/Health Planning A * Bibliography Series Si 7 Certificate of AizH4q Need/1122 Project Reviews: An Annotated Bibliography PAM ANAS 4 IO A12 Ht} PWBL U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public He. Ith S Health Resources Adminis tranon The Division of Planning Methods and Technology, Bureau of Health Planning and Resources Development, through the National Health Planning Information Center, is a primary resource for current information on a wide variety of topics relevant to health planning and resources development. To facilitate the dissemination of information to health planners, the Center will publish selected monographs and bibliographies in three series: 1. Health Planning Methods and Technology This series will focus on the technical and administrative aspects of the health planning process, including such areas as methods and approaches to the various aspects of the health planning process, techniques for analyzing health planning information and problems, and approaches to the effective dissemination and utilization of technical information. 2. Health Planning Information This series will focus on data and information to support the health planning process, including sources of information and data for use in health planning. 3. Health Planning Bibliography This series will focus on general and specialized bibliographies that relate to topical subject areas in health planning. Certificate - of - Need/1122 Project Reviews: A Bibliography is the sixth publication in the Health Planning Bibliography Series. Certificate of Need/1122 Project Reviews: An Annotated Bibliography Prepared By Aspen Systems Corporation ermantown, Maryland 20767 Under Contract No. HRA 230-75-00073 August 1977 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration Bureau of Health Planning and Resources Development Division of Planning Methods and Technology Center Building 3700 East-West Highway Hyattsville, Maryland 20782 DHEW Publication No. (HRA) 77-14541 CONTENTS Page Introducti0nNn.. .... sas ss ais sie sale a a lace a niks __ (4 Organization and Format................}.}. sh isk sk i 3 How To Obtain : 2 I. Descriptive and Analytical Reports and Studies. 3 TI. Project Review Procedures and Manuals.......... 25 III. Examples of Application RevIews.....s.w«ss.l.% o s s, 7 7. IV. Other Related 89 Author bls Oo 141 * 3441 INTRODUCTION This bibliography was compiled and arranged by the reference staff of the National Health Planning Information Center and includes references to documents on Certificate-of-Need and 1122 Project Review in the Center's automated searchable information file as of August 1, 1977. This topic was selected in response to the frequent inquiries received by the Center for reference material in this subject area. Although its coverage is extensive, the bibliography does not emcompass all available information on Certificate-of- Need and 1122 Project Reviews. Its usefulness will depend on the individual's prior knowledge of the subject area and on the need for selected types of reference tools. To prepare for possible future revisions of this bibliography, additional citations relevant to this topic and useful to health planners are needed and will be appreciated. Suggested references or donations of documents should be submitted to: National Health Planning Information Center P.0. Box. 31 Rockville, Maryland 20850 Organization and Format All references, although not mutually exclusive, have been assigned to one of the following four categories: I. Descriptive and Analytical Reports and Studies II. Project Review Procedures and Manuals III. Examples of Application Reviews IV. Other Related References Within each section, all references are arranged alphabet, ically by title. Following the title, each citation includes the number of pages and the date of the document, and if applicable, the name(s) of the corporate author(s), sponsor (s), and personal An abstract of the document's contents, along with information on how to obtain the docu- ment, follows the reference citation. An "Author Index" including all personal authors cited in the bibliography is included after Section Iv, "Other Related References." HOW TO OBTAIN DOCUMENTS All citations to documents, both published and unpublished, contain availability source information. ~For each reference, this information is noted in the section entitled "Ordering Information." - The availability sources for articles pub- lished in periodicals are presented as bibliographic citations 'after the statement "Pub. in......" under -the heading "Ordering Information." Issue information (volume, number, etc.) and page numbers are included. To obtain -copies -of any: journal artigle cited, consult a local university librarian or contact the librarian in your Regional Medical Library. For information on the price of a document listed under "Ordering Information" ag "Available NTIS, U.S. Dept. of Commerce, Springfield, Ya. 22161," write (do not call) Fo the National Technical Information Service (NTIS) at the above address, including the order number of the referenced document as indicated in its citation. Unless specified, do not contact the National Health Planning Information Center for a copy of the document. Additional Copies of this bibliography may be obtained from: The Superintendent of Documents U.S. Government Printing Office Washington, D.C. - 20402 I--DESCRIPTIVE AND ANALYTICAL REPORTS AND STUDIES fy. LE The Certificate of -Need Experience: An Early Assessment: Volume I., "summary Feport. Final rept. 280 Jun 73-37 Mar 74. PAGES ANC DATE 0066p Apr 74 CORPORATE RUTHOR/SPONSOP vaceero systoms, Inc., Silver spring, Md. Naticnal Conter for Health Services Research and Development Pockville, Ma. frureau of Health Services Research, Rockville, ma. ABSTEACT The three-volume report provides descriptive information abcut the implementation of state certificate-of-need laws for pealth care facilities. In tho latter part of 1973, ali. 23 states with coertificato-of-nesed legislation were included in the study. Yolume I., includes thoe study methodology, summary of the findings, and implications of the certificate-of-need experience for future development of the public regulatory role. ORDERING INFORMATION see also PB-237 945. Available NTIS, U.S. Dept. of Commerce, Springfiela, va. 22161 nRDEP NUMBER PB-237 944 /4 ST T X TLE The Certificato-of-Need Experience: An Farly Assessment. Folumse 11. . State Boports. Final - ropt. 28 Jun 73-27 Mar 74. PAGTS ANC DATE 0318p Apr 74 COPPORATE AUTHOR/SPONSOR Macro Systoms, InC., Silver Spring, Md. Naticnal Conter for Health Services Research a f : s l F [ele . FOoSskville, Mad. Bureau .cf Health Services Research, Rockville, Ma. ABSTRACT The three-yolume report, provides descriptive information abcut the implementation of state certificate-of-need laws for .health care facilitioes. In the latter part of 1973, ail 23 states with cortificate-of-need legislation were included in the study., Y¥olume II. contains data on the certificate-of-nsed experience in each state, including legislative background, coverage of the law, administrative structure, criteria for evaluation of applications, appeal procedures, and impact of the program. CRDERING INFORMATION See also PB-237 946. Availlable NTIS, - U.S. Dept. of Commerce, Springfield, Va. 22161 CRDEP NUMBER 045/187 TITLE The Certificate-of-Need Experience: An Farly Assessment:; Volume III. - Flowcharts. Final ropt. 28 Jun 73-27 Mar 74, PAGES ANT DATE 0N052p . Apr 74 CORPORATE AUTHOR/SPONS OR Macro Systoms, Ing., Silvor Spring, "#8. Naticnal Center for Health Services Research and Development Rock ville. Bureau of Health Services Ressarch, Rockville, Ma. ABSTRACT The three-volume provides descriptive implementation of state certificate-of-need laws for health care facilities. In the latter part of 1973, 23 states with certificate-of-nesod legislation were included in the stuneed applications. ORDERING INFORMATION See also PB-237 944. Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 CRDER NUMBFR PB-237 946/957 TITLE Certificate of Need: The Massachusetts Experience. PAGES AND DATE 00 28p 1974 CORPORATE AUTHOR/SPONSOR Boston Univ., Mass. Center for Law and Health Sciences. PERSONAL AUTHOR Alan E. Reider John R. Mason Leonard H. Glantz ABSTRACT The operation of certificate of need legislation in Massachusetts is explored in terms of administrative power and the scope of review agencies. Certificate of need legislation requires that all proposed construction or expansion of health facilities meet a legimate public need, in order to prevent duplication. The Massachusetts bDepartment of Public Health, as the administering agency, has the power to determine need based on an application approved by the CHP agency. The most controversial aspect of the Massachusetts program is the Department's practice of conditioning the determination of need with a requirement for change in an area outside the Department's scope, e.g., requiring Somerville Hospital to buy a neighboring hospital. Hospital administrators view the practice as interference. On the other hand, the Departnent views the use of conditions as a means to effectuate the broader goals of the legislation. The law contains no explicit criteria for determination of need; the Department uses flexible criteria generally aimed at raducing overbedding. Local hospitals feel that the Department has procrastinated in formulating specific criteria and that it refuses to use criteria adopted by other state planning agencies. Much of the confusion associated with the Massachusetts certificate of need experience has resulted from ambiguities in the legislation. Recommendations are presented regarding defining the roles of the participants, establishing criteria and setting standards and procedures for implementing such legislation. ORDERING INFORMATION Pub. in Anerican Jnl. of Law and Medicine vi ni p 13-40 Mar 75. 1T ITLE Critical Experiences in Organizing and Administering a State Certification of Need Program. PAGES AND DATE 00 17p 1975 .CORPORATE AUTHOR/SPONSOR Harvard School of Public Health, Boston, Mass. pepartnearat of Health, Education, and Welfare, Washington, D.C. PERSONAL AUTHOR William J. Bicknell Diana Chapman Walsh ABSTRACT , The regulation of capital expenditures through legislated State certification of need (CON) programs is examined in terms of the experience in Massachusetts. The background and early results of the program are discussed, and problems of implementing a consumer-Ooriented program in a State with a seriously overdeveloped bed capacity are addressed. State 'a" and 'b' agency roles are reviewed and it is noted that while the 'a' agency lacked formal power, the "b' agencies responded to a previously unmet need at the substate level. Relationships between CON and ten taxpayer groups and the Public Health Council are discussed, and the roles and responsibilities of CON support staff are delineated. Criteria for determining need are outlined and limitations of the program are noted. Other issues discussed include the use of conditional certificates of need, and problems related to timing which were met with fast-track processing of routine noncontroversial proposals. The following recommendations are drawn from the Massachusetts experience: improved linkages to other regulatory authorities (Federal, State, and substate levels); comprehensive baseline data; improved quantitative methods and skills; development of performance standards and criteria; better development of alternative proposails; and an evaluation procedure. Generalizing from the Massachusetts experience, it is observed that the consumer's influence on final decisions may be illusory and that the provider, for all his discomfort, still is in the position of power. ORDERING INFORMATION Pub. in Public Health Reports -vI01 nal p29-45¢ Jan-Feb 76. < TITLE Evaluatirag the Impact of Certificate of Nesad on Hospital and Health Facilities Planning Outcomes: The Naw York Experience. Dissertation. PAGES AND DATE 0207p Jun 75 CORPORATE AUTIOR/SPONSOR New York Vaiv. Graduate School of Arts and Scieaces. PERSONAL AUTHOR Eleanore Rothenberg ABSTRACT The inpact of certification of need on existing hospital planning functions in New York is evaluated. Two major issues were addressed in the evaluation: {1) the impact of certification of need on ths rats and pattern of change in the number of hospital and health care facilities available to the population in selected areas of New York; and (2) whother the certification of need program in New York has helped planning agencies to achievs end rasults which are closer to desired outcomss than was the case before the program's implementation. In order to invastigate these issues, a study design was used that compared certain observations for five years before implementation of the program with observatioas for five years immediately following implenentation of the certification of need progran. Changes in the number of beds in short term general care and long torm care facilities were analyzed. Also analyzed wore changes in the number of hospitals and long term care facilities, their average size, distribution of these facilities by county, and number of beds which conformed to U.S. Public Health Service standards for fire resistiveness. Multiple regression analysis was used to observe relationships between dependent variables (changes in the number of general care and long tarm care beds) and a set of stanlardizsd independent variables which included zartain population and planning variables. The most significant study finding was that little could be attributed to the introduction in 1965 of certificate of need legislatioa for regulating hospital bedi expansion. - Appendices contain a description of all izspenisnt and independent variables and bibliographic references. NOTES Submitted in partial fulfillment of the requirements for the degyrée of Doctor of Philosophy, 1975. ORDERING INFIJRMATION Available from University Microfilms International, 300 N. Zeeb Road, Ann Arbor, Michigan 48106. TIT LE Evaluation of the Efficiency and Effectiveness of the Section 1122 Review Process. Part I. PAGFS AND DATE 027 4p Sep 75 CORPORATE AUTHDR/SPONSOR Lewin and Associates, Inc., Washington, D.C. Health Resources Administration, Rockville, Md. ABSTRACT The efficiency and effectiveness of Section 1122 in controlling capital expenditures for health facilities and services are evaluated in this first volume of a three-part series. Data were obtained from a field survey in 20 sample Statss and a review of secondary data from public agencies, associations, and private sources. The data evaluate section 1122 on its own merits and in comparison with State Certificate of Need (C/N) programs. Analysis of the data indicates that fewer than half of State and area agencies administering Section 1122 and C/N controls share the Federal commitment to cost containment; they tend to place higher priority on improving the quality and distribution of health care. The most significant difference between Section 1122 and C/N laws is the type of sanction applied to enforce review decisions. Most State C/N programs and section 1122 have similar review processes. Few capital expenditure and services (CES) agencies at the State or area levels have adequate need projections, review criteria, or data resources with which to conduct the review process. A review of nearly 3,000 CES proposals reviewed reveals that regardless of the type of control, over 90 percent of all State proposals are approved, expansion proposals make up the majority of the proposals, and nursing home proposals are denied more frequently than hospital proposals. It appears that the administration of CES controls have achieved a relative success in limiting unnecessary capital investment, but not to the degree expected. All data are supportsd by charts and tables. Volume II contains a technical appendix and Volume III an executive summary. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER SRP-~0005 357 TITLE Evaluation of the Efficiency and Effectiveness of the Section 1122 Review Process. Part II. Technical Appendix. PAGES AND DATE 0079p sep 75 CORPORATE AUTHOR/SPONSOR Lewin and Associates, Inc., Washington, D.C. ABSTRACT Exhibits relevant to the evaluation of the Section 1122 review process and State Certificate of Need (C/N) programs are contained in this second volume of a three-part report on the efficiency and effectiveness of Section 1122. Basic survey interview instruments covering respondent attitudes and experiences are presented along with a discussion of construction measures and a review of all analyses performed. Data sheets to be filled out by agency personnel and a guide for flow charting the Section 1122 process are included. Portions of this document are not fully legible. ORDERING INFDRMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-G005 358 TITLE f EFvaluation of the Efficiency and Effectiveness of the Section 1122 Review Process. Part III. Executive Summary. PAGES AND DATE 004 5p sep 75 CORPORATE AUTHOR/SPONSOR Lewin and Associates, Inc., Washington, D.C. ABSTRACT An executive summary of an evaluation of the efficiency and effectiveness of the Section 1122 review process is provided as the third volume in a three-part report on capital expenditure and services (CES) controls. Data were obtained from a field survey of a sample of 20 States and through analysis of secondary source data. The evaluation determinsd that State and area agencies administering Section 1122 and Certificate of Need (C/N) programs do not necessarily share the Federal commitment to cost containment, but place a higher priority on improving the quality and distribution of health care. The most significant difference between Section 1122 and C/N laws is the type of sanction applied to enforce review decisions. Most State C/N programs and Section 1122 have similar reviey processes. Few CES agencies have adequate need projections, review criteria, or data resources to properly conduct the review process. A review of almost 3,000 CES proposals reveals that over 90 percent of the proposals are approved by the States, expansion proposals represent a majority of all proposals received, and nursing home proposals are denied more frequently than hospital proposals. Section 1122 doss appear to have made a contribution to strengthsning the CES review process, but not to the degree expected. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HERP-0005359 -10- FIT LE Government Intervention on Increase. PAGES AND DATE 0005p 1975 CORPORATE AUTHOR/SPONSOR Harvard Univ., Cambridge, Mass. Bureau of Health Services Research, Rockville, Md. Macro Systems, Inc., Silver spring, N4. PERSONAL AUTHOR William J. Curran Richard J. Stecle Ellen W. Ober ABSTRACT The results of a mid - 1974 on-site field investigation of the overall impact of the laws in 23 States with certificate-of-need programs are reported. The impression was gathered that a 'honeymoon period' still exists in most States between the health planners / regulators and the health care industry, particularly the voluntary hospital segment. Control of facilities expansion is currently in accordance with the goals of both the planners and the established health care institutions in most States and communities. It is noted that as the certificate-of-need programs become more agressive, their use of various enforcement methods will incur much greater resistance. Such resistance is, at the time of writing, becoming more evident in the legal challenges being brought in the courts in several jurisdictions. It is observed that the primary objective of the State legislatures in setting up certificate-of-need programs was related much more to reducing patient charges than to achieving a more rational delivery system through controlling facility development. As legislatures realize that certification alone cannot achieve the first goal, they impose further controls on the industry. Once a State embarks on health industry control through comprehensive planning and facilities construction regulation, it moves almost inevitably to further regulatory efforts. This pattern is exemplified in -11- several States, such as Connecticut, Massachusetts, California, and New York. The general findings of the survey are discussed relative to the impact of programs as viewed by respondents in regulatory agencies, among providers, and among consumers. States investigated, in addition to those above, included: Maryland, Rhode Island, Arizona, Minnesota, New Jersey, North Dakota, Oklahoma, Oregon, South Carolina, Washington, Florida, Colorado, Kansas, Kentucky, Michigan, Nevada, South Dakota, Tennessee, and Virginia. No study details, tabular data, or survey instrument are included. ORDERING INFORMATION Pub. in Hospitals, Jnl. of the American Hospital Association, -v49 p57-«61 16 May 75. TITLE Health Resources Studies. An Analysis of State and Regional Health. PAGES AND DATE 00 20p 1975 CORPORATE AUTHOR/SPONSOR Health Resources Administration, Rockville, Md. ABSTRACT The results of this 50-state survey indicate: ({1) kow States are attempting to control cost increases in the rates of institutional health care, {2) how States are using their regulatory power to control the expansion of health care facilities and services, and (3) what States are doing to strengthen their regulation of health insurance companies. Twenty-six States have attenpted to regulate the rising cost of health care by instituting prospective ~J9~ reimbursement systems which establish either government or private rate setting agencies. Three overlapping methodologies have been developed. - These include, systems basis, determination of reasonableness, and unit of payment. In the area of facilities, Capital Expenditure and services (CES) controls exist to discourage creation of facilities in excess of community need in all but one state.. Direct, indirect (the most widespread) and voluntary methods used by CES are described. These include Certificate of Need (C/N) laws, section 1122 programs, Blue Cross plans, State/ Local Construction Financing and voluntary CHP reviews. The study finds high degree of coordination between rate review and CES control processes.. State health insurance programs and policies are analyzed from a consumer's point of view, all data on individual state programs, control regulations, reimbursement methods and organizational relationships are shown in tabular form. NOTES The full report of the 50-State survey is available from NTIS as the "Nationwide Survey of State Health Regulations", PB-236660/AS. ORDERING INFORMATION Available from the superintendent - of Documents, U.S. Government Printing Office, Washington , 20402, $0.45. TITLE Improving Health Planning and Facilities Review in New Hampshire. PAGES AND DATE 0103p Juf 75 CORPORATE AUTHOR SO R Little (Arthur D.), inc., Cambridge, Mass. Tri-State BRegional Medical Program, Boston, Mass. ABSTRACT The operation of New Hampshire's 1122 program for reviewing -13- organizational aspects of health planning is assessed. It f is felt that the National Health Planning and Development ‘ Act of 1974 (P.L. 93-6411) will significantly change and | ‘ strengthen health plain in the U.S, by establishing 4} a mational, Stats, and regional network of planning 3 agencles which will have a major influence on the flow of health funds. Agencies being phased out in New Hampshire by P. L, - 93-f#41 are noted, along with the establishment of three new organizations: (1) health systems agencies (HSAs) ; (2) Stats health planning and development agency; and (3) State health coordinating council. The 1122 review program provides for local and Stats review of proposals for the construction of health care facilitiss, Primary factors that limit the effectiveness of 1122 review in New Hampshire are delineated, and suggestions are made for improving the review process and encouraging effective health planning under P.L. 93-641. / Phas following problems are noted in New Hampshire's 1122 reviey process: lack of a full-time director for the State's Office of Comprehensive Health Planning, lack of .a Stato health plan against which to judge proposals for the construction of health care facilities, needs for health data and skilled personnel to assess the financial feasibility of proposals and their impact on health care costs, deficiencies built into the. 1122 Fevisy process, and redundant aspects of some 1122 review provisions. An appendix provides information on the responsibilities of HSAs, the State health planning and development agency, and the State health coordinating council. ORDERING INFORMA TION Availabls NTLS,; g .S, bept. of Commerce, Springfield, Ya. 22161 ORDER NUMBER HRP- 000943 0 TITLE Massachusetts Determination of Need Regulations. PAGES AND DATE 008 7p Feb 75 CORPORATE AUTHOR/SPDONSOR Massachusetts Dept. of Public Health, Boston. « ABSTRACT The Massachusetts Department of Public Health's peternination of Need Regulations and the Department's assessment of how best to administer certificats of need laws are presented. These regulations represent a beginning effort to use the zcortificate of need process to encourage so und fiscal plaining by health care providers. Included in the regulations are: the scope of the problem, defiritioas, procedures for submission of applications, advisory rulings, public information provisions, and the participation of comprehensive health planning agencias. Duties before application are outlined, and a step-by-step application procedure is detailed. Public and staff review is described, including public hearings and staff reports. The review process of the Department of Public Health is also detailed, comprising final action in lismissal or dastermination of need. Appendices contain reprints of principal provisions of Massachusetts laws. ORDERING INFORMATION Availabls NTIS, U.S. Dept. of Commerce, Springfiel4, Va. 22161 ORDER NUMBER HRP-0009845 IITLE Nationwide Survey of State Health Regulations. Interim rept. PAGES AND 0274 p CORPORATE Lewin DATE 16 Sep 74 AUTHOR/SPONS OR and Associates, Inc., Washington, D.C. Health Resources Administration, Rockville, Ma. ABSTEACT The report provides a mass of descriptive data on the current status of state regulation of reimbursements for health care costs. Selected regulatory activities emphasized are those ~1§- most relevant to proposed forms of national health insurance and future health planning at the federal level. These include state regulations currently existing to contain costs in reimbursement for health services, for capital expenditures and service changes, and for health insurance. Survey enumerates cost containment activities in the light of negative and positive sanctions, direct and indirect controls, prospective and retrospective reimbursement systems, certificate of need laws and section 1122 programs, relationships between state regulatory bodies ard activities and Blue Cross-Blue Shield insurance organizations and existence of Comprehensive Health Planning and agencies. ORDERING INFORMATION Available NTIS, uU.g. Dept. of Commerce, Springfield, Va. 22161 CRDER NUMBER PB-236 660/757 TITLE The Need for Certificate of Need Authority Towards Building a Model Health System for Maine. - A Position Paper. PAGES ANC DATE 0002p PERSONAL AUTHOR John W. Norton ABSTRACT This article represents the view of the Mains Office of Comprehensive Health Planning (CHP) relative to the need for Certificate of Need Authority in the state, in order to establish a model health system. Certificates of Need are described as regulatory authority granted by stats legislatures to prevent unnecessary construction of health facilities, and are awarded to institutions delivering a range of medical, social and educational services to a | defined population, where there is a demonstrable need for these services. The Certiciate of Need Authority is considered by CHP as an important mechanism for deterring unnecessary health facilities expansion. This power, however, must be vested in the proper hands, with careful consideration of its desired effects. Under this system, a health facility would request permission to expand a =~16= € service cr construct a facility. CHP would be free to present planning interests to this authority from the | vantage point of how the proposal would affect the region or the entire state, The institution's proposal would hopefully have been previously coordinated with areawide health planning and differences of opinion, if existing, could be reviewed by the Certificate of Need Authority. The Certificate of Need Authority is viewed by CHP: as the first step toward franchising services, Or a utilities approach to health service delivery. CRDEPING INFCRMATION Published in Journal of the Maine Medical Association. ¥65 n1-pB, 6, 1973 TITLE Public Certification of Need for Health Facilities. PAGES AND DATE 0006p 1974 CORPORATE AUTHOR/SPONSOR Kennedy School of Government, Cambridge. PERSONAL AUTHOR FAdie Correia ABSTRACT The nature of certificate of need regulation and the ways such regulation can reduce health care costs are discussed. Proponents of certificate of need legislation expect it to reduce costs by preventing construction of facilities that woul d be underutilized and by influencing treatment patterns to be more efficient. The traditional method of determining the number of hospital beds needed in a community is based on past levels of utilization. This results in inefficient allocation patterns. A statistical analysis such as that applied by prepaid group plans might aid in determining bed needs, taking into account alternative care facilities. The excessive number ~17= of available beds denotes the necessity for a politically acceptable method of determining need which can serve as the basis for a governmentally imposed csiling on construction. The structure of the decision-making process which grants certificates of need is as important as is the methodology for determining need. Certification of need can deprive consumers of additional alternatives from which to choose care and can hinder the development of more efficient ways of providing care. Planning authorities must establish explicit criteria for certification of need to prevent planning agencies from developing into a 'decide as you go' pattern. ORDERING INFORMATION Pub. in American Jnl. of Public Health v65 n3 p260-2650 Mar 75. TITLE F # - - # = i Regulating Health Care Facilities: - The Certlflcate-oF-Need Process Re-Examined. | PAGES AND DATE 000 7p 1973 CORPORATE AUTHOR/SPONSOR National Center for Health Services Research and Developneat , Rockville, Ma. PERSONAL AUTHOR Harris S. Cohen ABSTRACT Political aspects underlying the certificate-of-nesad process are explored. - Basic assumptions in the certificate-of-need process are examined in relation to events that have taken place at both Faderal and State levels of government. P.L. 92-603, enacted in October 1972, stipulates -~18- that Fedoral funds under the Maternal and Child Health, Medicare, or Medicaid programs may not be used to support unnecessary capital expenditures made by or on behalf of health care facilities or maintenance organizations which are reimbursed under such programs. In November 1973, tha Senaral Accounting Office submitted to Congress a study on health facility construction costs. JIng of the findings of this study was that areawide health planning agencies are not effective in the regulation of health facility construction and expansion of services, even in States with coertificate-of-need legislation. A third davslopment involves the decision by the North Carolina Supreme Court in 1973 which stated that the State's certificate-of-need statute was an improper extension of the State's police power in denying to individuals the right to construct and operate certain health facilities except upon issuance of a certificate-of-need. standards and criteria for reviewing the certificate-of-need process with emphasis on Oregon's zertificate-of-need system are discussed. Different constituencies represented in certificate-of-need decisionmaking are noted, along with planning and regulation aspects in the administration of certificate-of-need laws. ORDERING INFIRM ATION Pub. in Enquiry v10 n3 p3-9 Sep 73. TETLE Regulating Health Facilities Construction. PAGES AND DATE 032 3p 1972 CORPORATE AUTHOR/SPONSOR Duke Univ., Durham, N. C. School of Law. National Center for Health Services Research and Development, Rockville, Md. American Enterprise Inst. for Public Policy Research, Washington D.C. -~19- PERSONAL AUTHOR Clack C. Havighurst ABSTRACT Papers and proceedings of a 1972 conference on regulating health facilities construction, which was organized to examine the trend toward State regulation of construction through certificates of need, are presented. Experts from various health disciplines examined the trend toward regulation as it affects health care delivery. Papers are divided into four sections, each covering a session of the conference. The session on health planning was designed to provide historical background of certificate of need laws and proposals. The second session dealt with arguments for and against certificate of need laws as a means of strengthening health facilities planning. The consequences of reduced competition in hospital services because of certificate of need laws is discussed in the third section. One of the purposes of this session was to call attention to consumer protests about health monopolies. The final session was concerned with fitting certificate of need legislation into other health policy developments and new directions. Fach section includes a discussion of the issues raised in the papers presented. Many of the papers are illustrated by tabular data. Appendices contain a prospectus for the conference and a list of conference participants. NOTES This document contains the proceedings and papers of a conference on health planning, certificates of need, and market entry held in Washington, D.C. in June, 1972. ORDERING INFORMATION Available from AEI, 1150 17th N.W., Washington, D.C. 20402, paper copy $4.00, hard copy $8.50. ~90. TITLE Review of 1971 Certificate-of-Need Legislation. - Survey Rept. PAGES AND DATE 0096p war 72 CORPORATE aAUTHOR/SPONSOR American Hospital association, Chicago, IIl. NO TES an analysis of legislative patterns and a State-by-State analysis of certificate-of-need legislation are provided. ORDERING INFORMATION Available from American Hospital association, 840 NK. Lake Shore Dr., Chicago, Ill. 60611. TITLE state Certificate of Need Legislation. A Study. PAGES AND DATE 00 25p 1974 CORPORATE AUTHOR/SPONSOR Texas Governor's Office of Comprehensive Health Planning, Austin. ABSTRACT The advantages and disadvantages offered by state certificate of need legislation in Texas were assessed by thoe State Office of Comprehensive Health Planning. ad vantages include:: regulation of duplication of equipment and health care services with accountability to consumer needs; control of escalating medical care costs, logical development of services and facilities to match local needs and resources; definition of the regulatory role of -291- the certificate of need decision agency; * increase in public awareness of health problems ; and participation by Texas in new Federal health legislation assuring Federal « reimbursenents for capital expenditures and services under Federal health and welfare programs. _ Disadvantages include: conflict with the free enterprise system of open competition ; possible discouragement of new health care providers, leaving the way open for cartels; possibility of the decision agency becoming bureaucratic If not properly established; and possible adverse effects of political pressures. It is noted that 22 of the 24 States which have passed certificate of need legislation have retained the final decision authority at development of State certificate of need the State level. Guidelines to the legislation are provided, including comments on the scope criteria for organization document are ORDERING INFIRMATION Available NTIS, Dept. of Commerce, Springfiela, va. 22161 CRDER NUMBER i HRP-000 3728 TITLE of program review, standards and not fully legible. program review, and review * and mechanisms. Portions of this Study on Legal Issues in the Reorganization of Health Care Instituti>is. PAGFS AND DATE Volume 13: special Topic Research Papers. 0063p 26 Oct 70 CORPORATE AUTHOR/SPDNSDR Harvard School of Public Health, Boston, Mass. National Zenter for Health Services Research and Development , Bocskville, nd. “22“ # Fi PERSONAL AUTHOR Willian J. Curran George B. Moseley ABSTRACT Research papers are presented on legislative measures to facilitate the development of allied manpower roles and a national survey and analysis of certification of need laws. These papers are provided as part of a 19-volume study of the legal and organizational problems confronting health care institutions in the United States. In the paper on the development of allied manpower roles, the licensure system is reviewed, and changes in the system are considered. These changes include: the movement for physicians' assistants (PAs), the Colorado Child Health Assozciats Law, and the California PA program. It is proposed that attention be given to legislative proposals and measures to 'open up!' the systen of health manpower licensing and regulation. Legislative history and political trenis ars discussed in the analysis of certificats of need laws and the constitutional justification for regulation. The coverage by State laws and the areas of operation actually controlled are outlined. The review process is discussed and supporting data are presented in tabular form for a number of States. References are provided for each research paper. NOTES ; see also volumes 1-12, 14-17, 19; HRP-00 10123 - HRP-0010134, HRP-0010136 - HRP-0010139, and HRP-0010141. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, springfield, Va. 2216 1 ORDER NUMBER HRP-0010135 ~93- TITLE Study on the Health Planning Agencies and "Certificate of Need" Legislation Concerning Health Facilities 1973. Final Rept. PAGFS AND DATE 0099p 1973 CORPORATE AUTHOR/SPONSOR Tennessee State Legislative Council Committee, Nashville. ABSTRACT A legislative subcommittee was formed to study a bill providing for a 'certificate of need!" process for Tennessee. - A certificate of need is a mechanism used to insure that health care facilities are expanded only in accordance with carefully formulated plans to provide an orderly accessibility, utilization, and availability of health care to the closest number of people. No construction of new health care facilities or expansion of existing installations is allowed without evidence from an appropriate State authority that a true need exists for it. This report includes recommendations for certain amendments to the proposed certificate of need legislation and its adoption as amended. It also provides recommendations for improvements in the areawide planning agencies. Appendices contain 1971 hospital occupancy rates, the text of the Senate and House Bill, features of the certificate of need legislation in other States, and regulations of DHEW . The study of the certificate of need legislation inciudes an analysis of the initiation of the certification process, scope of coverage, application and review process, appeal process, time limitation or certification, and the financing of the certification process. . Recommendations emphasize that the certification process must be expeditious and that financial disclosure provisions should be equitable and reasonable. ORDERING INFORMATION Available NTIS, U. s. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-00 02203 «24. 1I--PROJECT REVIEW PROCEDURES AND MANUALS TIT LS Alabama CHP Review and Comment Manual: Guidelines, Procedures, and Review Criteria. PAGES AND DATE 0016 p *pr 78 CORPORATE AUTHOR/SPONSO R Alabama State Dept. of Public Health, Montgomery. comprehensive Health Planning Administration. Public Health Service, Rockville, M4. ABSTRACT statewide guidelines are provided for the Alabama Comprehensive Health Planning Agency to standardize procedures and basic review criteria for health-related grant applications. Designed to assure applicants an objective and fair review, and each furding agency a complete rendering of valid community judgement, the manual consists of four sections. Section one is a general discussion of the principles to be considered, and background information relative to the review and comment function. The second section is an outline fo basic procedures and criteria as formulated to be used in applying for Federal funds. (Procedures and criteria applicable to the review process are contained in section three. section four is an appendix consisting of the project summary form, and a list of Comprehensive Health Planning Agencies in Alabama and the geographic locations where they serve. In addition to the standardized procedures provided, individual agencies may augument the process to indicate necessary variations as they deem appropriato. The manual does not include procedures for implementing Section 1122 of PL 92-603. References are supplied. Portions of this document are not fully legibls. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, springfield, Va. 2216 1 ORDER NUMBER HRP-00045 18 -25. FITLE Appendices to the 1976 Health Systems Plan. PAGES AND DATE 0140p Jan 76 CORPORATE AUTHC R/SPON SOR Comprehensive Health Planning Association of Imperial, Riverside, and San Diego Counties, San Diggo, Calif. Department of Health, Education, and ¥elfare, Washington, D.C. ABSTRACT Guidelines and criteria for the organization and delivery of selected health care services are presented in the appendices to the health systems plans for Riverside, Imperial, and San Diego counties, California. The quidelines constitute the basis for evaluation and review of such services in the planning area. In addition to a description of the review and comment responsibilities of the Comprehensive Health Planning Association of Imperial, Riverside, and San Diego Counties, quidelines and criteria are presented in the following areas: acute hospitals, nursing care facilities, and acute psychiatric facilities. Guidelines alone are presented for: ambulatory surgical facilities; renal dialysis units; prepaid health care systems; emergency services in health facilities (including categorization) ; maternity care; high risk obstetric units ; neonatal intensive care units; infant transport service; coronary care units; radiation therapy hospital services; rehabilitation facilities; home care; and drug abuse programs. - A glossary of health. terms is provided. NOTES - _ See also companion documents, HRP-0011229 and 1RP-00 11230. ORDER I NG INFORMATION Available NTIS, U.s. Dept. of Commerce, Springfield, Ya. 22161 ORDER NUMBER H4&P+-09011Z31 -26- ¥ >’;p:oaches to Health Plan Development and Project Revi PAGES AND DATE $37 17p 1975 AU THOR/SPON SO R kigan Univ., Ann Arbor. - School of Public Health. (1 & C MLL Bursau of Health Planning and Resources Development, Rockville, Md. PERS \ AUTHOR solomon G. Jacobson susan L. Halvorsen jean L. Hochheimsr Pavia J. Ward ABSTRACT Planning, revisw, and resources development were discussed in a series of seminars on Health Plan DPevelopment and Project Review conducted in 1975 by the Regional Center for Health Planning at the University of Michigan school of Public Health. participants in the seminars included health planners, project review officers, and volunteer board members. - Materials considered useful by the participants are presented as a reference source book to enable planners and project review officers and their staffs to establish systematic health planning approaches. The initial section of the document discusses fundamentals in health plan development and project review; these articles provide a framework for the systematic approach to health planning mandated by Federal law. Materials in this section deal with plan documents, planning requirements, problem identification, review mechanisms, and health resources. - The next section contains technical articles about the components of the review process: economic j feasibility, manpower planning, health statistics, program evaluation, and legal considerations. The final section of the document provides selected source material for project review. - This section includes tabular data on health projects subject to the review process, a list: of bibliographies,; and topics presented at the seminars. References follow many of the articles. -2"7- NOTES Selected materials from the seminars conducted at the University of Michigan, Ann Arbor, Mich., May - December 1975. ORDER ING INFOEMATIGON Avallable NTIS, t.s. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0O0 1302 TITLE ARCH Interim Operating Procedures, Standards and Criteria for Project Peview. § PAGES AND DATE 0049 p Nov 73 CORPORAT ER AUTHOR/SPONSO R Alliance for Regional Community Health, INC s », St. Louis, Mo. Department of Health, Education, and Welfare, Rockville, Ma. United Fund of Greater St. Louis, Mo. - ABSTRACT Interim criteria for evaluating proposed health care projects have been developed for use by the project | review committes of ARCH {(Alliance for Regional Community review activities including staff activities and committee actions, notification of action, and the general policies of the project review committse,. Determination of need, the primary consideration in expanding, modify ing or creating a new health facility or service, will be judged in part by the feasibility of establishing alternative ways of delivering health care. Other considerations are the availability and maintenance of adequate staffing, community impact, back-up manpower for emergency situations, management effectiveness, and non-discriminatory hiring policy with provisions made for =~28« career mobility within the organization. Other standards concern financial feasibility and cost effectiveness, and education of the general public and in-service staff training. Evidence of compliance with legislative requirements of licensure, accreditation and certification must be shown. Potential consumers of the health services must be involved in health care planning through provision for meaningful and significant input into the operation of the services. Standards for the purchase of new or specialized equipment, availability of transportation by public or special means, and location of the proposed service all must be considered. A peer review process for periodic independent evaluation of services should be instituted. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003762 TITLE CHPSI Review and Comment Guidebook, July 1974. PAGES AND DATE 0046p Jul 74 CORPORATE AUTHOR/SPONSOR Comprehensive Health Planning of Southern Illinois, Carbondale. ABSTRACT The review and comment responsibilities of the 27-county Comprehensive Health Planring in Southern Illinois, Inc. (CHPSI) are outlined, and guidelines for fulfilling these responsibilities are set forth. A flow chart depicts the functions and relationships of an areawide health planning agency. General goals and principles for review ard comment are described. In an explanation of the approach to review and comment, a conceptual model of the -29.- sponsor's responsibilities (provision of current status data and consideration of health, relationships, and economic criteria) is given. Agency responsibilities are also dclineated, and the CHPSI data base, which contains a variety of statistics including a detailed inventory of all health programs, facilities, services, manpower, and financing in the area, is described. Specific review and comment procedures are detailed. Appendices include a summary, in table format, of review and comment responsibilities of State and areawide planning agencies; CHPSI review and comment record, and recommendation forms; project control log and project status card; a rapid reference guide for estimating impact of borrowed funds on patient charges; and a glossary of health. ORDERING INFORMATION Available NTiLS, U.S. Dept. of Commerce, Springfield, Va. 22161 CRDER NUMBER HRP-000366 8 TITLE Compilation of Standards, Plans and Criteria. PAGES AND DATE C118p Aug 74 CORPCRATE AUTHOE/SPONSOR Bureau of Health Resources Development, Rockville Ma . ABSTRACT Documents submitted by State and areawide health planning agencies and CHP graduate education programs describing plans, standards, and criteria are cataloged. Each entry includes the document title and date {if available), source, and a brief description of the contents. The entries are grouped under the following headings: project review criteria, hospital and health care facilities, agency policy and plans, health manpower, maternal and child care, emergency medical services, hemodialysis care, home health -30- services, health maintenance organizations, mental health services, alcoholism, physician studies, radiation therapy, burn treatment material, drug abuse, out-patient facilities and services, nursing home services, cardiac care, stroke, medical / surgical care, multi-faceted documents, and miscellaneous. The catalog includes materials received from February 1974 through August 1974. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. bept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HBRP-0002717 TITLE Comprehensive Health Planning Project Review Manual for the State of Iowa. PAGES AND DATE 0029p 1974 CORPORATE AUTHOR/SPONSOR fowa State Office of Planning and Programming, Des Moines. Areawide 314-b Health Planning Agency Coord inating committes. Iowa Regional Medical Program, Oakdale. ABSTRACT an introduction to the project review process in Iowa is presented, including statutory requirements for project review, review criteria, and review procedures. - The manual is designed for use by health facilities, consumers, and local governments, and serves as the basis for review activities of health planning organizations that have responsibility for review and comment. Topics include the procedures for review of capital expenditure proposals such as findings of the review process, chart diagramming capital expenditure review procedures, project review cycle, and criteria and guidelines for comprehensive health planning review; and other project review required ~-31.- by, the following statutes: Hill-Burton applications; 315 {c) grant applications; 314 (4) State plans; 314 (e) health services development application; regional medical programs; migrant health program; National Health Service Corps; Health Maintenance Organizations; family planning prgorams; communicable disease control; health manpower programs; emergency medical services systems; and others. Procedures for CHP review of health-related projects are outlined. A list of Iowa-CHP agencies.and a map showing health planning regional designations are included. - A glossary is provided. ORDERING INFOPMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER » HRPP-O00452 1 TITLE Comprehensive Health Planning Review and Comment Manual. Region X. PAGES AND DATE 0087p dan : 75 CORFORATE AUTHOR/SPONSOR Department of Health, Education, and Welfare, Seattle, Wash. Region X. ABSTRACT Guidelines for reviewing applications for Federal health funds are presented for use by Comprehensive Health Planning (CHP) State and areawide agencies. The manual clarifies Regional Office and CHP agency review roles and responsibilities, establishes general and program specific review criteria, and outlines CHP model project review procedures. Using these guidelines, CHP agencies can produce review recommendations substantially benefiting the funding decision process. The manual does not attempt to address the entire process of grant application, review, and monitoring, but it does describe CHP agency and grantee ~39« interaction with the Uniform Grant Process Review (of which CHP review and comment is one part). Various legal and technical questions related to the review process are answored either in the manual proper or in the appendix. Material contained in appendices includes: Region X organization chart; project review process forms; conflict of interest statement; formats for public hearings / meetings; the appeals mechanism; and an f sxcerpt from a letter regarding the Freedom of Information Act. ORDERING INFORMATION © : Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER 138 TZTLE Criteria and Standards for Project Review. PAGES AND DATE 0020p 1975 CORPORATE AUTHOR/SPONSOR Mid-Missouri Areawide Comprehensive Health Planning Agency, Columbia. Missouri Regional Medical Program, Columbia. ABSTRACT The official policy of the Mid-Missouri Areawide Comprehensive Health Planning Agency with respect to the evaluation and review of health care facility and service project proposals is documented. The criteria and standards are intended to conform to Section 1122 of the Social Security Act and Section 1532 of the National Health Planning and Resources Development Act of 1974. Beyond the application to proposal review and evaluation, the guidelines presented are intended to serve as aids for the planning and implementation of health facilities and services within the spirit of the areawide health plan. Criteria are set forth in the following areas: =83. conformance with areawide plan; need determination; accessibility factors; resource availability; communication and coordination linkages; contribution to improvement or innovation in the health care system; organizational and administrative capabilities; quality of care; manpower considerations; financial feasibility; cost containment; public education and involvement; conformance with legal and licensure requirements; conformance with environmental controls and standards; consideration of viable alternatives; and alternative uses of resources. A bibliography is included. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. ORDER NUMBER HRP- 0004 05 2 TITLE 22161 Financial Analysis Methodology for Planning and Evaluating Capital Expenditure Under Section 1122 of the Social Security Act. PAGES AND DATE 00 55p Feb 75 CORPORATE AUTHOR/SPONSOR New Orleans Arca Health Planning Council, La. Project Review Committee. Public Health Service, Rockville, Md. Louisiana State Office of Comprehensive Health Planning, Baton Fouge. ABSTRACT A methodology for financial feasibility analysis of health expenditures is presented which is designed to assist health services providers and comprehensive health planning agencies. The methodology was developed by the New Orleans, Louisiana, Arca Health Planning Council (NOAH) =~34« to facilitate reviews of capital expenditures as required by Section" 1122 of the Social Security Act and has been approved by the NOAH Board for use in the New Orleans metropolitan planning area. Conditions under which financial planning should occur are suggested, as are criteria for review of expenditures. Sound financial planning is defined and examples of such are demonstrated. Examples of required documentation of financial planning, based on the NOAH principles of analysis, are presented in exhibit form. The appendix provides a ratio analysis of current and previous financial positions of a hypothetical health facility. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. ORDER NUMBER 4RP-000276 2 TITLE 2216 1 Guidance and Procedures for Designated Planning Agencies in Administering Section 1122 of the Social Security Act. PAGES AND DATE 0037p Mar 74 CORPORATE AUTHOR/SPONSDR Bureau of Health Resources Development, Rockville, Md. Div. of Comprehensive Health Planning. ABSTRACT Suidelines and procedures are presented by the Division of Comprehensive Health Planning, U.S. Department of Health, Education, and Welfare, for use by Designated Planning Agencies (DPA's) in carrying out the provisions and intent of Section 1122 of the' Social Security Act. - The purpose of Section 1122 is to assure that Federal funds appropriated under Titles V, XVIII, and XIX of the Act are not used to support unnecessary capital expenditures made by or on behalf of health care facilites or health maintenance -35- organizations reimbursed under these titles. Following a presentation of operational definitions, the various aspects of DPA activities and responsibilities are discussed as follows: provisions and renegotiation of the agreement between the State and DHEW concerning the DPA; coordination, information, and records; DPA review procedures; fair hearing under Section 1122 and State action; material to be forwarded to HEW; functions of HEW; and reimbursements to cover DPA costs of review and comment. - A sample form for notification of action under Section 1122 is appended. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 2216 1 ORDER NUMBER HRP-0006 311 TITLE Guide for Review by Georgia Comprehensive Health Planning Agencies of Health-Related Program Proposals. PAGES AND DATE OQ17p 5 Dec 73 CORPORATE AUTHOR/SPONSOR Georgia State Dept. of Human Resources, Atlanta. Comprehensive Health Planning Agency. ABSTRACT The responsibilities of State and areavwide comprehensive health planning {(CHP) agencies in reviewing health-related program proposals are set forth, and general principles to be followed by individual agencies in developing internal review processes and criteria are offered. The following basic procedures, applicable generally to all CHP agency project reviews, are described: publication of agency project review guidelines; receipt of proposal and initiation of review record; determination as to whether proposal is reviewable; formulation of agency plan for -36- review; staff analysis; interagency coordination; council consideration; review documentation and transmittal; and agency review record. Basic criterla are outlined. A summary of the Georgia Policy on Review by Comprehensive Health Planning Agencies of Health-Related Program . Proposals is included. ORDERING INFORMATION Available MTIS, U.S. Dept. of GConmetce, Springfield, Ya. 2216 1 ORDEE NUMBER HEP-0003964 TITLE Guide to Financial Analysis and Introduction to Economic Impact Analysis for Health Planning. PAGES AND DATE 026 3p Jun 76 CORPORATE AUTHOR/SPONSOR Gorsline (Lester) Associates, San Rafael, calif. National Health Planning Information Center, Rockville, Md. PERSONAL AUTHOR Lucy Johas Thomas Chapman Morton Raphael AB STRACT A guide is presented to aid health planners in performing financial feasibility review and economic impact analysis of health care service projects. A conceptual approach to the review of financial feasibility is provided as a basis for financial feasibility judgments required under Section 1122 of the Social Security Act of 1972 (P.L. 92-603) and the Zertificate of Need Laws. - Rlements ~37=- influencing the financial feasibility of capital projects are described, and feasibility is defined. A seven step decision sequence for determining financial feasibility is explained in detail and the decisions and their outcomes are summarized in a decision flow chart which is applicable to any typ2 of project and financing. - Data reguirenents for the determination of financial feasibility are specified and explained. Economic impact and economic impact analysis are defined, and methodologies applicable to some major impact factors are discussed. Issues raised by attention to economic impact are summarized, and data requirements necessary for economic impact analysis are described. An introduction to basic economics is presented in an attempt to provide an understanding of the ma jor assunptions, laws, and concepts involved in general economics and to support an approach to economic impact analysis. A brief introduction to health economics is also includei. Institutional finance is discussed, with enphasis placed on elements of accounting and financing such as financial statements, financial ratios, basic concepts, capital budgeting, and cost analysis. An appendix containing Section 1122 of the social Security Act of 1972 (P.L. 92-603) is provided. References are included. NOTES This is the third monograph in the National Health Planning Information Center's Health Planning Methods and Technology Series. ORDERING INFDRMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0007 379 -~-38- I LITLZ f Guide to the Reviowing Process in Health Care Proposals. Project Review. PAGES AND DATE 0 20 1p May 75 CORPORATE AUTHOR/SPON SOR Health Resources Development Inst., Inc., Lexington, Ky. American Association for Comprehensive Health Planning, Alexandria, Va. Robert Wood Johnson Foundation, Princeton, N.J. Bureau of Health Resources Development, Rockville, Md. Div. of Comprehensive Health Planning. PERSONAL AUTHOR 6. Collin" fyds ABSTRACT A 'how to' guide is presented for planning agencies involved in project review and health plan development, following field tests and review by selected CHP agencies. A non-technical overview describes the project review process, including the organizational structure of a planning agency, its review responsibilities under Section 1122 of the Social Security Act, requirements to be met under the review process, and criteria for evaluating proposed projects. Basic elements to be considered in implementing the organizational framework are: a Statewide agency with responsibilities designated under section 1122; a council which includes consumer representatives; bylaws which empower an agency's executive committee to act; recognition by council members of the agency's and their responsibilities; and coordinative arrangements with State and local agencies. The project review process is the responsibility of State and regional planning agencies; an organizational structure and establishment of responsiblities is suggested. The role and function of the review agency is defined in terms of Section 1122, and certificate of need review criteria are proposed. Coordinative relationships with other agencies are emphasized. Administrative and managerial -39- aspects of project review are described from pre-application through followup and feedback. Criteria for the evaluation of the health care system are suggested, as are tools for using review criteria and for implementation of the review process. Appendices present sample forms and procedures for a variety of review tasks. A bibliography is included. ORDERING INFORMATION Available from American Association for Comprehensive Health Planning, 801 North Fairfax Street, Suite 212, Alexandria, Va. - 22314, $7.50. TITLE Health Facilities Planning Suide for Reviewing Financial Feasibility of Proposed Capital Expenditure Projects. PAGES AND DATE 00 52p Feb 74 CORPORATE AUTHOR/SPONSOR Delaware UYJniv., Newark. Bursau of Economic and Business Research. Health Planning Council, Inc., Wilmington, Del. Young (Arthur) and Co., Washington, D.C. PERSONAL AUTHOR Robert L. Parcotta Donald J. Puglisi Henry C. Miller ABSTRACT | Guidelines are offered to Comprehensive Health Planning (CHP) Agencies for review of financial feasibility reports submitted for proposed capital expenditure projects. The main purpose of the CHP agency's financial analysis is to make such information available to the public. The roles of the CHP agency and problems in determining financial feasibility are explored in Chapter One. In the determination of financial needs outlined in Chapter Two, both working capital needs and fixed capital needs are -A40~- discussed. In developing a long-term financial plan, it is helpful to give separate consideration to two budgets which relate revenues and expenditures to operating costs and to capital improvements: the long-term operating budget; and the capital budget. The design of the financial structure is based on a realistic determination of the organization's needs for both operating (working) capital and plant {fixed) capital. Both internal and external sources of capital for long-term financing ars considered, as are debt financing through conventional mortgages, Federally insured mortgages, tax-exempt bond issues, and Hill-Burton loans. Debt provisions are defined, and ways to determine debt capacity explained. Project review procedures in Chapter Three include documentation requirements for reviewing financial feasibility, application review, gauging financial feasibility, and the nature and limitations of financial ratios. A selected bibliography and glossary are appended. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER T IT LE Health Facility and Services Review Function of the Community Health Planning Commission (CHPC). PAGES AND DATE 0028p oct 74 CORPOEATE AUTHOR/SPONSOR Community Service Council, Inc., Birmingham, Ala. Project Review Committee. Alabama Regional Medical Program, Birmingham. ABSTRACT Evaluative review criteria for health facility and service applications are presented for a six county area by the Project Review Committee of - 41 the Community Service Council, Inc. of Birmingham, Alabama. The legal basis for the project review function, as contained in P.L. sgg-FJ49 ana section 1122 of the social Security Act and ({[P.L. 92-603), and Office of Management Budget Circular A-95 is included, as well as the procedure for voluntary review. Criteria include: the establishment of need for the facility and/ or service; consistency with approved current health and development plans; satisfactory manpower considerations; cost containment; long range planned economy ; relationships between consumer and health facilities; capital expenditure financing; construction costs; and revenues. Attachments provide evaluative criteria for projects financed by tax-exempt bonds, a staff worksheso+ for project review, and an outline for an issue summary statement providing additional, pertinent information concerning major areas which are very strong or are questionable. The roles of the Community Health Planning Commission and its Project Review Committee are described, including a brief discussion of applicant challenges of committee recommendations, but specific appeals procedures are not provided. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HREP-0005001 TITL® Health Facility Capital Expenditure Review and Recommendation Procedures. PAGES AND DATE 0021p 1973 CORPORATE AUTHCR/SPONSOR Mississippi State Office of the Governor, Jackson. »Div. -of Comprehensive Health Planning. -42- ABSTRACT Procedures for determining the need for capital expenditures are outlined by the Division of Comprehensive Health Planning for the State of Mississippi. Definitions of what constitutes a health facility, a substantial change in service, areawide health planning, the Division of Comprehensive Health Planning, State Health Pianning Advisory Council, and Facilities Committee are given. Guidelines are provided for planning and submission of an application in consultation with the state agency and the areawide health planning council of the region. Appeal procedures are described for applicants dissatisfied with the Advisory Council's decision. If the application is approved, the provider may proceed with the capital expenditure and later claim reimbursement under Titles V, XVII, and XIX. Criteria for determining need include: whether the proposed project is needed or projected as needed for the community; whether the proposed project can be adequately staffed and operated when completed; whether the proposed capital expenditure is economically feasible; and whether the project will foster cost containment or improved quality of care. Basic information must be supplied together with a narrative describing need, relationships with other health-related organizations, staffing, and planning. A bibliography is provided. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Ya. 22161 ORDER NUMBER HRP- 0004320 TITLE Health Planning Council of the Midlands Project Review Guide. PAGES AND DATE 0031p 1975 CORPORATE AUTHOR Health Planning Council of the Midlands, Omaha, Nebr. -43- ABSTRACT # Guidelines are presented to assist individuals who are developing and submitting applications to the Health Planning Council of the Midlands (HPCM) in Omaha, Nebraska for review, as well as persons who participate in the project review process in the areas of capital expenditures of $100,000 or provision of public and / or mental health services, applications for Federal, State, or local governmental funds, Hill - Burton applications, Regional Medical Program activities, and other health proposals. The legislative and administrative basis for project review is discussed, and project review procedures, responsibilities, and scheduling are examined. The chapter on standards and criteria for project review outlines general criteria, the evaluation technique, financial feasibility criteria, and guidelines for financial feasibility review, or for proposals submitted for project review, including utilization and financial information. ORDERING INFORMATION f Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP- 000333 1 TITLE Hospital Supplement to Project Review Guidelines. PAGES AND DATE 002 3p 49 I0 CORPORATE AUTHOR/SPONSOR Region Three Comprehensive Health Planning Council, Inc., Fort Wayre, Ind. ABSTRACT A hospital questionnaire for Certificate of Need / 1122 and similar reviews is presented. The documents consist of questions or instructions broken down into the following seven areas: (1) a face sheet and certification form; (2) introductory information; (3) marketing analysis and plan -44- justification, including the uniqueness of the proposed facility; (4) community relations data; (5) a detailed description of the project; (6) the manpower required by the project; and (7) its financial requirements, including total capital expenditures of the project, sources of funding for the project, and actual and pro forma financial statements. Attachment A provides a working sheet for calculating source finances and application costs. Attachment B is a rate structure analysis computation sheet. ORDERING INFORMATION é Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-000 338 3 TITLE Interim Guidelines for Review and Comment. PAGES AND DATE 0015p Aug 74 CORPS RATE AUTHOBR/SPONSOR Regional Health Planning Council of the North Central Texas Council of Governments, Arlington. ABSTRACT Standardized procedures and basic review criteria to ensures that proposed health projects fulfill a community need and contribute to orderly planning processes are presented by the Regional Health Planning Council of North Texas. The guidelines for review and comment, a community process through which planners submit health proposals to areawide comprehensive planning agencies, are considered 'interim' because the role of areawide comprehensive health planning agencies in Texas is still evolving. The goals of the review process are stated in the context of areawide planning. - Significance criteria for determining the type of review-- community, agency or waived-- are -~4§4- discussed, as are criteria for determining the merits of a proposal. Local rationales for participation in the review and comment procedure are suggested; the review and comment process is described and diagrammed in a flow chart. Other procedural considerations are enumerated. The appendix contains a list of health programs sponsored by various government agencies. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0002724 TITLE : Nursing Home Supplement to Project Review Guidelines. PAGES AND DATE 0025p 1970 CORPORATE AUTHOR/SPONSOR Region Three Comprehensive Health Planning Council, Inc., Fort Wayne, Ind. ABSTRACT A nursing home questionnaire for Certificate of Need / 1122 and related reviews is presented. It consists of questions or instructions subdivided into the following seven areas: {1) a face sheet and certification, which requires a brief summary of the project; (2) an introduction; (3) a marketing analysis and justification of the proposed plan; (4) the philosophical foundation of the proposed facility; (5) a complete description of the project, including plot and interior plans, expected dates, bed capacity, zoning status of the property, a working plan to minimize environmental pollutants discharged or emitted from the proposed facility, and an analysis of parking or traffic flow patterns or problems resulting from the proposal; (6) the personnel necessitated by the project; and (7) its financial requirements. Attachments A and B provide computation forms for sources and applications and for rate structure analysis. -~4G- ORDERING INFIRMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003 38 2 TITLE Oklahoma Economic Development association. - Suggested Criteria standards for Facilities Review and Comment. PAGES AND DATE 0034 p 1971 CORPORATE AUTHOR/SPONSOR Oklahoma Economic Development Association, Beaver. i ABSTRACT suggested criteria and standards for Section 1122 facilities review and comment are presented by +he Oklahoma Economic Development Association (OEDA) as a starting point for area task for ces and for the O EDA Health Planning Council. - OEDA methods of administration are outlined, and review and comment procedures and appeal procedures are described. General guidelines and criteria are presented for consideration of hospital facility proposals, proposals for addition of inpatient beds, nursing home and nursing care facility proposals, and emergency medical service proposals. Included are methods of determining need for hospital and nursing home beds, and a specification of ambulance personnel, vehicle, and equipment requirements. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, springfield, Va. 22161 ORDER NUMBER HRP-0003990 -4"7 - TI TLE Policy and Procedures Manual. Determination of Need and Project Review. PAGES AND DATE 00 6 6p 1973 CORPORATE AUTHOR/SPONSOR New York State Dept. of Health, Albany, Div. of Health Facility Financing and Development. ABSTRACT A sunnary of New York State's certificate of need mechanisn, together with the philsophy and procedure for estimating future needs and the procedures followed in review of applications relative to need assessments, is presented primarily for the use of project sponsors in identifying criteria against which their applications will be reviewed. The background and development of the health facility planning and control program in New York are described. Planning principles, objectives, and policies are set forth. General planning principles are described in the areas of avoidance of unnecessary inpatient admissions, facility location, adequacy of site, projection of program, and safety of patients. Specific policies are described for general care hospital service, long-term care, ambulatory care, hospital-based emergency services, rehabilitation facilities, public health centers, tuberculosis facilities, hemodialysis units, and methadone maintenance programs. Procedures for determining quantitative needs for inpatient, outpatient, and specialty services are specified. General criteria for project review at the State and local or areawide levels are given. Criteria for mortgage loan feasibility studies also are described. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0004 023 =-48- TITLE Principles and Procedures for Planning and Review of Health services Proposals. PAGES AND DATE 00 11p Nov 74 CORPORATE AUTHOBR/SPONSOR Comprehensive Health Planning Association of Western Pennsylvania, Inc., Pittsburgh. ABSTRACT The principles and procedures utilized by the Comprehensive Health Planning Association of Western Pennsylvania, Inc. in reviewing proposals for the establishment or alteration of bealth facilities, services, and manpower projects are presented. The report reviews the purposes of principles for planning of hsalth services and lists five major guidelines. The health services review procedures are examined, and emphasis is placed on the proper sequence and opsrating policies. Information requirements for health services proposals are outlined. A schematic drawing of the sequence of formal review of health services proposals charts the course of the proposals from the applicant to-the Comprehensive Health Planning Association to the subarea advisory council, the community, and the appropriate public and voluntary agencies. ORDEEING INFORMATION Available NTIS, G.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003366 -49.- TITLE Principles and Procedures of Health Facility Planning and Review. PAGES AND DATE C0 23p Jun 71 CORPORATE AUTHOR/SPONSOR Kansas State Board of Health, Topeka. ABSTRACT Policy guidelines are offered for the provision of adequate facilities for health services for Kansas as part of the State Health Plan of Kansas. The material was developed by the Kansas State Board of Health for use by the State Office of Comprehensive Health Planning and areawide health planning councils. It consists of a discussion of the principles of health facility planning and the procedures for the review of health facility proposals. The pre-existing requirements for facilities review are described, and the additional procedures set up under comprehensive health planning are presented. - Criteria for good health facilities planning provide guidelines around which each areawide council can organize its goals, priorities, and recommendations for health facilities in its region. A review procedure for each areawide council to follow when examining health facility proposals is outlined. The dual review of health facility proposals, at the State and regional level, serves to guarantes that health facility construction will proceed in an orderly manner and will meet regional health facility needs as well as State and Federal requirements. ORDERING INFORMATION Available NTIS, U.S. Dept. Of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP- 0002329 -50- TITLE Procedure for Development of Health Systems Plan and Annual Implementation Plan. PAGES AND DATE C0 15p 29 Jan 75 CORPORATE AUTHOR/SPONSOR south Puget Sound Comprehensive Health Planning Council, Olympia, Wash. ABSTRACT Procedures for developing and implementing a health systems plan and for reviewing the Certificate of Need / 1122 are specified for the South Puget Sound, Washington, Comprehensive Health Planning Council. The 23 steps to be followed in proposing and carrying out a health systems plan are summarized and are presented schematically. The overview of the Certificate of Need review process includes a summary of the composition of the review and comment committee; the authority and general responsibilities of the review and comment committee, the subcouncils, and the regional council and staff; the specific responsibilities of the staff, acting in conjunction with the review and comment committee, regional or subcounzcils; the procedure for processing applications; and information to be provided by the applicant. Appendices contain the public meeting format for the Certificate of Need review, the conflict of interest statement, and criteria to be used in evaluating applications for Certificate of Need review. OA graph of the review process time frame is included. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003370 -$5{- TITLE Procedures and Criteria for Réview and Comment. - Certification of Need for Nursing Home Sub-Committee of the Areawide Health Planning Organization. PAGES AND DATE 0008p 22 Feb 73 CORPORATE AUTHOR/SPONSOR Areawide Health Planning Organization, Oklahoma City, OKHa . ABSTRACT The purpose of the Areawide Health Planning t Organization Sub-Committes for Certification of Need for Nursing Homes Construction is to provide comment on the need for specific construction or expansion proposals of nursing home facilities. The committee uses the critsria of community need, consistency with areawi de plans, the ability of the proposer organization to meet its stated objectives, and modifying factors effec ting specific and identifiable utilization trends. The committee's specific goals are described, and its functions and membership outlined. - The criteria for nursing home construction are also described. Work program objectives for 1973-1974 are listed, and a table presents projected nursing home bed need, using the estimated 1972 population aged 65 and over, and using Hill - Burton 1972 State Pian patient sdays. A final section delineates the boundaries of Oklahoma County. Portions of this documsant are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003213 -52. T Procedures and Guidelines for Processing Certificate of Need and Federally Assisted Applications. PASSES ANP DATE 0094 p 16 Sep 74 CORPORATE AUTHOR/SPONSOR North Shore Health Planning Council, Inc., Peabody, Mass. ABSTRACT Procedures to be followed by the North Shore Health Planning Council (Peabody, Massachusetts) in its certificate of need review 'activitises aro set forth-in s list of 16 quidelines. Potential applicants for cortificates of need are urged to discuss their proposals with staff or representatives of the review committee prior to preparing an application. Details of filing procedures are provided, and the process by which the review committee is to consider each application is described. It is noted that all proceciings of the review committee and of the board of trustees ani all -votes regarding Aecisions on applications and reviews of federally assisted programs are to be recorded on tape for the permanent public record. Policy for determining the need for site visits by review committee members is set forth. Sources of input to the review committsos -- consumer groups, community organizations, and health care providers in areas of proposed construction -- are identified. Procedures for reporting the committee's decisions regarding certificate of need applications are described. ORDERING INFORMATION Available NTIS, U«S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HEP-0010557 TITLE Procedures for Project Review. PAGES AND DATE 0006p oct 75 ~gg. CORPORATE AUTHOR/SPONSOR Health Planning Council for Central North Carolina, Durham. ABSTRACT A - progedural guide for project review concerning the establishmant and expansion of local health facilities and services is outlined by the Health Planning Council for Central North Carolina. This guide is designed for use by the Planning Council's Board, Committees, Task Forces, and staff in project review under Section 1122 of the Social Security Amendments, Circular A-95 of the U.S. Office of Management and Budget, or in response to requests from County Commissioners and other local groups and individuals. The 1122 project review process is outlined in detail to establish an objective and rational means for making decisions. All other reviews are to be treated in a manner similar to the non-Ssubstantive section of the 1122 review process. The project review process can serve to promote high quality health care by improving accessibility of services; guide prospective sponsors into areas of unmet need; provide increased opportunities for expression of community interest; conserve scarce manpower by encouraging cooperation and discouraging inappropriate programs; contain costs through elimination of duplication and stimulation of alternative means of providing care; and encourage programs that are adequately planned, staffed, and utilized, and discourage those that are not. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0005254 TITLE Procedures for Reviewing Hospital Construction Proposals In southeastern Michigan. PAGES AND DATE 00 18p 27 dun 723 CORPORATE AUTHODR/SPONSOR Greater Detroit Area Hospital Council, Inc., Mich. -54.- Comprehensive Health Planning Council of Southeastern Michigan, Inc., Detroit. ABSTRACT Five steps in the procedure to review hospital construction proposals are presented by the Greater Detroit Area Hospital Council and Comprehensive Health Planning Council (CHPC) of Southeastern Michigan. The review by the Hospital Council and CHPC is to obtain advice on whether a Certificate of Need application should be filed. The procedure specifies: (1) that there should be continuous interaction between the Hospital Council's planning staff and representatives of each hospital or community group actively engaged in planning; (2) that any hospital may request a periodic review of its planning by the Hospital Council's planning committee at any time to obtain objective advice and a general sense of direction; (3) at least six months prior to the expected date of application for a Certificate of Need, the Hospital Council and CHPC will, on request, carry out a program planning review; (4) at least three months prior to the expected application date for Certificate of Need, a simplified review of the specific construction proposal be furnished; and (5) after formal application for a Certificate of Need is filed with the State agency the Hospital Council and CHPC will make a pro forma review of the proposal and transnit its recommendations to the State agency. Detailed information is provided for each step in the review process. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDFR NUMBFR HRP-0005778 TIT LE § Procedures Manual of the Designated Planning Agency and the Subcontracting Arcawide Health Planning Agencies. Section 1122 of the 1972 Social Security Act. PAGES AND DATE 0031p 1973 -GB« CORPORATE AUTHOR/SPONSOR Maine Dept. of Health and Welfare, Augusta. ABSTRACT A procedures manual is presented for implementation of health planning agoncy responsibilities in the State of Maine under Section 1122 of the 1972 Social Security Act. Necessary operational definitions of bed capacity, capital expenditure, health maintenance organization, etc. are proessnted. - Areawide subcontracting agencies in Maine are listed and located on a map. Areas of attention for general project review are outlined, and mandated review criteria are given. The following areas are discussed: scheduling of projects for review and comment ; public notice of applications received; review time; findings and recommendations to the designated planning agency; process for capital expenditure applications; and letter of intent. A format to be followed in applying for review and recommendation is included, listing questions to be answered by the applicant. The appeal mechanism for applicants denied a favorable recommendation is explained and a list of material to be forwarded to the Department of Health, Education, and Welfare is given. Appendices include a form for notification of action under Section 1122; and forms for public announcement of receipt of initial complete proposals finding and recommendation, fair hearing, and outcome of fair hearing. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 2216 1 ORDER NUMBER HRp-00093646 TITLE Project Notification and Review Procedures Manual. PAGES AND DATE 0096p Apr 74 CORPORATE AUTHOR/SPON SOR Northeast Counties of Oklahoma Economic Development Association, Vinita. -56- i ABSTRACT a document prepared for the use of applicants for Federal assistance in programs available in the northeast counties of Oklahoma is presented which is designed to ancourage local comment and input concerning the many Federal programs being utilized in the area. Although primarily designed for the Project Notification and Review System (PNRS), additional information is presented concerning the Office of Management and Budget Circular A-102 process, the environmental assessment, and the southwest Regional Council tracking system. The document was developed utilizing information and direction from the Office of Management and Budget, the Oklahoma State Clearinghouse and all Federal agencies supporting programs in the area. The PNRS is discussed relative to purpose, scope and responsibility. Federal agency procedures and grant application forms are explained, and the roles, procedures and responsibility of the State Clearinghouse regarding direct Federal development projects, state plans, and programs with multipie funding sources are defined. The role of the clearinghouse in the preparation of environmental impact statements is discussed, and instructions for preparing these and certification statements are outlined. Appendices provide definitions of terms, sample application and statement forms, a list of Federal assistance programs available, and further information on the PNRS process. ORDEE ING INFORMATION Available NTIS, U.S. Dept. of Commerce, springfield, Va. 22161 ORDER NUMBET T IT LS Project Peview Guidelines. PAGES AND DATE 6025p 1975 CORBOBATE AUTHOR/SPONSOR region 3 Comprehensive Health Planning Council, Inc., Fort Wayne, Ind. -57- ABSTRACT Procedures and policies involved in applications for comprehensive health planning endorsement are reviewed for individuals or organizations wishing to initiate, expand, cut back or continue a health related program or facility. The report examines the various types of review to be undertaker, the relationship between early comprehensive health planning and a positive review, internal Health Planning Council procedures, actions to be taken on any proposal, input into the review process, the 1122 review process flow chart, review criteria for proposals, information needed in the proposal application, internal Region 3 Health Planning Council administrative procedures, and review cyclical target dates. ORDERING INFORMATION Avallable NTIS, U.S.: Pept.. ; of. Commerce, Springfield, Va. 22161 ORDER NUMBEP HRP-0003384 TITLE Project Review Manual. PAGES AND DATE C036p - fct 73 CORPORATE AUTHOR/SPONSOR Big Country Comprehensive Health Planning Council, Inc., Montrose, Colo. ABSTRACT Guidelines for the review and comment process of proposed new or expanded health facilities or services are presented by the Big Country Comprehensive Health Planning Council, Inc. for a six-county area in Colorado. The recent expansion of review and comment activities within the comprehensive health planning agencies is discussed, together with the importance of planning prior to review. The rationale for review in the planning process is presented and is viewed as a means of stimulating accessibility to services and guiding prospective sponsors -58- into areas of unmet needs. Conservation of scarce health manpower and containment of costs are other important considerations. Areawide and State agencies involved in the review process are listed and principles outlined for determining community need. General procedures for submitting applications for review are provided, and staff responsibilities for facilitating the orderly and prompt consideration of the application are given. Responsibilities of both the review committee and the Planning Council Board of Directors are outlined, and the review criteria used, which was formulated by the Colorado Health Facilities Advisory Council, is appended. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dbept. of Commerce, Springfield, Ya. 22161 ORDER NUMBER HRP-00044 33 TITLE Project Review Manual. PAGES AND DATE 0035p Feb 75 CORPORATE AUTHOR/SPONSOR f f Comprehensive Health Planning, Inc., Metropolitan Chicago, T1l}s PERSONAL AUTHOR Robert L. Devitt J. Kevin Eckert Jacolyn M. Schlautman ABSTRACT fay nos | The project review reponsibilities of Comprehensive Health Planning, Inc. Metropolitan Chicago, Illinois are dgscrlbed, and project review proceuures, policies, and criteria under Section 1122 are set forth. A flow chart depicting the project review process is included. Criteria for review and comment are specified in the following areas: determination of need for the project to meet the health service requirements of the community; determination of whether the project can be adequately staffed and operated when completed; determination of economic feasibility of proposed capital expenditure and accomodation in patient charge structure without unreasonable increases; determination of project's ability to foster cost containment through improved productivity and efficiency; determination of environmental impact by the project; and assurance of acceptable quality of patient care. Appendices delineate the legislative sources and powers for review and comment {Federal and State legislation)} and list agencies participating in review and comment in the area. The Metropolitan Chicago Comprehensive Health Policy Plan is outlined, and plan development is reviewed. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-000 3975 TITLE Project Review Manual. PAGES AND DATE 004 Op 1974 CORPORATE AUTHOR/SPONSOR ; Will - Grundy - Kankakee County Comprehensive Hea lth Planning Council, Jolisct, I11. ABSTRACT The review and comment procedures for health related project proposals in a three-county area of northea§tern Illinois are described and review procedures and criteria -GQ- are standardized. The manual is composed of four parts: (1) a description of the review and comment committee's membership, powers, and meetings; (2) project review procedures; (3) standards and guidelines for project review; and (4) appendices, including sources and powers of review and comment, and agencies participating in those functions. - A flow chart depicts the preliminary review and final review and comment procedure along a time framework. > Details of application letters of intent, process, and procedures are discussed. Standards and guidelines are listed for review in terms of facilities, manpower, finance, legislative conformance, consumer involvement, equipment, transportation, location and environmental use, operational planning, and evaluation. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-00034 48 TITLE Project Review Manual. Indiana. PAGES AND DATE 0054p 1 Nov 74 CORPORATE AUTHOR/SPONSOR Tri-State Aroa Health Planning Council, Inc., Evansville, Ind. ABSTRACT A reference manual for members of the Project Review Committee of the Tri-State Area Planning Council, Evansville, Indiana, provides a comprehensive view of Committee responsibilities and details the type, scope, rationale, nature, and impact of reviews assigned to the committee. In some cases, instructions regarding review methodology are specified. A framework for project review--goals, philosophy, approach, and interrelationships with other Council organizational -G@L= units and outside agencies--is also presented. Project review types and procedures discussed include Section .A122 rapita 1 expenditure, project notification and review system, environmental impact statement, 3144 and MCH, (Title ¥), regional medical program, emergency medical services training, emergency medical services system, addiction services, and non-mandate format. - Appendices include a list 'of committse members, flexible policy quif@eslines, a project summary and staff analysis, non-substantive review policy, a check-off system for determining project impact on the medically indigent, project review flow chart, Section 1122 flowchart, and A-95 summa ry notification .forms. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003612 TITLE Project Review. Procedures and Criteria: A Manual for Health Systems Agencies. AND DATE 0094 p 1976 CORPORATE AUTHOR/SPONSOR Heilth Planning / Development Center, Inc., Atlanta, Ga. Bureau of Health Planning and Resources Development, Rockville, #4, PERSONAL AUTHOR Alloys F. Branton Raphael B. Levine ArS TRACT An interim source book and guide for project review procedures and criteria is presenteil for use by health systems agencies. The stops an agency takes in performing a project review -62.- include administrative and policy procedures. Discussions of these procedures are organized according to the initiation of a review, the levels and typas of reviasws, the definition of staff functions, public hearings, ths review committee functions, governing body functions, and the closing of reviews. A sample set of procedures is supplied. The qualities the project must possess and the quantitative level of the criterion quality are examined. Criteria and standards are and the use of criteria and standards in project review is investigated. Extracts from the National Health Planning and Resource Development Act, P.L. 93-641, an outline of a modsl handbook for potential project proponents, a sample conflict of interest statement, and a sample project tracking form are appended. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 orRDER NUMBFR 014987 TITLE Reference Manual for Project Review Standards and Criteria. PAGES AND DATE 0134 p 7. Jan 74 CORFORATE AUTHOR/SPONSOR Tulane Univ., New Orleans, La. School of Public Health and Tropical Medicine. Department of Health, Education, and Welfare, ashington, D.C. Region TI. ABSTRACT This manual was developed to assist State and local planning agencies involved in the -~GQ- development of standards and criteria for 1122 review of capital expenditures by health care providers as designated by P.L. 92-603, the social Security Amendments of 1972. The manual is structured toward the development of specific and defendable standards and criteria. Policy issues each State must grapple with before designing the procedures or delegating responsibility to a planning agency for 1122 review and comment are outlined. Specific recommendations are made to determine the roles and relationships between state and local agencies involved. Comprehensive model standards and criteria are presented based on an analysis of standards and criteria used by planning agencies in Region IV for 1122 and certificate of need evaluation. The models and commentary are grouped under six major headings, four of which are based on the proposed regulations published in the 13 November 1973 Federal Register. A general task plan for States and communities to follow in developing standards and criteria is presented. Appendices include procedures for project review, a flow chart of the review and comment procedure, an annotated bibliography, and sections of the law and regulations. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0002502 TITLE Reference Manual for Project Review Standards and Criteria Covering Health Care Facilities and Health Services. PAGES AND DATE 0024 p Nov 74 -64- CORPORATE AUTHOR/SPONSOR Tennessee Dept. of Public Health, Nashville. Office of Comprehensive Health Planning. Community Health Service, Rockville, M4. ABSTRACT Guidelines are presonted for reviewing and commenting upon projects undertaken in Tennessee to improve health care services and facilitiss. The document outlines the major types of reviews carried out by the Tennessee Office of Comprehensive Health planning and gives the history of the authoriza-ion to establish a project review and comment committee. Among the guidelines used in the review and comment process are the need for standardization, the peer review process, separation of the dual aspects of planning and review and comment, the significance of review and comment in the decisionmaking process, implementation criteria, summary data on review activity, and publicity on project review decisions. The criteria used by the State Office of Comprehensive Health Planning in preparing review and comment reports covering health care facilities and health services arse outlined. - Procedures for preparing A-95 application review forms and certificate of need review forms are examined. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Ya. 22161 ORDER NUMBER HRpP-0003358 TITLE . f Review and Comment Guidelines. PAGES AND DATE 0024p 19 oct 74 -G5- CORPORATE AUTHOR/SPONSOR Comprehensive Health Planning Council of Region YII, inc., Elkins, @. Ya. ABSTRACT Application procedures and subsequent review process applied to evaluation of proposals involving deliverable health services in Health Region VII in West Virginia are presented. The sequence of events involved in the review of all proposals is described, as is the specific information required from applicants. Names and occupations of review committee members are provided; and the analytical process to be applied by the review staff in reviewing proposals is described. Finally, a sample of the project control log is provided. Portions of this document are not fully legible. ORDERING INFOPMATION Avallable NTIS, (U.S. Dept. of Commerce, SpringfieclA4, Ya. 22161 ORDER NUMBER §BP-00032 76 TITLE Review and Comment Manual. PAGES AND DATE £092p Jan 74 CORPORATE AUTHOR/SPONSOR Tulsa Area Health and Hospital Planning Council, Okla. ABSTRACT Instructions for submission of health care projects or programs for review are presented for member use by the Tulsa Area Health and Hospital Planning Council. Applicable to'the three Oklakoma counties of Tulsa, Osage, and -66- Creek, the review, comment and appeals process consists of a review and comment mechanism and an internal appeals mechanism. A flow chart illustrates the routing of proposed projects. The organizational structure of the planning council, including staff, technical advisory committees, board of directors, and planning council memberships is outlined. Guidelines for major program submission are provided with required information relating to history and organization, description of service area and service programs, manpower and staffing data, a description of the proposed program and any construction necessary to it, financial data, and any licensure or regulatory steps taken. Material indicating community support also is required. - Synopsis formats are included, and an outline is given of procedures followed by the facilities advisory committee, medical advisory committee, and nursing home advisory committee. Appendices contain a planning region map, pertinent laws, those Federal funding programs requiring review by the Comprehensive Health Planning Agency, coverage of health programs under circular number A-95, evaluation of financial feasibility, a glossary, and references. , Portions of this document are not fully legible. ORDERING INFORMATION s § Available NTIS, U.S. Dept. of Commerce, springfield, Va. 22161 ORDER NUMBER HRPp-00 044 07 TITLE Review and Comment Manual. Comprehensive Health Planning. PAGES AND DATE 0081p Nov 73 -67- CORPORATE AUTHOR/SPONSOR Mid-State» Committee on Area-Wide Health Planning, Inc., Utica, N. Y. Health Facilities Subcommittee. ABSTRACT Guidelines are presented for agencies submitting project applications for review and comment by comprehensive health planning agencies in mid-state New York. The manual is a composite of policies and procedures of many state and area-wide planning agencies. Rationale for review in the planning process and the importance of planning prior to review are discussed. Areawide, state, regional, and Federal agencies involved in the review process are listed and described. Some general comments on the review process are offered, relating to a simplified approach, use of a single coordinator, individual long-range plans, anticipation of projects, early discussions with sponsor, dissemination of information, data for planning and review, time table for review, and non-substantial projects. The internal review system of the Mid-State Committee on Area-Wide Health Planning, Inc., is described. Steps in the review process (receipt of application, staff review, subcommittee review of application, final actions) are delineated. Federal and state projects requiring areawide and state agency review are described; review and comment responsibilities of State and areawide planning agencies are summarized. Appendices include relevant legislation, criteria for review of health projects, guidelines for committses 'performing review and comment, a review and comment record form, and a glossary of health terms. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003 677 -68- TITLE j Review and Comment Manual. Comprehensive Health Planning. PAGES AND DATE 002 1p Jul 74 CORPORATE AUTHOR/SPONSOR Pee Dee Regional Development and Planning Council, Florence, S.C. ABSTRACT f Procedures are set forth for fulfillment of the review and comment responsibility of the Pee Dee Regional Planning and Development Council and the pee Dee Comprehensive Health Planning Council, which represent a six-county region in South Carolina. The structure and responsibilities of the council are described. Concepts to which criteria for review and basis for comments should be addressed are outlined. Organizational charts are included for both councils. Two checklists for review and comment, one prepared at the regional level and the other from the State Board of Health, are presented. The latter is categorized as follows: general considerations; need for the project; program goals; resources available; community relationships and support; agency relationships; evaluation; staff considerations; continuity; and cost-budget. Comprehensive criteria are presented for determining certificates of need. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003755 TITLE Review and Comment Manual. Guidlelines and Criteria, 1973. PAGES AND DATE 00 19p 1973 -69- CORPORATE AUTHOR/SPON SOR Superior California Comprehensive Health Planning Association Chico. ABSTRACT Guidelines, standardized procedures, and basic criteria for review of health-related grant applications by the Superior California Comprehensive Health Planning Association are presented. The basis for CHP review and comment is outlined, and four general review priniciples are set forth. It is noted that primary focus for review should be on the need for the project; that constructive help is preferable to negative comments without help; and that the 'open forum! is the preferable method of review. General review procedures (submissions; staff, council, ani board activities; conduct of meetings; actions) are described. A checklist of basic criteria for grant review is presented. Specific review and comment procedures are delineated. Appendices include a project summary form, a list of areawide comprehensive health planning agencies in California, and a list of programs requiring CHP review. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0004017 TIT LE Review and Comment Responsibilities of State and Areawide Comprehensive Health Planning Agencies. PAGES AND DATE 0027p Feb 73 CORPORATE AUTHOR/SPON SO R Comprehensive Health Pilanning Service, Rockville, Md. -70- ABSTRACT Sseneral principles and guidelines are set forth to assist comprehensive health planning (CHP) agencies in implementing their review and comment responsibilities with respect to ensuring that federally funded health projects are in accord with community nesds. CHP comments should generally be addressed to the following concepts: harmony of the project with general objectives of comprehensive health planning; needs of the population to be served; community attitudes regarding the project; availability of resources; extent of cooperation available with other resources serving the area; elimination of unnecessary costs; and ability of sponsor to continue project after Federal support ends. Procedural details are discussed for considering applications in several specific programs: - 314 (c) grants for training, studies and demonstrations in comprehensive health planning; 314 ({d) State plans for public health and mental health services; 314({e) health services development project grants; Hill -- Purton projects and State agency plans; regional medical program grants; migrant health grants; National Health Service Corps; Health Maintenance Organization grants and contracts; family planning project grants; community mental health center grants; communicable disease control grants; venereal disease control grants; health manpower programs; Health Services and Mental Health Administration centrally administered programs; narcotic addict rehabilitation projects; and alcohol abuse and alcoholism prog rams. ORDERING INFORMA TION Availabls from the Superintendent of Documents, U.S. sovernment Printing Office, Washington, D.C. 20402, $. 80. TITLE Review Guide. 1451. PAGES AND DATE 0019 Mar 74 =-71- CORPORATE AUTHOR/SPONSOR Golden Empire Comprehensive Health Council, Inc., Sacramento, Calif. ABSTRACT § Guidelines are furnished by the Golden Empire Comprehensive Health Council for individual proposals by health care facilities for the construction, expansion or alteration of these facilities to increase bed capacity cr to change license category. In an effort to promote the coordinated growth and development of hospitals and related health facilities to serve the best interests of the community, the Council is authorized to review applications for facilities licensed by the Department of Health ina six county area of California. Principles for the determination of community requirements are outlined; they include: need; availability and adequacy of existing facilities and ancillary services; the possible advantages to be derived from joint or shared resources; and the development of a comprehensive program. Application procedures are given in detail. Applications must include a narrative summary that outlines community need, financial means, physical plant, staffing, services offered, and standards for providing continuity of patient care in the community. Council decisions may be appealed and the procedures for filing an appeal are noted. The review process consists of an analysis of the proposal by the Council's planning staff, evaluation of the proposal by local health planning councils, a public hearing, and a public meeting of the Council's Board of Directors. Porticns of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-000 3826 TITLE Review of Health Facilities in VYermont. PAGES AND DATE 0 bec 74 CORPORATE AUTHOR/SPONSOR Vermont State Agency of Human Services, Montpelier. Comprehensive Health Planning. ABSTRACT Procedures for the review of health facilities are provided to assure that any additional capital investment in health facilites in Vermont is really needed. This regulation is necessary because no market mechanism exists to limit the supply of facilities and services to what is needed. The current excess of hospital and nursing home beds in Vermont attests to this necessity. These review procedures emphasize public participation through public hearings, service on citizen review boards, and agency staff working with local citizens. The first step in the review process consists of the selection of such review committses as the designated planning agency review committee, local review committee, and review coordination committee. The six steps in the application for review process are outlined. - Procedures are also described concerning full review of applications and the functions of DHEW in the review process are discussed. Appendices contain proposed bases for review of capital expenditures, construction, and expansion. ORDERING INFORMATION Avallable NTLSyp U.S..Dept. of Commerce, Springfield, Va.. 22161 ORDER NUMBER HEP-00094 61 TITLE Rule§ and Regulations for Capital Expenditure Reviews under Section 1122, Social Security Act. PAGES AND DATE 00 3 4p Mar 74 -FG CORPORATE AUTHOR/SPDNSOR South Carolina State Dept. of Health and Environmental Control, Columbia. Office of Comprehensive Health Planning. ABSTRACT Rules and regulations for capital expenditure reviews under Section 1122 are provided to familiarize South Carolina applicants with review and comment procedures and activities. The State Comprehensive Planning Agency is designated the administering body, with other State agencies requested to comment as required. A list of areawids planning agencies is provided, as are definitions to be used in the application of these rules and regulations. Specific information to be included in the application is outlined, and disposition of the application described. Review and recommendation alternatives include a standard review, a nonsubstantive review, and an elected not-to-review. Supplemental information required for application is also described, as are penalties for noncompliance. Review criteria basically include the following: (1) community need for the proposed facility or service, (2) ability of the applicant to adequately staff the facility, (3) economic feasibility of the facility, and (4) cost containment. Review and reporting procedures of the areawide planning agencies, the Designated Planning Agency, and other planning agencies - are outlined. ORDERING INFORMATION Avallable «TIS, U.S. bept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-000 3316 TITLE Suggested Health Planning Council Review Process for Certificate of Need. PAGES AND DATE C0 O0 5p 15 Jan 74 - 74A CORPORATE AUTHDOR/SPONSOR Comprehensive Health Planning Council of South Florida, Inc., Miami. ABSTRACT A systen for Certificate of Need review by health planning councils is suggested by the Comprehensive Health Planning Council of South Florida. The following elements of the review process are discussed: (1) letter of intent to submit a petition; (2) submission of completed petition; (3) referral of petition by Board to appropriate task force of committee; (4) staff analysis of petition; (5) task force or committes hearing, at which applicant and others may present oral arguments pro and con; (6) Board hearing, at which task force or committee recommendation is reviewed and limited oral arguments by applicant and others are heard; and (7) notification of applicant and appropriate agencies of Board's action. The importance of an orderly, consistent decision - making process in the fulfillment of a health planning council's review role is noted. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-00048 78 III--EXAMPLES OF APPLICATION REVIEWS TIT LE Capital Expansion Program. Project Number 73-0356-1. PAGES AND DATE 006 0p 17 Jan 74 CORPORATE AUTHOR/SPONSOR Comprehensive Health Planning of Northwest Zllinois, Inc., Rockford. ABSTRACT The report of the staff of Comprehensive Health Planning of Northwest Illinois, Inc., on an application by Rockford Memorial Hospital for Section 1122 review and comment with regard to a proposed capital expansion program (a four-story addition and renovation of existing hospital complex) is presented. The report incorporates the following: an assessment of the propriety of the proposal; a summary description of the proposal (current health care services affected, scope of services to be provided, general effect on health care delivery system, nature and purpose of construction and / or capital equipment involved, estimated total capital expenditures, expected operational date, proposed service area, ability to comply with legal requirements, and evidence of prior planning and community relationships); and a detailed evaluation of applicant's proposal by selected criteria, including projected utilization estimates and support ing documentation The economic feasibility of the proposed project is examined, including considerations of financial impact on patients and on the community and cost containment; statements of income and expense and of cash flow for the first five years after completion of the expansion program are included. Staff comments are presented with regard to each of the hospital services to be affected by the proposed expansion; approval is given to the addition of a high-risk newborn nursery, an ambulatory care center, and rehabilitation center, as well as the expansion of the diagnostic laboratory. Medical / surgical bed expansion is not approved. A lack of coronary care unit bed utilization data -717~ is noted. Appendices include supporting documents and additional tabular data. Portions of this document are not fully legible. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0004 383 TITLE Capital Expenditure Review for the Purchase of a Computerized Tomography {(CT) Scanning Device by the Fairfax Hospital Association. PAGES AND DATE 0031p 18 Nov 75 CORPORATE AUTHOR/SPONSOR Comprehensive Health Planning Council of Northern Virginia, Falls Church. PERSONAL AUTHOR Jeffrey Human ABSTRACT The review of a certificate of need request concerning the proposed purchase of a computerized tomography (CT) scanning device by the Fairfax (Virginia) Hospital Association (FHA) is documented. The review was performed by the staff of the Comprehensive Health Planning Council of Northern Virginia preparatory to making its recommendation to the Commissioner of Health and the Virginia Health Department, concerning approval of the purchase. A background discussion and summary of the proposal is presented, together with a summary of the FHA application, which requests approval to purchase a scanning device without specifying which specific device will be purchased. The staff analysis of the proposal includes consideration of community need for computerized tomography, including investigation of the current utilization of various CT -7178- devices in other communities; quality of care considerations; cost considerations; and other considerations. The staff concluded that evidence warrants the purchase of a CT scanning device by the FHA and recommended that approval for the capital expenditure be granted. Proof of the diagnostic effectiveness of the CT scanner, an estimate of need based on a methodology using the numbers of three types of neurodiagnostic procedures performed, and the size of the neurosurgical caseload of FHA are cited as factors in the recommendation. The staff also suggested that comparison of the three CT machines on the market with clinical experience in non-experimental settings indicates that the Delta Scanner is apparently preferable to the ACTA Scanner, and is superior to the EMI Brain Scanner in that it has extra-cranial scanning capability and is as effective as the EMI in scanning the head. Additional recommendations are offered concerning the coordination of future development of CT technology in Yirginia. Supporting documents are appended. ORDER ING INFORMATION Available STIS, U4.S. Pept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP- 00062 78 TITLE End Stage Renal Disease Certificate of Need Application. Review Guidelines. PAGES AND DATE 8019p Aug 74 CORPORATE AUTHOR/SPONSOR Kou Jorsey Regional Medical Program, Inc., East Orange. ABSTRACT Review guidelines for applications for initiation and /] mY expansion of end stage renal disease facilities are proposed by the New Jersey Regional Medical Program. Applications for acute hemodialysis services in hospitals not presently providing these services should be reviewed -~40G«- according to these criteria:; 24 acute cases during the previous 12 months; absence of nearby Chronic Renal Disease Center; and facilities for intensive care and availability of all professional requirements established by the New Jersey Department of Health., 'To consider current facility adequacy and future need of maintenance hemodialysis services, the following considerations must be reviewed: general population growth, the population at-risk, and utilization of resources. Organ availability is the primary determinant of transplant activity and no accurate projections can be made. Facility personnel standards for chronic renal disease centers and transplant centers must comply with the Manual of Standards of the Department of Health. The appendix contains an approved facility inventor and a hemodialysis caseload projection for 1974-1980. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0005514 TT TLT! Long Tern Care - Review Actions. PAGES AND DATE N148p bec 75 TORPORATE AUTHOR/SPONSOR south Central Connecticut Comprehensive Health Planning, Inc., New Haven. ABSTRACT All review actions taken by the South Central Connecticut Cconprshensive Health Planning, Inc. Board of Directors between Jungs 1, 1973, and December 10, 1975, on proposals involving funding for long-term care programs are reported. Included are reviews of proposed extended care facilities, services for the elderly, home care programs, and transportation requests for the benefit of the elderly and the chronically ill. The report includes brief statements of the policies followed by the Board -80Q- in its review activities. The Board's actions in assessing proposals for two additional long-term care facilities are described in particular detail as an example of how such capital expenditure reviews are conducted. The bulk of the document consists of a number of exhibits: copies of correspondence; a report on the effects of Medicare and Medlicaid. on the utilization of health care facilities; a summary of a collaborative effort between South Central Connecticut Comprehensive Health Planning, Inc., and the Yale hefiical School on long-tarm care for the elderly and the disabled; an executive summary of an evaluation report on a transportation project for the elderly and the handicapped; and other supporting documentation and data. oRDERING INFORMATION Available. NTIS, U.S. -Dept s.-of conmerce, Springfiscld, Va. 22161 ORDER NUMBER HRP-0012187 TITLE st. Anthony Hospital, Rockford. - Staff Rept. PAGES AND DATE 00 31p 17 Dec 73 ORPORATE SOR f z C Comprehensive Health Planning of Northwest Illinois, Inc., Rockford. BSTRACT $.. , $ * A report on the proposed addition of a six bed burn unit, to St. Anthony Hospitql, Rockford! 11112015, is presented as part of the Sectlon'1122 review anriet comment procedure regarding §he project. The prifimar Y of the applicant's proposal is gsses§ed,_and a s ludizg' description of the proposed prOJect 1s gllrené 1nco $ $ (1) current health care services affected; (2) scop -81- Report on the Burn Unit Project (Number 73-0344- 1) Proposed by of services to te provided; (3) general effect of proposal on the health care delivery system; (4) nature and s purpose of construction and capital equipment involved; (5) estimated capital expenditures for the project; (6) expected operational date; (7) proposed service >] area; (8) ability to comply with legal requirements; and (9) evidence of prior planning and community relationships. The application is evaluated by the following criteria: need, staffing, economic feasibility, cost containment, and evaluation mechanisms. The staff recommends that cooperative agreements and / or committments from region hospitals and physicians to refer burn patients to St. Anthony Hospital be obtained, and that a four - bed burn unit be built. It is recommended that the progress of the unit be monitored and evaluated at the end of the first year, and, if demand so indicates, the unit should then be expanded to six beds. Development of standards and criteria aimed at elimination of unnecessary referrals to the burn unit also is recommended. Appendices include a list of equipment to be incorporated into the proposed unit; a discussion of the Feller - Crane method for determining need for specialized burn resources; and additional supporting data. Portions of this document are not fully legible. ORDER ING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-000454 2 TITLE Report on the Certificate of Need Application of the College of Medicine and Dentistry of New Jersey for a 486 Bed Teachin fospital. f PAGES AND DATE 005 1p 26 Nov 74 -82- CORPORATE AUTHOR/SPONSOR Hospital and Health Planning Council of Metropolitan New Jersey, InC., Newark. ABSTRACT results of the review and comment procedure applied to the Certificate of Need application for a 486-bed teaching hospital for the New Jersey College of Medicine and Dentistry are presented in this report of the Hospital and Health Planning Council of Metropolitan New Jersey. The Council concluded that the College had not demonstrated a definitive need for the 486-bed teaching hospital, but it recognizes the need for, and will support a strategically planned facility of reduced size and scope. Observations are presented on the relationship of the teaching hospital to community medical service delivery and needs. The opportunity of building an institutional base for a comprehensive educational program using both new university facilities together with existing facilities is discussed. Certificate of need criteria are outlined, and each specific point is followed by the review committee's comment. - A staff analysis of the proposal is given, taking into consideration the following factors: primary health care to Newark residents; regional health care needs; and teaching and research needs of the medical school. Appendices present tables of supplementary data. ORDEEING INFORMATION Available NTIS, U.S. Dept. of Commerce, springfield, Va. 2216 1 ORDER NUMBER HREP- 00044 2 7 T IT LE Technical Review of a Proposal for a Hemodialysis Facility at Los Robles Hospital. PAGES AND DATE 004 0p Jan 73 -~83~ CORPORATE AUTHOR/SPONSOR Channel Counties Comprehensive Health Planning Council, Santa Barbara, Calif. PERSONAL AUTHOR Roger H. McDonald ABSTRACT Background information is provided to assist the Channel Counties, California, Review Committee to assess the need for the five bed hospital - based chronic hemodialysis facility proposed by Los Robles Hospital in Thousand Oaks, California. On the basis of projected patient build-up and the operating schedules presently followed by the other five-bed facility located at St. John's Hospital in Oxnard, California, there is a need for additional beds to serve the projected patient load in 1973 and 1974. In conjunction with the existing facility, the proposal submitted by Los Robles should satisfy this need through 1973, although expansion of one or both facilities may be necessary in 1974. Assuming that patient costs are not an important criterion in deciding between centralization and decentralization of chronic hemodialysis facilities, it would appear that adoption of the proposal would offer significant advantages to the chronic hemodialysis patients residing in the County. Appendix A shows the California patient flow for 1970 and 1971. Appendix B reviews the technical procedures used in analyzing the need for the proposed facility. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0003339 a* -84- IV--OTHER RELATED REFERENCES TITLE Capital Projects for Health Care Facilities. PAGES AND DATE 026 4p 1976 CORPORATE AUTHOR/SPONSOR Medicon, Inc., Philadelphia, Pa. Amarican Medicorp, Inc., Philadelphia, Pa. PFRSONAL AUTHOPR William J. Essick Peter Bentivegna W. Thomas Berriman ABSTRACT Guidelinas for administrators involved in designing, building, and financing capital projects in health care facilities are presented. An underlying assumption is that the reader has a particular project at hand and is more interested in how to carry out the project than in whether the project should be undertaken. One exception is a discussion of how to identify projects that are not economically fsasible for their sponsors. Opening chapters present an overview of alternate approaches to a project and of the stages of a project. The stages include internal planning, feasibility determination, implementation, construction, start-up, and audit. Each stage is described briefly, and a graphic illustration of their interrelationship is provided. The second section examines planning and external controls and includes a review of comprehensive health planning efforts, the provisions of the National Health Planning and Resources Development Act of 1974, State certificate of needs programs, and Medicare planning requirements. The role of the institutional governing board in planning is described, and the elements of a long-range institutional plan -- role determination, examination of needs, physical location, goal setting, projects, and implementation staging -- are outlined. Controversies concerning comprehensive planning approval of the capital projects of health care institutions are discussed. subsequent chapters address internal control over capital projects, offering guidelines for selecting the project team, determining design and construction processes, and examining contractual provisions. Factors affecting the financing of a project are delineated, and sources of long term financing are described. Effective permanent financing costs expressed as interest rates are compared for a conventional mortgage, a Federal Housing Administration - insured loan with Government National Mortgage Association backing, a tax-exempt authority -85- bond issue, and Hill - Burton Suaranteed Loan with interest subsidy. Supporting documentation, including standard forms of agreement between owner and architect and owner and contractor, are appended. An index, a glossary, and a bibliography are provided. orDERING INFORMATION Available from Aspen Systems Corporation, 20010 Cantury Boulevard, Sermantown, M4. 20767. TITL® ®xzhangse of Information Between Hospital Rate Setting andi Cartificate of Need Agencies: Selected State Experiences. Working Paper. PAGFS AND DATE 0085p Oct 76 CORPORATE AUTHOR/SPONSOR Harvard Zenter for Community Health and Medical Care, Boston, Mass. Social Security Administration, Washington, D.C. Piv. - of Health Insurance Studies. PFRSONAL AUTHOR Jonathan B. Brown Diane Rowland Margaret Sweetland ABSTRACT The exchange of information between and within the orjanizations that share regulatory authority over medical cars institutions in New York, Arizona, and Connecticut is Aiscussei. New York provides several examples of information sharing between certificate of need and rate setting bodies. The most successful linkages are sail to be the financial feasibility analyses that accompany each certificate of need review and the architectural cost monitoring that acconpanies the process of planning and construction. One lesson that emerges from the New York axperience is the impact on information sharing of a regulatory structure administered in one agency led by one decisionmaker. The integration of rate review and regulatory functions in Arizona is sail to offer -86- several advantages: good communication between rate review ani certificate of need analysts, as well as with licensing and certification reviewers; full access by analysts at the Stats and arsa levels to each sthoers' files; the need for only -one filing package from applicants for certificate of need and rats review for use by both State and local agencies}; and more informed decisionmaking. The Arizona system is handicapped by the fact that rate recommendations are not enforceable and by inadequate numbers of staff analysts. Connecticut's Commission on Hospitals and Health Care is said to provide a vehicle for close coordination of rate review and facility proposal review. However, the opportunity for closely aligned information activities has not been fully utilized due to both internal and external constraints. ORDERING INFORMATION Avallabls NTIS, U.3. Dept. of Commerce, SpringfiglA, Va. 2216 1 oRDER NUMBER HRP-0O0 14698 TITLE Legal and Business Problems of Health Maintenance Organizations. PAGES AND DATE 0214 p 1974 CORPORATE AUTHOR/SPONSOR Practicing Law Inst., New York. ABSTRACT A course handbook, intended as a supplement to a 1974 program held at the Practicing Law Institute, outlines the legal, commercial, and political structure of health maintenance organizations (HMOs) and describes their legislative history and barriers to their growth. The complex description of HMOs contained in the final -87- version of P.L. 93-222 is shown to be different from the administration's prototype and its historical antecedents; the full text of the Act is provided along with an extrapolated outline. Federal and State constraints to HMO commercial success are delineated, and needed legislative remedies are suggested. Structural alternatives are examined relative to financial considerations. Regulation of the HMO under Certificate-of-Need legislation is analyzed as is the assistance available for HMO development in underserved areas. Cases cited in the outline are indexed and a selected bibliography is included. NOTES This is Course Handbook Series Number 115. ORDERING INFORMATION Available from Practicing Law Institute, Order Yerification Dept., 910 7th Ave., K.1., K.Yf. 19019, $20.00. TITLE Legal Implications for Health Systems Agencies. Volume I: series of Legal Briefs on P.L. 93-641. PAGES AND DATE 009 5p 16 Sep 75 CORPORATE AUTHDR/SPONSOR Public Health Service, Rockville, M4. Mountain Ramparts Health Planning, Inc., Asheville, N.C. PERSONAL AUTHOR Robert J. Deutsch Joseph Schatz -88- a ABSTRACT A series of legal briefs concerning the National Health Planning and Resources Development Act of 1974 (P.L. 93-641) is presented as an aid for attorneys involved in assisting health planning organizations. Together with a companion document intended for volunteers serving on the governing boards of health planning organizations, Volume I focuses on the Health Systems Agency (HSA), the health planning and development organization established by the Act to serve local communities. Both documents view the Act as it relates to North Carolina law. Beginning with a description of the process of HSA designation by the Secretary of Health, Education, and Welfare, including model Articles of Incorporation and Bylaws, the document attempts to explain and prescribe methods of HSA operation after designation has been obtained. An overview of HSA functions, review functions of HSAs, the fair hearing board model vs. the technocratic model, HSA legal liability, Section 509 (a) of the Internal Revenue Code, Stat2 Certificate of Need law, and subarea councils are among the topics discussed. It is noted that the concepts presented were conceived prior to promulgation of Federal regulations and guidelines implementing the Act. NOTES Yolumne II is available as HRP-0007632 from NTIS. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0007633 -89- TITLE Legal Problems of Hospitals and Nursing Homes. PAGFS AND DATE 0224p 1974 CORPORATE AUTHOR/SPONSOR Practicing Law Inst., New York. ABSTRACT A manual composed largely of citations to available written naterial is provided as an aid to participants in the Legal Problems of Hospitals and Nursing Homes, held July-August 1974 at the Practicing Law Institute, New York City. Procedural steps are outlined {with references to Federal and State precedents) for provider reimbursement determination under Medicare and Medicaid. Prehearing procedures, the provider's right to an administrative hearing after an unfavorable audit, his right to judicial review of reimbursamant issues, and the rights of the patient are discussed. Outlines of Professional Standards Review Organizations and the Occupational Safety and Health Act of 1970 are accompanied by citations from the Acts and from administrative codes. The texts of the Labor Manageneart Relations Act of 1947 and the Senate report of 1974 or the amendment to cover nonprofit hospitals under the National Labor Relations Act are included in the outline of labor - management relations problems in health care institutions. Federal and State requlations of capital expenditure and service offerings, Certificate-of-Need laws, and Section 1122 of the Social Security Act are outlined. The history and the implications of these regulations are discussed in an article reprinted from the Virginia Law Review. An index to cases cited in the outlines and a selected bibliography are appended. ORDERING INFORMATION Available from Practicing Law Inst., Order Verification Pept., S10 jth Ave., N.Y., NYC $20.00. >~90- TITLE * New Hampshire Data Manual for 1122 Review. PAGES AND DATE 0169p Jun 75 CORPORATE AUTHOR/SPONSOR Dartmouth Medical School, Hanover, N. H. Dept. of Community Medicine. Tri-State Regional Medical Program, Boston, Mass. ABSTRACT A data manual is described that was developed for use by New Hampshire in conducting 1122 reviews of health facility expenditures. Section 1122 of the Social security Amendments (P.L. 92-603) requires that a State designated planning agency (DPA) be responsible for reviews of proposed health facility development programs. Because the DPA is a key element in the Federal reimbursement process and because it is essentially an arm of State government, New Hampshire as well as other States have considerable influence on how health care systems are developed. Coupled with a statewide plan for health care, the DPA is a significant factor in health care policy-making. Federal criteria for the review of health facility capital expenditures are presented, and two major considerations essential to efféctive health planning are noted: (1) population receiving services; and (2) facili+ies providing services. Concepts important in New Hampshire facilities review are outlined in relation to nosed determination, health facility program staffing and organizational structure, economic feasibility of program objectives, and efficiency and productivity requirements of a proposed health care facility. The following aspects of 1122 review are considered in the data manual: - hospital service areas, demographic and socioeconomic characteristics, health status, manpo¥Yer, and facility utilization and costs. Data items included in the manual were selected for their general relationship to the construction or expansion of hospitals and nursing homes. ORDERING INFORMATION Available NTIS, U.3. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER HRP-0009464 -91- 20 @@ TITLE What Does 'Economically Feasible' Mean to a Regional Health Planning Agency. PAGES AND DATE 00 12p Apr 75 CORPORATE AUTHOR/SPONSOR Region 3 Comprehensive Health Planning Council, Inc., Fort Wayne, Ind. ABSTRACT A summary is presented of critical issues to be explored in the analysis of financial feasibility as one component of the capital expansion review process. An overview is given of financial data sources and resources needed. Analysis of financial statements by review agencies is discussed, with emphasis on rate structure analysis as a powerful and revealing tool yielding per diem rate and per diem cost figures. Analysis and computation of ratios are reviewed, and industry ranges for ratios are given. ORDERING INFORMATION Available NTIS, U.S. Dept. of Commerce, Springfield, Va. 22161 ORDER NUMBER UHRP-0003379 -92- I y NAME Bentivegna, Peter . Berriman, W. Thomas Bicknell, William J. Branton, Alloys F.. Brown, Jonathan B.. Chapman, Thomas.... Cohen, Harris S.... Correia, Eddie..... Curran, William J.. Deutsch, Robert J.. Devitt, Robert L... Eckert, J. Kevin... _William J.. Glantz, Leonard H.. Halvorsen, Susan IL. Havighurst, Clark c Hochheimer, Jean L. Human, Jeffrey ..... Hyde, G. Collin... .. Jacobson, Solomon G Johns, Lucy.....;.. Levine, Raphael B.. AUTHOR INDEX -93- PAGE 93 93 66 94 41 19 18 12, 24 +96 y 63 63 93 31 21 31 84 43 31 41 66 Mason, JOhn R.. @@ s sit sls ssirns ss +r a's sin's s r ¥ rje s v8 s * # s 6 McDonald, ROGEL H..... ... «.+ ss woe sees a nace aoe e s ak s a w ec s 90 Miller, Henry sale sials'e a aoe. sis sie s a b aos 41 Moseley, George B...... . +s ese se ec ce ccs vla's ale ais aon on's as s 24 _N_ NOFLORN, JONN «« «wa «eosla s soele aoele sie sles s a) e a sisie » 17 _O_ Ober; ELLGN «rw sess sin's s slack bus ece aso a nle sis 12 _P_ Paretta, RODGLE .L. «««« ase sa oa aw ro ele e son aoe eels boe acb 6 a's 44 Puglisi, DOnald ««« s a's« os sin 666 60 sis s s/s e s + s 44 _R_ Raphagl, ..... ass son aon son aon bie aon aa 60+ 41 ReiGer, AlAM uas e sinln'e aon sles s sona a noelle s 6 Rothenberg, ELlGeanOF@...... ... « es e e e e ee e ece e e e e e e es 6 e® 8 Rowland, «««« «««« + « «s slsle a soe s aa e aoe soe a sos ais s a a os 94 _S_ a i.. i% .+ n aon ai alban loon noelle a ace ania a si 90s 96 Schlautman, Jacolylh ess sess ee 60 ks «¢ .++ 63 Steele, Richard J...... s ais s a n s a siele s wok s a % o a a 8 8 a % 12 Sweetland, MargArQlt.. ..... +a. «res ew ss sie e e ee sis s 6 e aoe s s 94 ..W_ Walsh, Diana Chapman....... a i a's's 'a % aa bence s ance a son aoe ao be # 7 Ward, David «uus «wss. ess sis's s aoa a aon tidings aon a s s 31 -94- Le r BHPRD@® U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration Bureau of Health Planning and Resources Development DHEW Publication No. (HRA) 77-14541 EEEEEEEEEEEEEEEEE word €O28992175