicants
proposing to relocate licensed nursing facility beds to a contiguous county shall:
1. Demonstrate that the facility losing beds or moving to a contiguous county is currently
serving residents of that contiguous county; and
2. Demonstrate that the proposal shall not result in a deficit, or increase and existing 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
3. Demonstrate that the proposal shall not result in a surplus, or increase an existing 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. Certificate of need applicants proposing to relocate licensed adult care home beds to
a contiguous county shall:
1. Demonstrate that the facility losing beds or moving to a contiguous county is currently
serving residents of that contiguous county; and
2. Demonstrate that the proposal shall not result in a deficit, or increase an existing 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
3. Demonstrate that the proposal shall not result in a surplus, or increase an existing 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 county1 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.)
1 Except Granville County that has been served by Granville Vance District Health Department and recognized by
DHSR as a single geographic entity for purposes of location of a home health agency office.
POLICIES APPLICABLE 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. Certificate of need applicants proposing to relocate dialysis stations to a contiguous county
shall:
1. Demonstrate that the facility losing dialysis stations or moving to a contigous county is
currently serving residents of that contigous county; and
2. Demonstrate that the proposal shall not result in a deficit, or increase an existing 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
3. Demonstrate that the proposal shall not result in a surplus, or increase an existing 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.
POLICIES 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 Certificate of Need 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)
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 Certificate of Need
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 Certificate of Need 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.
Policy ICF/IID-3: Transfer of ICF/IID Beds from State Operated Developmental Centers to
Community Facilities for Adults with Severe to Profound Developmental Disabilities
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) beds in state operated
developmental centers may be relocated to existing community facilities through the certificate of need
process for the replacement of Community Alternatives Program for Individuals with Intellectual and
Developmental Disabilities (CAP I/DD) waiver slots lost as a result of the Centers for Medicaid and
Medicare Services (CMS) policy designed to prohibit CAP I/DD waiver and ICF/IID beds from being
located on the same campus. 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 Certificate of Need
demonstrating a commitment to serve adults who have severe to profound developmental disabilities.
This policy applies only to facilities that have lost waiver slots as a result of the CMS ruling and does not
apply for expansion beyond the lost beds. 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 community-based facility is
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 community-based facility.
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, Healthcare Planning 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 Certificate of Need 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 Certificate of Need; rather Healthcare Planning
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 Certificate of Need, but beginning no earlier than 60 days from the
date that the appeal is resolved. Notice shall be mailed by Certificate of Need 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 Certificate of Need, 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 Certificate of Need 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 Certificate of Need 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: Certificate of Need shall not reallocate the services or beds in this category for
which no applications were received, because Healthcare Planning 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 Healthcare Planning
and 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 Certificate of Need before August 17, shall not be reallocated by
Certificate of Need. Instead Healthcare Planning 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 Certificate of Need on or after August 17, shall be reallocated by
Certificate of Need, except for dialysis stations. A need in this category shall be
available for a review period to be determined by Certificate of Need 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 Healthcare Planning and 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, Healthcare Planning 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 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;
g. operating rooms as defined in Chapter 6; and
as those changes are reported to Healthcare Planning. 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. de-licensure 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;
and
h. corrections of errors in the inventory as reported to Healthcare Planning.
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 Healthcare Planning.
4. Need determinations resulting from changes in inventory shall be available for a review
period to be determined by Certificate of Need, 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 Healthcare Planning 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 Healthcare Planning and 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, Certificate of Need 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 is 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 2015, there are 110 licensed acute care hospitals and 20,899 licensed acute care beds in North
Carolina. Data provided by Truven Health Analytics indicated that 4,270,449 days of care were provided
to patients in those hospitals during 2014, which represents an average annual occupancy rate of 55.98
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 822 pending beds and to decrease in other markets by 145 beds, for a net increase of 677 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
No substantive changes to the Acute Care Bed Need methodology have been incorporated into the North
Carolina 2016 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 Certificate of Need 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 2014 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 most recent update
occurred in the North Carolina 2014 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.
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 2014. (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 2018 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 2014 –
YR 2013) / YR 2013; 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 2014 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 2018 at each hospital.
Step 5 (Column I)
Calculate the projected midnight average daily census for each hospital in Federal Fiscal Year 2018 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
TRANSYLVANIA
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
BEAUFOR
HYDE
T
PITT
HYDE
MITCHELL
ANCEY Y
BUNCOMBE
YANCEY
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.
Figure 5.1: Acute Care Bed Service Areas
Hospital Multicounty Service Area Color Code
Duke University Hospital, Duke Regional Hospital, North Carolina Specialty Hospital Durham, Caswell
Murphy Medical Center Cherokee, Clay
Mission Hospital Buncombe, Graham, Madison, Yancey
Maria Parham Medical Center Vance, Warren
Our Community Hospital and Halifax Regional Medical Center Halifax, Northampton
Vidant Medical Center Pitt, Greene, Hyde, Tyrrell
CarolinaEast Medical Center Craven, Jones, Pamlico
Vidant Beaufort Hospital Beaufort, Hyde
Vidant Roanoke-Chowan Hospital Hertford, Gates
Sentara Albemarle Medical Center Pasquotank, Camden, Currituck, Perquimans
Blue Ridge Regional Hospital Mitchell, Yancey
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
2014 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2014 Days,
if negative
growth)
2018
Projected
Average
Daily
Census
(ADC)
2018 Beds
Adjusted
for Target
Occupancy
Projected
2018 Deficit
or Surplus
(surplus
shows as
a "-")
2018 Need
Determination
2014 Utilization Data from Truven Health Analytics 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 40,367 -1.0264 40,367 111 155 -27
Alamance Total 182 0 0
Alexander H0274 Alexander Hospital (closed)* 25 -25 0.0000 0 0 0 0
Alexander Total 25 -25 0
Alleghany H0108 Alleghany Memorial Hospital 41 0 2,027 -1.0445 2,027 6 8 -33
Alleghany Total 41 0 0
Anson H0082 Carolinas HealthCare System Anson 15 0 667 -1.3251 667 2 3 -12
Anson Total 15 0 0
Ashe H0099 Ashe Memorial Hospital 76 0 4,681 -1.0038 4,681 13 19 -57
Ashe Total 76 0 0
Avery H0037 Charles A. Cannon, Jr. Memorial Hospital 30 0 5,239 -1.0094 5,239 14 22 -8
Avery Total 30 0 0
Beaufort H0188 Vidant Beaufort Hospital 120 0 9,786 1.0699 12,823 35 53 -67
Beaufort H0002 Vidant Pungo Hospital (closed) 39 0 565 1.0699 740 2 3 -36
Beaufort/Hyde Total 159 0 0
Bertie H0268 Vidant Bertie Hospital 6 0 1,552 1.0037 1,575 4 6 0
Bertie Total 6 0 0
Bladen H0154 Cape Fear Valley-Bladen County Hospital 48 0 3,571 1.0360 4,114 11 17 -31
Bladen Total 48 0 0
Brunswick H0150 J. Arthur Dosher Memorial Hospital 36 -11 2,877 1.0631 3,675 10 15 -10
Brunswick H0250 Novant Health Brunswick Medical Center 74 0 16,003 1.0631 20,441 56 84 10
Brunswick Total 110 -11 0
Buncombe H0036 Mission Hospital 701 32 180,673 -1.0048 180,673 495 634 -99
Buncombe/Graham/Madison/Yancey Total 701 32 0
Burke H0062 Carolinas HealthCare System Blue Ridge 293 0 24,205 -1.0058 24,205 66 99 -194
Burke Total 293 0 0
Cabarrus H0031 Carolinas Medical Center-NorthEast 447 0 88,723 -1.0244 88,723 243 323 -124
Cabarrus Total 447 0 0
Projections based on four-year average county-specific growth rates, compounded annually over the next four years. Acute Care
Days data from 2010, 2011, 2012, 2013 and 2014 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
2014 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2014 Days,
if negative
growth)
2018
Projected
Average
Daily
Census
(ADC)
2018 Beds
Adjusted
for Target
Occupancy
Projected
2018 Deficit
or Surplus
(surplus
shows as
a "-")
2018 Need
Determination
2014 Utilization Data from Truven Health Analytics 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
Caldwell H0061 Caldwell Memorial Hospital 110 0 17,158 -1.0106 17,158 47 71 -39
Caldwell Total 110 0 0
Carteret H0222 Carteret General Hospital 135 0 22,359 -1.0244 22,359 61 92 -43
Carteret Total 135 0 0
Catawba H0223 Catawba Valley Medical Center 200 0 34,418 -1.0329 34,418 94 141 -59
Catawba H0053 Frye Regional Medical Center 209 0 33,599 -1.0329 33,599 92 138 -71
Catawba Total 409 0 0
Chatham H0007 Chatham Hospital** 25 0 2,053 -1.0215 2,053 6 8 -17
Chatham Total 25 0 0
Cherokee H0239 Murphy Medical Center 57 0 6,810 -1.0754 6,810 19 28 -29
Cherokee/Clay Total 57 0 0
Chowan H0063 Vidant Chowan Hospital** 49 0 5,197 -1.0544 5,197 14 21 -28
Chowan Total 49 0 0
Cleveland H0024 Carolinas HealthCare System Cleveland 241 0 30,437 -1.0307 30,437 83 125 -116
Cleveland Carolinas HealthCare System Kings
Mountain
H0113 47 0 6,280 -1.0307 6,280 17 26 -21
Cleveland Total 288 0 0
Columbus H0045 Columbus Regional Healthcare System 154 0 17,898 -1.0556 17,898 49 74 -80
Columbus Total 154 0 0
Craven H0201 CarolinaEast Medical Center 307 0 50,232 -1.0475 50,232 138 193 -114
Craven/Jones/Pamlico Total 307 0 0
Cumberland H0213 Cape Fear Valley Medical Center 490 99 160,154 1.0107 167,119 458 586 -3
Cumberland Total 490 99 0
Dare H0273 The Outer Banks Hospital** 21 0 2,710 -1.0258 2,710 7 11 -10
Dare Total 21 0 0
Davidson H0027 Lexington Medical Center 94 0 9,544 -1.0179 9,544 26 39 -55
Davidson H0112 Novant Health Thomasville Medical Center 101 0 8,866 -1.0179 8,866 24 36 -65
Davidson Total 195 0 0
Projections based on four-year average county-specific growth rates, compounded annually over the next four years. Acute Care
Days data from 2010, 2011, 2012, 2013 and 2014 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
2014 Acute
Care Days
County
Growth
Rate
Multiplier
4 Years Growth
Using County
Growth Rate
( = 2014 Days,
if negative
growth)
2018
Projected
Average
Daily
Census
(ADC)
2018 Beds
Adjusted
for Target
Occupancy
Projected
2018 Deficit
or Surplus
(surplus
shows as
a "-")
2018 Need
Determination
2014 Utilization Data from Truven Health Analytics 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 Occu