Chapter 3701-12 Certificate of Need

As used in Chapter 3701-12 of the Administrative Code:

(A) Except as otherwise provided in sections 3702.51 to 3702.62 of the Revised Code, “affected person” means:

(1) An applicant for a certificate of need, including an applicant whose application was reviewed comparatively with the application in question;

(2) Any person that resides or regularly uses health care facilities within the geographic area served or to be served by the health care services that would be provided under the certificate of need or reviewability ruling in question;

(3) Any health care facility that is located in the health service area where the health care services would be provided under the certificate of need or reviewability ruling in question;

(4) The person that requested the reviewability ruling in question;

(5) Third-party payers that reimburse health care facilities for services in the health service area where the health care services would be provided under the certificate of need or reviewability ruling in question;

(6) Any other person who testified at a public hearing held under division (B) of section 3702.52 of the Revised Code and rule 3701-12-11 of the Administrative Code in the course of review of the application in question or who submitted written comments on the application in question.

(B) “Affiliated person” means a corporation, business trust, estate, firm, partnership, association, joint stock company, insurance company, government unit, or other entity that:

(1) Has an ownership or beneficial ownership interest, either direct or indirect, of five per cent or more of the voting stock of the person transferring a certificate of need (PTCN);

(2) Participates as a general, junior, or limited partner in a partnership with the PTCN;

(3) Shares a common officer, director, member, trustee, or partner with the PTCN;

(4) Shares twenty-five per cent or more of its employees with the PTCN;

(5) Loans twenty-five per cent or more of the total capital needed to implement the activity, either directly or through a loan guarantee or similar arrangement, to the PTCN;

(6) Locates the site or allows the location of the site of the activity on its campus or on its property; or

(7) Enters an agreement with the PTCN to use its name as part of the name of the health care facility or service:

(a) As part of the implementation of the activity; or

(b) In advertising or promotional material that holds the facility or service out as being operated or offered by it or on behalf of it.

(C) “Ambulatory surgical facility” or “ASF” has the same meaning as in paragraph (A) of rule 3701-83-15 of the Administrative Code.

(D) “Applicant” means any person that submits an application for a certificate of need and who is designated in the application as the applicant.

(E) “Bed capacity” means:

(1) The number of hospital beds registered by service under section 3701.07 of the Revised Code;

(2) The number of nursing home beds licensed under Chapter 3721. of the Revised Code;

(3) The number of beds in county homes or county nursing homes, as defined in section 5155.31 of the Revised Code, which are certified as skilled nursing facilities or intermediate care facilities under Title XVIII or XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981);

(4) The number of perinatal beds or pediatric intensive care unit beds; or

(5) The number of renal dialysis stations used for chronic maintenance dialysis located in a health care facility. For the purposes of this definition:

(a) “Chronic maintenance dialysis” means regular provision of hemodialysis on an outpatient basis for an end-stage renal disease patient with any level of patient involvement.

(b) “End-stage renal disease patient” or “patient” means an individual who is at a stage of renal impairment that appears irreversible and permanent and who requires a regular course of dialysis or renal transplantation to ameliorate uremic symptoms and maintain life.

(c) “Renal dialysis station” means the equipment used to provide chronic maintenance dialysis for a single patient at a given time, including equipment used for self-dialysis and isolation stations but not including equipment used exclusively to train patients in self-dialysis.

(F) “Cardiac catheterization” has the same meaning as in paragraph (CCC) of rule 3701-84-01 of the Administrative Code.

(G) “Certificate of need” means a written approval granted by the director to an applicant to authorize conducting a reviewable activity.

(H) “Children’s hospital” means any of the following:

(1) A hospital registered under section 3701.07 of the Revised Code that provides general pediatric medical and surgical care and in which at least seventy-five per cent of annual inpatient discharges for the preceding two calendar years were individuals less than eighteen years of age;

(2) A distinct portion of a hospital registered under section 3701.07 of the Revised Code that provides general pediatric medical and surgical care, has a total of at least one hundred fifty registered pediatric special care and pediatric acute care beds, and in which at least seventy-five per cent of annual inpatient discharges for the preceding two calendar years were individuals less than eighteen years of age; or

(3) A distinct portion of a hospital, if the hospital is registered under section 3701.07 of the Revised Code as a children’s hospital and the children’s hospital meets all the requirements of paragraph (H)(1) of this rule.

(I) “Cobalt radiation therapy unit” or “cobalt radiation therapy service” means the structural unit of a health care facility that provides radiation therapy using a cobalt teletherapy machine.

(J) “Director” means the director of health or an authorized designee of the director.

(K) “Existing health care facility” means either of the following:

(1) A health care facility that is licensed or otherwise authorized to operate in this state in accordance with applicable law, is staffed and equipped to provide health care services, and is actively providing health care services; or

(2) A health care facility that is licensed or has beds registered under section 3701.07 of the Revised Code as skilled nursing beds or long-term care beds and has provided services for at least three hundred sixty-five consecutive days within the twenty-four months immediately preceding the date a certificate of need application is filed with the director of health.

(L) “Freestanding birthing center” has the same meaning as in division (Z) of section 3702.51 of the Revised Code.

(M) “Freestanding cardiac catheterization facility” is a facility that performs cardiac catheterization and which:

(1) Is physically separated from a hospital, requiring use of an ambulance or other vehicle for emergency transportation of patients;

(2) Is organizationally separate from a hospital; or

(3) Is not subject to the hospital’s credentialing procedures.

(N) “Freestanding diagnostic imaging center” has the same meaning as in paragraph (F) of rule 3701-83-51 of the Administrative Code.

(O) “Freestanding dialysis center” or “dialysis center” has the same meaning as in paragraph (D) of rule 3701-83-23 of the Administrative Code.

(P) “Freestanding inpatient rehabilitation facility” or “inpatient rehabilitation facility” has the same meaning as in paragraph (A) of rule 3701-83-25 of the Administrative Code.

(Q) “Freestanding radiation therapy center” has the same meaning as in paragraph (D) of rule 3701-83-43 of the Administrative Code.

(R) “Gamma knife unit” has the same meaning as the term “gamma knife service” in paragraph (PP) of rule 3701-84-01 of the Administrative Code.

(S) “Government unit” means the state of Ohio and any county, municipal corporation, township, or other political subdivision of the state, or any department, division, board, or other agency of any of the foregoing.

(T) “Health care facility” or “HCF” means:

(1) A hospital registered under section 3701.07 of the Revised Code;

(2) A nursing home licensed under section 3721.02 of the Revised Code, or by a political subdivision certified under section 3721.09 of the Revised Code;

(3) A county home or a county nursing home as defined in section 5155.31 of the Revised Code that is certified under Title XVIII or XIX of the “Social Security Act,” 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981);

(4) A freestanding dialysis center;

(5) A freestanding inpatient rehabilitation facility;

(6) An ambulatory surgical facility;

(7) A freestanding cardiac catheterization facility;

(8) A freestanding birthing center;

(9) A freestanding or mobile diagnostic imaging center; or

(10) A freestanding radiation therapy center.

(U) “Health maintenance organization” or “HMO” means a public or private organization organized under the law of any state that is qualified under section 1310(d) of Title XIII of the “Public Health Service Act,” 87 Stat. 931 (1973), 42 U.S.C. section 300e-9.

(V) “Health service” means a clinically related service, such as a diagnostic, treatment, rehabilitative or preventive service.

(W) “Health service agency” or “HSA” means an agency that has been designated by the director to serve a health service area in accordance with section 3702.58 of the Revised Code.

(X) “Health service area” means a geographic region designated by the director of health under section 3702.58 of the Revised Code.

(Y) “Linear accelerator” has the same meaning as in paragraph (RR) of rule 3701-84-01 of the Administrative Code.

(Z) “Long-term care bed” means a bed in a long-term care facility.

(AA) “Long-term care facility” means any of the following:

(1) A nursing home licensed under section 3721.02 of the Revised Code or by a political subdivision certified under section 3721.09 of the Revised Code;

(2) The portion of any facility, including a county home or a county nursing home, that is certified as a skilled nursing facility or a nursing facility under Title XVIII or XIX of the Social Security Act; or

(3) The portion of any hospital that contains beds registered under section 3701.07 of the Revised Code as skilled nursing beds or long-term care beds.

(BB) “Magnetic resonance imaging unit” or “MRI unit” means an integrated set of machines that use radio frequency and magnetic fields to produce images of organs and tissue or spectroscopic quantitative data.

(CC) “Medical equipment” means a single unit of medical equipment or a single system of components with related functions that is used to provide health services.

(DD) “Megavoltage radiation therapy service” means a radiation therapy service which uses ionizing radiations with energy over one MeV.

(EE) “Mobile diagnostic imaging center” has the same meaning as in paragraph (J) of rule 3701-83-51 of the Administrative Code.

(FF) “Newborn care service” or “newborn care unit” has the same meaning as the term “obstetric and newborn care service” in paragraph (III) of rule 3701-84-01 of the Administrative Code.

(GG) “New health care facility” means any health care facility that is not an existing health care facility as defined in paragraph (K) of this rule.

(HH) “Obstetric care service” or “obstetric care unit” has the same meaning as the term “obstetric and newborn care service” in paragraph (III) of rule 3701-84-01 of the Administrative Code.

(II) “Open-heart surgery service” has the same meaning as in paragraph (GGG) of rule 3701-84-01 of the Administrative Code.

(JJ) “Pediatric intensive care unit” or “PICU” or “pediatric intensive care service” has the same meaning as in paragraph (BB) of rule 3701-84-01 of the Administrative Code.

(KK) “Pediatric intensive care unit bed” means a bed located in a pediatric intensive care unit or PICU, or pediatric intensive care service.

(LL) “Perinatal bed” means a bed in a hospital that is registered under section 3701.07 of the Revised Code as a newborn care or obstetric bed, or bed in a freestanding birthing center.

(MM) “Person” means any individual, corporation, business trust, estate, firm, partnership, association, joint stock company, insurance company, government unit or other entity.

(NN) “Physician” means a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the state of Ohio.

(OO) “PTCN” is an acronym for “person transferring a certificate of need” and refers to a person holding a certificate of need issued on or after April 20, 1995, that transfers the certificate to another person before the reviewable activity is completed, or that enters into an agreement that contemplates the transfer of the certificate of need on the completion of the reviewable activity.

(PP) “Radiation therapy” has the same meaning as in paragraph (AAA) of rule 3701-84-01 of the Administrative Code.

(QQ) “Related person” means an affiliated person or an individual who, by virtue of blood or adoption, is the spouse, father, mother, sister, brother, half-sister, half-brother, grandmother, grandfather, or first cousin of a PTCN.

(RR) “Rural area” means any area of the state not located within a metropolitan statistical area.

(SS) “Small rural hospital” means a hospital located in a rural area that has fewer than one hundred beds and to which fewer than four thousand persons were admitted during the most recent calendar year.

(TT) “State agency” means the director.

(UU) “Third-party payer” means a health insuring corporation licensed under Chapter 1751. of the Revised Code, a health maintenance organization as defined in division (K) of section 3702.51 of the Revised Code, an insurance company that issues sickness and accident insurance in conformity with Chapter 3923. of the Revised Code, a state-financed health insurance program under Chapter 3701., 4123., or 5101. of the Revised Code, or any self-insurance plan.

(VV) “To offer” means, with respect to a health service, that a health care facility holds itself out as capable of providing, or as having the means for the provision of, a specified health service. Referral to another provider of health services does not constitute offering of the health service.

(WW) “Ultimate controlling interest” means a person who holds a majority of the voting power within a corporation, business trust, firm, partnership, association, joint stock company, or insurance company and is:

(1) The applicant for a certificate of need; or

(2) Represented by the applicant for a certificate of need.

Effective: 03/17/2008

R.C. 119.032 review dates: 05/21/2007 and 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.51, 3702.57

Rule Amplifies: 3702.51, 3702.511, 3702.52, 3702.5210, 3702.5211, 3752.13, 3702.522, 3702.523, 3702.524, 3702.525, 3702.526, 3702.527, 3702.528, 3702.529, 3702.5212, 3702.53, 3702.531, 3702.532, 3702.54, 3702.541, 3702.542. 3702.544, 3702.55, 3702.56, 3702.57, 3702.58, 3702.60, 3702.68

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 7/21/83, 10/18/83 (Emer.), 6/22/84 (Emer.), 9/28/84, 12/2/85, 12/25/86, 7/23/87 (Emer.), 10/12/87, 3/3/88, 11/28/88, 6/18/90, 9/6/99

(A) The director shall issue rulings on whether a particular proposed project is a reviewable activity or not a reviewable (reviewability and nonreviewability rulings). The director may issue such a ruling within forty-five days after receiving a notice of intent or other information relating to a proposed or actual activity that may be reviewable. The director shall issue a ruling upon written request by any person. The director may request additional information necessary to determine whether the activity is a reviewable activity as described in any provision of rule 3701-12-05 of the Administrative Code. The director shall issue a ruling not later than forty-five days after receiving a request for the ruling provided the request is accompanied by the information necessary to make the ruling. The date that the ruling is mailed to the person who filed the request shall be the date of issuance of the ruling. If the director does not issue a ruling in that time, the project shall be considered to have been ruled not a reviewable activity. A determination that a project is not a reviewable activity only relates to the project as described in the request and any additional information and does not authorize conducting a different, reviewable activity.

(B) An affected person may appeal a ruling of reviewability or nonreviewability to the director of health. The director shall provide a hearing in accordance with Chapter 119. of the Revised Code. A person appealing a ruling shall file a notice of appeal with the director that designates the ruling appealed from not later than thirty days after the ruling is mailed.

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3702.57, 3702.528

Rule Amplifies: 3702.51 to 3702.60

Prior Effective Dates: 3/19/1983, 7/23/87 (Emer.), 10/12/87, 9/6/99

(A) Reviewable activities. The following activities are reviewable activities which shall not be conducted without a valid certificate of need.

(1) The establishment, development, or construction of a new long-term care facility.

(2) The replacement of an existing long-term care facility.

(3) The renovation of a long-term care facility that involves a capital expenditure of two million dollars or more, not including expenditures for equipment, staffing, or operational costs.

(4) Any of the following changes in long-term care bed capacity:

(a) An increase in bed capacity;

(b) A relocation of beds from one physical facility or site to another, excluding the relocation of beds within a long-term care facility or among buildings of a long-term care facility at the same site; or

(5) Any change in the health services, bed capacity, or site, or any other failure to conduct the reviewable activity in substantial accordance with the approved application for which a certificate of need concerning long-term care beds was granted, if the change is made within five years after the implementation of the reviewable activity for which the certificate was granted;

(6) The expenditure of more than one hundred ten per cent of the maximum expenditure specified in a certificate of need concerning long-term care beds.

(B) The director shall consider the factors set forth in paragraphs (B)(1) to (B)(7) of this rule in determining whether an activity is conducted on behalf of a health care facility. The existence or nonexistence of any of the factors is not necessarily determinative of whether the activity is or is not conducted on behalf of the health care facility.

(1) An ownership or beneficial ownership interest of twenty-five per cent or more of the facility or service that results from the activity or the entity conducting the activity by the health care facility or an affiliated corporation. For the purposes of this paragraph, a health care facility is not considered to have an ownership interest in a building arising out of an interest as a lessor in a ground lease for fair market value.

(2) Participation by the health care facility or an affiliated corporation as a general partner in a partnership conducting the activity.

(3) The presence of officers, directors, members of a nonprofit corporation or association, trustees or partners of the entity operating the health care facility in a majority of similar positions with the entity conducting the activity.

(4) Twenty-five per cent or more of the individuals employed in conducting the activity, once implemented, also will be employees of the health care facility.

(5) Provision by the health care facility of twenty-five per cent or more of the total capital expenditure needed to implement the activity either directly or through a loan guarantee or similar arrangement.

(6) Location of the site of the activity on the campus of the health care facility or on property owned by the health care facility, if the real property is leased to the entity conducting the activity for substantially less than fair market value.

(7) Agreement by the health care facility to the use of its name as part of the name of the health care facility or service resulting from implementation of the activity or in advertising or promotional material that holds the facility or service out as being operated or offered by or on behalf of the health care facility.

(C) Nonreviewable activities. Activities that are not described in paragraph (A) of this rule generally are not reviewable activities. Only a project or the portion of a project that meets the requirements of this paragraph is not a reviewable activity.

The following activities are not reviewable activities:

(1) Acquisition of computer hardware or software;

(2) Acquisition of a telephone system;

(3) Construction or acquisition of parking facilities;

(4) Correction of cited deficiencies that are in violation of federal, state or local fire, building or safety laws or rules and that constitute an imminent threat to public health or safety;

(5) Acquisition of an existing health care facility that does not involve a change in the number of beds, by service, or in the number or type of health services;

(6) Correction of cited deficiencies identified by accreditation surveys of the “Joint Commission” or the “American Osteopathic Association”;

(7) Acquisition of medical equipment to replace the same or similar equipment for which a certificate of need has been issued if the replaced equipment is removed from service;

(8) Mergers, consolidations or other corporate reorganizations of existing health care facilities that do not involve a change in the number of beds, by service, or in the number or type of health services;

(9) Construction, repair or renovation of bathroom facilities;

(10) Construction of laundry facilities, waste disposal facilities, dietary department projects, heating and air conditioning projects, administrative offices and portions of medical office buildings used exclusively for physician services;

(11) Acquisition of medical equipment to conduct research required by the United States food and drug administration or clinical trials sponsored by the national institutes of health; and

(12) Removal of asbestos from a health care facility;.

Effective: 09/27/2007

R.C. 119.032 review dates: 05/21/2007 and 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.511, 3702.57

Rule Amplifies: 3702.51, 3702.511, 3702.52, 3702.5210, 3702.5211, 3702.5212, 3702.5213, 3702.522, 3702.523, 3702.524, 3702.525, 3702.526, 3702.527, 3702.528, 3702.529, 3702.53, 3702.531, 3702.532, 3702.54, 3702.541, 3702.542, 3702.544, 3702.55, 3702.56, 3702.57, 3702.60, 3702.68

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 7/23/87 (Emer.), 10/12/87, 4/4/88, 3/29/90 (Emer.), 6/23/90

Rescinded eff 11-15-04

(A) Applications for certificates of need to add long-term care beds shall be submitted in January or July. All other applications may be submitted at any time, including applications to relocate existing long-term care beds. To be considered timely, the director must receive an application to add long-term care beds on or before January thirty-one or July thirty-one, whichever applies. If an application to add long-term care beds is not timely received, the director shall not review it and shall return the fee specified in paragraph (D) of this rule, minus a one hundred dollar application processing fee. As used in this rule and rule 3701-12-09 of the Administrative Code, “batching period” means either the period from January first to the first Friday of March, or the period from July first to the last Friday of August.

(B) Each applicant shall submit one original and one copy of the application forms and attachments prescribed by the director. The applicant also shall submit a timetable for implementing the project and identify a specific site for the project designated by a street address or, if there is no street address, a plot or parcel number. In addition, the applicant shall designate an authorized representative in the application. The authorized representative shall sign an affidavit that to the best of his or her knowledge the information in the application and any accompanying material is true and accurate. In the case of a construction project, the applicant shall submit a copy of the written notice that the applicant has provided to:

(1) The chief executive officer of the municipality in which the reviewable activity will be conducted or the township trustees of the township in which the activity will be conducted, if it will not be conducted in a municipality; and

(2) The state senator and state representative for the area in which the activity will be conducted.

(C) The applicant also shall file two copies of the application with the HSA designated for the health service area in which the applicant plans to conduct the reviewable activity.

(D) The application shall be accompanied by a nonrefundable fee in the form of a cashier’s check or a postal money order, payable to the “Treasurer – State of Ohio,” in the following amount:

(1) For a project not involving a capital expenditure, three thousand dollars; or

(2) For a project involving a capital expenditure, the greater of three thousand dollars or nine-tenths of one per cent of the capital expenditure proposed, with a maximum fee of twenty thousand dollars.

(E) Upon receipt of an application and the appropriate fee, the director shall review the application for completeness of information. The director shall consider an application complete when the applicant:

(1) Furnishes the information specified in paragraph (B) of this rule;

(2) Complies with paragraph (C) of this rule;

(3) Pays the fee specified in paragraph (D) of this rule; and

(4) If required to, adequately and completely responds to the director’s requests for additional information.

If the applicant changes the site identified for the project, as specified in paragraph (B) of this rule, the director shall deem the application incomplete.

To determine completeness, the director may request additional information from the applicant but shall not request any information that is not necessary to review the application in relation to the criteria established by this chapter, as the chapter is in effect at the time the request is made. The director may make two requests for the additional information needed to complete an application under this paragraph and paragraph (F) of this rule. Except when paragraph (F) of this rule applies, the applicant shall have ninety days to respond to a request for additional information. The director shall deem an application incomplete if the applicant does not timely respond to the director’s request for additional information or if the director does not receive the information necessary to complete the application within the appropriate time frame specified in this rule.

No later than fifteen days after the director receives the application and the appropriate fee or fifteen days after the director receives additional information submitted in response to the first request, the director shall mail to the applicant by certified mail notice of completeness or a second request for additional information. No later than fifteen days after the director receives additional information submitted in response to the second request, the director shall mail to the applicant by certified mail notice of completeness or shall deem the application incomplete.

When responding to requests for additional information, applicants shall submit two copies of responses not only to the director but also to the health service agency in which the applicant plans to conduct the reviewable activity.

(F) If notice of completeness of an application proposing addition of long-term care beds, is not mailed on or before the end of the batching period, the director nonetheless shall issue a notice of completeness, a request for additional information, or deem the application incomplete, as required by paragraph (E) of this rule.

(1) If the director issues notice of completeness, the ninety day time period in which the director must grant or deny the application does not begin until the end of the next batching period.

(2) If the director requests additional information, the applicant shall not submit the information until the beginning of the next batching period. In such a case, if the director does not receive the information necessary to complete the application and mail notice that it is complete by the end of the next batching period, the director shall deem the application incomplete.

(G) After notice of an application’s completeness is mailed under paragraph (E) or (F)(1) of this rule, the applicant may supply and the director may request additional information pertinent to review of the application in relation to the criteria established by this chapter, as this chapter is in effect at that time. The applicant shall not make any amendment of the application that alters the site of the reviewable activity specified in accordance with paragraph (B) of this rule, the activity’s scope, or its cost.

(H) The director may deny an application for any false statement knowingly made in the application or in supplemental information submitted pursuant to this rule.

(I) The director shall include the information specified in paragraphs (I)(1) to (I)(3) of this rule with the notice of completeness. The applicant shall provide notice of all the information set forth in this rule, by notice in a newspaper of general circulation published in the municipal corporation, county, or other political subdivision where the reviewable activity (project) will take place. The applicant shall provide the notice within seven business days after the notice of completeness specified in paragraph (E) or (F) of this rule is received. If the newspaper notice is not provided within the time frame specified by this paragraph, the applicant shall document in writing why the time frame was not met. The applicant shall provide a copy of the published notice and, if applicable, written documentation of why the time frame for the newspaper notice was not met to the director by certified mail within five business days after the day the notice is first published. The notice shall include the following information:

(1) The date that the review period began;

(2) The date that the decision on the application is due;

(3) The deadline and procedure for requesting a public informational hearing during the course of review and the deadline and procedure for filing objections to an application, as set forth in paragraphs (A) and (B) of rule 3701-12-11 of the Administrative Code;

(4) A general description of the nature of the project, which shall include its cost, the facilities involved in the project; and

(5) The street address or plot or parcel number that the project will take place.

(J) The director shall deny an application if the applicant fails to provide timely newspaper notice as required in paragraph (I) of this rule, or the director determines that the applicant failed to document in writing that timely notice was not provided for reasons beyond the applicant’s control.

(K) If the director deems an application incomplete as authorized by this rule, the director shall notify the applicant by certified mail, not process the application, and keep the fee specified in paragraph (D) of this rule. The director’s act of deeming an application incomplete and any of the other actions specified in this paragraph shall not be subject to appeal.

Effective: 09/27/2007

R.C. 119.032 review dates: 05/21/2007 and 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.51, 3702.57

Rule Amplifies: 3702.52, 3702.57

Prior Effective Dates: 12/21/82 (Emer.), 3/19/83, 7/27/84 (Emer.), 10/28/84, 7/1/86, 7/23/87 (Emer.), 10/15/87 (Emer.), 11/30/87, 5/16/88, 11/28/88, 12/22/88 (Emer.), 2/8/90 (Emer.), 8/3/90, 5/20/91, 12/28/92 (Emer.), 3/19/93, 5/28/93 (Emer.), 9/6/99

(A) The director shall review applications for certificates of need which have been declared complete to determine whether a certificate should be granted. The director shall batch all applications to add long-term care beds for comparative review by county. Applications to relocate long-term care beds are not additions.

(B)(1) If the director does not receive an objection from an affected person. The director shall grant or deny all completed applications for certificates of need:

(a) No later than ninety days after the date of mailing of notice of completeness under paragraph (E) of rule 3701-12-08 of the Administrative Code: or

(b) To add long-term care beds:

(i) No later than ninety days after the batching period, if notice of completeness is mailed on or before the end of the batching period; or

(ii) No later than ninety days after the end of the next batching period, if notice of completeness is mailed after the batching period.

(2) The director or the applicant may extend the review period once, for no longer than thirty days, by written notice within thirty days after the mailing of the notice of completeness

An extension by the director shall apply to all applications in a comparative review. No applicant in a comparative review may extend the review period.

(C) The director may grant a certificate of need for all or part of a project that is the subject of the application.

(D) If the director does not grant or deny the certificate of need on or before the applicable deadline specified in paragraph (B) of this rule, the certificate shall be considered granted.

(E) The director shall mail notice of the decision on an application for a certificate of need to the applicant by certified mail and to other persons by ordinary mail upon request. The notice shall include a statement of the reasons for the decision, citations of the applicable provisions of the Revised Code and Administrative Code, and a description of the right to appeal the decision, in accordance with sections 3702.60 and 119.07 of the Revised Code.

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3702.52, 3702.57

Rule Amplifies: 3702.52

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 7/23/87 (Emer.), 10/12/87, 5/16/88, 8/3/90, 5/20/91, 9/6/99

(A) (1) The director may conduct a public informational hearing during the course of review of an application for a certificate of need. A public informational hearing may be requested by any affected person, as defined in paragraph (A) of rule 3701-12-01 of the Administrative Code. If an affected person files a timely request for a public informational hearing, the director shall conduct a hearing.

(2) An affected person may request a public informational hearing during the course of review by filing a written request with the director not later than fifteen days after the date of mailing of the notice of completeness specified in rule 3701-12-08 of the Administrative Code. The informational hearing shall be held in the community in which the reviewable activity would be carried out.

(3) The director may hold the informational hearing or may contract with an HSA to hold the hearing.

(4) Between seven and fourteen days prior to the public informational hearing, the director or the HSA, if applicable, shall provide notice of the time, date, and place of the hearing to the affected person who requested the hearing by certified mail and to other affected persons by publication of a notice in a paper of general circulation in the community in which the reviewable activity would be carried out.

(5) The director may preside over the informational hearing or the director or the HSA, if applicable, may appoint a presiding officer for the hearing.

(6) The director or the HSA, as applicable, shall maintain a verbatim record of the informational hearing.

(7) Neither the director nor an HSA may impose fees for a public informational hearing conducted under this rule.

(B) An affected person may file written objections to an application with the director not later than thirty days after the date of the mailing of the notice of completeness specified in rule 3701-12-08 of the Administrative Code. The director shall notify:

(1) The applicant and assign a hearing examiner who shall conduct an adjudication hearing concerning the application in accordance with Chapter 119. of the Revised Code, if an affected person objects; or

(2) In the case of an application for comparative review, all of the applicants and assign a hearing examiner who shall conduct a consolidated adjudication hearing concerning the applications in accordance with Chapter 119. of the Revised Code, if the director receives objections to any of the applications from an affected person not later than thirty days after the director mails the last notice of completeness for the batching period.

(C) The applicant, the director, and any affected person who filed an objection to an application shall be parties to a hearing conducted as authorized by division (C)(3) of section 3702.52 of the Revised Code and paragraph (B) of this rule.

(D) If none of the affected persons that submitted written objections to the application appears or prosecutes the hearing conducted as authorized by division (C)(3) of section 3702.52 of the Revised Code and paragraph (B) of this rule, the hearing examiner shall dismiss the hearing and the director shall grant a certificate of need for the entire project that is the subject of the application, provided the project meets the criteria for approval specified in this chapter.

(E) Except as provided in division (C)(5) of section 3702.52 of the Revised Code, when the director issues a decision to grant or deny a certificate of need application for which an adjudication hearing was conducted as authorized by division (C)(3) of section 3702.52 of the Revised Code and paragraph (B) of this rule, the director shall grant or deny the certificate of need application not later than thirty days after the expiration of the time for filing objections to the report and recommendations of the hearing examiner under section 119.09 of the Revised Code.

(F) When the director issues a decision to grant or deny a certificate of need application for which an adjudication hearing was not conducted as authorized by division (C)(3) of section 3702.52 of the Revised Code and paragraph (B) of this rule, the applicant or another affected person may appeal the decision to the director in accordance with Chapter 119. of the Revised Code. The director shall conduct the hearing in accordance with Chapter 119. of the Revised Code. Each person who appeals to the director shall file with the director, not later than thirty days after the decision of the director is mailed, a notice of appeal that designates the decision the person is appealing.

(G) The applicant or an affected person that was a party to and participated in an adjudication hearing as authorized by division (C)(3) of section 3702.52 of the Revised Code and paragraph (B) of this rule may appeal to the tenth district court of appeals the decision issued by the director following the adjudication hearing. Each person who appeals to the tenth district court of appeals shall file with the court, not later than thirty days after the director’s adjudication order is mailed, a notice of appeal that designates the order the person is appealing. The appellant also shall file notice with the director not later than thirty days after the date the director mailed the order.

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3702.51, 3702.57

Rule Amplifies: 3702.52, 3702.60

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 7/23/87 (Emer.), 10/15/87 (Emer.), 11/30/87, 5/16/88, 9/6/99

(A) Any person present at the public hearing shall be afforded an opportunity to present testimony.

(B) A request to testify shall be made to the presiding officer on a registration form provided by the presiding officer prior to the beginning of each public hearing.

(C) Questions may be asked of any witness by the presiding officer and by any member of the director’s staff or, if applicable, the HSA’s staff. Others in attendance at the hearing shall be permitted by the presiding officer to ask reasonable questions of witnesses or others present. In no event shall the presiding officer permit cross-examination of witnesses or other questioning inappropriate to a nonevidentiary hearing.

(D) At the hearing, any person shall have the right to be represented by counsel and to present oral or written arguments and evidence relevant to the matter which is the subject of the hearing.

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3701.52

Rule Amplifies: 3702.51 through 3702.62

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 8/21/86, 7/23/87 (Emer.), 3/19/86 (Emer.), 10/12/87

(A) For the purposes of this rule, “holder” means the applicant to whom a certificate of need was granted. In addition to compliance with validity requirements established by any other rule of this chapter, to maintain the validity of a certificate of need, the holder shall:

(1) Obligate the capital expenditure, within the meaning of paragraph (A)(1)(a) of this rule, within twenty-four months after the date of mailing of the notice that the certificate was granted or, if the grant or denial of the certificate is appealed under section 3702.60 of the Revised Code, within twenty-four months after the issuance of an order granting the certificate, which order is not subject to further appeal.

(a) For the purposes of this rule, “to obligate” means:

(i) For a project that primarily involves construction and is to be financed through external borrowing of funds, to secure financial commitment for the stated purpose of developing the project and commencing construction that continues uninterrupted except for interruptions or delays that are unavoidable due to reason’s beyond the person’s control, including labor strikes, natural disasters, material shortages, or comparable events; or to enter into a construction contract or, if the holder will act as its own construction contractor, to make a formal internal commitment for construction of the project specified in the application. The construction contract or internal commitment shall specify the cost of construction and apply to a site that has been acquired by the holder or other appropriate party and that is zoned properly for the project.

(ii) For a project that primarily involves construction and is to be financed internally, to receive formal approval from the holder’s board of directors or trustees, or other governing authority to commit specified funds for the implementation of the project and commence construction that continues uninterrupted except for unavoidable interruptions or delay due to reason’s beyond the person’s control, including labor strikes, natural disasters, material shortages, or comparable events; or to enter into a construction contract or, if the holder will act as its own construction contractor, to make a formal internal commitment for construction of the project specified in the application. The construction contract or internal commitment shall specify the cost of construction and apply to a site that has been acquired by the holder or other appropriate party and that is zoned properly for the project.

(iii) For a project that primarily involves acquisition of medical equipment, to enter into a contract to purchase or lease the equipment or to acquire the equipment by other means and to accept the equipment at the site for which the certificate of need was granted.

(iv) For a project that involves no capital expenditure or only minor renovations to existing structures, to provide the health service or activity by the means specified in the approved application for the certificate.

(v) For a project that primarily involves leasing a building or space that requires only minor renovations to the existing space, to execute a lease and provide the health service or activity by the means specified in the approved application for the certificate.

(vi) For a project that primarily involves leasing a building or space that has not been constructed or requires substantial renovations to existing space, to commence construction that continues uninterrupted except for interruptions or delays that are unavoidable due to reasons beyond the person’s control, including labor strikes, natural disasters, material shortages, or comparable events, for the purpose of implementing the reviewable activity.

(2) After obligating, maintain reasonable progress towards completion of the project. Reasonable progress includes, but is not limited to:

(a) When the holder maintains uninterrupted progress except for delays that are unavoidable due to reasons beyond the holder’s control; or

(b) When the holder provides reasonable assurance that it will provide the health service or activity specified in the approved application for the certificate by the projected completion date approved by the director.

(3) Submit all documents required by paragraph (B) of this rule for monitoring implementation of the reviewable activity in a timely manner.

(4) Not transfer the certificate, within the meaning of sections 3702.51 and 3702.524 of the Revised Code.

(5) Conduct the reviewable activity in substantial accordance with the approved application.

(6) Conduct the reviewable activity at the site specified in the approved application.

(7) Not expend more than one hundred ten per cent of the maximum capital expenditure stated in the certificate.

(B) The director shall monitor project implementation activities by holders of certificates of need. The director’s monitoring shall include but shall not be limited to review of documentation submitted by holders. Each holder shall submit the following:

(1) Progress reports, on forms provided by the director, not less than six months after obligating the project and every six months thereafter until the project is complete. The holder shall submit progress reports more frequently if requested by the director;

(2) An affidavit of substantial completion, on a form provided by the director, upon project completion;

(3) Architectural drawings or design development drawings, when appropriate to the nature of the activity and when requested by the director;

(4) Written documentation of obligating the project, which shall be submitted to the director not later than the earlier of thirty days after obligating or five days after the twenty-four month period expires. Documentation of obligation may include, but shall not be limited to, design drawings, a notarized statement by the general contractor attesting to the date construction commenced, a building permit issued by the building authority having jurisdiction, approval to commit the specified funds for implementation of the approved project from a board of directors or trustees or other governing authority, construction contracts, purchase or lease contracts for major equipment, equipment acceptance certificates, purchase or lease contracts for the building, zoning approvals, evidence of site acquisition, or secured financial agreements;

(5) Monitoring reports, on forms provided by the director, one year after implementing the project and annually thereafter ending five years after implementation of the activity for which the certificate was granted for certificates concerning long-term beds;

(6) Timely notification of any delay and request for approval of any changes to the projected completion date; and

(7) Any other documents relevant to project implementation, upon request by the director.

(C) The director may issue and enforce, in the manner provided in section 119.09 of the Revised Code, subpoenas duces tecum to compel the production of documents relevant to the director’s monitoring of the approved project. The director or the director’s representative may visit sites where the activities are or will be conducted.

(D) The director shall send a notice to the holder of the certificate that states whether or not the holder has obligated the approved project. The director shall send the notice not later than fifteen days after the director receives the obligation documentation or fifteen days after the twenty-four month period expires, whichever is later.

(E) The director may withdraw a certificate of need for failure to comply with the requirements for maintaining the validity of the certificate established by this rule or any other rule of this chapter or because the application or supplemental information contained material, false or misleading statements or knowing omissions of material information. In withdrawing a certificate, the director shall use the following procedures:

(1) At least thirty days before withdrawing the certificate, the director shall notify the holder of the proposed withdrawal by certified mail. The notice shall include the reasons for the proposed action and a statement that the holder may respond to the proposal in writing within thirty days after the mailing of the notice of the proposed withdrawal.

(2) The director shall provide notice of the proposed withdrawal to other affected persons in the same manner as for the notice required by paragraph (I) of rule 3701-12-08 of the Administrative Code. The notice of withdrawal shall not include the information specified in paragraphs (I)(1) to (I)(3) of rule 3701-12-08 of the Administrative Code but shall include the other information specified in paragraph (I) of that rule.

(3) Before withdrawing the certificate, the director shall consider any information timely filed by the holder and may consider any other information that the director considers appropriate.

(4) The director shall notify the holder of the withdrawal of the certificate or the decision not to withdraw the certificate by certified mail within ninety days after the mailing of the notice of the proposed withdrawal. The notice of withdrawal shall specify the reasons for the withdrawal, citations of relevant provisions of the Revised Code and the Administrative Code and a description of the right to appeal the withdrawal, in accordance with Chapter 119. and section 3702.60 of the Revised Code.

(5) The director shall hold a hearing in accordance with Chapter 119. of the Revised Code before withdrawing a certificate of need that was not properly obligated within twenty-four months, if the holder requests.

Effective: 09/27/2007

R.C. 119.032 review dates: 05/21/2007 and 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.52, 3702.525, 3702.526, 3702.57

Rule Amplifies: 3702.51, 3702.511, 3702.52, 3702.522, 3702.523, 3702.524, 3702.525, 3702.526, 3702.527, 3702.528, 3702.529, 3702.5212, 3702.53, 3702.531, 3702.532, 3702.54, 3702.541, 3702.542, 3702.544, 3702.55, 3702.56, 3702.57, 3702.60, 3702.63, 3702.68

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 3/3/88, 1/2/89, 5/14/90, 9/6/99

(A) The director shall monitor the implementation of an activity that the director has determined, under rule 3701-12-04 of the Administrative Code, is not a reviewable activity if the director determines that the activity requires monitoring under paragraph (B) of this rule. The director shall monitor the activity to determine whether it is implemented in the manner described in the request for the ruling and whether it still is not reviewable.

(B) The director may determine that an activity requires monitoring under this rule at the time that the ruling of nonreviewability is issued or at any subsequent time. The director shall commence monitoring when the director determines that one or more of the factors specified in this paragraph are applicable. The director may consider the following factors in determining which activities require monitoring under this rule:

(1) Whether the ruling of nonreviewability was based upon representations that certain services would or would not be provided as a result of the activity;

(2) Whether the ruling of nonreviewability was based upon representations that the activity would be conducted through a particular organizational structure or by a certain type of facility such as a physician’s office;

(3) Whether the ruling of nonreviewability was based upon certain configurations, types, or uses of physical space or the request lacked specificity concerning the configuration, type, or use of physical space;

(4) Whether the activity involved exclusion of items listed in division (T) of section 3702.51 of the Revised Code from a construction or renovation project that otherwise would have been reviewable;

(5) Whether the activity involved acquisition of medical equipment that would be reviewable if it is not used to conduct research required by the United States food and drug administration (FDA) or clinical trials sponsored by the “National Institutes of Health” or any new or experimental medical technology that is designated by the public health council;

(6) The director has reason to believe that the activity is being implemented differently from the representations made in the request for the ruling or in a manner that may make the activity a reviewable activity;

(7) Whether the activity is reviewable if a determination of adverse affect on access to health care has been made; or

(8) Whether the activity is reviewable if any of the conditions specified under division (T) of section 3702.51 of the Revised Code were not been met.

(C) Upon determining that an activity requires monitoring under this rule, the director shall provide written notice of that determination to the person who received the ruling. The notice shall specify the provisions of paragraph (B) of this rule that form the basis for the determination that monitoring is required. In the case of monitoring on the basis of paragraph (B)(6) of this rule, the notice shall specify the reason why the director believes that paragraph applies.

(D) For purposes of conducting monitoring under this rule, the director may request compliance with the provisions of this paragraph that are relevant to the basis for monitoring a particular activity, as specified in the notice provided under paragraph (C) of this rule. Upon request by the director, a person who has received a ruling of nonreviewability for an activity that the director determines requires monitoring under this rule shall do all of the following, as applicable, beginning no later than forty-five days after the director’s request:

(1) Provide progress reports on the implementation of the activity, at the times and containing the information requested by the director;

(2) In the case of an activity monitored under paragraph (B)(4) of this rule, provide accurate statements of costs involved in implementation or operation of the activity and supporting documentation;

(3) In the case of an activity monitored under paragraph (B)(3) (B)(4), or (B)(6) of this rule, provide contracts, drawings, descriptions, or other information relating to construction or renovation work associated with the activity;

(4) In the case of an activity monitored under paragraph (B)(1) or (B)(2) of this rule, provide information about the services to be furnished as a result of the activity, including the identity and type of the providers of the services and data on the utilization of the services;

(5) In the case of an activity monitored under paragraph (B)(5) of this rule, provide information about the current use and FDA approval status of medical equipment acquired under the ruling of nonreviewability or information about the disposition of equipment replaced as the result of the activity;

(6) In the case of an activity monitored under paragraph (B)(2) of this rule, provide information about the organizational relationships of persons involved in implementing and operating the activity;

(7) Allow the director to have access to the site or sites at which the activity is implemented or operated and to examine records pertinent to implementation or operation of the activity, subject to applicable confidentiality laws. The director shall examine only those portions of the site or those records that are relevant to the basis for the determination that monitoring is required, as specified in the notice provided under paragraph (C) of this rule;

(8) Provide any other information that is relevant to monitoring whether the activity is being conducted in a manner consistent with the representations in the request for the ruling and that does not render it reviewable; and

(9) Provide documentation to verify compliance with the conditions specified under division (T) of section 3701.51 of the Revised Code, if the activity is monitored under paragraph (B)(8) of this rule.

(E) The director shall monitor an activity under this rule only for the period of time necessary to determine that the activity has been implemented in accordance with the request for the ruling and in a manner that does not make it a reviewable activity. For other activities, such as activities monitored under paragraph (B)(1) or (B)(5) of this rule, monitoring may be continuing.

(F) Upon request by the director, the person to whom a ruling of nonreviewability was issued shall provide affidavits from appropriate individuals attesting to the accuracy of any information provided under this rule.

(G) In order to assist the director in monitoring any approved projects, each hospital for which a certificate of need for skilled nursing beds was granted shall report the information prescribed by this paragraph on a form prescribed by the director. The hospital shall submit the form no later than the last day of January, April, July and October of each year. The form shall cover the calendar quarter most recently ended. The information submitted in the form shall include, but not be limited to:

(1) On an aggregate basis, by diagnosis-related group prescribed under the program for health insurance for the aged and disabled established by Title XVIII of the Social Security Act, 42 U.S.C. 301, as amended (the medicare program), the number of patients admitted to the skilled nursing beds, the number of hours of care provided by technical and professional personnel and the number of procedures requiring technical or professional personnel that were provided;

(2) The average length of stay in the skilled nursing beds;

(3) The number of patients whose length of stay in the skilled nursing beds exceeded thirty days and the reasons why each such patient’s length of stay exceeded thirty days.

After reviewing the aggregate information submitted under this paragraph, the director may request additional, patient-specific information from the hospital to verify compliance with this rule and with the approved application for the certificate of need.

(H) For the purposes of this rule, “skilled nursing bed” means a bed that was approved under former rule 3701-12-233 of the Administrative Code, effective May 20, 1991, and that is in the portion of the hospital that participates in the program for health insurance for the aged and disabled established by Title XVIII of the Social Security Act, 42 U.S.C. 301, as amended (the medicare program).

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3702.51, 3702.57

Rule Amplifies: 3702.52

Prior Effective Dates: 5/20/1991, 9/6/99

(A) The director shall apply each of the criteria prescribed in this rule, as applicable, when reviewing an application for a certificate of need, in addition to any criteria specific to the application that are established by this chapter of the Administrative Code. An applicant for a certificate of need shall provide sufficient information to enable the director to perform a thorough review of the application in relation to each relevant criterion established by this chapter of the Administrative Code by completely responding to each applicable portion of the application form and attachments prescribed by the director and by attaching the necessary supporting documentation.

(B) For projects involving any new construction, renovation or remodeling, the director shall consider:

(1) The costs, methods and type of construction including energy conservation features, if applicable;

(2) The current and projected zoning status of the project site, if applicable; and

(3) Space allocations and the configuration of existing and proposed areas.

(C) If applicable, the director shall consider the relationship of the project to the most current edition of the “State Health Plan.”

(D) If applicable, the director shall consider the relationship of the project to the long-range plan of the applicant and the planning process that the applicant has employed.

(E) The director shall consider the need that the population served or proposed to be served has for the services to be provided upon implementation of the project. In assessing the need for a project, the director shall examine:

(1) The current and proposed primary and secondary service areas and their corresponding population;

(2) Travel times and the accessibility of the project site and of the sites of similar services to the proposed service area population;

(3) Current and projected patient origin data, by zip code;

(4) Any special needs and circumstances of the applicant or population proposed to be served by the proposed project, including research activities, prevalence of a particular disease, unusual demographic characteristics, cost-effective contractual affiliations, and other special circumstances and

(5) Special needs related to any research activities, such as participation by the applicant in research conducted by the United States food and drug administration or clinical trials sponsored by the national institute of health, that will be conducted as a result of implementation of the reviewable activity.

(F) The director shall consider the impact of the project on all other providers of similar services in the HSA including the impact on their utilization, market share and financial status.

(G) The director shall consider alternatives to the project and the advantages, disadvantages and costs of each alternative.

(H) If the project involves an existing health care facility, the director shall consider the historical, current and projected utilization of the facility as a whole and the utilization specific to the services affected by the project.

(I) The director shall consider the effectiveness of the project in meeting the health-related needs of medically underserved groups such as low-income individuals, handicapped individuals and minorities. If applicable, this consideration shall include review of the applicant’s historical experience in meeting the needs of under-served groups.

(J) The director shall consider the short-term and long-term financial feasibility and the cost effectiveness of the project and its financial impact upon the applicant, other providers, health care consumers and the medicaid program established under Chapter 5111. of the Revised Code.

Among other relevant matters, the director shall evaluate:

(1) The availability of financing for the project, including all pertinent terms of any borrowing, if applicable;

(2) The operating costs specific to the project and the effect of these costs on the operating costs of the facility as a whole based upon review of balance sheets, cash flow statements and available audited financial statements;

(3) The effect of the project on charges and payment rates for the facility as a whole and specific to the project; and

(4) The costs and charges associated with the project compared to the costs and charges associated with similar services furnished or proposed to be furnished by other providers, ; and

(5) The historical performance of the applicant and related parties in providing cost-effective health care services.

(K) The director shall consider the impact of the project on existing staffing levels, if applicable, and the availability of personnel resources to meet the applicant’s projected requirements.

(L) If medical or allied health education is an integral part of the project, the director shall examine the impact of the project on the advancement of the educational endeavor.

(M) The director shall consider the availability of and the impact upon ancillary and support services that relate directly and indirectly to the project.

(N) The director shall consider the extent to which the project, the facility as a whole and the applicant comply and will comply with applicable standards for licensure, certification, accreditation and similar approvals.

(O) The director shall consider the need for and the availability in the community of services and hospitals for osteopathic physicians and their patients and the impact of the project on existing and proposed institutional training programs for doctors of osteopathy and doctors of medicine at the student, internship and residency training levels.

(P) The director shall consider the special needs and circumstances resulting from moral and ethical values and the free exercise of religious rights of health care facilities administered by religious organizations.

(Q) The director shall consider the special needs and circumstances of children’s hospitals, inner city hospitals, and small rural hospitals.

(R) The director shall consider the historical performance of the applicant and related parties in complying with previously granted certificates of need.

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3702.57

Rule Amplifies: 3702.57

Prior Effective Dates: 12/21/1982 (Emer.), 3/20/83, 4/4/88, 11/28/88, 9/6/99

(A) Except as otherwise specifically provided in this rule or in another rule of this chapter, the director shall apply all of the criteria prescribed by this rule when reviewing an application for a certificate of need that relates to an existing or proposed long-term care facility, including an application for:

(1) The establishment, development, or construction of a new long-term care facility;

(2) The replacement of an existing long-term care facility;

(3) The renovation of a long-term care facility that involves a capital expenditure of two million dollars or more, not including expenditures for equipment, staffing, or operational costs;

(4) Any of the following changes in long-term care bed capacity:

(a) An increase in bed capacity; or

(b) A relocation of beds from one physical facility or site to another, excluding the relocation of beds within a long-term care facility or among buildings of a long-term care facility at the same site.

(5) Any change in the health services, bed capacity, or site, or to conduct a reviewable activity that is not in substantial accordance with the approved application for which a certificate of need concerning long-term care beds was granted, if the change is made within five years after the implementation of the reviewable activity for which the certificate was granted; or

(6) The expenditure of more than one hundred ten per cent of the maximum expenditure specified in a certificate of need concerning long-term care beds.

(B) Subject to the restrictions imposed under division (E) of section 3702.68 of the Revised Code, the director shall utilize the following formula to determine the number of long-term care beds needed for each county for each year:

(1) [(Population × .163) × risk adjustment ratio]

- net migration ×.5 ÷.9 = total bed need;

(2) (Total bed need) – (existing and approved beds) – (.5 × passport placements)] = new bed need or bed excess;

Population – the director’s estimate of the most recent county population of persons aged seventy-five and over based on the most recent Ohio department of development projections.

.163 – ratio of existing and approved beds to population aged seventy-five and over statewide as of December 31, 1980.

Risk adjustment ratio – the county-specific measure of the risk of a county resident entering a long-term care facility, as set forth in the appendix to this rule, based upon presence of factors influencing the utilization of long-term care beds. These factors are the county’s designation by the United States department of commerce, bureau of the census, as rural or metropolitan, the number of employed women aged thirty-five to fifty-four, the number of medicare and medicaid hospital patient days for persons sixty-five or more years of age (rural counties) and the number of persons seventy-five or more years of age living alone (metropolitan counties).

Net migration x .5 – adjustment to the bed-to-population ratio to account for fifty per cent of the portion of the county’s population that uses long-term care beds in other counties, based upon data for the most recent year for which complete data are available from the “Annual Survey of Long Term Care Facilities” and the “Annual Hospital Registration and Planning Report” for patient migration by county. Net migration shall be calculated by subtracting the number of patients in long-term care beds in the county who came from elsewhere (in-migration) from the number of patients from the county who are in long-term care beds in other counties (out-migration).

.9 – occupancy factor based on the average occupancy of long-term care beds statewide.

Existing and approved beds – presently licensed, registered, or certified long-term care beds located in long-term care facilities that are existing health care facilities as defined in paragraph (L) rule 3701-12-01 of the Administrative Code and long-term care beds for which a certificate of need or a determination of nonreviewability has been granted but that are not yet licensed, registered, or certified. Existing and approved beds shall not include any hospital skilled nursing beds for which a certificate of need was granted under rule 3701-12-233 of the Administrative Code.

.5 x PASSPORT placements – fifty per cent of the number of clients projected to be served in the county by the PASSPORT homecare program established by Chapter 5101:3-31 of the Administrative Code in the calendar year following the year in which the application for a certificate of need is submitted. Projected PASSPORT placements shall be considered only for counties in which the program is serving clients at the time the director issues a decision on the application for a certificate.

(3) Annual bed need. For each calendar year, 1989 through 1993, and for each county, the director shall recalculate new bed need or bed excess under paragraphs (B)(1) and (B)(2) of this rule. For counties with new bed need, the director then shall determine annual bed need for each calendar year in the following manner:

(a) By dividing the recalculated new bed need for that year by the number of years between that year and 1993, both inclusive.

(b) By adding to the number of beds calculated under paragraph (B)(3)(a) of this rule the number of beds, if any, for which there was annual bed need in the immediately preceding calendar year and for which a certificate of need has not been granted.

(c) Reducing the annual bed need for the year to a number equal to the recalculated new bed need, if the sum obtained under paragraph (B)(3)(b) of this rule exceeds the recalculated new bed need.

In reviewing applications relative to which the director issues a decision in a particular calendar year, the director shall consider annual bed need, if any, for the calendar year in question, less any beds for which a certificate of need has been granted since that year’s annual bed need was calculated.

(C) Subject to the restrictions imposed under division (E) of section 3702.68 of the Revised Code, a county with a bed excess or annual bed need of less than the total number of long-term care beds included in any application reviewed under this rule, both as calculated under paragraph (B) of this rule, or in the case of a renovation, replacement, or bed relocation project, if the excess is greater than the number of beds included in the application, a presumption is created that the beds are not needed. The director shall not grant the certificate of need unless the applicant successfully bears the burden of establishing that:

(1) The project will result in renovation or replacement of one or more existing long-term care facilities, relocation of long-term care beds, or addition of long-term care beds in existing space, and:

(a) The application for the certificate of need does not propose addition of long-term care beds or proposes:

(i) Addition of a number of long-term care beds for which there is annual bed need; or

(ii) Addition of the number of beds, not to exceed five beds, sufficient to enable the long-term care facility to comply with the criterion prescribed in paragraph (G) of this rule, if addition of the beds will not affect the quality of care or life for the facility’s residents such as through overcrowding;

(b) The renovation, replacement, relocation, or addition project is needed because:

(i) The existing facility or facilities are seriously substandard with respect to physical plant, as evidenced by copies of reports of deficiencies cited by building, fire, health, or safety inspectors, by other adequate documentation, or by the existence of a restriction on placing nonambulatory patients in a portion of the facility; or

(ii) The project will result in a demonstrable improvement in the efficiency of facility operations;

(c) The project will result in the long-term care facility being in compliance with current applicable building and safety codes without waivers; and

(d) The certificate of need may be granted under all applicable criteria prescribed by this rule, rules 3701-12-20 and 3701-12-232 of the Administrative Code, and any other applicable rules of this chapter;

(2) The project will serve a special need that otherwise will go unserved, taking into account resources that are or will become available in the county or other relevant larger area; or

(3) The average annual occupancy rate for long-term care beds in the county in which the project will be located and in each contiguous county was at least ninety-five per cent during the two most recent years for which complete data are available from the “Annual Survey of Long-Term Care Facilities” and the “Annual Hospital Registration and Planning Report.” In determining whether to allow a waiver under this paragraph, the director shall consider whether the relevant counties’ occupancy rates otherwise would continue to be at least ninety-five per cent taking into account changes in the population of persons seventy-five and over, as projected by the Ohio department of development, and the number of long-term care beds for which certificates of need have been granted but which are not licensed, registered, or certified yet. The director shall not grant certificates of need under this paragraph for more than fifty beds or ten per cent of the county’s existing and approved beds, whichever is less, in any calendar year.

(D) Subject to the restrictions imposed under division (E) of section 3702.68 of the Revised Code, if there is annual bed need for at least the number of long-term care beds proposed in an application, the director nonetheless may determine that the project is not needed, based upon consideration of:

(1) The existence of significant community resources serving elderly or disabled individuals that are demonstrably effective in providing alternatives to placement in long-term care facilities;

(2) The effects of preadmission screening of potential long-term care facility residents and alternative disposition of long-term care facility residents under section 1919 of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981), enacted by the Omnibus Budget Reconciliation Act of 1987;

(3) Whether the occupancy rate for the county’s long-term care beds, as reflected in the most recent available year’s “Annual Survey of Long-Term Care Facilities” and “Annual Hospital Registration and Planning Report,” was below eighty-five per cent; or

(4) Whether the application proposes to reduce alternatives to placement in long-term care beds by converting rest home or other alternative beds to long-term care beds, particularly if the alternative beds were included in an earlier certificate of need and have not been constructed. For the purposes of this paragraph, the director shall not consider conversion of alternative beds to long-term care beds to be a reduction in alternatives to placement in long-term care beds if:

(a) The beds are proposed to be converted to serve current residents of a retirement community to whom the community has a contractual obligation to provide long-term care and who now require long-term care. This exception shall be applicable only if the application contains documentation and a certification by an authorized representative of the community that the community currently provides and will continue to provide preference in admissions to contractual residents of the community, consistent with applicable law. The application also shall contain documentation that no more than ten per cent of the admissions to the long-term care beds during the six months preceding the month of application originated from outside the community;

(b) The alternative beds that are proposed to be converted have been in operation for at least two years before the conversion application is filed and there is documented lack of demand in the county for alternative facilities providing a substantially equivalent level of care, as indicated by significant countywide underutilization during the two years preceding the date of application; or

(c) The alternative beds proposed to be converted were included in an earlier certificate of need application which specifically stated that an application for conversion of the beds to long-term care beds would be filed when sufficient bed need became available and the previous application did not receive any advantage in a comparative review because the alternative beds were proposed.

(E) The director shall not grant a certificate of need under this rule unless the application contains the following items:

(1) A copy of an agreement with an existing state or county-sanctioned preadmission screening program that provides that the entire facility will participate in the program. If no program exists in the relevant county at the time of application, the applicant shall state in the application that the facility will participate in any program that becomes available within eighteen months after services begin to be offered as the result of the project;

(2) Documentation that the project will comply with the following requirements, as applicable:

(a) For homes required to be licensed under Chapter 3721. of the Revised Code, the requirements for licensure under Chapter 3721. of the Revised Code and Chapter 3701-17 of the Administrative Code;

(b) For hospital long-term care beds, beds in county homes as defined in section 5155.31 of the Revised Code that are long-term care facilities as defined in this chapter, and long-term care beds in a long-term care facility, the requirements for certification as a nursing facility or skilled nursing facility under Title XVIII or XIX of the Social Security Act. 49 Stat. 620 (1935), 42 U.S.C. 301, as amended.

(F) The director shall not grant certificates of need for establishment, construction, or development of new long-term care facilities, including replacement facilities, other than hospitals that are long-term care facilities, with a long-term care bed capacity of less than fifty beds. The director may waive the criterion prescribed by this paragraph if the applicant demonstrates that the proposed facility of less than fifty beds can be operated in a cost-effective manner, and:

(1) The proposed facility’s size is essential to serve a special health care need that otherwise will not be served, or will serve a special health care need in accordance with current, evidence-based standards of care;

(2) The proposed facility is the only feasible alternative for cost-effective correction of physical plant deficiencies; or

(3) The proposed facility is part of a continuing care retirement or life care community and the application demonstrates the following:

(a) The applicant will be contractually obligated to provide long-term care to current residents of the continuing care retirement or life care community; and

(b) The continuing care retirement or life care community currently provides and will continue to provide preference in admission to contractual residents of the community.

(G) The director shall not grant certificates of need for:

(1) New or replacement long-term care facilities of more than one hundred fifty beds or for bed additions to existing long-term care facilities if the resulting facility will have more than one hundred fifty beds, except for a facility to replace a single, existing long-term care facility. The director may waive the criterion prescribed by this paragraph if the applicant demonstrates that a facility of more than one hundred fifty beds is essential to serve a special health care need that otherwise will not be served and that the facility can be operated in an efficient manner without sacrificing quality care for its patients; or

(2) An application accepted under division (C)(2) of section 3702.68 of the Revised Code unless all requirements for accepting the application under that division will continue to be met after project completion.

(H) In reviewing a certificate of need application under this rule, the director may examine and consider, in accordance with this paragraph, any state or federal records relating to the licensure under Chapter 3721. of the Revised Code or, if applicable, the participation as a provider under Title XVIII or XIX of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended, of any long-term care facilities owned, operated, or managed by the applicant, the owner or the operator of the long-term care facility to which the application relates, or by any principal participant, as defined in paragraph (H)(4) of this rule, in an entity which is or will be the applicant, owner, or operator. The application shall contain a list of all relevant long-term care facilities with dates of ownership, operation, or management. The director also may consider records pertaining to ownership or operation by these persons of long-term care facilities in other states.

(1) The director may deny the certificate of need if the records reveal that a relevant long-term care facility’s license has been revoked or its certification involuntarily denied, terminated, or not renewed, that a state licensing, survey, or medicaid agency or the United States department of health and human services has issued written notice proposing to take such an action or has imposed other sanctions, or that the facility has or had serious deficiencies that jeopardize the life, health, safety, or welfare of the residents or seriously limit the facility’s capacity to provide adequate care, particularly if governmental action was based upon repeated citation of the same or similar deficiencies.

(2) The director also may deny the certificate of need if the applicant, owner, operator, or any principal participant has been the subject of a final determination of medicare or medicaid fraud or abuse.

(3) The director shall not approve an application for a certificate of need for addition of long-term care beds to an existing health care facility by relocation of beds or for the development of a new health care facility by relocation of beds unless all of the following conditions are met:

(a) The existing health care facility to which the beds are being relocated has no life safety code waivers, no state fire code violations, and no state building code violations;

(b) During the sixty month period preceding the filing of the application, no notice of proposed revocation of the facility’s license was issued under section 3721.03 of the Revised Code to the operator of the existing facility to which the beds are being relocated or to any health care facility owned or operated by the applicant or any principal participant in the same corporation or other business; and

(c) Neither the existing health care facility to which the beds are being relocated nor any health care facility owned or operated by the applicant or any principal participant in the same corporation or other business has had a long-standing pattern of violations of this chapter or deficiencies that caused one or more residents physical, emotional, mental, or psychosocial harm.

(4) For the purposes of this paragraph, “principal participant” means:

(a) Any person who has an ownership or controlling interest of five per cent or more in the applicant, the facility, or its owner or operator;

(b) An officer, director, trustee, or general partner of the applicant or of the owner or operator of the facility.

(I) In reviewing applications that propose addition of long-term care beds for which there is sufficient annual bed need, as determined under paragraph (B) of this rule, and that are batched together for comparative review under rule 3701-12-09 of the Administrative Code, the director shall consider, in conjunction with all other applicable criteria prescribed by this chapter, whether:

(1) One or more of the applications propose renovation or replacement of one or more existing long-term care facilities, particularly if the facility or facilities serve and will serve a medically underserved population, instead of any other type of project, and meets the criteria prescribed by paragraph (C)(1) of this rule. If more than one application in a comparative review meets the criteria prescribed by paragraph (I)(1) of this rule, the director shall consider the applications under the criteria prescribed by paragraph (I)(2) of this rule.

(2) One or more of the projects, as described in the applications, include delivery of alternatives to inpatient long-term care, such as adult day care, home health care, beds dedicated exclusively to a respite care or hospice care program, mobile or congregate meals, a residential care or adult care facility, or facilities for independent, congregate or assisted living, instead of any other type of project except for a project covered by paragraph (I)(1) of this rule. This paragraph shall not apply to an application which states that conversion of the alternative beds to long-term care beds is contemplated in the future.

(a) The alternative services shall be available to the residents and potential residents of the long-term care facility.

(b) If the alternative services involve facilities for rest home care, independent or congregate living, or any other type of facility or beds that are not long-term care facilities or beds as defined in this chapter:

(i) Appropriate agreements shall exist between the long-term care facility and the alternative facility for transfer of residents;

(ii) The applicant shall certify that the capital expenditure for the alternative facility will be obligated, within the meaning of paragraph (A)(1)(a) of rule 3701-12-18 of the Administrative Code, at the same time as the capital expenditure for the portion of the project involving the long-term care facility; and

(iii) The applicant shall certify that no application will be filed by any person for a certificate of need for conversion of the alternative beds to long-term care beds for at least two years after the alternative beds are occupied by residents.

(c) The application shall contain a certification that if for any reason the alternatives to inpatient long-term care cannot be developed or provided, development of the portion of the project involving the long-term care facility will be discontinued and the director will be notified immediately.

(d) The application shall contain documentation of how the long-term care facility and the alternative services proposed will be integrated into the existing and projected community system for caring for elderly and disabled individuals. This documentation shall include at least:

(i) A thorough inventory of existing and projected alternatives to inpatient long-term care within the county;

(ii) A description of the planning process leading to selection of the alternatives proposed in the application, including discussions with appropriate community groups such as local aging agencies regarding the community’s needs for alternative services; and

(iii) An analysis of the need in the community for the proposed alternative services, taking into account the needs of the target population, the existing and projected alternative services in the community, the ability of the target population to pay for the alternative services, and the expected effect of the alternative services on utilization of long-term care facilities. The application also shall contain a demonstration of the economic viability of the proposed alternative services.

(J) If an application for a certificate of need to conduct a reviewable activity relating to a long-term care facility that is not yet existing and that proposes to reduce or eliminate any alternatives to inpatient long-term care that were included in a previous, approved certificate of need application, the director shall review the application under all applicable criteria established by this rule and by other rules of this chapter as if the earlier certificate had not been granted.

Effective: 09/27/2007

R.C. 119.032 review dates: 05/21/2007 and 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.51, 3702.522, 3702.57

Rule Amplifies: 3702.51, 3702.52

Prior Effective Dates: 12/21/1982 (Emer.), 3/19/83, 6/22/84 (Emer.), 9/14/84 (Emer.), 12/13/84, 12/23/87 (Emer.), 4/4/88, 1/2/89, 12/31/90, 5/28/93 (Emer.), 9/6/99

(A) In addition to review under other applicable provisions of the Administrative Code, the director shall not approve an application for a certificate of need to replace an existing long-term care facility or to relocate existing long-term care beds from one site to another unless the application meets all of the criteria prescribed by this rule. To the extent that they are made applicable by the provisions of this rule, the criteria also shall apply to an application for relocation of long-term care beds for which a certificate of need has been granted but which have not been licensed (“approved beds”).

(B) The applicant or the person proposed to own or operate the replacement facility or the facility to which the beds will be relocated:

(1) Owns the operating rights to the facility being replaced or from which the beds are being relocated and is the licensed operator of that facility;

(2) Has entered into a contract to acquire the right to operate the facility being replaced or has acquired or entered into a contract to acquire the beds being relocated; or

(3) In the case of an application to relocate approved beds, is the holder of the certificate of need for the beds or is proposed in the application to enter into a contract to acquire the certificate.

(C) The applicant provides documentation of a feasible plan to care for the residents served in the beds being replaced or relocated until the new beds are operational and thereafter. The application shall state whether those residents will be admitted to the new beds and the procedure for facilitating availability of the beds to the residents.

(D) The applicant demonstrates that replacement of the facility or relocation of the beds is more cost-effective or otherwise more feasible for the applicant than renovation of the facility being replaced or from which the beds are being relocated. This information shall be provided in the form of a detailed study of the respective costs of renovation and replacement or relocation, taking into account the useful lives of the respective facilities, or documentation of the circumstances that make renovation otherwise less feasible.

(E) The facility being replaced or from which beds are being relocated is an existing health care facility, as defined in paragraph (L) of rule 3701-12-01 of the Administrative Code, within the same county. If the application proposes relocation of approved beds, the certificate of need for the beds shall not have been withdrawn before the decision is made on the application proposing relocation.

(F) The replacement of the existing facility or relocation of the existing or approved beds will not impair the access of the population served or proposed to be served by the existing facility or the existing or approved beds to quality long-term care, particularly in the case of medically underserved populations, including consideration of:

(1) Geographic access; and

(2) Availability of medicaid-certified long-term care beds.

(G) The applicant documents, and the director shall consider, the impact of the replacement or relocation project on costs and charges on both a per diem and an aggregate basis. This documentation shall include portrayal of all costs, including any costs of acquiring the existing facility or beds, and of how the costs will be recovered and a demonstration that the costs are reasonable when compared to the benefits of replacement or relocation.

(H) The application does not propose relocation of an existing facility or existing or approved long-term care beds across county lines.

Effective: 09/27/2007

R.C. 119.032 review dates: 05/21/2007 and 09/01/2012

Promulgated Under: 119.03

Statutory Authority: 3702.528, 3702.57

Rule Amplifies: 3702.51, 3702.511, 3702.52, 3702.522, 3702.524, 3702.525, 3702.526, 3702.5212, 3702.53, 3702.531, 3702.532, 3702.54, 3702.56, 3702.57, 3702.58, 3702.60, 3702.61, 3702.63, 3702.68

Prior Effective Dates: 8/31/1986, 4/4/88, 1/2/89, 12/31/90, 9/6/99

(A) This rule prescribes criteria and procedures for the director to follow in designating nursing home placement clearinghouses pursuant to division (F) of section 3702.522 of the Revised Code. Each clearinghouse designated under this rule shall perform the following functions:

(1) Maintain a complete and accurate list of licensed nursing homes and other long-term care facilities, within the county served by the clearinghouse. Any nursing home or other long-term care facility may list with a nursing home placement clearinghouse the services it provides and the types of patients it is approved for and equipped to serve. The clearinghouse shall maintain any such information furnished by long-term care facilities and shall make reasonable efforts to obtain the information from all facilities in the county;

(2) Maintain information concerning out-of-county long-term care facilities that provide care for specialized medical conditions, when the clearinghouse is able to obtain this information;

(3) To the extent that the information is furnished by a long-term care facility, maintain information about the availability of beds at the facility, including the availability of skilled nursing beds and of beds used to provide care for specialized medical conditions;

(4) Keep the information specified in paragraphs (A)(1), (A)(2) and (A)(3) of this rule as current as possible. The clearinghouse shall make reasonable efforts to update its information at least every one hundred eighty days; and

(5) Assist hospitals in the county in placing patients no longer requiring acute care by providing information about possible placement options that is maintained by the clearinghouse. The clearinghouse shall have hours of operation reasonably necessary to perform its functions. No clearinghouse designated under this rule may charge a mandatory user fee to a hospital granted a certificate of need for recategorization of beds under section 3702.522 of the Revised Code Clearinghouses also may maintain information about other providers of care to patients after hospitalization, provide bed availability information to other persons and agencies and furnish other placement and referral services.

(B) Any public or private agency or facility may apply to the director to serve as a nursing home placement clearinghouse. Each applicant for designation as a nursing home placement clearinghouse shall provide the following information:

(1) The name, address and telephone number of the applicant and of any person or agency preparing the application on behalf of the applicant;

(2) The location at which the applicant proposes to operate the nursing home placement clearinghouse;

(3) The counties for which the applicant proposes to operate a clearinghouse;

(4) The qualifications of the applicant to serve as a clearinghouse, including the qualifications of the applicant’s governing body and its personnel and a description of the applicant’s previous experience in performing services similar to those provided by a nursing home placement clearinghouse;

(5) A detailed description of the applicant’s projected annual operating costs and sources of funding;

(6) Documents from health care providers in the relevant county or counties indicating willingness to participate in the applicant’s clearinghouse or supporting the application; and

(7) A detailed description of the services that the applicant proposes to provide and the manner in which they will be provided.

The director may request any additional information necessary to review the application. The applicant shall provide any such information requested by the director.

(C) After receiving an application for designation as a nursing home placement clearinghouse, the director shall provide written notice to all long-term care facilities and hospitals in the county. The notice shall contain:

(1) The name and address of the applicant;

(2) The proposed location of the clearinghouse and the county or counties to be served;

(3) A statement that any person or agency may provide written comments on the application to the director by a date specified by the director, which shall not be less than thirty days after the last date on which notice was mailed under paragraph (C) of this rule.

(D) The director may designate one or more clearinghouses under this rule, but in no event shall there be more than one nursing home placement clearinghouse in each county.

(1) The director shall decide whether or not to designate an applicant as the nursing home placement clearinghouse for one or more of the counties for which application was made by determining whether the applicant has demonstrated the ability to perform the functions of a nursing home placement clearinghouse effectively. In particular, the director shall consider the scope of services to be provided by the clearinghouse and the clearinghouse’s methods for assuring that the information that it maintains is complete and current. The decision shall be based upon review of the application, additional information submitted by the applicant, support by health care providers, comments received during the review and other pertinent information.

(2) The director shall encourage competition for designation as a nursing home placement clearinghouse for a given geographic area. If competing applications are filed for a particular county, the director shall review the applications comparatively and shall designate the applicant, if any, that demonstrates that it can serve the long-term care placement needs of the county’s hospitals most effectively.

(E) The director may revoke a designation granted under this rule upon a determination that the clearinghouse is not functioning effectively or that another applicant for designation would serve the long-term care placement needs of the county better. The director shall provide a clearinghouse with an opportunity to respond to the director’s proposal to revoke its designation before making a final decision on the matter.

(F) If an appropriate clearinghouse has been designated, each hospital granted a certificate of need after August 5, 1989, to recategorize hospital beds as skilled nursing beds shall, and every other hospital may, utilize the nursing home placement clearinghouse prior to admitting a patient to a skilled nursing bed within the hospital and prior to keeping a patient in a skilled nursing bed in excess of thirty days. For the purposes of this paragraph, an appropriate clearinghouse is a clearinghouse that has been designated to serve the county in which the patient wishes to be placed or that the hospital knows could assist in placing the patient in that county. Nothing in this rule shall be construed to require a clearinghouse to prohibit any hospital or other person or agency from using the services of a nursing home placement clearinghouse.

(G) The director shall publish at least annually to all hospitals a list of the designated nursing home placement clearinghouses.

(H) For the purposes of this rule, “skilled nursing bed” means a bed in a facility that participates, in its entirety, in the program for health insurance for the aged and disabled established by Title XVIII of the Social Security Act, 42 U.S.C. 301, as amended (the Medicare program) as a skilled nursing facility or in that portion of a facility that participates as a skilled nursing facility.

R.C. 119.032 review dates: 07/28/2004 and 07/01/2009

Promulgated Under: 119.03

Statutory Authority: 3702.522, 3702.57

Rule Amplifies: 3702.522

Prior Effective Dates: 2/8/1990 (Emer.), 8/3/90, 9/6/99