9 CERTIFICATE OF NEED REVIEW STANDARDS

 

 

 

MIC HIGAN DE PARTMEN T OF COMM UN ITY HEALT H

 

C ER TI F ICAT E O F NEED  RE VI EW S TA ND A RDS

F O R NURS I N G H OM E A ND H O S P ITAL LO N G-T ER M-CA RE UN IT BEDS

 

(By auth ority conferr ed on th e Cert ificat e of Need Comm ission by Section 22215 of Act No. 368 of th e Pu blic Act s of 1978 , as am ended, an d sections 7 an d 8 of Act No. 306 of th e Pu blic Act s of 1969 , as am ended, being sections 333 .22215 , 24.207 , an d 24.208 of th e Michigan Compiled Laws.)

 

Section   1.  App li ca bility

 

Sec. 1. (1) These stan dar ds ar e requirement s for app roval an d delive ry of services for all project s app roved an d cert ificat es of need iss ued un der Part 222 of th e Code which involve nur sing homes an d hospita l long-term -car e un its.

 

(2)    A nur sing home licensed un der Part 217 an d a hospita l long-term -car e un it (HLTC U) defined in Section 20106 (6) ar e cove red health facilities for pur poses of Part  222  of  th e Code.

(3)    The Dep artm ent sha ll use sections 3, 4, 5, 6, 8, 9, 12, 13, an d 14 of th ese stan dar ds, as applicable, in applying Section 22225 (1) of th e Code, being Section 333 .22225 (1) of th e Michigan Compiled Laws.

(4)     The Dep artm ent sha ll use Section 7 of th ese stan dar ds, as applicable, in applying Section 22225 (2)(a)(iii) of th e Code, being Section 333 .22225 (2)(a)(iii) of th e Michigan Compiled Laws.

(5)     The Dep artm ent sha ll use Section 11 of th ese stan dar ds, as applicable, in applying Section 22225 (2)(c) of th e Code, being Section 333 .22225 (2)(c) of th e Michigan Compiled Laws.

(6)    The Dep artm ent sha ll use Section 10(2) of th ese stan dar ds, as applicable, in applying Section 22230 of th e Code, being Section 333 .22230 of th e Michigan Compiled Laws.

 

Section   2.  De finitio ns

 

Sec. 2.  (1)  As used in th ese stan dar ds:

(a)  "Acquisition of a new nur sing home or HLTC U" mean s th e iss uan ce of a new nur sing home (including HLTC U) license as th e res ult of th e acquisition (including purcha se, lease, donat ion, or oth er com para ble arran gement) of an exis ting licensed  nur sing  home (including HLTC U) an d which does not involve a chan ge in bed  capacity of that  health facili ty.

 

 

(b)  "ADC adjustm ent factor" mean s th e factor by which th e avera ge daily census (ADC), derived dur ing th e bed need meth odology calculat ion set forth in Section 3(2)(d) for each plann ing ar ea, is divided . For plann ing ar eas with an ADC of less than 100 , th e ADC adjustm ent factor is 0.90 an d for plann ing ar eas with an ADC of 100 or more, th e ADC adjustm ent factor is 0.95.

(c) "App licant 's cash" mean s th e tota l of th e followin g items report ed by th e applicant on th e "Sour ce of Fun ds" form (form num ber T-150 -G-11.04, or an y subseq uent replacement form ):

(i) unr estr icted cash; (ii) designat ed fun ds; (iii) restr icted fun ds; (iv) plann ed gifts, bequests, donat ions, an d pledges; an d (v) int erest in com e dur ing con stru ct ion.

(d) "Avera ge tota l proposed pr oject cost per bed " or "A" is calculat ed by th e Dep artm ent by summ ing th e "Tota l proposed pr oject cost " of each qua lifying pr oject , an d th en dividing th e sum by th e tota l num ber of beds proposed by th ose qua lifying pr oject s. The tota l num ber of beds sha ll include new, replacement , an d con vert ed beds .

(e)  "Base year " mean s 1987 or th e most recent year for which verifiable data colle cted as part of th e Michigan Dep artm ent of Commun ity Health Annua l Sur vey of Long-Term -Car e Fa cilities or oth er com para ble MDCH sur vey instrum ent ar e available.

(f)  "Cert ificat e of Need Comm ission" or  "Comm ission"  mean s  th e  comm ission  creat ed pur suant to Section 22211 of th e Code, being Section 333 .22211 of th e Michigan Compiled Laws.

(g)  "Code" mean s Act No. 368 of  th e  Pu blic  Act s  of  1978 ,  as  am ended ,  being  Section 333 .1101 e t seq. of th e Michigan Compiled Laws.

(h)  "Comparat ive group" mean s th e applicat ions which ha ve been grouped for th e sam e type of project in th e sam e plann ing ar ea an d which ar e being reviewed  comparat ively in a ccor d with th e Cert ificat e of Need ru les.

(i) "Convert ed bed/space" mean s, for pur poses of th ese stan dar ds, an existing bed or space in a health facility that is not curr ent ly licensed as a nur sing home/HLTCU bed an d  is proposed to be licensed as a nur sing home or HLTCU bed . An exam ple is proposing to license a home for th e aged bed as a nur sing home bed .

(j) "Dep artm ent " mean s th e Michigan Dep artm ent of Commun ity Health (MDCH).

(k)   "Dep artm ent  invent ory  of  beds "  mean s  th e  curr ent  list ,  for  each   plann ing  ar ea ma inta ined on a cont inu ing basis by th e Dep artm ent : (i) licensed nur sing home beds (including MR an d MI beds ) an d (ii) nur sing home beds approved by a valid Cert ificat e of Need issued un der eith er form er Part 221 or Part 222 of th e Code  which  ar e  not  yet licensed. It does not  include  (a) nur sing  home  beds  approved  from  th e  stat ewide  pool esta blished pur suant to Section 22217 (1)(b) of th e Code, being Section  333 .22217 (1)(b) of th e Michigan Compiled Laws an d  (b)  short -term  nur sing  car e  program  beds  approved pur suant to Section 22210 of th e Code, being Section 333 .22210 of th e Michigan Compiled Laws.

(l) "Existing nur sing home beds " mean s, for a spe cific plann ing ar ea, th e tota l of all nur sing home beds locat ed with in th e plann ing ar ea including: (i) licensed nur sing home beds (including MR an d MI beds ), (ii) nur sing home beds approved by a valid Cert ificat e of Need issued un der eith er form er Part 221 or Part 222 of th e Code which ar e not yet licensed , (iii) proposed nur sing home beds un der appe al from a fina l Dep artm ent decision ma de un der form er Part 221 or Part 222 or pending a hear ing from a proposed decision issued un der Part  222  of th e Code, an d (iv) proposed  nur sing home beds  that  ar e part  of a  com pleted

 

 

applicat ion un der Part 222 of th e Code (oth er than th e applicat ion or applicat ions in th e com parat ive group un der review ) which is pending fina l Dep artm ent decision.  The followin g exceptions to th is definition exist: (a) th e 174  licensed  beds  at  th e  Pinecrest Medi cal Car e Fa cility geogra phically locat ed in Menominee  Count y will  be  a llocat ed  to thr ee plann ing ar eas as follows : 68 beds in th e Menominee plann ing ar ea, 53 beds in th e Delta plann ing ar ea, an d 53 beds in th e Dickinson plann ing ar ea; (b) nur sing home beds approved from th e stat ewide pool esta blished pur suant to Section 22217 (1)(b) of th e Code, being Section 333 .22217 (1)(b) of th e Michigan Compiled Laws ar e excluded ; an d (c) short - term nur sing car e program beds approved pur suant to Section 22210 of th e Code, being Section 333 .22210 of th e Michigan Compiled Laws, ar e excluded .

(m)  "Gross squar e feet" mean s th e ar ea of th e building as measur ed by th e out side building walls.

(n)   "Health service ar ea" mean s th e geogra phic ar ea esta blished for a health systems agency pur suant to form er Section 1511 of th e Pu blic Health Service Act an d set forth in Section 14.

(o)  "Hospita l long-term -car e un it " or "HLTCU" mean s a nur sing car e facility, owned an d operat ed by an d as part  of a  hospita l, that  provides  organ ized nur sing car e an d medical tr eatm ent to seven (7) or more unr elat ed individua ls su ffer ing or recover ing from illness , injur y, or infirm it y.

(p) "Licensed site" mean s eith er (i) in th e case of a single site hospita l or nur sing home, th e locat ion of th e health facility auth orized by license an d listed on that licensee's cert ificat e of licensur e or (ii) in th e case of a hospita l or nur sing home with mu lt iple sites, th e locat ion of each sep arat e an d distinct health facility as auth orized by licensur e.

(q) "Medi caid" mean s Title XIX of th e Socia l Secur ity Act , 42 U.S.C. 1396 .

(r)    )  "Medi caid   eligible   recipient "  mean s   a   pat ient   deemed   eligible   by   th e   Michigan Dep artm ent of  Commun ity  Health ,  or   it s   des ignat ed   agent ,   to   receive    Medi caid reimbur sement from th e t ime of admission to a nur sing home/HLTCU.

(s)  "MI beds " mean s nur sing home beds in a nur sing home licensed by th e Dep artm ent of Consum er an d Industr y Services for th e car e of menta lly ill pat ient s.

(t)  ) "MR beds " mean s nur sing home beds  in a nur sing home licensed by th e Dep artm ent  of Consum er an d Industr y Services for th e car e of menta lly retar ded pat ient s.

(u)  "Net usable ar ea" mean s th e usable floor ar ea of a pat ient sleeping r oom excluding an y vestibules (including door swings), toilet r oom s, an d built-in closets.

(v) "Nonr enewal or revocat ion of license for cau se" mean s that th e Dep artm ent of Consum er an d Industr y Services did not renew or revoked th e nur sing home's/HLTCU's license based on th e nur sing home's/HLTCU's failur e to com ply with stat e licensing stan dar ds.

(w) "Nonr enewal or term inat ion of cert ificat ion for cau se" mean s th e nur sing home/HLTCU Medi car e an d/or Medi caid cert ificat ion was term inat ed or not renewed based on th e nur sing home's/HLTCU's failur e to com ply with Medi car e an d/or  Medi caid  part icipat ion requirement s.

(x) "Nurs ing home" mean s a nur sing car e facility, including a count y medical car e facility, but excluding a hospita l or a facility creat ed by Act No. 152 of th e Pu blic Acts of 1885 , as am ended , being sections 36.1 to 36.12 of th e  Michigan  Compiled  Laws,  that  provides organ ized nur sing car e an d medical tr eatm ent to seven (7) or more unr elat ed individua ls su ffer ing or recover ing from illness , injur y, or infirm ity.

 

 

(y) "Nurs ing home bed " mean s a bed in a health facility licensed un der Part 217 of th e Code or a licensed bed in a hospita l long-term -car e un it . The term does not include short -term nur sing car e program beds approved pur suant to Section 22210 of th e Code being Section 333 .22210 of th e Michigan Compiled Laws or beds in health facilities  listed  in  Section 22205 (2) of th e Code, being Section 333 .22205 (2) of th e Michigan Compiled Laws.

(z) "Occu pan cy rat e" mean s th e percenta ge which expresses th e rat io of th e actua l num ber of pat ient days of car e provided divided by th e tota l num ber of pat ient days. Tota l pat ient days is calculat ed by summ ing th e num ber of licensed an d/or CON approved but not yet licensed beds an d mu lt iplying th ese  beds  by th e num ber of days that  th ey were licensed an d/or CON approved but not yet licensed . This sha ll include nur sing home beds approved from th e stat ewide pool esta blished pur suant to Section 22217 (1)(b) of th e Code, being Section 333 .22217 (1)(b) of th e Michigan Compiled Laws. Occu pan cy  rat es  sha ll  be calculat ed using verifiable data from eith er (i) th e actua l num ber of pat ient days of car e for 12 cont inu ous month s of data from th e MDCH Annua l Sur vey of Long-Term -Car e Fa cilit ies or oth er com para ble MDCH sur vey instrum ent or (ii) th e actua l num ber of pat ient days of car e for 4 cont inu ous quart ers  of  data as  report ed  to  th e  Dep artm ent  for  pur poses  of com piling th e "Sta ffin g/Bed Ut ilizat ion Rat ios Rep ort ," whichever is th e most recent available data .

(aa ) "Plann ing ar ea" mean s th e geogra phic boun dar ies of each count y in Michigan with th e exception of: (i) Hought on an d Kewee na w count ies, which ar e  com bined  to  form  one plann ing ar ea an d (ii) Wayne Count y which is divided int o thr ee plann ing ar eas. Section 13 ident ifies th e thr ee plann ing ar eas in Wayne Count y an d th e spe cific geogra phic ar ea included in each.

(bb) "Plann ing year " mean s 1990 or th e year in th e futur e, at least Thr ee (3) year s but no more than seven ( 7) year s, esta blished by th e Cert ificat e of Need Comm ission for which nur sing home bed needs ar e developed . The plann ing year sha ll be a year for which official populat ion pr oject ions, from th e Dep artm ent of Mana gement an d Budget or U.S. Census, data ar e available.

(cc) "Ph ysically con form ing beds ," for pur poses of Section 10(3), mean s beds which meet th e ma ximum occu pan cy an d minimum squar e foota ge requirement s  as  spe cified  in  Section 483 .70(d)(1) of th e Code of Fede ra l Regulat ions for Medi car e cert ificat ion (42 CFR) or an y fede ra l regulat ions for Medi car e cert ificat ion addressi ng ma ximum  occu pan cy  an d minimum squar e foota ge requirement s approved subseq uent to th e effect ive dat e of th ese stan dar ds.

(dd) "Qua lifying pr oject " mean s each applicat ion in a  com parat ive group which ha s been reviewed individua lly an d ha s been determ ined by th e Dep artm ent to ha ve sat isfied all of th e requirement s of Section 22225 of th e Code, being Section 333 .22225 of th e Michigan Compiled Laws an d all oth er applicable requirement s for approval in th e Code an d th ese stan dar ds.

(ee) "Readmission" mean s th e admission of a pat ient followin g a temporar y abse nce from th e sam e nur sing home/HLTCU dur ing which t ime th e bed was held open or th e pat ient ha d th e option to return  to th e next available bed at th e sam e nur sing home/HLTCU.

(ff) "Repl acement bed " mean s a nur sing home bed with a valid license that meets all of th e followin g con ditions: (i) an equa l or great er num ber of nur sing home beds ar e curr ent ly licensed to th e applicant at th e licensed site at which th e beds proposed for replacement ar e

 

 

curr ent ly licensed ,(ii) th e nur sing home beds ar e proposed for replacement in new physical plant space being developed in new con stru ct ion or in newly  acquired  space  (pur cha se, lease, donat ion, etc.), an d (iii) th e nur sing home beds to be replaced will be locat ed in th e replacement zone.

(gg) "Repl acement zone" mean s a proposed licensed site which is,

(i)   for a rura l count y, with in th e sam e plann ing ar ea as th e existing licensed site.

(ii)    or a count y that  is not a rura l count y,

(A)  with in th e sam e plann ing ar ea as th e existing licensed site an d

(B)   with in a thr ee-mile ra dius of th e existing licensed site.

(hh ) "Room plan chan ges" mean s an y con stru ct ion activities in pat ient r oom s, including bathr oom ar eas, which involve moving walls. This does not include cosm etic renovat ions such as wallpaper, paint ing, car peting, or oth er activities ass ociat ed with norma l wear an d tear .

(ii)   "Rura l count y" mean s a count y not locat ed in a metr opolitan ar ea as that term is defined pur suant to th e "Revised stan dar ds for defining metr opolitan ar eas in th e 1990 's" by th e Stat ist ical Policy Office of th e Office of In format ion an d Regulat ory Affa irs of th e Un ited Stat es Office of Mana gement an d Budget, 55 F.R. p. 12154 (Mar ch 30, 1990 ).

(jj) "Sta ffin g/Bed Ut ilizat ion Rat ios Rep ort " mean s th e report issued by th e Dep artm ent on a quart erly basis.

(kk ) "Tota l proposed pr oject cost " mean s th e tota l of all th e items listed on th e applicant 's "Pr oject Cost" form (form num ber T-150 -G-11.02 or an y subseq uent replacement form ) excluding th e it em "Pr e-existing debt  to  be  refinan ced."  For  pr oject s  where  existing beds /space ar e being con vert ed to nur sing home/HLTCU beds an d th e num ber of squar e feet of facility space to be allocat ed to th e nur sing home/HLTCU will increase, th e imput ed cost s of th e beds /space to be con vert ed sha ll be determ ined based on a fair mark et value appra isal of th e tan gible asse t s to be con vert ed. The imput ed cost s for th e beds /space to be con vert ed sha ll be ent ered on th e "Pr oject Cost" form on th e line for "Constru ct ion Costs: Oth er."

(ll) "Tota l proposed pr oject cost per bed" is determ ined by dividing th e applicant 's "Tota l proposed pr oject cost " by th e applicant 's proposed  num ber  of beds .  The  tota l  proposed num ber of beds sha ll include new, replacement , an d con vert ed beds .

(mm ) "Use rat e" mean s th e num ber of nur sing home an d hospita l long-term -car e un it days of car e per 1,000 populat ion dur ing a one-year period.

(nn ) "Ves tibule" mean s a sma ll entran ce ha ll or passageway, between a comm on corr idor an d a pat ient r oom , of su fficient width an d length to allow a corr idor entran ce door to swing in with out obstru ct ion. A  vestibule  also  ma y  provide  an  adequat e  ar ea  to  perm it  an atta ched toilet r oom door  su fficient  clear  swing  space  so as  not  to impact  on  minimum pat ient r oom net usable ar ea requirement s.

 

(2) The definitions in Part  222 of th e Code sha ll apply to th ese stan dar ds.

 

Section   3.  Dete rm ina tio n of needed  nu rsing  home  bed supp ly

 

Sec. 3    (1)(a )    The  age  spe cific use  rat es  for  th e  plann ing year  sha ll be  th e  actua l stat ewide age specific nur sing home use rat es using data from th e base year .

 

 

(b) The age coh ort s for each plann ing ar ea sha ll be: (i) age 0 - 64 year s, (ii) age 65 - 74 year s,

(iii)    age 75 - 84 year s, an d (iv) age 85 an d older.

(c)    Unt il th e base year is chan ged by th e Comm ission in a ccor d with Section  4(3) an d Section 5, th e use rat es for th e base year for each corr esp onding age coh ort , esta blished in a ccor d with subse ct ion (1)(b), ar e set forth in Appe ndix A.

(2) The num ber of nur sing home beds needed in a plann ing ar ea sha ll be determ ined by th e followin g formu la:

(a)    Determ ine th e populat ion for th e plann ing year for each sep arat e plann ing ar ea in th e age coh ort s esta blished in subsection (1)(b).

(b)     Multiply each populat ion age coh ort by th e corr esp onding use  rat e  esta blished  in Appe ndix A.

(c)   Sum th e pat ient days resulting from th e calculat ions per form ed in subsection (b). The resultant  figur e is th e tota l pat ient days.

(d)   Divide th e tota l pat ient days obta ined in subse ct ion (c) by 365 (or 366 for leap year s) to obta in th e pr oject ed avera ge daily census (ADC).

(e)   The followin g sha ll be kn own as th e ADC adjustm ent factor. (i) If th e ADC determ ined in subse ct ion (d) is less than 100 , divide th e ADC by 0.90. (ii) If th e ADC determ ined in subse ct ion (d) is 100 or great er, divide th e ADC by 0.95.

(f)   The num ber determ ined in subse ct ion (e) represe nt s th e num ber of nur sing home beds needed in a plann ing ar ea for th e plann ing year .

 

Section  4.  Bed  need

 

Sec. 4. (1) For pur poses of th ese stan dar ds, unt il oth erwise chan ged by th e Comm ission, th e bed need num bers shown in Appe ndix B an d in cor porat ed as part of th ese stan dar ds sha ll apply to pr oject applicat ions subject to review un der th ese stan dar ds, except where a specific Cert ificat e of Need stan dar d stat es oth erwise .

(2)     The Comm ission ma y direct th e Dep artm ent to apply th e bed need meth odology in Section 3.

(3)     The Comm ission sha ll des ignat e  th e  base  year  an d  th e  plann ing year  that  sha ll be ut ilize d in applying th e meth odology pur suant  to subse ct ion (2).

(4) When directed by th e Comm ission to apply th e meth odology pur suant to subse ct ion (2), th e effect ive dat e of th e bed need num bers sha ll be esta blished by th e Comm ission.

(5)  New bed need num bers esta blished by subsections (2) an d (3) sha ll supersede th e bed need num bers shown in Appe ndix B an d sha ll be included as an am ended appe ndix to th ese stan dar ds.

(6)   Modificat ions ma de by th e Comm ission pur suant to th is section sha ll not require ad h oc advisory comm itt ee action, a public hear ing, or submitta l of th e stan dar d to th e Legisl atur e an d th e Govern or in order to becom e effect ive.

 

Section   5.  Modi ficatio n of the  age  speci fic use  rates  by changing   the  bas e yea r.

 

Sec. 5. (1) The Comm ission ma y modify th e base year based on data obta ined from th e Michigan Dep artm ent of Commun ity Health Annua l Sur vey of Long-Term -Car e Fa cilit ies or  oth er  com para ble  MDCH  sur vey  instrum ent   prese nt ed  to  th e  Comm ission  by  th e

 

 

Dep artm ent . The Dep artm ent sha ll calculat e use rat es for each of th e age coh ort s set forth in Section 3(1)(b) an d bienn ially prese nt th e revised use rat es based on 1989 in format ion, or th e most recent base year in format ion available bienn ially after  1989 ,  to  th e  CON Comm ission.

(2)   The Comm ission sha ll esta blish th e effect ive dat e of th e modificat ions ma de pur suant to subsection (1).

(3)    Modificat ions ma de by th e Comm ission pur suant  to subsection (1) sha ll not require ad h oc advisory comm itt ee action, a public hear ing, or submitta l of  th e  stan dar d  to  th e Legisl atur e an d th e Govern or in order to becom e effect ive.

 

Section  6.  Re qu ir emen ts  for  app rova l  - app li cants   proposing   to  inc rease  beds in a planning  area or rep lace  beds  outside   a rep lacement   zo ne

 

Sec. 6. (a) An applicant proposing to increase th e num ber of nur sing home beds in a plann ing ar ea mu st demonstrat e that th e proposed increase, if approved, will not result in th e tota l num ber of existing nur sing home beds in that plann ing ar ea exceedi ng th e needed nur sing home bed supply set forth in Appe ndix B. An applicant ma y request an d  be approved for up to a ma ximum of 20 beds if, when th e tota l num ber of "existing nur sing home beds " is subtra cted from th e bed need for th e plann ing ar ea set forth in Appe ndix B, th e differ ence is equa l to or more than  1 an d equa l to or less than  20.

This subsection is not applicable to pr oject s seek ing approval for beds from th e stat ewide pool of beds esta blished  pur suant  to  Section  22217 (1)(b)  of  th e  Code,  being  Section 333 .22217 (1)(b) of th e Michigan Compiled Laws.

(b)     An applicant proposing to replace existing licensed nur sing home beds  in  th e  sam e plann ing ar ea, but  out side th e replacement  zone, mu st demonstrat e each of th e followin g:

(i) th e tota l num ber of existing nur sing home beds in that plann ing ar ea is equa l to or less than th e needed nur sing home bed supply set forth in Appe ndix B an d (ii) th e num ber of beds to be replaced is equa l to or less than th e num ber of curr ent ly licensed beds at th e health facility at which th e beds proposed for replacement ar e curr ent ly locat ed. This subsection is not applicable to pr oject s seek ing approval for beds from th e stat ewide pool of beds esta blished pur suant to Section 22217 (1)(b) of th e Code, being Section 333 .22217 (1)(b) of th e Michigan Compiled Laws.

(c)   An exception to th e num ber of beds that  ma y be approved pur suant  to subse ct ion (a) or

(b) sha ll be ma de if th e requirement s set forth in both (i) an d (ii) ar e met. The num ber of beds that ma y be approved in excess of th e bed need for each plann ing ar ea ident ified in Appe ndix B is set forth in subsection (iii).

(i)     The applicant requesting additiona l nur sing home/HLTCU  beds  ha s  expe rienced  an occu pan cy rat e, at th e nur sing home/HLTCU at which th e additiona l beds ar e proposed , of at least 97% for each of th e 12 most recent cont inu ous quart ers for which verifiable data ar e available to th e Dep artm ent on it s "Sta ffin g/Bed Ut ilizat ion Rat ios Rep ort ."

(ii)     The occupan cy rat e for all  nur sing  homes/HLTCUs  in  th e  plann ing  ar ea, including nur sing home beds approved from th e stat ewide pool esta blished  pur suant  to  Section 22217 (1)(b) of th e Code, being Section 22217 (1)(b) of th e Michigan Compiled Laws, ha s been at least 97% for each of th e 12 most recent cont inu ous quart ers for which verifiable data ar e available to th e Dep artm ent on it s "Sta ffin g/Bed Ut ilizat ion Rat ios Rep ort ."

 

 

(iii)      The num ber of beds that ma y be approved pur suant to th is subse ct ion sha ll be  th e num ber of beds necess ar y to reduce th e occu pan cy rat e for th e plann ing ar ea in which th e additiona l beds ar e proposed to th e ADC adjustm ent factor for that plann ing ar ea as shown in Appe ndix B. The num ber of beds sha ll be calculat ed by (1) dividing th e actua l num ber of pat ient days of car e provided dur ing th e most recent 12-month period for which verifiable data ar e available to th e Dep artm ent provided by all nur sing home (including HLTCU) beds in th e plann ing ar ea, including pat ient  days of car e provided in beds  approved from th e stat ewide pool of beds esta blished pur suant to Section 22217 (1)(b) of th e Code, being Section 333 .22217 (1)(b) of th e Michigan Compiled Laws an d dividing that result by 365 (or 366 for leap year s); (2) dividing th e result of step (1) by th e ADC adjustm ent factor for th e plann ing ar ea in which th e beds ar e proposed to be added ; (3) roun ding th e result of step (2) up to th e next whole num ber; an d (4) subtra ct ing th e tota l num ber of beds in th e plann ing ar ea including beds approved from th e stat ewide pool of beds esta blished  pur suant  to Section 22217 (1)(b) of th e Code, being Section 333 .22217 (1)(b) of th e Michigan Compiled Laws from th e result of step (3). If th e num ber of beds  necess ar y to reduce th e plann ing ar ea occu pan cy rat e to th e ADC adjustm ent factor for that plann ing ar ea is equa l to or more than 20, th e num ber of beds that  ma y be approved pur suant  to th is subse ct ion sha ll be up to that num ber of beds . If th e num ber of beds necess ar y to reduce th e plann ing ar ea occu pan cy rat e to th e ADC adjustm ent factor for that plann ing ar ea is less than  20, th e num ber of additiona l beds that ma y be approved sha ll be that num ber of beds  or up to a ma ximum of 20 beds .

 

Section   7.  Re qu iremen ts for projec ts invo lving  ne w const ruc tio n or renova tio n

 

Sec. 7.   (1) For  pr oject s involving new con stru ct ion or  renovat ion, an  applicant  sha ll demonstrat e each of th e followin g, as applicable:

(a)  For pr oject s involving th e new con stru ct ion of pat ient r oom s, or r oom plan chan ges, th e pat ient r oom s sha ll be con stru cted or renovat ed to be con sistent with th e followin g minimum squar e feet of net usable ar ea:

 

Room Type	Net Usa ble Area Minimum Sq. ft .
One person	100
Two person	160
Thr ee person	240
Four person	320

 

(b)      For proposed pr oject s involving con stru ct ion of an ent ire facility (wheth er new or replacement ), th e proposed tota l gross squar e foota ge of th e facility sha ll be no less than 200 gross squar e feet per bed an d no more than  450 gross squar e feet per bed .

(2) An applicant proposing a project involving new constru ct ion or renovat ion sha ll demonstrat e that a plan of corr ection for cited code deficiencies including life an d fire safety (if an y) for th e applicant  health  facility  ha s  been  submitt ed  to  an d  approved  by  th e Dep artm ent of Consum er an d Industr y Services, Divisi on of Licensing an d Cert ificat ion.

 

 

Section   8.  Re qu iremen ts for app rova l -- rep lacement   beds

 

Sec.  8.  An  applicant  proposing  replacement  beds   sha ll  not  be  required  to  be  in com plian ce with th e needed nur sing home bed supply set forth in Appe ndix B if th e applicant demonstrat es all of th e followin g:

(b)   th e proposed licensed site is in th e replacement zone, an d

(c) th e applicant meets all oth er applicable Cert ificat e of Need review stan dar ds an d agrees an d assur es to com ply with all applicable pr oject delivery requirement s.

 

Section 9. Re qu iremen ts for app rova l -- acquisition of a ne w nu rsing home or HLTCU

 

Sec. 9. An applicant proposing to acquire a new nur sing home or HLTCU sha ll not be required to be in com plian ce with  th e  needed  nur sing  home  bed  supply  set  forth  in Appe ndix B for th e plann ing ar ea in which th e nur sing home or HLTCU subject to th e proposed acquisition is locat ed if th e applicant demonstrat es that all of th e followin g ar e met:

(a)    th e acquisition will not result in a chan ge in bed capacity,

(b)   th e licensed site does not chan ge as a result of th e acquisition, an d

(c)   th e pr oject is limited solely to th e acquisition of a nur sing home or HLTCU with a valid license.

 

Section   10 .  Rev ie w standa rds for compa rative  rev ie w

 

Sec. 10 (1) Any applicat ion subject to com parat ive review , un der Section 22229 of th e Code, being Section 333 .22229 of th e Michigan Compiled Laws, or un der th ese stan dar ds, sha ll be grouped an d reviewed  com parat ively with  oth er  applicat ions in  a ccor dan ce with th e Cert ificat e of Need ru les.

 

(2)    The degree to which each applicat ion in a com parat ive group meets th e criterion set forth in Section 22230 of th e Code, being Section 333 .22230 of th e Michigan  Compiled Laws, sha ll be determ ined based on th e sum of point s awar ded un der subsections (a), (b), an d (c).

(a)  A qua lifying pr oject will be awar ded point s, in a ccor d with th e schedule set forth below, based on th e nur sing home's/HLTCU's proposed percenta ge of th e nur sing home's/HLTCU's pat ient days of car e to be reimbur sed by Medi caid (ca lculat ed using tota l pat ient days for all existing an d proposed beds at th e facility) for th e secon d 12 month s of operat ion followin g pr oject com pletion, an d annua lly for at least seven year s th ereafter.

 

Pr oposed Percenta ge of Medi caid Pat ient Days	Point s Awar ded
0	0

 

 

1 - 19	1
20 -  39	2
40 -  59	3
60 - 100	4

 

(b)  A qua lifying pr oject will be awar ded point s, in a ccor d with th e schedule set forth below, based on th e nur sing home's/HLTCU's proposed percenta ge, for th e secon d 12 month s of operat ion followin g pr oject com pletion an d annua lly for at least seven year s th ereafter, of all of th e nur sing home's/HLTCU's newly admitt ed pat ient s (not including readmissions) that  will be Medi caid recipient s or Medi caid eligible recipient s.

 

Pr oposed Percenta ge of Medi caid Admissions	Point s Awar ded
0	0
1 - 5	1
6 - 15	2
16 -  30	3
31 - 100	4

 

(c)    A qua lifying pr oject will be awar ded Thr ee point s if, with in six month s of beginn ing operat ion an d for at least seven year s th ereafter, 100 percent (100 %) of th e licensed nur sing home beds at th e facility (both existing an d proposed) will be Medi caid cert ified.

(3)    A qua lifying pr oject will be awar ded point s, in a ccor d with th e schedule set forth below, based on it s proposed part icipat ion in th e Medi car e program with in six month s of beginn ing operat ion an d annua lly for at  least  seven  year s  th ereafter,  including  both  physically con form ing existing an d proposed beds .

 

Pr oposed Part icipat ion	Point s Awar ded
No Medi car e cert ificat ion of an y physically conform ing existing an d proposed beds .	0
Medi car e cert ificat ion of at least one (1) bed but less than  100 % of all physically conform ing existing an d proposed beds .	1
Medi car e cert ificat ion of 100 % of all physically conform ing existing an d proposed beds .	2

 

(4)      A  qua lifying  pr oject  will  ha ve  point s  ded ucted  based  on  th e  applicant 's  recor d  of com plian ce  with   applicable  fede ra l  an d  stat e  safety  an d  operat ing  stan dar ds  for  an y

 

 

nur sing home/HLTCU owned an d/or operat ed by th e applicant in Michigan . Point s sha ll be ded ucted in a ccor d with th e schedule set forth below if, followin g th e effect ive dat e of th ese stan dar ds, th e recor ds  which  ar e  ma inta ined  by  th e  Dep artm ent  docum ent  (a)  an y nonr enewal or revocat ion of license for cau se an d/or (b) nonr enewal or term inat ion for cau se of eith er Medi car e or Medi caid cert ificat ion of an y Michigan nur sing home/HLTCU owned an d/or operat ed by th e applicant .

 

Nurs ing home/HLTCU Complian ce Action	Point s Ded ucted
Nonr enewal or revocat ion of license	2
Nonr enewal or term inat ion of:
Cert ificat ion-Medi car e	2
Cert ificat ion-Medi caid	2

 

(5)  A qua lifying pr oject will be awar ded two point s if, followin g pr oject com pletion, th e applicant will provide eith er directly or thr ough contra ctua l relat ionships, as part of it s living or housing arran gement s, a home for th e aged, an adult  fost er  car e  home,  or indepe ndent housing locat ed on th e sam e site or in th e sam e plann ing ar ea.

(6)     A qua lifying pr oject will be  awar ded  point s  based  on  th e applicant 's "Tota l proposed pr oject cost per bed," in a ccor d with th e schedule set forth below, (where "A" represe nt s "Avera ge tota l proposed pr oject cost per bed "):

 

Ran ge of "Tota l proposed pr oject cost per bed"	Point s Awar ded
0 to (A minu s $3000 )	5
(A minu s $2999 ) to (A minu s $1000 )	4
(A minu s  $999 ) to (A plus $1000 )	3
(A  plus $1001 ) to (A plus $5000 )	2
(A  plus $5001 ) to (A plus $11 ,000 )	1
Above (A plus $11 ,000 )	0

 

(7)     A qua lifying pr oject will be awar ded point s based on th e proposed  percenta ge of th e "App licant 's cash" to be applied towar d fun ding th e "Tota l proposed pr oject cost " in a ccor d with th e schedule set forth below:

 

Percenta ge "App licant 's Cash"	Point s Awar ded
Over 20 percent	5
15.1 to 20 percent	4

 

 

10.1 to 15 percent	3
5.1 to 10 percent	2
1.1 to 5 percent	1
0 to 1 percent	0

 

(8) qua lifying pr oject will be awar ded point s for th e followin g finan cing cat egory:

 

Finan cing Cat egory	Point s Awar ded
Int erest only payment s after th e period of con stru ct ion	0
Pa yment of principal an d int erest after th e period of con stru ct ion, according to an am ort izat ion schedule	2

 

(9)  No point s will be awar ded  to an  applicant  un der  specific subsections of Section  10  if in format ion prese nt ed in Section  10  is in con sistent  with  relat ed  in format ion  provided  in oth er port ions of th e Cert ificat e of Need applicat ion.

(10)      The stan dar ds set forth in th is section ar e assigned th e weight s listed below, with a weight of "1" being important , a weight of "2" being more important , an d a weight of "3" being very important . The point s awar ded to an applicant in each of th e subse ct ions sha ll be mu lt iplied by th e applicable weight set forth below to determ ine th e tota l num ber of point s awar ded to each applicant for each subse ct ion.

 

Subse ct ion	Weight
2(a)	3
2(b)	3
29(c)	3
3	1
4	2
5	1
6	2
7	2
8	1

 

(11)           The Dep artm ent sha ll approve th ose qua lifying pr oject s which, tak en togeth er, do not exceed th e need as defined in Section 22225 (1) of th e Code, being Section 333 .22225 (1) of th e Michigan Compiled Laws, an d which ha ve th e highest num ber of point s when th e results of subsections (2) thr ough (10) ar e tota led. If two or more qua lifying pr oject s ar e determ ined to ha ve an ident ical num ber of point s, th en th e Dep artm ent sha ll approve th ose qua lifying pr oject s which, tak en togeth er, do not exceed th e need , as defined in Section 22225 (1), in th e order in which th e applicat ions were received by th e Dep artm ent , based on th e dat e an d t ime stam p placed on th e applicat ion for Cert ificat e of Need form (form T-150 -

 

 

G-1.01 or an y subseq uent replacement form ) by th e Health Fa cilities Section, Cert ificat e of Need, when th e applicat ion is filed.

 

Section   11 .  P rojec t de li ve ry re qu iremen ts -- te rms of app rova l for all app li cants

 

Sec. 11.  (1)  An applicant  sha ll agree that , if approved, th e pr oject sha ll be delivered in com plian ce with th e followin g term s of Cert ificat e of Need approval:

(a) Complian ce with th ese stan dar ds, including th e requirement s of Section 10.

(b)       Complian ce with Section 22230 of th e Code sha ll be based on th e nur sing home's/HLTCU's actua l Medi caid part icipat ion with in th e t ime periods specified in th ese stan dar ds. Complian ce with Section 10(2)(a ) of th ese stan dar ds  sha ll be  determ ined  by com par ing th e nur sing home's/HLTCU's actua l pat ient days reimbur sed by Medi caid, as a percenta ge of th e tota l pat ient days, with th e applicable schedule set forth  in  Section 10(2)(a ) for which th e applicant ha d been awar ded point s in th e com parat ive review pr ocess . Complian ce with Section 10(2)(b) sha ll be determ ined by com par ing th e actua l num ber of Medi caid recipient s an d Medi caid eligible recipient s who were newly admitt ed, as a percenta ge of all pat ient s newly admitt ed to th e nur sing home/HLTCU, with th e applicable schedule set forth in Section 10(2)(b) for which th e applicant  ha d been awar ded point s in th e com parat ive review pr ocess . If an y of th e followin g occur s, an applicant sha ll  be required to be in com plian ce with th e ran ge in th e schedule imm ediat ely below th e ran ge for which point s ha d been awar ded in Section 10(2)(a ) or (b), instead of th e ran ge of point s for which point s ha d been awar ded  in  th e  com parat ive  review  in  order  to be  foun d  in com plian ce with Section 22230 of th e Code: (i) th e avera ge percenta ge  of  Medi caid recipient s in all nur sing homes/HLTCUs in th e plann ing ar ea decreased by at least 10 percent between th e secon d 12 month s of operat ion after pr oject com pletion an d th e most recent 12-month period for which data ar e available, (ii) th e actua l rat e of increase in th e Medi caid program per diem reimbur sement to th e applicant nur sing home/HLTCU is less than th e annua l inflat ion index for nur sing homes/HLTCUs as defined in an y curr ent approved Michigan Stat e Plan submitt ed un der Title XIX of th e Socia l Secur ity Act which conta ins an annua l inflat ion index, or (iii) th e actua l percenta ge of th e nur sing home's/HLTCU's pat ient days reimbur sed by Medi caid (ca lculat ed using tota l pat ient days for all existing an d proposed nur sing home beds at  th e  facility)  exceeds  th e  stat ewide avera ge plus 10 percent of th e pat ient days reimbur sed by Medi caid for th e most recent year for which data ar e available from th e Michigan Dep artm ent of Commun ity Health [subse ct ion (iii) is applicable only to Section 10(2)(a )].  In  evaluat ing subse ct ion  (ii), th e Dep artm ent sha ll rely on both th e annua l inflat ion index an d th e actua l rat e increases in per diem reimbur sement to th e applicant nur sing home/HLTCU an d/or all nur sing homes/HLTCUs in th e health service ar ea provided to th e Dep artm ent  by th e Michigan Dep artm ent of Commun ity Health .

(c)    For pr oject s involving th e acquisition of a nur sing home/HLTCU, th e applicant sha ll agree to ma inta in th e nur sing home's/HLTCU's level of Medi caid  part icipat ion  (pat ient days an d new admissions) for th e  t ime  periods  specified  in  th ese  stan dar ds, with in  th e ran ges set forth in Section 10(2)(a ) an d (b) for which th e seller or  oth er  previous owner/lessee ha d been awar ded point s in a com parat ive review .

(d) Complian ce with applicable operat ing stan dar ds.

 

 

(e) Complian ce with th e followin g qua lity assuran ce stan dar ds:

(i)    For pr oject s involving replacement beds , th e curr ent pat ient s of th e facility/beds being replaced sha ll be admitt ed to th e replacement beds when th e replacement beds ar e licensed, to th e extent that  th ose pat ient s desire to tran sfer to th e replacement facility/beds .

(ii)     The applicant will assur e com plian ce with Section 20201  of th e Code, being Section 333 .20201 of th e Michigan Compiled Laws.

(iii)        The applicant sha ll part icipat e in a data colle ct ion network esta blished an d administered by th e Dep artm ent . The data ma y include, but is not  limited  to, annua l budget an d cost in format ion; operat ing schedules; an d demogra phic, diagnostic, morbidity, an d morta lity in format ion, as well as th e volum e of car e provided to pat ient s from all payor sour ces. The applicant sha ll provide th e required data on an individua l basis for each licensed site, in a format esta blished by th e Dep artm ent , an d in a mutua lly agreed upon media. The Dep artm ent ma y elect to verify th e data thr ough on-site review of appropriat e recor ds.

(iv)    The applicant sha ll provide th e Health Fa cilities Section, Cert ificat e of Need , with a notice with in 10 days after th e beds ar e licensed an d placed in operat ion.

(2) The agreement s an d assuran ces required  by  th is  section  sha ll  be  in  th e  form  of  a cert ificat ion auth orized by th e govern ing body of th e applicant or it s auth orized agent .

 

Section    12 .  Depa rt men t inven tory  of beds

 

Sec.  12.    The  Dep artm ent  sha ll  ma inta in,  an d  provide  on  request,  a  list ing  of  th e Dep artm ent Invent ory of Beds for each plann ing ar ea.

 

Section   13 .  Wayne  County  planning  areas

 

Sec. 13.    (1)    For  pur poses  of th ese  stan dar ds  th e cities an d/or  townships  in  Wayne Count y ar e assigned to th e plann ing ar eas as follows :

 

P lann in g Ar e a 84 /N orth wes t Wa yn e

 

Cant on Township, Dear born , Dear born Height s, Gar den City, Ink ster, Livonia, North ville (part ), North ville Township, Plymouth , Plymouth Township, Red for d Township, Wayne, Westlan d

 

P lann in g ar e a 85 /S outh wes t Wa yn e

 

Allen Park , Belleville , Brownstown Township, E cor se, Flat Rock, Gibra ltar , Grosse Ile Township, Hur on Township, Lin coln Park , Melvindale, River Rouge, Riverview, Rock wood, Romu lus, South gat e, Sum pter Township, Taylor,  Trent on,  Van  Bur en  Township, Woodha ven, Wyan dott e

 

P lann in g ar e a 86 /De tr oit

 

 

Detr oit, Grosse Point e, Grosse Point e Township, Grosse Point e Farm s, Grosse Point e Park ,

Grosse Point e Woods , Hamtram ck, Har per Woods , Highlan d Park

 

(2) A ma p showing th e plann ing ar eas as listed in subse ct ion (1) sha ll be available from th e Departm ent .

 

Section   14 .  Hea lt h Se rvice  Areas

 

Sec. 14.  Count ies assigned to each of th e health service ar eas ar e as follows : HSA                      COUN TIE S

1	Livingston	Monr oe	St. Clair
	Ma com b	Oak lan d	Washt ena w
	Wayne
2	Clint on	Hillsdale	J ackson
	Eat on	Ingham	Lena wee
3	Barr y	Calhoun	St. J oseph
	Berr ien	Cass	Van Bur en
	Bran ch	Kalama zoo
4	Allegan	Mason	Newaygo
	Ionia	Mecosta	Oceana
	Kent	Mont calm	Osceola
	Lak e	Muske gon	Otta wa
5	Genesee	Lapeer	Shiawassee
6	Arena c	Hur on	Roscomm on
	Ba y	Iosco	Sagina w
	Clar e	Isabella	San ilac
	Gladwin	Midlan d	Tuscola
	Grat iot	Ogema w
7	Alcona	Cra wfor d	Miss auk ee
	Alpena	Emm et	Montm orency
	Antr im	Gd Tra verse	Os coda
	Benzie	Kalkaska	Otsego
	Char levoix	Leel anau	Pr esq ue Isle
	Cheboygan	Man istee	Wexford

 

 

8	Alger	Gogebi c	Mackina c
	Bara ga	Hought on	Mar quett e
	Chippew a	Iron	Menominee
	Delta	Kewee na w	Ont ona gon
	Dickinson	Luce	Sch oolcra ft

 

Section 15 . Effec t  on  pri or  Ce rtifi cate  of  Need  rev ie w  standa rds , compa rative rev ie w s

 

Sec. 15. (1)  These  Cert ificat e of Need  review  stan dar ds  supersede  an d replace th e Ce rt ificat e of N eed S tan d ar ds for Nurs in g H om e an d H osp ita l L on g-Te rm -C ar e Un it Beds approved by th e Cert ificat e of Need Comm ission an d effect ive on J uly 8, 1994 .

(2)  Pr oject s reviewed un der th ese stan dar ds, involving a chan ge in bed capacity, sha ll be subject to com parat ive review except for replacement beds being replaced with in th e replacement zone.

(3)    Pr oject s reviewed un der th ese stan dar ds that relat e solely to th e acquisition of a new nur sing home or HLTCU sha ll not be subject to com parat ive review .

 

APP END I X A

 

C ER TI F ICAT E O F NEED RE VI E W S TAND ARDS

F O R NURS I N G H OME AND H O S P ITAL LO N G-T ER M-CARE UN IT BEDS

 

The use rat e per 1000 populat ion for each age coh ort , for pur poses of th ese stan dar ds, unt il oth erwise chan ged by th e Comm ission, is as follows .

 

(i)	age	0	- 64	:	209 days of car e
(ii)	age	65 - 74		:	4,165 days of car e
(iii)	age	75 - 84		:	19,459 days of car e
(iv)	age	85 +		:	54,908 days of car e

 

APP END I X B

 

C ER TI F ICAT E O F NEED RE VI E W S TAND ARDS

F O R NURS I N G H OME AND H O S P ITAL  LO N G-T ER M-CARE UN IT BEDS

 

The bed  need  num bers, for  pur poses  of th ese  stan dar ds, unt il oth erwise  chan ged by th e Comm ission, ar e as follows :

 

 

Plann ing Area	Bed  Need	Dep artm ent Invent ory*	ADC Adjustm ent Fa ctor
ALCONA	102	106	0.9
ALGER	70	106	0.9
ALLEGAN	474	565	0.95
ALPEN A	203	208	0.95
ANTRIM	134	113	0.95
AREN AC	106	148	0.9
BARAGA	72	87	0.9
BARRY	262	252	0.95
BAY	638	668	0.95
BEN ZIE	93	102	0.9
BERRI EN	965	867	0.95
BRANCH	241	283	0.95
CALHOUN	805	866	0.95
CASS	272	222	0.95
CHARLEVOIX	134	134	0.95
CHE BOYGAN	154	162	0.95
CHIPPE WA	193	173	0.95
CLARE	173	200	0.95
CLI NTON	251	251	0.95
CRAWFORD	85	160	0.9
DELTA	260	292	0.95
DICKI NSON	230	256	0.95
EATON	431	444	0.95
EMMET	167	230	0.95
GENE SEE	1,951	1,951	0.95
GLADWIN	150	180	0.95
GOGEBIC	195	221	0.95
GD. TRAVE RSE	368	552	0.95
GRATIOT	272	556	0.95
HILLSD ALE	262	262	0.95
HOUGHTON/KEWEE NAW	314	335	0.95
HU RON	278	313	0.95
ING HAM	1,180	1,181	0.95
IONI A	275	248	0.95
IOSCO	193	244	0.95
IRON	150	249	0.95
ISABELLA	214	309	0.95
J ACKSO N	828	847	0.95

 

 

KALAMAZOO	1,120	1,384	0.95
KALKASKA	76	88	0.9
KEN T	2,566	2,761	0.95
LAKE	78	89	0.9
LAPEE R	291	272	0.95
LEE LANAU	111	97	0.9
LEN AWEE	497	497	0.95
LIVINGSTON	421	475	0.95
LUCE	46	61	0.9
MACKINAC	81	79	0.9
MACOMB	3,636	4,056	0.95
MANIS TEE	170	221	0.95
MARQUE TTE	361	441	0.95
MASON	197	202	0.95
MECOST A	184	232	0.95
MEN OMINEE	197	195	0.95
MIDL AND	338	414	0.95
MISS AUKEE	81	95	0.9
MONROE	619	696	0.95
MONTCALM	285	285	0.95
MONTMOR EN CY	89	84	0.9
MUSKEGON	904	945	0.95
NE WAYGO	222	245	0.95
OTT AWA	874	970	0.95
OAKLAND	5,241	5,241	0.95
OCEANA	130	113	0.95
OGEMAW	131	233	0.95
ONTONAGON	76	110	0.9
OSC EOLA	118	54	0.95
OSCOD A	69	90	0.9
OTS EGO	111	154	0.9
PRESQU E  ISL E	111	106	0.95
ROSCOMMO N	171	179	0.95
SAGINAW	1,156	1,175	0.95
ST. CLAIR	789	765	0.95
ST. J OSEPH	355	369	0.95
SANILAC	269	267	0.95
SCHOOLCR AFT	72	75	0.9
SHIAWASSEE	350	327	0.95
TUS COLA	292	293	0.95

 

 

VAN  BUREN	411	424	0.95
WASHTEN AW	1,032	1,360	0.95
WEXFORD	161	218	0.95
NW  WAYNE	3,166	3,181	0.95
SW WAYNE	1,818	2,033	0.95
DETROIT	6,297	6,277	0.95

 

* Dep artm ent Invent ory shown is as of August  20, 1999 .  Applicant s  mu s t  conta ct  th e Dep artm ent to obta in th e curr ent num ber of beds in th e Dep artm ent Invent ory of Beds . Note th e figur es in th e Bed  Invent ory  Column  do  not  reflect  an y  data  regar ding applicat ions for beds un der appe al or pending a fina l Dep artm ent decision.

MICHIGAN DE P ARTMEN T OF COMMUN ITY HE ALTH CER TIFICATE OF NEED  RE VIEW STAND ARDS

FOR NURS ING HOME AND HOSP ITAL LONG-TER M CARE UN IT BEDS

--ADDENDU M FOR SP ECIAL P OP ULATIO N GROUP S

 

(By auth ority con ferr ed on th e Cert ificat e of Need Comm ission by Section 22215 of Act No. 368 of th e Pu blic Act s of 1978 , as am ended , an d Sections 7 an d 8 of Act No. 306 of th e Pu blic Act s of 1969 , as am ended , being Sections 333 .22215 , 24.207 an d 24.208 of th e Michigan Compiled Laws.)

 

Section  1.  App li ca bility ; de fin itio ns

 

Sec. 1. (1) This adde ndum supplement s th e Cert ificat e of Need Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds an d sha ll be used for determ ining th e need for pr oject s esta blished to bett er meet  th e  needs  of special  populat ion  groups with in th e long-term car e an d nur sing home populat ions, pur suant to Section 22217 (1)(b) of th e Pu blic Health Code being Section 333 .22217 (1)(b) of th e Michigan Compiled Laws.

(2)   Except as provided in Sections 2, 3 an d 6 of th is adde ndum , th ese stan dar ds supplement , an d do not supersede , th e requirement s an d term s of approval required by th e Cert ificat e of Need Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds .

(3)    The definitions which apply to th e Cert ificat e of Need Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds sha ll apply to th ese stan dar ds.

(4)   For pur poses of th is adde ndum , th e followin g term s ar e defined:

(a)   "Hospice" mean s a health car e program licensed un der Part 214 of th e Code, being Section 333 .21401 e t seq.

(b)     "Infection contr ol program ," for pur poses of section 4(7), mean s a program that will reduce th e r isk of th e intr oduction of commun icable diseases  int o a  vent ilat or-depe ndent un it , provide an active an d ongoing sur veill an ce program to detect th e prese nce  of commun icable  diseases  in  a  vent ilat or-depe ndent  un it ,  an d  resp ond  to  th e  prese nce  of

 

 

commun icable diseases with in a vent ilat or-depe ndent un it so as to minimize th e spread of a commun icable disease.

(c) "Licensed hospita l" for pur poses of Section 3(6) of th is adde ndum , mean s eith er:

(i)   ) a hospita l licensed un der Part  215 of th e Code; or

(ii)    a psychiatr ic hospita l or un it licensed pur suant to Act 258 of th e Pu blic Act s of 1974 , as am ended , being Sections 330 .1001 to 330 .2106 of th e Michigan Compiled Laws.

(d)   "Organ ized program ," for pur poses of Sections 3(8) an d 4(7), mean s a program operat ed by an applicant at th e locat ion at which th e proposed nur sing home beds will be operat ed that  is  con sistent  with  th e  requirement s  of  Section  4(7)(a )   thr ough   (e),   except Section 4(7)(c)(iv).

(e)   "Pr ivat e reside nce" for pur poses of Section 3(6) of th is adde ndum , mean s a sett ing oth er than :

(i)   a licensed hospita l; or

(ii)    a nur sing home including a nur sing home or part of a nur sing home approved pur suant to Section 3(6).

(f) "Vent ilat or-depe ndent pat ient ," for pur poses of Sections 3(8) an d 4(7), mean s a pat ient who does not require acut e inpat ient hospita l services an d eith er:

(i)   requires mechan ical vent ilat ory assistan ce for a minimum of 6 hour s each day; or

(ii)    is being wean ed from vent ilat ory depe ndency.

 

Section   2.   Re qu ir emen ts   for   app rova l   --  app li cants    proposing    to   inc rease nu rsing  home  beds  -- specia l use  excep tio ns

 

Sec. 2. A pr oject to increase nur sing home beds in a plann ing ar ea which, if approved, would oth erwise cau se th e tota l num ber of nur sing home beds in that plann ing ar ea to exceed th e needed nur sing home bed supply or cau se an increase in an existing excess as determ ined un der th e applicable Cert ificat e of Need Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , ma y neverth eless be approved pur suant  to Section 3 of th is adde ndum .

 

Section 3. State w id e poo l for the needs of specia l popu lation groups w it h in the long -te rm ca re and  nu rsing  home  popu lations

 

Sec. 3. (1)  A stat ewide pool of additiona l nur sing home beds of 2.0% of th e beds needed in th e stat e thr ough applicat ion of th e bed need meth odology in th e Cert ificat e of Need Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds is esta blished to bett er meet th e needs of spe cial populat ion groups with in th e long-term car e an d nur sing home  populat ions,  pur suant   to   Section   22217 (1)(b)   of   th e   Code,   being   Section 333 .22217 (1)(b) of th e Michigan  Compiled  Laws.   Beds  in  th e pool sha ll be  a llocat ed  in a ccor dan ce with subsections 3(a), 4(a), 5(a), an d 6(a).

(2) Increases in nur sing home beds approved un der th is adde ndum for spe cial populat ion groups sha ll not cau se plann ing ar eas curr ent ly showing an unm et bed need to ha ve that need reduced or plann ing ar eas showing a curr ent sur plus of beds to ha ve that sur plus increased.

 

 

(3)(a ) The Cert ificat e of Need Comm ission determ ines th ere is a need for beds for religious needs for spe cialized services with in th e long-term car e an d nur sing home populat ions an d sets aside 302 beds from th e tota l stat ewide pool esta blished in subsection (1) to address th is need . Those needs ar e defined as  being  met  by  th ose  applicat ions  meeting  th e requirement s of subsection (3)(b) or (c).

(b)     An applicant proposing nur sing home beds a llocat ed un der th is subse ct ion  due  to migrat ion of th e pat ient populat ion sha ll demonstrat e with credible docum entat ion to th e sat isfaction of th e Dep artm ent each of th e followin g:

(i)     The applicant is curr ent ly licensed to operat e a nur sing home in Michigan an d th e applicat ion is for replacement an d/or relocat ion of an existing licensed facility.

(ii)    The num ber of beds proposed for replacement mu st be equa l to or less than th e licensed capacity of th e applicant 's existing nur sing home on th e dat e on which th e Cert ificat e of Need applicat ion is filed.

(iii)    The facility to be replaced does not meet licensing or cert ificat ion stan dar ds for health facilities as determ ined by th e Dep artm ent .

(iv) The applicant  is a part  of, closely a ffiliat ed with , contr olled, san ct ioned or support ed by a recognized  religious  organ izat ion,  denominat ion  or  fede rat ion  as  evide nced  by docum entat ion of it s fede ra l  ta x  exempt  statu s  as  a  religious  cor porat ion,  fun d,  or foun dat ion un der Section 501 (c)(3) of th e Un ited Stat es Int erna l Revenu e Code.

(v)  The applicant 's pat ient populat ion includes a ma jority of members  of  th e  religious organ izat ion or denominat ion represe nt ed by th e sponsoring organ izat ion.

(vi)    The applicant 's existing services an d/or operat ions ar e ta ilored to meet certa in special needs of a spe cific religion, denominat ion or order, including un ique dietar y requirement s, or oth er un ique religious needs regar ding ceremony, r itua l, an d organ izat ion which cann ot be sat isfactorily met in a secular sett ing.

(vii)        The  replacement  pr oject  resp onds  to  demogra phic   chan ges,   verifiable   by   th e Dep artm ent , which ha ve  decreased  th e  represe ntat ion  of  members  of  th e  religious organ izat ion or denominat ion in th e plann ing ar ea of th e facility to be replaced an d which ha ve increased th e represe ntat ion of th e members of th e religious organ izat ion or denominat ion in th e plann ing ar ea of th e replacement facility.

(viii)  An applicant proposing replacement beds sha ll not be required to be in  com plian ce with Section 8 (b) of th e Cert ificat e of Need Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , or an y subseq uent stan dar d approved which requires th e proposed new licensed site to be in th e replacement zone.

(c)   An applicant proposing to add nur sing home beds a llocat ed un der th is subse ct ion for a pr oject  oth er  than  described  in   subsection   (b)   sha ll   demonstrat e,   with   credible docum entat ion to th e sat isfaction of th e Dep artm ent , each of th e followin g:

(i)   The applicant is a part of, closely a ffiliat ed with , contr olled, san ct ioned or support ed by a recognized  religious  organ izat ion,   denominat ion   or   fede rat ion   as   evide nced   by docum entat ion of it s fede ra l  ta x  exempt  statu s  as  a  religious  cor porat ion,  fun d,  or foun dat ion un der Section 501 (c)(3) of th e Un ited Stat es Int erna l Revenu e Code.

(ii)     The applicant 's proposed pat ient populat ion includes a ma jority of members of th e religious organ izat ion or denominat ion represe nt ed by th e sponsoring organ izat ion.

(iii)    The applicant 's proposed services an d/or operat ions ar e ta ilored to meet certa in special needs of a spe cific religion, denominat ion, or order, including un ique dietar y requirement s,

 

 

or oth er un ique religious needs regar ding ceremony, r itua l, an d organ izat ion which cann ot be sat isfactorily met in a secular sett ing.

(4)(a ) The Cert ificat e of Need Comm ission  determ ines  th ere  is  a  need  for  beds  for applicat ions des igned to determ ine th e efficien cy an d effect iveness of specialized program s for th e car e an d tr eatm ent of persons with Alzheimer's disease as com par ed to serving th ese needs in genera l nur sing home un it (s) an d des igned to stu dy th e relat ionship between th e needs of Alzheimer's disease pat ient s an d  th ose  of oth er  non-specialized  nur sing  home pat ient s. The Cert ificat e of Need Comm ission sets aside 300 beds from th e tota l stat ewide pool esta blished in subsection (1) to address th is need . Those needs ar e defined as being met by th ose applicat ions meeting th e requirement s of subsection (4).

(b)   An applicant proposing to add nur sing home beds a llocat ed un der th is subse ct ion sha ll demonstrat e with credible docum entat ion to th e sat isfaction of th e Dep artm ent each of th e following:

(i) The beds ar e part of a specialized program  for Alzheimer's disease which will admit an d tr eat only pat ient s which require long-term nur sing car e an d ha ve been appropriat ely classified as a pat ient on th e Global Deteriorat ion Scale (GDS) for age-ass ociat ed cogn itive decline an d Alzheimer's disease as a level 4 (when  a ccom pan ied  by  cont inu ous  nur sing needs ), 5, or 6.

The specialized program will part icipat e in th e stat e registr y for Alzheimer's disease.

The spe cialized program sha ll be atta ched or geogra phically adjacent to a licensed nur sing home an d be no lar ger than  20 beds in size.

(iv)    The proposed Alzheimer's un it sha ll ha ve direct  a ccess  to a  secur e out door  or  indoor ar ea at th e health facility, appropriat e for un supervised activity.

(v)     The Alzheimer's un it sha ll ha ve with in th e un it or imm ediat ely adjacent to it a day/dining ar ea which is solely for th e use of th e Alzheimer's un it pat ient s.

(vi)    The physical environm ent of th e Alzheimer's un it sha ll be des igned to minimize noise an d light reflections to promote visua l an d spat ia l orientat ion.

(vii)           Sta ff will be spe cially tra ined in Alzheimer's disease tr eatm ent .

(viii)       If th e applicant ha s operat ed  a  spe cialized  program  an d  ha s  demonstrat ed  an occu pan cy rat e of at least 97 percent in th e Alzheimer’s specialized un it (s) for th e most recent , cont inu ous 24-month period prior to submitt ing it s applicat ion to th e dep artm ent , it ma y request up to an additiona l 20 beds but cann ot exceed a tota l of 40 beds awar ded from th e stat ewide pool esta blished in subsection (1).

(A)  The spe cialized un it (s) sha ll be no lar ger than  20 beds .

(B)   An applicant sha ll not be awar ded more than  a tota l of 40 beds .

(c)    Beds approved un der th is subse ct ion sha ll not be con vert ed to non-spe cialized non- Alzheimer's long-term car e services with out a Cert ificat e of Need for nur sing home an d hospita l long-term car e un it beds un der th e  Cert ificat e  of  Need  Review  Stan dar ds  for Nurs ing Home an d Hospita l Long-term Car e Un it Beds .

(5)(a ) The Cert ificat e of Need Comm ission determ ines th ere is a need for  beds  for  th e health needs for sk illed nur sing car e services with in th e long-term car e an d nur sing home populat ions an d sets aside 257 beds from th e tota l stat ewide pool esta blished in subsection

(1)     to address th is need . Those needs ar e defined as being met by  th ose  applicat ions meeting th e requirement s of subsection (5).

 

 

(b) An applicant proposing to add nur sing home beds a llocat ed un der th is subse ct ion sha ll demonstrat e with credible docum entat ion to th e sat isfaction of th e Dep artm ent each of th e following:

(i)    The plann ing ar ea in which th e beds will be locat ed sha ll ha ve a populat ion density of less than 28 individua ls per squar e mile based on th e 1990 U.S. Census figur es as set forth in Appe ndix A.

(ii)    An applicat ion for beds from th e special stat ewide pool of beds sha ll not be approved if an y applicat ion for beds in that plann ing ar ea ha s been approved from th e spe cial stat ewide pool of beds un der Section 3(5).

(iii)     The avera ge occupan cy rat e for th e plann ing ar ea in which th e beds  will be locat ed sha ll ha ve been at least 95%  for  each  of  th e  thr ee  most  recent  year s  for  which  th e Dep artm ent ha s eith er: annua l  sur vey  data ;  or  data  report ed  to  th e  Dep artm ent  for pur poses of com piling th e "Sta ffin g/Bed Ut ilizat ion Rat ios Report ," whichever is th e most recent data  available.  In determ ining th e avera ge occupan cy rat e for th e plann ing ar ea, th e fir st six month s of occu pan cy for an y newly opened facility or newly opened part of a facility in that  period sha ll be excluded .

(iv)   An applicat ion sha ll not be approved if it proposes more than  40 beds .

(v)   All beds approved pur suant to th is subse ct ion sha ll be dua lly cert ified for Medi car e an d Medi caid.

(6)(a ) The Cert ificat e of Need Comm ission determ ines th ere is a need for beds for pat ient s requiring both hospice an d long-term nur sing car e services with in th e long-term car e an d nur sing home populat ions an d sets aside 100 beds from th e tota l stat ewide pool esta blished in subsection (1) to address th is need . Those needs ar e defined as being met by th ose applicat ions meeting th e requirement s of subsection (6).

(b) An applicant proposing to add nur sing home beds a llocat ed un der th is subse ct ion sha ll demonstrat e, with credible docum entat ion to th e sat isfaction of th e dep artm ent , each of th e following:

(i)    An applicant sha ll be a hospice cert ified by Medi car e pur suant to th e Code of Fede ra l Regulat ions, Title 42, Cha pter iv, Subpart B (Medi car e program s), Part 418 an d sha ll ha ve been a Medi car e cert ified hospice for at least 24 cont inu ous month s prior to th e dat e an applicat ion is submitt ed to th e Dep artm ent .

(ii)    An applicant sha ll demonstrat e that , dur ing th e most recent 12 month  period prior to th e dat e an applicat ion is submitt ed to th e Dep artm ent for which verifiable data ar e available to th e Dep artm ent , at least 64% of th e tota l num ber of hospice days of car e provided to all of th e client s of th e applicant hospice were provided in a privat e reside nce.

(iii)    An applicat ion sha ll propose 30 beds or less.

(iv)    An applicant for beds from th e special stat ewide  pool of beds  sha ll not be approved if an y applicat ion for beds in that sam e plann ing ar ea  ha s been approved from th e spe cial stat ewide pool of beds un der Section 3(6).

(v)   An applicant sha ll submit, at th e t ime an applicat ion is submitt ed to th e Dep artm ent , a stu dy which docum ent s, to th e sat isfaction of th e Dep artm ent , that both (A) an d (B) ha ve been conta cted regar ding th e availability of eith er beds or space for acquisition (wheth er thr ough pur cha se, lease or oth er com para ble arran gement ) for use by th e proposed pr oject , an d that  eith er: (1) beds or space ar e not available for acquisition; or (2) if beds or space ar e

 

 

available for acquisition, th e capita l cost s of developing th e beds or space in th e acquired space for use by th e proposed pr oject ar e higher than  th e applicant 's proposed pr oject cost s.

(A) Ea ch licensed hospita l in th e plann ing ar ea.

(B) Ea ch licensed nur sing home or hospita l long-term car e un it in th e plann ing ar ea.

If an applicant does not receive a resp onse from (A) or (B) with in  30 days of th e dat e of conta ct , an applicant sha ll demonstrat e that conta ct was ma de by 1 cert ified ma il return receipt for each organ izat ion conta cted. The requirement s of th is  subdivisi on  sha ll not apply to nur sing homes or hospita l long-term car e un it s that  eith er:

(1)   Ha ve not been cited by th e Dep artm ent 's Divisi on of Licensing an d Cert ificat ion for 1 or more level a deficiencies dur ing th e 12 month s prior to th e dat e an applicat ion is submitt ed to th e Dep artm ent .

(2)  Ha ve been grant ed, by th e Dep artm ent , a waiver of 1 or more physical plant licensur e requirement s.

(7)(a )  The num ber of beds set aside from th e tota l stat ewide pool esta blished in subsection

(1) for a spe cial populat ion group sha ll be reduced if th ere ha s been no Cert ificat e of Need activity for that  spe cial populat ion group dur ing at least 6 con secut ive applicat ion periods.

(b) The num ber of beds in a spe cial populat ion group sha ll be reduced to th e tota l num ber of beds for which a valid Cert ificat e of Need ha s been issued for that  special populat ion group.

(c)   The num ber of beds reduced from a special populat ion group pur suant to th is subse ct ion sha ll revert to th e tota l stat ewide pool esta blished in subsection (1).

(d)    The Dep artm ent sha ll notify th e Comm ission of th e dat e when  action  to reduce  th e num ber of beds set aside for a special populat ion group  ha s  becom e  effect ive  an d  sha ll ident ify th e num ber of beds that revert ed to th e tota l stat ewide pool esta blished in subsection (1).

(e)    For pur poses of th is subsection, "applicat ion period" mean s th e period of t ime from one des ignat ed applicat ion dat e to th e next subseq uent des ignat ed applicat ion dat e.

(f)   For pur poses of th is subsection, "Cert ificat e of Need activity" mean s one or more of th e following:

(i)     Cert ificat e of Need applicat ions for beds for a special populat ion group ha ve been submitt ed to th e Dep artm ent for which eith er a proposed or fina l decision ha s not yet been issued by th e Dep artm ent .

(ii)    Administrat ive hear ings or appe als to court of decisions issued on Cert ificat e of Need applicat ions for beds for a spe cial populat ion group ar e pending resolut ion.

(iii)    An approved Cert ificat e of Need for beds for each special populat ion group ha s expired for lack of appropriat e action by an applicant to implement an approved Cert ificat e of Need . (8)(a )  The  Cert ificat e  of  Need  Comm ission  determ ines  th ere  is  a  need  for  beds   for vent ilat or-depe ndent pat ient s with in th e long-term car e an d nur sing home populat ions an d sets aside 0 beds from th e tota l stat ewide pool esta blished in subsection (1) to address th is need . Those needs ar e defined as being met by th ose applicat ions meeting th e requirement s of  subsection  (8).  By  sett ing  aside  th ese  beds  from  th e  tota l  stat ewide   pool,  th e Comm ission's action applies only to  applicant s  seek ing  approval  of  nur sing  home  beds pur suant to th is subsection an d does not preclude th e car e of vent ilat or-depe ndent pat ient s in un it s of hospita ls, hospita l long-term car e un it s, nur sing homes, or oth er health  car e sett ings in com plian ce with applicable statut ory or cert ificat ion requirement s.

 

 

(b) An applicant proposing to add nur sing home beds a llocat ed un der th is subse ct ion sha ll demonstrat e, with credible docum entat ion to th e sat isfaction of th e Dep artm ent , each of th e following:

(i)    An applicant ha s an organ ized program for car ing for vent ilat or-depe ndent pat ient s in licensed hospita l beds , an d ha s been  recogn ized  by  th e  Dep artm ent  or  th e  Michigan Dep artm ent of Socia l Services as ha ving provided an  organ ized  program  for  car ing  for vent ilat or-depe ndent pat ient s for at least 30 cont inu ous month s prior to th e dat e on which an applicat ion un der th is subsection is submitt ed to th e Dep artm ent .

(ii)  An applicat ion proposes no more than 15 beds that will be licensed  as nur sing home beds un der Part  217 of th e Code.

(iii) The proposed un it will be locat ed in a hospita l licensed un der Part  215 of th e Code.

(iv)    An applicant for beds from th is special stat ewide pool of beds  sha ll not be approved if an y applicat ion for beds in th e sam e count y ha s been approved from th e special stat ewide pool of beds un der Section 3(8).

(v) The proposed un it will serve only vent ilat or-depe ndent pat ient s.

(vi) An applicant sha ll delicense a num ber of licensed hospita l beds equa l to or than great er than  th e num ber of beds proposed pur suant  to th is subse ct ion.

(vii)    All beds approved pur suant to th is subse ct ion sha ll be dua lly cert ified for Medi car e an d Medi caid.

 

Section 4. P rojec t de li ve ry re qu ir emen ts -- te rms of app rova l for all app li cants seeking   app rova l unde r Section   3

 

Sec. 4. (1) An applicant sha ll agree that if approved, th e services sha ll be delivered in com plian ce with th e term s  of  approval  required by  th e  Cert ificat e  of  Need  Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds .

(2)   In addition to th e term s of approval  required  by  th e  Cert ificat e  of  Need  Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , an applicant for beds un der Section 3(3)(b) sha ll agree that , if approved, th e services provided by th e specialized long-term car e beds sha ll be delivered in com plian ce with th e followin g term s of Cert ificat e of Need approval:

(a)     The applicant sha ll submit a resolut ion of it s govern ing body cert ifying that it sha ll cease operat ions as a licensed health car e facility at th e existing licensed site, an d that th e license of th e existing site which is replaced un der Section 3(3) sha ll be surr endered to th e Dep artm ent con curr ent ly with th e licensur e of a replacement facility approved un der Section 3(3)(b).

(b)  The applicant sha ll docum ent , at th e end of th e th ird year followin g initiat ion of beds approved pur suant to Section 3 (3)(b), an annua l avera ge occu pan cy rat e of 95 percent or more. If th is occu pan cy rat e ha s not been met, th e applicant sha ll delicense a num ber of beds necess ar y to result in a 95 percent occu pan cy based upon it s avera ge daily census for th e th ird full year of operat ion.

(c)   When opening, th e replacement facility sha ll admit th e curr ent pat ient s of th e facility being replaced to th e extent th ose pat ient s des ire to tran sfer to th e replacement facility.

(3)     In addition to th e term s of approval  required  by  th e  Cert ificat e  of  Need  Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , an applicant for beds

 

 

un der Section 3(3)(c) sha ll agree that , if approved, th e services provided by th e specialized long-term car e beds sha ll be delivered in com plian ce with th e followin g term of Cert ificat e of Need approval:

(a)  The applicant sha ll docum ent , at th e end of th e th ird year followin g initiat ion of beds approved pur suant to Section 3 (3)(c) an annua l avera ge occu pan cy rat e of 95 percent or more. If th is occu pan cy rat e ha s not been met, th e applicant sha ll delicense a num ber of beds necess ar y to result in a 95 percent occu pan cy based upon it s avera ge daily census for th e th ird full year of operat ion.

(4)   In addition to th e term s of approval  required  by  th e  Cert ificat e  of  Need  Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , an applicant for beds un der Section 3 (4) sha ll agree that  if approved:

(a)    The services provided by th e spe cialized Alzheimer's disease beds sha ll be delivered in com plian ce with th e requirement s for approval in subsections 3(4)(a ) an d (b); an d

(b) All beds approved pur suant  to that  subsection sha ll be cert ified for Medi caid.

(5)   In addition to th e term s of approval  required  by  th e  Cert ificat e  of  Need  Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , an applicant for beds un der Section 3(5) sha ll agree that if approved, all beds approved pur suant to that subsection sha ll be dua lly cert ified for Medi car e an d Medi caid.

(6)     In addition to th e term s of approval  required  by  th e  Cert ificat e  of  Need  Review Stan dar ds for Nurs ing Home an d Hospita l Long-term Car e Un it Beds , an applicant for beds un der Section 3(6) sha ll agree that , if approved, all beds approved pur suant to that subsection sha ll be operat ed in a ccor dan ce with th e followin g Cert ificat e of Need term s of approval.

(a)     An applicant sha ll ma inta in Medi car e cert ificat ion of th e hospice program an d  sha ll esta blish an d ma inta in th e ability to provide, eith er  directly  or  thr ough  contra ctua l arran gement s, hospice services as out lined in th e Code of Fede ra l Regulat ions, Title 42, Cha pter IV, Subpart B, Part  418 , hospice car e.

(b)     The proposed pr oject sha ll be des igned to promote a home-like atm osphere which includes a ccomm odat ions for fam ily members to ha ve overn ight sta ys an d part icipat e in fam ily meals at th e applicant facility.

(c)  An applicant approved for nur sing home beds pur suant to Section 3(6) sha ll not refuse to admit a pat ient solely on th e basis that  he/she is  HIV positive, ha s  AIDS  or  ha s  AIDS relat ed com plex.

(d)   An applicant sha ll mak e a ccomm odat ions to serve pat ient s that ar e HIV positive, ha ve AIDS or ha ve AIDS relat ed complex in nur sing home beds approved pur suant to Section 3(6).

(e)    An applicant sha ll mak e a ccomm odat ions to serve children an d adolescent s as well as adults in nur sing home beds approved pur suant  to Section 3(6).

(f)  Nurs ing home beds approved pur suant to Section 3(6) sha ll only be used to provide services to individua ls su ffer ing from a disease or con dition with a term ina l prognosis in accordan ce with Section 21417 of th e Code, being Section 333 .21417 of th e Michigan Compiled Laws.

(g)   An applicant sha ll agree that th e nur sing home beds approved pur suant  to Section 3(6) of th ese stan dar ds sha ll not be used to serve individua ls not meeting th e provisions of Section 21417 of th e Code, being Section 333 .21417 of th e Michigan Compiled Laws, un less

 

 

a sep arat e Cert ificat e of Need is requested an d approved pur suant to applicable Cert ificat e of Need review stan dar ds.

(h)  An applicant sha ll be licensed as a hospice program un der Part 214 of th e Code, being Section 333 .21401 e t seq. of th e Michigan Compiled Laws.

(i)  An applicant sha ll agree that at least 64% of th e tota l num ber of hospice days of car e provided by th e applicant hospice to all of it s client s will be provided in a privat e reside nce.

(j)   An applicant sha ll annua lly provide data to determ ine th e efficien cy an d effect iveness of providing, in a nur sing home or hospita l long-term car e un it , r oom an d boar d services to hospice client s that would oth erwise be tr eat ed in a privat e reside nce if a capable primar y car egiver was available. An applicant sha ll, at a minimum , provide data to th e Dep artm ent on a calendar year basis for each of th e followin g:

(i)    The num ber of hospice pat ient s an d ass ociat ed days of car e for genera l inpat ient an d respi te inpat ient hospice car e;

(ii)     The num ber of hospice pat ient s an d ass ociat ed  days  of car e  for  hospice  rout ine  an d cont inu ous home car e not provided in a nur sing home or hospita l long-term car e un it ; an d

(iii)    The num ber of hospice pat ient s an d ass ociat ed days of car e for hospice r oom an d boar d in a nur sing home.

(iv)    The tota l num ber of hospice client s an d ass ociat ed days of car e served by th e applicant hospice which sha ll be th e sum of subdivisi ons (i), (ii), an d (iii).

These data sha ll be con sidered  when  revisions  to th ese  stan dar ds  ar e  con sidered.  The Dep artm ent sha ll annua lly report to th e  Comm ission  a  summar y  of th e  data  colle cted pur suant to th is requirement . At a minimum , th e summar y sha ll report th e occu pan cy rat e an d avera ge length of sta y for each applicant approved pur suant to Section  3(6) of th is adde ndum .

(7)   In addition to th e term s of approval required by th e Cert ificat e of Need review stan dar ds for nur sing home an d hospita l long-term car e un it beds , an applicant for beds un der Section 3(8) sha ll agree that , if approved, all beds approved pur suant to that subse ct ion sha ll be operat ed in a ccor dan ce with th e followin g Cert ificat e of Need term s of approval.

(a)     An applicant sha ll sta ff th e  proposed  vent ilat or-depe ndent  un it  with  employees  that ha ve been tra ined in th e car e an d tr eatm ent of vent ilat or-depe ndent pat ient s an d includes at least th e followin g:

(i)      a medical director with specialized kn owledge ,  tra ining,  an d  sk ills  in  th e  car e  of vent ilat or-depe ndent pat ient s.

(ii)    program director that  is a registered nur se.

(b)     An  applicant  sha ll   mak e   provisions,   eith er   directly   or   thr ough   contra ctua l arran gement s, for at least th e followin g services:

(i)   respi rat ory th era py.

(ii)    cupat iona l an d physical th era py.

(iii)    psychological services.

(iv)   fam ily an d pat ient teaching activities.

(c)   An applicant sha ll esta blish an d ma inta in writt en policies an d pr oced ur es for each of th e following:

(i)     pat ient admission criteria that  describe  minimum  an d  ma ximum  chara cteristics  for pat ient s appropriat e for  admission  to th e vent ilat or-depe ndent  un it .   At  a  minimum , th e

 

 

criteria sha ll address th e am ount of mechan ical vent ilat ory depe ndency, th e required medical sta bility, an d th e need for an cillar y services.

(ii)    The tran sfer of pat ient s requiring car e at oth er health car e facilities.

(iii)      Upon  admission  an d  periodically  th ereafter,  a  com prehensive  needs  assess ment ,  a tr eatm ent plan , an d a dischar ge plan that  at  a  minimum  addresses  th e car e needs  of a pat ient followin g dischar ge.

(iv)    Pat ient right s an d resp onsibili ties in a ccor dan ce with Sections 20201 an d 20202 of th e Code, being Sections 333 .20201 an d 333 .20202 of th e Michigan Compiled Laws.

(v)    The type of vent ilat ory equipment to be used on th e un it an d provisions for back-up equipment .

(d)   An applicant sha ll esta blish an d ma inta in an organ ized infection contr ol program that ha s writt en policies for each of th e followin g:

(i)   use of intra venous infusion apparatu s, including sk in preparat ion, monitoring sk in site, an d frequency of tu be chan ges.

(ii)    placement an d car e of ur inar y cath eters.

(iii)    car e an d use of th erm ometers.

(iv)   car e an d use of tra cheostomy devices.

(v)   employee persona l hygiene.

(vi)   asep t ic techn ique.

(vii)    car e an d use of respi rat ory th era py an d relat ed equipment . (viii) isolat ion techn iques an d pr oced ur es.

(e)   An applicant sha ll esta blish a mu lt i-disciplinar y infection contr ol comm itt ee that meets on at least a month ly basis an d includes th e director of nur sing, th e vent ilat or-depe ndent un it program director, an d  represe ntat ives  from  administrat ion,  dietar y,  housekeep ing, ma int enan ce, an d respi rat ory th era py. This subse ct ion  does  not  require  a  sep arat e comm itt ee, if an applicant organ izat ion ha s a stan ding infection contr ol comm itt ee an d that comm itt ee's char ge is am ended to include a specific focu s on th e vent ilat or-depe ndent un it .

(f)  The proposed vent ilat or-depe ndent un it sha ll ha ve barr ier -fr ee a ccess to an out door ar ea in th e imm ediat e vicinity of th e un it .

(g)   An applicant sha ll agree that all beds approved pur suant to Section 3(8) will be dua lly cert ified for Medi car e an d Medi caid reimbur sement .

(h)  An applicant approved for beds pur suant to Section 3(8) sha ll agree that th e beds  will not be used to service individua ls  that  ar e  not  vent ilat or-depe ndent  un less  a  sep arat e Cert ificat e of Need is requested an d approved by th e Dep artm ent pur suant to applicable Cert ificat e of Need review stan dar ds.

(i)     An applicant approved  for  beds  pur suant  to  Section  3(8)  sha ll  provide  data to  th e Dep artm ent that evaluat es th e cost  efficien cies  that  result  from  providing  services  to vent ilat or-depe ndent pat ient s in a hospita l.

 

Section 5. Compa rative rev ie w s ,  e ffec t  on  pri or  Ce rtifi cate  of  Need  rev ie w standa rds

 

Sec. 5.  (1)  Pr oject s proposed un der Section 3(3) sha ll be con sidered a distinct cat egory an d sha ll be subject to com parat ive review on a stat ewide basis.

 

 

(2)   Pr oject s proposed un der Section 3(4) sha ll be con sidered a distinct cat egory an d sha ll be subject to com parat ive review on a stat ewide basis.

(3)   Pr oject s proposed un der Section 3(5) sha ll be con sidered a distinct cat egory an d sha ll be subject to com parat ive review on a stat ewide basis.

(4)   Pr oject s proposed un der Section 3(6) sha ll be con sidered a distinct cat egory an d sha ll be subject to com parat ive review on a stat ewide basis.

(5)   Pr oject s proposed un der section 3(8) sha ll be con sidered a distinct cat egory an d sha ll be subject to com parat ive review on a stat ewide basis.

(6)     These Cert ificat e of Need review stan dar ds supercede an d replace  th e  Cert ificat e  of Need Review Stan dar ds for Nurs ing Home an d Long-term Car e Un it Beds --Adde ndum for Spe cial Populat ion Groups approved by th e Comm ission on Mar ch 20, 1996 an d effect ive on May 10 , 1996 .

 

Section  6.  Acqu isitio n  of  nu rsing  home  or  hosp ital  long -te rm  ca re  un it  beds app roved  pu rsuant  to th is addendum  .

 

Sec. 6. (1) An applicant proposing to acquire nur sing home or hospita l long-term car e un it beds approved pur suant to Section 3(3)(b) or (c) of th is adde ndum sha ll demonstrat e that it is in com plian ce with th e requirement s  of Section  3(3)(b)(iv), (v) an d  (vi) of th is adde ndum .

(2)    An applicant proposing to acquire nur sing home or hospita l long-term car e un it beds approved pur suant to  Section  3(4)  of  th is  adde ndum  sha ll  demonstrat e  that  it  is  in com plian ce with th e requirement s of Section 3(4)(b)(i), (ii), (iii), (iv), (v), (vi), (vii) an d (viii) of th is adde ndum .

(3)    An applicant proposing to acquire nur sing home or hospita l long-term car e un it beds approved pur suant to  Section  3(6)  of  th is  adde ndum  sha ll  demonstrat e  that  it  is  in com plian ce with th e requirement s of Section 3(6)(b)(i) an d (ii) of th is adde ndum .

(4)     An applicant proposing to acquire beds  approved  pur suant  to  Section  3(8)  of  th is Adde ndum sha ll demonstrat e that it is in com plian ce with th e requirement s of Section 3(8) of th is Adde ndum .

(5)    An applicant proposing to acquire nur sing home or hospita l long-term car e un it beds approved pur suant to th is adde ndum sha ll agree to all applicable pr oject delivery requirement s set forth in Section 4 of th is adde ndum .

 

APP END I X A

 

CER TIFICATE OF NEED  RE VIEW STAND ARDS

FOR NURS ING HOME AND HOSP ITAL LONG-TER M CARE UN IT BEDS

--ADDENDU M F OR S P E CIAL P O P U LATIO N GR O U P S

 

Michigan  nur sing  home  plann ing  ar eas  with  a   populat ion   density  of  less   than   28 individua ls per squar e mile based on 1990 U.S. Census figur es.

 

 

Plann ing Area	Populat ion Density per Squar e Mile
Luce	6.4
Ont ona gon	6.8
Sch oolcra ft	7.1
Bara ga	8.8
Alger	9.8
Mackina c	10.4
Iron	11.3
Os coda	13.8
Alcona	14.9
Lak e	15.1
Montm orency	16.2
Gogebi c	16.3
Pr esq ue Isle	21
Miss auk ee	21.5
Chippew a	21.8
Cra wfor d	21.9
Menominee	23.8
Hought on/Kewee na w	23.9
Kalkaska	24

 

Sour ce:            Michigan Dep artm ent of Mana gement an d Budget an d th e U.S. Bur eau of th e Census