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S TAT E H E A L TH COORDINAT I N G C O U N C I L
State
Medical
Facilities
Plan
DHSR N. C. Division of Health Service Regulation
North Carolina Department of Health and Human Services
NORTH CAROLINA
2009 STATE MEDICAL FACILITIES PLAN
Effective January 1, 2009
Prepared by the
North Carolina Department of Health and Human Services
Division of Health Service Regulation
Medical Facilities Planning Section
Under the direction of the
North Carolina State Health Coordinating Council
For information or copies, contact the
North Carolina Division of Health Service Regualtion
2714 Mail Service Center
Raleigh, North Carolina 27699- 2714
http:// 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.
TABLE OF CONTENTS
Background
Chapter 1 Overview of the N. C. 2009 State Medical Facilities Plan 1
Chapter 2 Amendments and Revisions 9
Chapter 3 Certificate of Need Review Categories and Schedule 17
Chapter 4 Statement of Policies: 21
Acute Care Hospitals 21
Nursing Care Facilities 24
Adult Care Homes 30
Home Health Services 31
End- Stage Renal Disease Dialysis Services 32
Mental Health, Developmental Disabilities, and 32
Substance Abuse ( General)
Psychiatric Inpatient Services 33
Intermediate Care Facilities for the Mentally Retarded 33
All Health Services 34
Acute Care Facilities and Services
Chapter 5 Acute Care Hospital Beds 39
Chapter 6 Operating Rooms 55
Chapter 7 Other Acute Care Services 89
Open Heart Surgery Services and 89
Heart- Lung Bypass Machines
Burn Intensive Care Services 94
Transplantation Services 97
Chapter 8 Inpatient Rehabilitation Services 105
Technology and Equipment
Chapter 9 Technology 109
Lithotripsy 110
Gamma Knife 117
Radiation Oncology Services - Linear Accelerators 118
Positron Emission Tomography Scanner 131
Magnetic Resonance Imaging 136
Cardiac Catheterization Equipment 157
Long- Term Care Facilities and Services
Chapter 10 Nursing Care Facilities 171
Chapter 11 Adult Care Homes 195
Chapter 12 Home Health Services 229
Chapter 13 Hospice Services 269
Chapter 14 End- Stage Renal Disease Dialysis Facilities 311
Chapter 15 Psychiatric Inpatient Services 317
Chapter 16 Substance Abuse Inpatient and Residential Services 329
Chapter 17 Intermediate Care Facilities for the Mentally Retarded 337
Appendices
Appendix A: North Carolina Counties by Health Service Areas 353
Appendix B: Partial Listing of Health Planning Acronyms 355
Appendix C: List of Contiguous Counties 357
Appendix D: North Carolina Certificate of Need Statute 361
Appendix E: Regulation of Detoxification Services Provided in 381
Hospitals Licensed under Article 5, Chapter 131E,
of the General Statutes
DISCLAIMER
Please note the North Carolina State Medical Facilities Plan is subject to revision throughout the year.
Notices containing updates and changes will be posted on the North Carolina Division of Health Service
Regulation web page at http:// www. ncdhhs. gov/ dhsr/ ncsmfp/ index. html as they are approved.
Please periodically check our web site for updates.
Chapter 1:
Overview of the 2009 State
Medical Facilities Plan
CHAPTER 1
OVERVIEW OF THE NORTH CAROLINA 2009 STATE MEDICAL FACILITIES
PLAN
Purpose
The North Carolina 2009 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,
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
􀂋 operating rooms
􀂋 inpatient rehabilitation facilities
􀂋 technology services
􀂋 nursing care facilities
􀂋 adult care facilities
􀂋 Medicare- Certified home health agencies
􀂋 end- stage renal disease dialysis facilities
􀂋 hospice home care and hospice inpatient beds
􀂋 psychiatric hospital units and specialty hospitals
􀂋 substance abuse hospital units, specialty hospitals,
and residential facilities
􀂋 intermediate care facilities for mentally retarded people
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 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
A Quality, Access and Value ( QAV) work group, tasked with rewriting the Basic
Principles Governing the Development of the State Medical Facilities Plan, was convened in the
spring of 2008. The work group met four times and through careful and thorough consideration
of each Basic Principle in relation to the many and varied changes which have occurred in the
health care environment since the Basic Principles were first published, drafted revised Basic
Principles.
The draft revised Basic Principles were presented to the full State Health Coordinating
Council ( SHCC) at the May 28, 2008 SHCC meeting. As recommended by the SHCC at that
meeting, a new QAV work group was authorized to continue to refine the revised Basic
Principles. Additionally, the revised Basic Principles were published in the Proposed 2009
North Carolina State Medical Facilities Plan with a note requesting comments.
In August of 2008, the new QAV work group met, reviewed the comments submitted on
the Revised Basic Principles and recommended separating the revised Basic Principles into two
parts:
1. For each Basic Principle, a broad principle statement, and;
2. An action plan for specific application of the Principles, to be developed and maintained
by the Planning Section
At its October 8, 2008 meeting, the SHCC reviewed and approved the new QAV work
group’s recommendations. The revised Basic Principles, as approved by the SHCC, are shown
below:
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 heath
services to be safe and efficacious. 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 of 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 foundation 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 healthcare 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 circumstance that all competitors
deliver like services to similar populations.
The SHCC assigns the highest priority to a 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 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 SMFP.
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 heath 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 ( Table 1A). 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 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 his review and approval. With the Governor’s approval, the State Medical
Facilities Plan becomes the official document for health facility and health service planning in
North Carolina for the specified calendar year.
Other Publications
Information concerning publications or the availability of other data related to the health
planning process may be obtained by contacting the North Carolina Division of Health Service
Regulation, Medical Facilities Planning Section.
North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, North Carolina 27699- 2714
Telephone Number: ( 919) 855- 3865
FAX Number: ( 919) 715- 4413
NOTE
Determinations of need for services and facilities in this Plan does 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.
Table 1A: North Carolina State Health Coordinating Council Members,
Committee Membership, and Staff
Members: Representing: From:
Dan A. Myers, MD, Chairman At- Large Kinston
Donald C. Beaver Health Care Facilities Association Hickory
Bill Bedsole At- Large Washington
Greg Beier At- Large Winston- Salem
Don Bradley, MD Health Insurance Industry Durham
Richard F. Bruch, MD Medical Society Durham
Dennis A. Clements, III, MD Academic Medical Centers Durham
Dana D. Copeland, MD At- Large Raleigh
Lawrence M. Cutchin, MD At- Large Tarboro
Senator Anthony Foriest N. C. Senate Graham
Sandra B. Greene, DrPH At- Large Chapel Hill
Ted Griffin Business & Industry Durham
Charles Hauser At- Large Winston- Salem
Laurence C. Hinsdale At- Large Concord
Ken Hodges Long- Term Care Facilities Association Flat Rock
Daniel F. Hoffmann Veterans Administration Durham
John P. Holt, Jr., MD At- Large Wake
Frances D. Mauney At- Large Durham
Mac McCrary Business & Industry Morganton
William O. McMillan, Jr., MD Area Health Education Centers Wilmington
M. Jackson Nichols County Commissioners Association Raleigh
Stephen W. Nuckolls At- Large New Bern
Jerry Parks Association of Local Health Directors Edenton
Thomas J. Pulliam, MD At- Large Winston- Salem
Timothy R. Rogers Home Care Association Raleigh
Michael C. Tarwater Hospital Association Charlotte
Christopher G. Ullrich, MD At- Large Charlotte
Rep. William Wainwright N. C. House of Representatives Havelock
Zane Walsh, MD At- Large Fayetteville
Committees and Staff Members
Acute Care Services Committee
( Planning for acute care beds, operating rooms, open heart surgery services, heart- lung
bypass machines, burn intensive care services, transplantation services [ bone marrow
transplants and solid organ transplants], and inpatient rehabilitation services):
Michael C. Tarwater ( Chair); Sandra B. Greene, DrPH; ( Vice Chair), Bill Bedsole; Greg Beier;
Don Bradley, MD; Dana D. Copeland, MD; Lawrence M. Cutchin, MD; Jack Nichols; Daniel F.
Hoffmann; Zane Walsh, MD
Staffed by: Victoria McClanahan
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; and intermediate care facilities for the mentally
retarded):
Thomas J. Pulliam, MD, ( Chair); Jerry Parks ( Vice Chair); Donald C. Beaver; Senator Anthony
Foriest; Ted Griffin; Ken Hodges; John P. Holt, Jr., MD; Frances D. Mauney; Timothy R.
Rogers.
Staffed by: Floyd Cogley, Victoria McClanahan and Carol G. Potter
Technology and Equipment Committee
( Planning for lithotripsy, gamma knife, radiation oncology services – linear accelerators,
positron emission tomography scanners, magnetic resonance imaging scanners, and
cardiac catheterization/ angioplasty equipment):
Christopher G. Ullrich, MD ( Chair); William O. McMillan, Jr., MD, ( Vice Chair);
Richard F. Bruch, MD; Dennis A. Clements III, MD; Charles Hauser; Laurence C. Hinsdale;
Mac McCrary; Stephen W. Nuckolls; Rep. William L. Wainwright
Staffed by: Carol G. Potter
Medical Facilities Planning Section Staff
Floyd Cogley, Planner
Victoria McClanahan, Planner
Carol G. Potter, Planner
Kelli Fisk, Administrative Assistant
Elizabeth K. Brown, Chief
Division of Health Service Regulation
Jeff Horton, Acting Director
Chapter 2:
Amendments and Revisions
CHAPTER 2
AMENDMENTS AND REVISIONS TO THE STATE MEDICAL FACILITIES PLAN
Amendment of Approved Plans
After the North Carolina State Medical Facilities Plan ( SMFP) has been signed by the
Governor, it will be amended only as necessary to correct errors, 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 SMFP's policies or methodologies, or the results of their
application, are inappropriate may petition for changes or revisions. Such petitions are of two
general types: those requesting changes in basic policies and methodologies; and those
requesting adjustments to the need projections.
Petitions for Changes in Basic Policies and Methodologies
People who wish to recommend changes that may have a statewide effect are asked to
contact the Medical Facilities Planning staff as early in the year as possible, and to submit
petitions no later than March 4, 2009. Changes with the potential for a statewide effect are the
addition, deletion, and revision of policies and revision of the projection methodologies. These
types of changes will need to be considered in the first four months of the calendar year as the
" Proposed SMFP" ( explained below) is being developed.
Instructions for Writing Petitions for Changes in Basic Policies and Methodologies
Beginning with the 2009 SMFP, Step 5 has been added to these 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 SMFP 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 SMFP 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 SMFP: Safety and Quality,
Access, and Value.
Each written petition must be clearly labeled “ Petition” and one copy of each petition
must be received by the North Carolina Division of Health Service Regulation’s Medical
Facilities Planning Section by March 4, 2009. Petitions may be mailed to:
North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, NC 27699- 2714
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 person and
organization( s) who may be affected by the proposed change;
2. The petition and other information will be forwarded 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 final SMFP.
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 SMFP will be made no later than the final Council meeting of the calender
year.
Petitions for Adjustments to Need Determinations
A Proposed SMFP 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 Proposed SMFP is determined annually and dates are available from the
Medical Facilities Planning Section.
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 polices may submit a written petition requesting an adjustment
be made to the need determination given in the Proposed SMFP. These petitions should be
delivered to the Medical Facilities Planning Section 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 Proposed SMFP are given below.
Instructions for Writing Petitions for Adjustments to Need Determinations
Beginning with the 2009 SMFP, Step 5 has been added to these 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 SMFP 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 SMFP 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 SMFP: Safety and Quality,
Access and Value.
Petitioners should use the same service area definitions as provided in the program
chapters of the Proposed SMFP.
Petitioners should also be aware that the Medical Facilities Planning staff, in reviewing
the proposed adjustment, may request additional information and opinions from the petitioner or
any other person and organization( s) who may be affected by the proposed adjustment.
Each written petition must be clearly labeled “ Petition” and one copy of each petition
must be received by the Medical Facilities Planning Section prior to the end of the Public
Review and Comment Period. Petitions may be mailed to:
North Carolina Division of Health Service Regulation
Medical Facilities Planning Section
2714 Mail Service Center
Raleigh, NC 27699- 2714
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. A copy of the agency report will be
mailed to the petitioner when it is distributed to Committee members.
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 SMFP 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 SMFP 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
North Carolina State Health Coordinating Council
March 4, 2009 Jane S. McKimmon Center 10: 00 a. m.
( Wednesday) 1101 Gorman Street
Raleigh, N. C. 27695
( The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2010 State Medical Facilities Plan
immediately following the business meeting on March 4, 2009.)
May 27, 2009 Jane S. McKimmon Center 10: 00 a. m.
( Wednesday) 1101 Gorman Street
Raleigh, N. C. 27695
October 9, 2009 Jane S. McKimmon Center 10: 00 a. m.
( Friday) 1101 Gorman Street
Raleigh, N. C. 27695
Please find a map to the McKimmon Center at the website page:
http:// www. mckimmon. ncsu. edu/ mckimmon/ directions. html
Acute Care Committee
April 8, 2009 Jane S. McKimmon Center 10: 00 a. m.
Wednesday 1101 Gorman Street
Raleigh, N. C. 27695
May 6, 2009 Jane S. McKimmon Center 10: 00 a. m.
Wednesday 1101 Gorman Street
Raleigh, N. C. 27695
Sept. 16, 2009 Jane S. McKimmon Center 10: 00 a. m.
Wednesday 1101 Gorman Street
Raleigh, N. C. 27695
Long- Term and Behavioral Health Committee
May 15, 2009 Jane S. McKimmon Center 10: 00 a. m.
Friday 1101 Gorman Street
Raleigh, N. C. 27695
September 25, 2009 Jane S. McKimmon Center 10: 00 a. m.
Friday 1101 Gorman Street
Raleigh, N. C. 27695
Technology and Equipment Committee
April 29, 2009 Jane S. McKimmon Center 10: 00 a. m.
Wednesday 1101 Gorman Street
Raleigh, N. C. 27695
September 2, 2009 Jane S. McKimmon Center 10: 00 a. m.
Wednesday 1101 Gorman Street
Raleigh, N. C. 27695
Deadlines for Petitions and Comments, and Public Hearing Schedule
Any changes to Council, Committee and Public Hearing meeting dates, times and locations will be
posted on the meeting web page: http:// www. ncdhhs. gov/ dhsr/ mfp/ meetings. html.
The deadline for receipt by the Medical Facilities Planning Section ( MFPS) of petitions, written
comments and written comments on petitions and comments is 5: 00 p. m. on dates listed below.
March 4, 2009 The Council will conduct a Public Hearing on statewide issues related to
development of the North Carolina Proposed 2010 State Medical Facilities Plan
( SMFP) immediately following the business meeting.
March 4, 2009 Deadline for receipt of petitions for changes in basic policies and methodologies and
other written comments regarding the Proposed 2010 State Medical Facilities Plan
March 18, 2009 Deadline for receipt by the MFPS of written comments about Acute Care
Services related petitions and comments.
April 8, 2009 Deadline for receipt by the MFPS of written comments about Technology &
Equipment related petitions and comments.
April 29, 2009 Deadline for receipt by the MFPS of written comments about Long- Term
and Behavioral Health related petitions and comments.
2009 Schedule for Public Hearings on the Proposed 2010 SMFP ( all hearings begin at 1: 30 p. m.)
July 15, 2009 Greensboro Wesley Long Community Hospital - Classroom 3
July 17, 2009 Greenville Pitt County Office Bldg. - Commissioners Auditorium
July 21, 2009 Wilmington Coastal Area Health Education Center - Auditorium
July 24, 2009 Asheville Mountain Area Health Education Center – Classroom 4
July 28, 2009 Charlotte Carolinas College of Health Sciences - Auditorium
July 31, 2009 Raleigh Jane S. McKimmon Center - Area 6
July 31, 2009 Deadline for receipt by MFPS of petitions for adjustments to need determinations and
other written comments regarding the Proposed 2010 SMFP.
August 14, 2009 Deadline for receipt by the MFPS of written comments about Technology &
Equipment related petitions and comments.
August 26, 2009 Deadline for receipt by the MFPS of written comments about Acute Care
Services related petitions and comments.
September 9, 2009 Deadline for receipt by the MFPS of written comments about Long- Term
and Behavioral Health related petitions and comments.
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 ( SMFP). The
Certificate of Need Section shall determine the appropriate review category or categories in
which an application shall be submitted pursuant to 10A NCAC 14C .0202. For proposals
which include more than one category, an applicant must contact the Certificate of Need Section
prior to submittal of the application for a determination regarding the appropriate review
category or categories and the applicable review period in which the proposal must be submitted.
The categories are as follows:
Category A
Proposals submitted by acute care hospitals, except those proposals included in
Categories B through H and Categories J through M, ( Note: Proposals for additional
or new acute care beds in a service area are included in Category K. Proposals for an
additional hospital facility that is developed by relocating beds to a different site
within the same county and does not include the addition of new acute care beds are
included in Category M.)
Category B
Proposals to increase the number of nursing care or adult care home beds in a county
for which there is a need determination for additional beds; and proposals for new
continuing care retirement communities applying for exemption under Policy NH- 2
or Policy LTC- 1.
Category C
Proposals for new psychiatric facilities; psychiatric beds in existing health care
facilities; new intermediate care facilities for the mentally retarded ( ICF/ MR) and
ICF/ MR beds in existing health care facilities; new substance abuse and chemical
dependency treatment facilities and substance abuse and chemical dependency
treatment beds in existing health care facilities; and transfers of nursing care beds
from State Psychiatric Hospitals to local communities pursuant to Policy NH- 5,
psychiatric beds from state psychatric hospitals to community facilities pursuant to
Policy PSY- 1, and ICF/ MR beds from State developmental centers to community
facilities pursuant to Chapter 858 of the 1983 Session Laws or Policy ICF/ MR- 2.
Category D
Proposals for new dialysis stations in response to the “ County Need” or “ Facility
Need” methodologies; and relocations of existing certified dialysis stations to another
county.
Category E
Proposals for inpatient rehabilitation facilities; inpatient rehabilitation beds; and
licensed ambulatory surgical facilities; new operating rooms and relocations 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 new Medicare- Certified home health agencies or offices; new hospices;
new hospice inpatient facility beds; and new hospice residential care facility beds.
Category G
Proposals for conversion of acute care beds to nursing care beds under Policy NH- 1;
and proposals for the conversion of acute care beds to long- term care hospital
( LTCH) beds.
Category H
Proposals for bone marrow transplantation services, burn intensive care services,
neonatal intensive care services, open heart surgery services, solid organ
transplantation services, air ambulance equipment, cardiac catheterization equipment,
heart- lung bypass machines, gamma knives, lithotriptors, fixed site magnetic
resonance imaging scanners, positron emission tomography scanners, linear
accelerators, simulators, major medical equipment as defined in G. S. 131E- 176( 14f),
and diagnostic centers as defined in G. S. 131E- 176( 7a).
Category I
Proposals for: cost overruns; expansions of existing continuing care retirement
communities which are licensed by the Department of Insurance at the date the
application is filed and are applying under Policy NH- 2 or Policy LTC- 1 for
exemption from need determinations in Chapter 10: Nursing Care Facilities or
Chapter 11: Adult Care Homes; relocations within the same county of an entire
existing health service facility ( excluding acute care hospitals); relocations within the
same county of existing licensed nursing facility, or existing licensed adult care home
beds, or existing certified dialysis stations; transfer of continuing care retirement
community beds pursuant to Policy NH- 7; reallocation of beds or services pursuant to
Policy Gen- 1; Category A or Policy AC- 3 projects submitted by Academic Medical
Center Teaching Hospitals designated prior to January 1, 1990; acquisition of
replacement equipment that does not result in an increase in the inventory of the
equipment; and, any other project not included in Categories A through H or
Categories J through M.
Category J
Proposals for: demonstration projects; statewide MRI scanner need determinations;
and relocation of exisitng 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.
Category K
Proposals for new or additional acute care beds in the service area.
Category L
Proposals for mobile magnetic resonance imaging scanners.
Category M
Proposals for: new or additional gastrointestinal endoscopy rooms as defined in G. S.
131E- 176( 7d); relocation of exisitng gastrointestinal endoscopy rooms as set forth in
G. S. 131E- 176( 16) u; relocations of one or more existing licensed acute care beds to a
different site within the same county that does not include the addition of new acute
care beds or operating rooms; and, new long term care hospital beds.
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 SMFP 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 SMFP, an applicant must refer to the applicable need determination
table for that service in the related chapter in the Plan. Applications for certificates of need for
new institutional health services not specified in other chapters of the Plan shall be reviewed
pursuant to the following review schedule, with the exception that no reviews are scheduled if
the need determination is zero. Need determinations for additional dialysis stations pursuant to
the “ county need” or “ facility need” methodologies shall be reviewed in accordance with the
provisions of Chapter 14.
In order to give the Certificate of Need Section sufficient time to provide public
notice of review and public notice of public hearings as required by G. S. 131E- 185, the
deadline for filing certificate of need applications is 5: 30 p. m. on the 15th day of the month
preceding the “ CON Beginning Review Date.” In instances when the 15th day of the month
falls on a weekend or holiday, the filing deadline is 5: 30 p. m. on the next business day. The
filing deadline is absolute and applications received after the deadline shall not be reviewed
in that review period. Applicants are strongly encouraged to complete all materials at least
one day prior to the filing deadline and to submit material early on the “ Certificate of Need
Application Due Date.
Table 3A: 2009 Certificate of Need Review Schedule
CON Beginning
Review Date
Health Service Area
I, II, III
Health Service Area
IV, V, VI
January 1, 2009 -- --
February 1, 2009 A, B, C, G, H, I --
March 1, 2009 -- A, B, C, E, G, H, I
April 1, 2009 B, C, D, E, F, H, I, M( 1) D
May 1, 2009 J C, F, H, I, J, K, M( 4)
June 1, 2009 A, C, F, H, I
July 1, 2009 -- A, B, C, E, H, I, M( 5)
August 1, 2009 B, C, E, F, H, I, M( 2) --
September 1, 2009 -- B, C, E, F, H, I
October 1, 2009 A, C, D, F, H, I D
November 1, 2009 B, C, E, H, I, K, L, M( 3) --
December 1, 2009 -- A, B, C, F, H, I, L, M( 6)
( 1) HSA I only.
( 2) HSA II only.
( 3) HSA III only.
( 4) HSA IV only.
( 5) HSA V only.
( 6) HSA VI only.
For further information about specific schedules, timetables, and certificate of need
application forms, contact:
North Carolina Division of Health Service Regulation
Certificate of Need Section
2704 Mail Service Center
Raleigh, N. C. 27699- 2704
Phone: ( 919) 855- 3873
Chapter 4:
Statement of Policies:
• Acute Care Hospitals
• Nursing Care Facilities
• Adult Care Homes
• Home Health Services
• End- Stage Renal Disease Dialysis Services
• Mental Health, Developmental
Disabilities, and Substance Abuse ( General)
• Psychiatric Inpatient Services
• Intermediate Care Facilities for the
Mentally Retarded
• All Health Services
CHAPTER 4
STATEMENT OF POLICIES
Summary of Policy Changes for 2009
The following substantive changes have been incorporated into the North Carolina 2009
State Medical Facilities Plan:
• POLICY PSY- 2: ALLOCATION OF PSYCHIATRIC BEDS has been deleted for the
North Carolina 2009 State Medical Facilities Plan.
• POLICY GEN- 3: BASIC PRINCIPLES has been updated to reflect the revised Basic
Principles shown in Chapter 1.
In addition, 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
.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- 2: UTILIZATION OF ACUTE CARE HOSPITAL BED CAPACITY
POLICY AC- 3: EXEMPTION FROM PLAN PROVISIONS FOR CERTAIN
ACADEMIC MEDICAL CENTER TEACHING HOSPITAL PROJECTS
Projects for which certificates of need are sought by academic medical center teaching hospitals
may qualify for exemption from the need determinations of this document. The Medical
Facilities Planning 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 comply with one of the
following conditions:
a. Necessary to complement a specified and approved expansion of the number or
types of students, residents or faculty, as certified by the head of the relevant
associated professional school; or
b. 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; or
c. 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 also 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 the service for which the exemption is requested and which is within 20 miles of the
Academic Medical Center Teaching Hospital.
Any health service facility or health service facility bed that results from a project submitted
under this Policy after January 1, 1999 shall be excluded from the inventory of that health
service facility or health service facility bed in the North Carolina State Medical Facilities Plan.
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 “ Thomson” Days of Care as provided to the Medical Facilities Planning Section by The
Cecil G. Sheps Center, 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. In
determining utilization of acute care beds, only acute care bed “ days of care” shall be counted.
Any hospital proposing replacement of acute care beds 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( 2).
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, 2009; and
2. on January 1, 2009, had a licensed acute care bed capacity of 150 beds or less.
The certificate of need shall remain in force as long as the 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 and 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:
a. the nursing care beds shall be certified for participation in the Title XVIII ( Medicare)
and Title XIX ( Medicaid) Programs;
b. 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;
c. 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:
a. 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
b. currently has nursing home beds licensed as a part of the hospital under G. S. 131E,
Article 5, or
c. 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 Department of Health and
Human Services annually. Certificates of need issued under policies analogous to this policy in
the North Carolina State Medical Facilities Plans subsequent to the 1986 Plan are automatically
amended to conform with the provisions of this policy at the effective date of this policy.
The 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 N. C. 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 SMFP are automatically amended to conform with the provisions
of this policy at the effective date of this policy. Certificates of need awarded pursuant to the
provisions of Chapter 920, Session Laws 1983 or Chapter 445, Session Laws 1985 shall not be
amended.
POLICY NH- 3: DETERMINATION OF NEED FOR ADDITIONAL NURSING
CARE BEDS IN SINGLE PROVIDER COUNTIES
When a nursing care facility with fewer than 80 nursing care beds is the only nursing care
facility within a county, it may apply for a certificate of need for additional nursing care beds in
order to bring the minimum number of nursing care beds available within the county to no more
than 80 nursing care beds without regard to the nursing care bed need determination for that
county as listed in Chapter 10: Nursing Care Facilities.
POLICY NH- 4: RELOCATION OF CERTAIN NURSING FACILITY BEDS
A certificate of need to relocate existing licensed nursing facility beds to another county( ies)
may be issued to a facility licensed as a nursing facility under G. S. Chapter 131E, Article 6, Part
1, provided that the conditions set forth below and in 10A NCAC 14C .1100 and the review
criteria in G. S. 131E- 183( a) are met. A facility applying for a certificate of need to relocate
nursing facility beds shall demonstrate that:
1. it is a non- profit nursing facility supported by and directly affiliated with a
particular religion and that it is the only nursing facility in North Carolina
supported by and affiliated with that religion;
2. the primary purpose for the nursing facility’s existence is to provide long- term care
to followers of the specified religion in an environment which emphasizes religious
customs, ceremonies, and practices;
3. relocation of the nursing facility beds to one or more sites is necessary to more
effectively provide nursing care to followers of the specified religion in an
environment which emphasizes religious customs, ceremonies, and practices;
4. the nursing facility is expected to serve followers of the specified religion from a
multi- county area; and
5. the needs of the population presently served shall be met adequately pursuant to
G. S. 131E- 183.
Exemption from the need determinations in Chapter 10: Nursing Care Facilities shall be granted
to a nursing facility for purposes of relocating existing licensed nursing care beds to another
county provided that it complies with all of the criteria listed in Subparts A through E 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 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 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 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
Chief of State Operated Services in the Division of MH/ DD/ SAS; the Secretary of Health and
Human Services; and the person submitting the proposal.
This policy does not allow the development of new nursing care beds. Nursing care beds
transferred from State Psychiatric Hospitals to the community pursuant to Policy NH- 5 shall be
excluded from the inventory.
POLICY NH- 6: RELOCATION OF NURSING FACILITY BEDS
Relocations of existing licensed nursing facility beds are allowed only within the host county and
to contiguous counties currently served by the facility, except as provided in Policies NH- 4, NH-
5 and NH- 7. Certificate of need applicants proposing to relocate licensed nursing facility beds to
contiguous counties shall:
1. demonstrate that the proposal shall not result in a deficit in the number of licensed
nursing facility beds in the county that would be losing nursing facility beds as a
result of the proposed project, as reflected in the North Carolina State Medical
Facilities Plan in effect at the time the certificate of need review begins, and
2. demonstrate that the proposal shall not result in a surplus of licensed nursing facility
beds in the county that would gain nursing facility beds as a result of the proposed
project, as reflected in the North Carolina State Medical Facilities Plan in effect at the
time the certificate of need review begins.
POLICY NH- 7: TRANSFER OF CONTINUING CARE RETIREMENT COMMUNITY
BEDS
A certificate of need to relocate existing licensed nursing beds to another county or counties may
be issued to a facility licensed as a nursing facility under G. S. Chapter 131E, Article 6, Part 1
without regard to the nursing care bed need shown in Chapter 10, provided that the following
conditions are met:
1. Any CON 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).
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
N. C. 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
CON 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 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 SMFP are automatically amended to conform with
the provisions of this policy at the effective date of this policy.
POLICY LTC- 2: RELOCATION OF ADULT CARE HOME BEDS
Relocations of existing licensed adult care home beds are allowed only within the host county
and to contiguous counties currently served by the facility. Certificate of need applicants
proposing to relocate licensed adult care home beds to contiguous counties shall:
1. Demonstrate that the proposal shall not result in a deficit in the number of licensed
adult care home beds in the county that would be losing adult care home beds as a
result of the proposed project, as reflected in the North Carolina State Medical
Facilities Plan in effect at the time the certificate of need review begins, and
2. Demonstrate that the proposal shall not result in a surplus of licensed adult care home
beds in the county that would gain adult care home beds as a result of the proposed
project, as reflected in the North Carolina State Medical Facilities Plan in effect at the
time the certificate of need review begins.
POLICIES APPLICABLE TO HOME HEALTH SERVICES ( HH)
POLICY HH- 3: NEED DETERMINATION FOR MEDICARE- CERTIFIED HOME
AGENCY IN A COUNTY
When a county has no Medicare- certified home health agency office physically located within
the county’s borders, and the county has a population of more than 20,000 people; or, if the
county has a population of less than 20,000 people and there is not an existing Medicare-
Certified Home Health Agency Office located in a North Carolina county within 20 miles, need
for a new Medicare- Certified home health agency office in the county is thereby established
through this policy. The “ need determination” shall be reflected in the next annual North
Carolina State Medical Facilities Plan that is published following determination that a county
meets the criteria indicated above. ( Population is based on population estimates/ projections from
the North Carolina Office of State Budget and Management for the plan year in which the need
determination would be made excluding active duty military for any county with more than 500
active duty military personnel. The measurement of 20 miles will be in a straight line from the
closest point on the county line of the county in which an existing agency office is located to the
county seat of the county in which there is no agency.)
POLICIES RELATED TO END- STAGE RENAL DISEASE
DIALYSIS SERVICES ( ESRD)
POLICY ESRD- 2: RELOCATION OF DIALYSIS STATIONS
Relocations of existing dialysis stations are allowed only within the host county and to
contiguous counties currently served by the facility. Certificate of need applicants proposing to
relocate dialysis stations to contiguous counties shall:
1. demonstrate that the proposal shall not result in a deficit in the number of dialysis
stations in the county that would be losing stations as a result of the proposed
project, as reflected in the most recent Dialysis Report, and
2. demonstrate that the proposal shall not result in a surplus of dialysis stations in the
county that would gain stations as a result of the proposed project, as reflected in
the most recent Dialysis Report.
GENERAL POLICY APPLICABLE TO ALL MENTAL HEALTH,
DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE FACILITIES ( MH)
POLICY MH- 1: LINKAGES BETWEEN TREATMENT SETTINGS
An applicant for a certificate of need for psychiatric, substance abuse, or Intermediate Care
Facilities for the Mentally Retarded ( ICF/ MR) beds shall document that the affected Local
Management Entity 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 hospital beds that are relocated to community facilities shall be closed
within 90 days following the date the transferred beds become operational in the community.
Facilities proposing to operate transferred beds shall submit an application to the Certificate of
Need Section of the 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 persons 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 serving the county where the beds are to be
located, the Secretary of Health and Human Services, and the person submitting the proposal.
POLICY PSY- 2: ALLOCATION OF PSYCHIATRIC BEDS
The former policy was deleted for the North Carolina Proposed 2009 State Medical Facilities
Plan.
POLICIES APPLICABLE TO INTERMEDIATE CARE FACILITIES FOR THE
MENTALLY RETARDED ( ICF/ MR)
POLICY ICF/ MR- 1: TRANSFER OF ICF/ MR BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES
FOR MEDICALLY FRAGILE CHILDREN
ICF/ MR beds in state operated developmental centers may be relocated to community facilities
through the Certificate of Need process for the establishment of community ICF/ MR 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/ MR beds that are relocated to community facilities shall be closed upon licensure of
the transferred beds.
Facilities proposing to operate transferred beds shall submit an application to the Certificate of
Need Section demonstrating a commitment to serve children ages birth through six years who
have severe to profound developmental disabilities and are medically fragile. To help ensure the
relocated beds will serve these residents such proposal shall include a written agreement with the
following representatives: director of the Local Management Entity serving the county where the
group home is to be located; the director of the applicable state operated developmental center;
the Chief of State Operated Services in the DMH/ DD/ SAS; the Secretary of the Department of
Health and Human Services and the operator of the group home.
POLICY ICF/ MR- 2: TRANSFER OF ICF/ MR BEDS FROM STATE OPERATED
DEVELOPMENTAL CENTERS TO COMMUNITY FACILITIES
FOR INDIVIDUALS WHO CURRENTLY OCCUPY THE BEDS
Existing certified ICF/ MR beds in state operated developmental centers may be transferred
through the Certificate of Need process to establish ICF/ MR group homes in the community to
serve people with complex behavioral challenges and / or medical conditions for whom a
community ICF/ MR 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/ MR 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/ MR beds in the
community facility. Providers proposing to develop transferred ICF/ MR beds, as those beds are
described in this policy, shall submit an application to the Certificate of Need Section that
demonstrates their clinical experience in treating individuals with complex behavioral challenges
or medical conditions in a residential ICF/ MR 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
serving the county where the group home is to be located, the director of the applicable
developmental center, the Chief of State Operated Services in the N. C. Division of Mental
Health/ Developmental Disabilities/ Substance Abuse Services ( DMH/ DD/ SAS), the Secretary of
the Department of Health and Human Services and the operator of the group home.
POLICIES APPLICABLE TO ALL HEALTH SERVICES ( GEN)
The policy statements below apply to all health services including acute care ( hospitals,
ambulatory surgical facilities, operating rooms, rehabilitation facilities, and technology); long-term
care ( nursing homes, adult care homes, Medicare- Certified home health agencies, end- stage
renal disease services and hospice services); mental health ( psychiatric facilities, substance
abuse facilities, and intermediate care facilities for the mentally retarded) 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, air
ambulances, cardiac catheterization equipment, heart- lung bypass machines, gamma knives,
linear accelerators, lithotriptors, magnetic resonance imaging scanners, positron emission
tomography scanners, simulators, major medical equipment as defined in G. S. 131E- 176( 14f),
and diagnostic centers as defined in G. S. 131E- 176( 7a).
POLICY GEN- 1: REALLOCATIONS
1. Reallocations shall be made only to the extent that the methodologies used in this Plan to
make need determinations indicate that need exists after the inventories are revised and
the need determinations are recalculated.
2. Beds or services which are reallocated once in accordance with this policy shall not be
reallocated again. Rather, the Medical Facilities Planning Section 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 Dialysis Report.
4. Appeals of Certificate of Need Decisions on Applications
Need determinations of beds or services for which the CON Section decision to approve
or deny the application has been appealed shall not be reallocated until the appeal is
resolved.
a. Appeals resolved prior to August 17:
If such an appeal is resolved in the calendar year prior to August 17, the beds or
services shall not be reallocated by the CON Section; rather the Medical Facilities
Planning Section shall make the necessary changes in the next annual North
Carolina State Medical Facilities Plan, except for dialysis stations which shall be
processed pursuant to Item ( 3).
b. Appeals resolved on or after August 17:
If such an appeal is resolved on or after August 17 in the calendar year, the beds or
services, except for dialysis stations, shall be made available for a review period to
be determined by the CON Section, but beginning no earlier than 60 days from the
date that the appeal is resolved. Notice shall be mailed by the Certificate of Need
Section to all people on the mailing list for the North Carolina State Medical
Facilities Plan, no less than 45 days prior to the due date for receipt of new
applications.
5. Withdrawals and Relinquishments
Except for dialysis stations, a need determination for which a certificate of need is issued,
but is subsequently withdrawn or relinquished, is available for a review period to be
determined by the Certificate of Need Section, but beginning no earlier than 60 days
from:
a. the last date on which an appeal of the notice of intent to withdraw the certificate
could be filed if no appeal is filed,
b. the date on which an appeal of the withdrawal is finally resolved against the holder,
or
c. the date that the Certificate of Need Section receives from the holder of the certificate
of need notice that the certificate has been voluntarily relinquished.
Notice of the scheduled review period for the reallocated services or beds shall be mailed
by the Certificate of Need Section to all people on the mailing list for the North Carolina
State Medical Facilities Plan, no less than 45 days prior to the due date for submittal of
the new applications.
6. Need Determinations for which No Applications are Received
a. Services or beds with scheduled review in the Calendar Year on or before September
1: The Certificate of Need Section shall not reallocate the services or beds in this
category for which no applications were received, because the Medical Facilities
Planning Section 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 HSA. Notice of the scheduled review period for
the reallocated beds or services shall be mailed by the Certificate of Need Section
to all people on the mailing list for the North Carolina State Medical Facilities Plan,
no less than 45 days prior to the due date for submittal of new applications.
7. Need Determinations not Awarded because Application Disapproved
a. Disapproval in the Calendar Year prior to August 17:
Need determinations or portions of such need for which applications were
submitted but disapproved by the Certificate of Need Section before August 17,
shall not be reallocated by the Certificate of Need Section. Instead the Medical
Facilities Planning Section shall make the necessary changes in the next annual
North Carolina State Medical Facilities Plan if no appeal is filed, except for dialysis
stations.
b. Disapproval in the Calendar Year on or after August 17:
Need determinations or portions of such need for which applications were
submitted but disapproved by the Certificate of Need Section on or after August 17,
shall be reallocated by the Certificate of Need Section, except for dialysis stations.
A need in this category shall be available for a review period to be determined by
the Certificate of Need Section but beginning no earlier than 95 days from the date
the application was disapproved, if no appeal is filed. Notice of the scheduled
review period for the reallocation shall be mailed by the Certificate of Need Section
to all people on the mailing list for the North Carolina State Medical Facilities Plan
no less than 80 days prior to the due date for submittal of the new applications.
8. Reallocation of Decertified Intermediate Care Facilities for the Mentally Retarded
( ICF/ MR) Beds
If an ICF/ MR facility’s Medicaid certification is relinquished or revoked, the ICF/ MR
beds in the facility may be reallocated by the Department of Health and Human Services,
Division of Health Service Regulation, Medical Facilities Planning Section after
consideration of recommendations from the Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services. The Department of Health and Human
Services, Division of Health Service Regulation, Certificate of Need Section shall
schedule reviews of applications for any reallocated beds pursuant to Section ( 5) of this
Policy.
POLICY GEN- 2: CHANGES IN NEED DETERMINATIONS
1. The need determinations adopted in this document or in the Dialysis Reports shall be
revised continuously throughout the calendar year to reflect all changes in the inventories of:
a. the health services listed at G. S. 131E- 176 ( 16) f;
b. health service facilities;
c. health service facility beds;
d. dialysis stations;
e. the equipment listed at G. S. 131E- 176 ( 16) f1;
f. mobile medical equipment; and
g. operating rooms as defined in Chapter 6;
as those changes are reported to the Medical Facilities Planning Section. 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, intermediate
care facilities for the mentally retarded and dialysis stations;
b. delicensure of health service facilities and health service facility beds;
c. demolition, destruction, or decommissioning of equipment as listed at G. S. 131E-
176( 16) f1 and s;
d. elimination or reduction of a health service as listed at G. S. 131E- 176( 16) f;
e. addition or reduction in operating rooms as defined in Chapter 6;
f. psychiatric beds licensed pursuant to G. S. 131E- 184( c);
g. certificates of need awarded, relinquished, or withdrawn, subsequent to the
preparation of the inventories in the North Carolina State Medical Facilities Plan;
h. corrections of errors in the inventory as reported to the Medical Facilities Planning
Section.
3. Any person who is interested in applying for a new institutional health service for which a
need determination is made in this document may obtain information about updated
inventories and need determinations from the Medical Facilities Planning Section.
4. Need determinations resulting from changes in inventory shall be available for a review period
to be determined by the Certificate of Need Section, but beginning no earlier than 60 days
from the date of the action identified in Subsection ( b), except for dialysis stations which
shall be determined by the Medical Facilities Planning Section and published in the next
Dialysis Report. Notice of the scheduled review period for the need determination shall be
mailed by the Certificate of Need Section to all people on the mailing list for the North
Carolina State Medical Facilities Plan no less than 45 days prior to the due date for submittal
of the new applications.
POLICY GEN- 3: BASIC PRINICPLES
A CON 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 ( SMFP) 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 CON 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 CON applicant shall also document how its projected volumes incorporate
these concepts in meeting the need identified in the SMFP as well as addressing the needs of all
residents in the proposed service area.
Chapter 5:
Acute Care Hospital Beds
CHAPTER 5
ACUTE CARE HOSPITAL BEDS
Summary of Bed Supply and Utilization
Data reported on the " 2008 Hospital License Renewal Applications" indicate that there
are 114 licensed acute care hospitals and 20,294 licensed acute care beds in North Carolina. Data
provided by Thomson ( formerly Solucient) indicated that 4,511,691 days of care were provided
to patients in those hospitals during 2007, which represents an average annual occupancy rate of
60.91 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 955 pending beds and to be reduced in other markets
by 404 beds, for a net gain of 551 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 change from the previous Plan have been incorporated into the 2009
North Carolina 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. Out patient diagnostic studies;
d. Prea dmission testing;
e. Prea dmission certification;
f. Programs to reduce admission and readmission rates;
g. Timely scheduling of admissions;
h. Effe ctive utilization review;
i. Dis charge planning;
j. Appropriate use of alternative services such as home health services,
hospice, adult care homes, nursing homes; and
k. Initiating new, or maximizing existing, preventive health services.
5. To assure that substantial capital expenditures for the construction or renovation of
health care facilities are based on demonstrated need.
6. To assure that applicants proposing to expand or replace acute care beds should
provide careful analysis of what they have done to promote cost- effective
alternatives to inpatient care and to reduce average length of stay.
B. Use of Swing Beds
The North Carolina Department of Health and Human Services supports the use of " swing
beds" in providing long- term nursing care services in rural acute care hospitals.
Section 1883 of the Social Security Act provides that certain small rural hospitals may use
their inpatient facilities to furnish skilled nursing facility ( SNF) services to Medicare and
Medicaid beneficiaries and intermediate care facility ( ICF) services to Medicaid beneficiaries.
Hospitals wishing to receive swing bed certification for Medicare patients must meet the
eligibility criteria outlined in the law which include:
1. Have a certificate of need, or a letter from the Certificate of Need Section indicating that
no certificate of need review is required to provide " swing bed" services; and
2. Have a current valid Medicare provider agreement; and
3. Be located in an area of the State not designated as " urbanized" by the most recent
official
census; and
4. Have fewer than 100 hospital beds, excluding beds for newborns and beds in intensive
type inpatient units; and
5. Not have in effect a 24- hour nursing waiver granted under 42 CFR 488.54( c); and
6. Not have had a swing bed approval terminated within the two years previous to
application; and
7. Meet the Swing Bed Conditions of Participation ( see 42 CFR 482.66) on Resident
Rights; Admission, Transfer, and Discharge Rights; Resident Behavior and Facility
Practices; Patient Activities; Social Services; Discharge Planning; Specialized
Rehabilitative Services; and Dental Services.
A Certificate of Need is not required if capital expenditures associated with the swing bed
service do not exceed $ 2 million, and there is no change in bed capacity.
Sources of Data
Inventory of Acute Care Beds:
The inventory of hospital facilities is maintained through the hospitals' response to a state
law that requires each facility to notify the North Carolina Department of Health and Human
Services and receive appropriate approvals before construction, alterations or additions to
existing buildings or any changes in bed capacities. Bed counts are revised in the state's
inventory as changes are reported and approved.
Days of Care and Patient Origin Data for the Bed Need Methodology:
The data source for annual Days of Care used in the methodology is Thomson, a collector of
hospital patient discharge information. The general acute care days of care by facility and
data on patient’s county of residence were provided by the Sheps Center, based on the
Thomson 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 Thomson by facilities on the UB- 92 form. Included in Column F,
" Thomson 2007 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
1 - 99 66.7 %
100 - 200 71.4 %
Greater than 200 75.2 %
• 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
The Acute Care Bed Service Area is a single county, except where there is no hospital located
within the county in which case the county or counties without a hospital are combined in a
multi- county grouping with a county that has a hospital. Multi- county groupings are determined
based on the county in which the hospital or hospitals that provide the largest number of
inpatient days of care to the residents of the county which has no hospital. Data to determine
patient’s county of residence ( based on the Thomson data) that is used to establish the multi-county
groupings were provided by the Sheps Center. ( Note: 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 multi- county 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 SMFP 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 2007. ( Please see note
in “ Sources of Data” regarding identification of general acute days of care.)
Step 4 ( Column G)
Calculate the projected inpatient days of care in Federal Fiscal Year 2013 as follows:
( a) Determine the total annual number of inpatient days of care provided to North Carolina
residents in North Carolina acute care hospitals during each of the last four federal fiscal
years based on data provided by the Sheps Center.
( b) Calculate the difference in the number of inpatient days of care provided from year to year.
( c) For each of the last three years, divide the calculated difference in inpatient days by the total
number of inpatient days provided during the previous year to determine the percentage
change from the previous year. ( Example: ( YR 2005 – YR 2004) / YR 2004; etc.)
( d) Total the annual percentages of change and divide by three to determine the average annual
historical percentage change for the State. ( Note: The average annual statewide percent of
change is 0 .01% per year, a multiplier of 1.0001.)
( e) Calculate the compounded statewide growth factor projected for the next six 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. ( Example: YR1@ 1.0001; YR2
@ 1.0001 x 1.0001 = 1.0002; YR3 @ 1.0002 x 1.0001 = 1.0003; etc.)
( f) For each hospital, multiply the acute inpatient days of care from Column E by the
compounded statewide growth factor to project the number of acute inpatient days of care to
be provided in Federal Fiscal Year 2013 at each hospital.
Step 5 ( Column H)
Calculate the projected midnight average daily census for each hospital in Federal Fiscal Year
2013, by dividing the projected number of acute inpatient days of care provided at the hospital
( from Column G) by 365 days.
Step 6 ( Column I)
Multiply each hospital's projected midnight average daily census from Step 5 ( Column H) by the
appropriate target occupancy factor below:
Average Daily Census less than 100 = 1.50
Average Daily Census 100- 200 = 1.40
Average Daily Census greater than 200 = 1.33
Step 7 ( Column J)
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 I).
( Note: Deficits will appear as positive numbers; surpluses, as negative numbers.)
Step 8 ( Column K)
The number of acute care beds needed in a service area is determined as follows:
( a) 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.
( b) When the deficit of total acute care beds in the service area for an owner ( regardless of
number of hospitals owned) equals or exceeds 20 beds or 10% of the inventory of acute care
beds for that owner, the deficits of all 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
Figure 5.1: Acute Care Bed Service Areas
Hospital Multi- County Service Area Color Code
CHEROKEE
SWAIN
JA CKSON
GRAHAM
CHATHA M
POLK
BUNCOMBE
MADISON
ASHE
WATAUGA
WILKES YADKIN
D AVIE
R O WA N
ST OKES
FORSYTH
GUILFORD
ROCKINGHA M
CASWELL
R ANDOLPH
DAVIDSON
C O LUMBUS
ONSLOW
MOORE
HOKE
LEE
HARNE TT
SCOTLAND
BL ADEN
SAMPSON DUPLIN
WILSON
W AY N E
LENOIR
GREENE
CARTERET
UNION ANSON
CABARRUS
ST ANLY
RICHMOND
CR AVEN
JONES
PIT T BEAUFORT
WASHINGTON
TYRRELL
D ARE
MARTIN
EDGECOMBE
BERTIE
GATES NORTHAMPTON
HER TFORD
W ARREN
FR ANKLIN
W AKE
PERSON
VANCE
MCDOWELL BURKE
CALDWELL
MITCHELL
YANCEY
LINC OLN
GASTON
RUTHERFORD
CLEVELAND
M A C O N
CL AY
TRANSYLVANIA
AVER Y
C AT A WBA
H Y D E
BRUNSWICK
MONTGOMERY
ALEXANDER
ALLEGHANY
HENDERSON
CURRITUCK
PASQUOTANK
PERQUIM.
CAMDEN
CHOWAN
PAMLICO
NEW
HANOVER
SURR Y
IREDELL
HAYWOOD
GRANVILLE
HALIFAX
NASH
JOHNST ON
DURHAM
ORANGE
ALAMANCE
CUMBERLAND
ROBESON
PENDER
MECKLENBURG
Murphy Medical Center Cherokee, Clay and Graham
Mission Hospitals Buncombe, Madison and Yancey
First Health Moore Regional Moore and Hoke
University of North Carolina Hospital Orange and Caswell
Maria Parham Hospital Vance and Warren
Our Community Hospital and
Halifax Regional Medical Center Halifax and Northampton
Pitt County Memorial Hospital Pitt and Greene
Craven Regional Medical Center Craven, Jones and Pamlico
Pungo District Hospital Corporation
and Beaufort County Hospital Beaufort and Hyde
Roanoke- Chowan Hospital Hertford and Gates
Chowan Hospital Chowan and Tyrell
Albemarle Hospital Pasquotank, Camden,
Currituck and Perquimans
Shaded counties are multi- county 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. Counties without acute care
hospitals were grouped with the county
where a plurality of residents were served.
Source: 2001 ( HCIA) Solucient data
Table 5A: Acute Care Bed Need Projections
( 2007 Utilization Data from Thomson as compiled by the Cecil B. Sheps Center for Health Services Research)
A B C D E F G H I J K
License # Facility Name County
Licensed
AC Beds
Adjustments
for CONs and
Previous Need
Thomson
2007
Acute
Care Days
6 Years
Growth at
0.01%
Annually
2013
Projected
Average
Daily
Census
( ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit
( Bolded) or
Surplus ("-" )
2013 Need
Determination
H0272 Alamance Regional Medical Center Alamance 182 0 43,733 43,759 120 168 - 14
Alamance Total 182 0
H0274 Alexander Hospital Alexander 25 0 0 0 0 0 - 25
Alexander Total 25 0
H0108 Alleghany Memorial Hospital Alleghany 41 0 2,399 2,400 7 10 - 31
Alleghany Total 41 0
H0082 Anson Community Hospital Anson 52 0 5,367 5,370 15 22 - 30
Anson Total 52 0
H0099 Ashe Memorial Hospital Ashe 76 0 5,070 5,073 14 21 - 55
Ashe Total 76 0
H0037 Charles A. Cannon, Jr. Memorial Hospital Avery 30 0 5,965 5,969 16 25 - 5
Avery Total 30 0
H0188 Beaufort County Hospital Beaufort 120 0 10,684 10,690 29 44 - 76
H0002 Pungo District Hospital Corporation Beaufort 39 0 2,369 2,370 6 10 - 29
Beaufort Total 159 0
H0268 Bertie Memorial Hospital Bertie 6 0 1,566 1,567 4 6 0
Bertie Total 6 0
H0154 Cape Fear Valley - Bladen County Hospital Bladen 48 0 4,729 4,732 13 19 - 29
Bladen Total 48 0
H0250 Brunswick Community Hospital Brunswick 60 0 11,205 11,212 31 46 - 14
H0150 J. Arthur Dosher Memorial Hospital Brunswick 36 0 4,696 4,699 13 19 - 17
Brunswick Total 96 0
H0036 Mission Hospitals Buncombe 673 0 182,390 182,499 500 665 - 8
Buncombe Total 673 0
H0062 Grace Hospital Burke 162 0 20,151 20,163 55 83 - 79
H0091 Valdese General Hospital Burke 131 0 12,151 12,158 33 50 - 81
Burke Total 293 0
H0031 Carolinas Medical Center - NorthEast Cabarrus 447 0 98,475 98,534 270 359 - 88
Cabarrus Total 447 0
H0061 Caldwell Memorial Hospital Caldwell 110 0 15,095 15,104 41 62 - 48
Caldwell Total 110 0
H0222 Carteret General Hospital Carteret 135 0 28,952 28,969 79 119 - 16
Carteret Total 135 0
H0223 Catawba Valley Medical Center Catawba 200 0 39,233 39,257 108 151 - 49
H0053 Frye Regional Medical Center Catawba 209 0 48,577 48,606 133 186 - 23
Catawba Total 409 0
H0007 Chatham Hospital Chatham 25 0 2,855 2,857 8 12 - 13
Chatham Total 25 0
H0239 Murphy Medical Center Cherokee 57 0 8,000 8,005 22 33 - 24
Cherokee Total 57 0
0
0
0
0
0
0
0
0
0
0
0
0
0
Projections based on Growth Factor at .01% per year for the next 6 years. Target Occupancy Factors: ADC< 100 = 150%, ADC 100- 200 = 140%, ADC> 200 = 133%.
0
0
0
0
0
Table 5A: Acute Care Bed Need Projections
( 2007 Utilization Data from Thomson as compiled by the Cecil B. Sheps Center for Health Services Research)
A B C D E F G H I J K
License # Facility Name County
Licensed
AC Beds
Adjustments
for CONs and
Previous Need
Thomson
2007
Acute
Care Days
6 Years
Growth at
0.01%
Annually
2013
Projected
Average
Daily
Census
( ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit
( Bolded) or
Surplus ("-" )
2013 Need
Determination
Projections based on Growth Factor at .01% per year for the next 6 years. Target Occupancy Factors: ADC< 100 = 150%, ADC 100- 200 = 140%, ADC> 200 = 133%.
H0063 Chowan Hospital Chowan 49 0 6,596 6,600 18 27 - 22
Chowan Total 49 0
H0024 Cleveland Regional Medical Center Cleveland 241 0 37,094 37,116 102 142 - 99
H0236
Crawley Memorial Hospital
( CON to convert 41 AC beds to LTCH beds and 10
AC beds to nursing beds issued 7.14.08.) Cleveland 50 0 9 9 0 0 - 50
H0113 Kings Mountain Hospital Cleveland 72 0 7,171 7,175 20 29 - 43
Cleveland Total 363 0
H0045 Columbus County Hospital* Columbus 154 0 25,813 25,828 71 106 - 48
* Note: Hospital's Thomson 2007 Acute Care Days have not been verified as correct - service area need determination not affected.
Columbus Total 154 0
H0201 Craven Regional Medical Center Craven 270 0 78,365 78,412 215 286 16
Craven Total 270 0
H0213 Cape Fear Valley Medical Center Cumberland 397 0 136,755 136,837 375 499 102
Cumberland Total 397 0
H0273 The Outer Banks Hospital Dare 19 2 3,644 3,646 10 15 - 6
Dare Total 19 2
H0027 Lexington Memorial Hospital Davidson 94 0 11,661 11,668 32 48 - 46
H0112 Thomasville Medical Center Davidson 123 0 13,498 13,506 37 56 - 67
Davidson Total 217 0
H0171 Davie County Hospital Davie 81 0 1,264 1,265 3 5 - 76
Davie Total 81 0
H0166 Duplin General Hospital* Duplin 61 0 11,459 11,466 31 47 - 14
* Note: Hospital's Thomson 2007 Acute Care Days have not been verified as correct - service area need determination not affected.
Duplin Total 61 0
H0015 Duke University Hospital Durham 924 0 235,196 235,337 645 858 - 66
( Duke University Hospital has a CON for 14 additional acute care beds under Policy AC- 3. These 14 beds are not counted when determining acute care bed need.)
H0233 Durham Regional Hospital Durham 316 0 63,487 63,525 174 244 - 72
Totals Duke/ Durham Regional Totals 1,240 0 - 139
H0075 North Carolina Specialty Hospital Durham 18 0 2,505 2,507 7 10 - 8
Durham Total 1,258 0
H0258 Heritage Hospital Edgecombe 101 0 14,054 14,062 39 58 - 43
Edgecombe Total 101 0
H0209 Forsyth Medical Center Forsyth 751 39 208,327 208,452 571 760 - 30
H0229 Medical Park Hospital Forsyth 22 0 5,684 5,687 16 23 1
Totals Forsyth/ Medical Park Totals 773 39 - 29
H0011 North Carolina Baptist Hospitals Forsyth 789 0 213,567 213,695 585 779 - 10
2007 SMFP Need Determination Forsyth 26 0 0 0 0
Forsyth Total 1,562 65
0
0
0
0
0
0
0
0
0
0
0
0
Table 5A: Acute Care Bed Need Projections
( 2007 Utilization Data from Thomson as compiled by the Cecil B. Sheps Center for Health Services Research)
A B C D E F G H I J K
License # Facility Name County
Licensed
AC Beds
Adjustments
for CONs and
Previous Need
Thomson
2007
Acute
Care Days
6 Years
Growth at
0.01%
Annually
2013
Projected
Average
Daily
Census
( ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit
( Bolded) or
Surplus ("-" )
2013 Need
Determination
Projections based on Growth Factor at .01% per year for the next 6 years. Target Occupancy Factors: ADC< 100 = 150%, ADC 100- 200 = 140%, ADC> 200 = 133%.
H0261 Franklin Regional Medical Center Franklin 70 0 13,645 13,653 37 56 - 14
Franklin Total 70 0
H0105 Gaston Memorial Hospital Gaston 372 0 87,990 88,043 241 321 - 51
Gaston Total 372 0
H0098 Granville Medical Center Granville 62 0 7,280 7,284 20 30 - 32
Granville Total 62 0
H0052 High Point Regional Health System Guilford 291 16 72,495 72,539 199 278 - 29
H0159 Moses Cone Health System Guilford 818 - 41 192,620 192,736 528 702 - 75
Guilford Total 1,109 - 25
H0230 Halifax Regional Medical Center Halifax 186 0 33,124 33,144 91 136 - 50
H0004 Our Community Hospital Halifax 20 0 139 139 0 1 - 19
Halifax Total 206 0
H0224 Betsy Johnson Regional Hospital Harnett 101 0 28,675 28,692 79 118 17
N/ A Harnett Health System Central Campus Harnett 0 50 0 0 0 0 - 50
Totals Betsy Johnson/ Harnett Health System Totals 101 50 - 33
H0080 Good Hope Hospital ( closed effective 4/ 11/ 06) Harnett 0 34 0 0 0 0 - 34
Harnett Total 101 84
H0025 Haywood Regional Medical Center Haywood 153 0 21,412 21,425 59 88 - 65
Haywood Total 153 0
H0161 Margaret R. Pardee Memorial Hospital Henderson 193 0 26,797 26,813 73 110 - 83
H0019 Park Ridge Hospital Henderson 62 0 13,397 13,405 37 55 - 7
Henderson Total 255 0
H0001 Roanoke- Chowan Hospital Hertford 86 0 15,220 15,229 42 63 - 23
Hertford Total 86 0
H0248 Davis Regional Medical Center Iredell 120 - 18 16,644 16,654 46 68 - 34
H0259 Lake Norman Regional Medical Center Iredell 105 18 27,757 27,774 76 114 - 9
Totals Davis Regional/ Lake Norman Totals 225 0 - 42
H0164 Iredell Memorial Hospital Iredell 199 0 41,817 41,842 115 160 - 39
Iredell Total 424 0
H0087 Harris Regional Hospital Jackson 86 0 19,445 19,457 53 80 - 6
Jackson Total 86 0
H0151 Johnston Memorial Hospital Johnston 157 22 38,576 38,599 106 148 - 31
Johnston Total 157 22
H0243 Central Carolina Hospital Lee 127 0 20,645 20,657 57 85 - 42
Lee Total 127 0
H0043 Lenoir Memorial Hospital Lenoir 218 0 43,336 43,362 119 166 - 52
Lenoir Total 218 0
H0225 Carolinas Medical Center - Lincoln Lincoln 101 0 15,624 15,633 43 64 - 37
Lincoln Total 101 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Table 5A: Acute Care Bed Need Projections
( 2007 Utilization Data from Thomson as compiled by the Cecil B. Sheps Center for Health Services Research)
A B C D E F G H I J K
License # Facility Name County
Licensed
AC Beds
Adjustments
for CONs and
Previous Need
Thomson
2007
Acute
Care Days
6 Years
Growth at
0.01%
Annually
2013
Projected
Average
Daily
Census
( ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit
( Bolded) or
Surplus ("-" )
2013 Need
Determination
Projections based on Growth Factor at .01% per year for the next 6 years. Target Occupancy Factors: ADC< 100 = 150%, ADC 100- 200 = 140%, ADC> 200 = 133%.
H0034 Angel Medical Center Macon 59 0 5,655 5,658 16 23 - 36
H0193 Highlands- Cashiers Hospital Macon 24 0 756 756 2 3 - 21
Macon Total 83 0
H0078 Martin General Hospital Martin 49 0 7,894 7,899 22 32 - 17
Martin Total 49 0
H0097 The McDowell Hospital McDowell 65 0 7,307 7,311 20 30 - 35
McDowell Total 65 0
H0042 Carolinas Medical Center - Mercy & Pineville Mecklenburg 294 36 56,294 56,328 154 216 - 114
H0255 Carolinas Medical Center - University Mecklenburg 130 - 36 21,378 21,391 59 88 - 6
H0071 Carolinas Medical Center / Center for Mental Health Mecklenburg 795 0 228,343 228,480 626 833 38
Totals Carolinas Medical Center Totals 1,219 0 - 82
H0010 Presbyterian Hospital Mecklenburg 463 76 159,139 159,235 436 580 41
H0282 Presbyterian Hospital Huntersville Mecklenburg 50 0 15,993 16,003 44 66 16
H0270 Presbyterian Hospital Matthews Mecklenburg 102 0 27,408 27,424 75 113 11
N/ A Presbyterian Hospital Mint Hill Mecklenburg 0 50 Utilization for reporting period shown with Presb Ortho. - 50
H0251 Presbyterian Orthopaedic Hospital Mecklenburg 140 - 126 12,915 12,923 35 53 39
Totals Presbyterian Hospital Totals 755 0 57
2008 SMFP Need Determination Mecklenburg 27
Mecklenburg Total 1,974 27
H0169 Blue Ridge Regional Hospital Mitchell 46 0 6,410 6,414 18 26 - 20
Mitchell Total 46 0
H0003 FirstHealth Montgomery Memorial Hospital Montgomery 37 0 1,568 1,569 4 6 - 31
Montgomery Total 37 0
H0100 FirstHealth Moore Regional Hospital Moore 297 23 78,816 78,863 216 287 - 33
Moore Total 297 23
H0228 Nash General Hospital Nash 270 0 58,151 58,186 159 223 - 47
Nash Total 270 0
H0221 New Hanover Regional Medical Center New Hanover 647 0 147,013 147,101 403 536 - 111
New Hanover Total 647 0
H0048 Onslow Memorial Hospital Onslow 162 0 32,776 32,796 90 135 - 27
Onslow Total 162 0
H0157 University of North Carolina Hospitals Orange 621 72 193,172 193,288 530 704 11
Orange Total 621 72
H0054 Albemarle Hospital Pasquotank 182 0 31,121 31,140 85 128 - 54
Pasquotank Total 182 0
H0115 Pender Memorial Hospital Pender 43 0 3,603 3,605 10 15 - 28
Pender Total 43 0
H0066 Person Memorial Hospital Person 50 0 11,868 11,875 33 49 - 1
Person Total 50 0
H0104 Pitt County Memorial Hospital Pitt 628 106 196,651 196,769 539 717 - 17
Pitt Total 628 106
0
0
30
0
0
0
0
0
0
0
0
0
0
0
0
Table 5A: Acute Care Bed Need Projections
( 2007 Utilization Data from Thomson as compiled by the Cecil B. Sheps Center for Health Services Research)
A B C D E F G H I J K
License # Facility Name County
Licensed
AC Beds
Adjustments
for CONs and
Previous Need
Thomson
2007
Acute
Care Days
6 Years
Growth at
0.01%
Annually
2013
Projected
Average
Daily
Census
( ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit
( Bolded) or
Surplus ("-" )
2013 Need
Determination
Projections based on Growth Factor at .01% per year for the next 6 years. Target Occupancy Factors: ADC< 100 = 150%, ADC 100- 200 = 140%, ADC> 200 = 133%.
H0079 St. Luke's Hospital Polk 45 0 3,493 3,495 10 14 - 31
Polk Total 45 0
H0013 Randolph Hospital Randolph 145 0 24,464 24,479 67 101 - 44
Randolph Total 145 0
H0158 FirstHealth Richmond Memorial Hospital Richmond 99 0 14,171 14,180 39 58 - 41
H0265 Sandhills Regional Medical Center Richmond 54 6 13,227 13,235 36 54 - 6
Richmond Total 153 6
H0064 Southeastern Regional Medical Center Robeson 292 0 61,776 61,813 169 237 - 55
Robeson Total 292 0
H0023 Annie Penn Hospital Rockingham 110 0 16,465 16,475 45 68 - 42
H0072 Morehead Memorial Hospital Rockingham 108 0 24,150 24,164 66 99 - 9
Rockingham Total 218 0
H0040 Rowan Regional Medical Center Rowan 223 0 35,958 35,980 99 148 - 75
Rowan Total 223 0
H0039 Rutherford Hospital Rutherford 129 0 18,989 19,000 52 78 - 51
Rutherford Total 129 0
H0067 Sampson Regional Medical Center Sampson 116 0 15,749 15,758 43 65 - 51
Sampson Total 116 0
H0107 Scotland Memorial Hospital Scotland 97 21 24,557 24,572 67 101 - 17
Scotland Total 97 21
H0008 Stanly Regional Medical Center Stanly 97 0 14,763 14,772 40 61 - 36
Stanly Total 97 0
H0165 Stokes- Reynolds Memorial Hospital Stokes 53 0 1,365 1,366 4 6 - 47
Stokes Total 53 0
H0049 Hugh Chatham Memorial Hospital Surry 81 0 16,475 16,485 45 68 - 13
H0184 Northern Hospital of Surry County Surry 100 0 16,678 16,688 46 69 - 31
Surry Total 181 0
H0069 Swain County Hospital Swain 48 0 1,645 1,646 5 7 - 41
Swain Total 48 0
H0111 Transylvania Community Hospital Transylvania 42 0 6,406 6,410 18 26 - 16
Transylvania Total 42 0
H0050 Carolinas Medical Center - Union Union 157 0 36,629 36,651 100 141 - 16
Union Total 157 0
H0267 Maria Parham Hospital Vance 91 0 20,106 20,118 55 83 - 8
Vance Total 91 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Table 5A: Acute Care Bed Need Projections
( 2007 Utilization Data from Thomson as compiled by the Cecil B. Sheps Center for Health Services Research)
A B C D E F G H I J K
License # Facility Name County
Licensed
AC Beds
Adjustments
for CONs and
Previous Need
Thomson
2007
Acute
Care Days
6 Years
Growth at
0.01%
Annually
2013
Projected
Average
Daily
Census
( ADC)
2013 Beds
Adjusted
for Target
Occupancy
Projected 2013
Deficit
( Bolded) or
Surplus ("-" )
2013 Need
Determination
Projections based on Growth Factor at .01% per year for the next 6 years. Target Occupancy Factors: ADC< 100 = 150%, ADC 100- 200 = 140%, ADC> 200 = 133%.
H0238 Duke Health Raleigh Hospital Wake 186 0 23,185 23,199 64 95 - 91
H0065 Rex Hospital Wake 388 45 101,520 101,581 278 370 - 63
H0276 WakeMed Cary Hospital Wake 156 0 36,625 36,647 100 141 - 15
H0199 WakeMed Raleigh Campus Wake 515 60 175,351 175,456 481 639 64
Totals WakeMed Totals 671 60 49
2008 SMFP Need Determination Wake 41
Wake Total 1,245 146
H0006 Washington County Hospital Washington 49 - 37 2,140 2,141 6 9 - 3
Washington Total 49 - 37
H0160 Blowing Rock Hospital Watauga 28 0 683 683 2 3 - 25
H0077 Watauga Medical Center Watauga 117 0 22,661 22,675 62 93 - 24
Watauga Total 145 0
H0257 Wayne Memorial Hospital Wayne 255 0 59,380 59,416 163 228 - 27
Wayne Total 255 0
H0153 Wilkes Regional Medical Center Wilkes 120 0 17,707 17,718 49 73 - 47
Wilkes Total 120 0
H0210 Wilson Medical Center Wilson 294 - 96 33,691 33,711 92 139 - 59
Wilson Total 294 - 96
H0155 Hoots Memorial Hospital Yadkin 22 0 1,002 1,003 3 4 - 18
Yadkin Total 22 0
0
0
0
0
0
0
Wake County 2013 Need Determination for 18 beds results from an Adjusted Need Determination petition. The 18 beds are to be designated as licensed neonatal beds only. 18
Need Determination
Application of the methodology to current data from Thomson indicated need for 30 additional
acute care beds for the Mecklenburg County service area. In addition, the State Health
Coordinating Council made an adjusted need determination for 18 additional acute care beds for
Wake County, to be designated as licensed neonatal beds only.
Table 5B: Acute Care Bed Need Determinations
( Scheduled for Certificate of Need Review Commencing in 2009)
It is determined that the counties listed in the table below need additional
Acute Care Beds as specified.
SERVICE AREA
ACUTE CARE BED
NEED
DETERMINATION*
CERTIFICATE OF
NEED
APPLICATION
DUE DATE**
CERTIFICATE
OF NEED
BEGINNING
REVIEW DATE
Mecklenburg 30 October 15, 2009 November 1, 2009
Wake 18
( To be designated as
licensed neonatal beds
only.)
April 15, 2009 May 1, 2009
It is determined that there is no need for additional Acute Care Beds anywhere else in the state
and no other reviews are scheduled.
* Need Determinations shown in this document may be increased or decreased during the year
pursuant to Policy GEN- 2 ( see Chapter 4).
** Application Due Dates are absolute deadlines. The filing deadline is 5: 30 p. m. on the
Application Due Date. The filing deadline is absolute ( see Chapter 3).
Inventory of Long- Term Care Hospital Beds
As a result of the August 2005 change in the Certificate of Need Statute which made “ long-term
care hospital beds” a separate category of health service facility beds, the bed days
associated with long- term care hospitals have been removed from the acute care bed need
determinations. For information purposes only, a listing of long- term care hospital beds is
provided in Table 5C, based on 2007 data from the 2008 Hospital License Renewal
Applications.
Table 5C: Long- Term Care Hospital ( LTCH) Bed Inventory
LICENSE # FACILITY NAME COUNTY
LICENSED
LTCH
BEDS
ADJUSTMENTS
FOR CONS AND
PREVIOUS NEED
H0279 Asheville Specialty Hospital Buncombe 34 0
H0236 Crawley Memorial Hospital Cleveland 0 41
H0249
Highsmith- Rainey Memorial
Hospital Cumberland 112 - 46
H0280
Select Specialty Hospital -
Durham Durham 30 0
H0277
Select Specialty Hospital -
Winston- Salem Forsyth 42 0
H0073 Kindred Hospital- Greensboro Guilford 101 0
n/ a
Select Specialty Hospital -
Greensboro Guilford 0 30
H0278
Carolinas Select Specialty
Hospital Mecklenburg 40 0
H0242
LifeCare Hospital of North
Carolina Nash 50 0
Chapter 6:
Operating Rooms
CHAPTER 6
OPERATING ROOMS
Summary of Operating Room Inventory and Utilization
In the Fall of 2008, the combined inventory of operating rooms in hospitals and
ambulatory surgical facilities consisted of 151 dedicated inpatient surgery rooms ( including 82
dedicated C- Section rooms), 281 dedicated ambulatory surgery rooms and 863 shared operating
rooms. Data from the 2008 Hospital and Ambulatory Surgical Facility License Renewal
Applications indicated that of the total reported surgical cases, ( excluding C- Section cases), 70
percent of the cases were ambulatory cases and 30 percent of the cases were inpatient cases.
Changes from the Previous Plan
Two substantive changes to the Operating Room Need Methodology have been
incorporated into the 2009 North Carolina State Medical Facilities Plan.
The first change is to Step 4( j). Whereas before the change, one operating room was excluded
for each Level I, II, and III Trauma Center; after the change one operating room is excluded for
each Level I and II Trauma Center. The new Step 4( j) is shown below:
( j) For each OR Service Area, exclude one OR for each Level I and II Trauma Center and one
additional OR for each designated Burn Intensive Care Unit. ( Column Q)
The second change is to Step 5( o) and is shown below:
( o) For each OR Service Area with more than 10 operating rooms and a projected deficit of 0.50
or greater, the “ Operating Room Need Determination” is equal to the “ Projected Operating
Room Deficit” rounded to the next whole number. ( In this step, fractions of 0.50 or greater
are rounded to the next highest whole number.) For each OR Service Area with more than
10 operating rooms and a projected deficit that is less than 0.50 or in which there is a
projected surplus, the Operating Room Need Determination is zero. ( Column U)
For each OR Service Area with six to 10 operating rooms and a projected deficit of .30 or
greater, the “ Operating Room Need Determination” is equal to the “ Projected Operating
Room Deficit” rounded to the next whole number. ( In this step, fractions of .30 or greater
are rounded to the next highest whole number.) For each OR Service Area with six to 10
operating rooms and a projected deficit that is less than 0.30 or in which there is a projected
surplus, the Operating Room Need Determination is zero. ( Column U)
For each OR Service Area with five or fewer operating rooms and a projected deficit of .20
or greater, the “ Operating Room Need Determination” is equal to the “ Projected Operating
Room Deficit” rounded to the next whole number. ( In this step, fractions of .20 or greater
are rounded to the next highest whole number.) For each OR Service Area with five or
fewer operating rooms and a projected deficit that is less than 0.20 or in which there is a
projected surplus, the Operating Room Need Determination is zero. ( Column U)
In addition, the inventory and case data have been updated and references to dates have
been advanced by one year, as appropriate.
Sources of Data
Data on the number of cases and procedures for the 2009 North Carolina State Medical
Facilities Plan were taken from the “ 2008 Hospital License Renewal Applications” and the
“ 2008 Ambulatory Surgical Facility License Renewal Applications” as submitted to the
Licensure and Certification Section of the Division of Health Service Regulation. ( Note: While
data are reported on the annual license renewal applications regarding dedicated C- Section
rooms, data must be collected separately for the exclusions related to trauma centers and burn
intensive care units. For purposes of the 2009 Plan, the trauma center and burn intensive care
rooms are excluded in Table 6B. Additional data on cases referred to excluded operating rooms
by trauma centers and burn intensive care units have not been collected. Excluding cases for
Service Areas with projected surpluses would only increase the size of the projected surplus.)
Inventory data for the 2009