§ 131E-183. Review criteria. - North Carolina Statutes

§ 131E‑183.  Review criteria.

(a)        The Department shall review all applications utilizing thecriteria outlined in this subsection and shall determine that an application iseither consistent with or not in conflict with these criteria before acertificate of need for the proposed project shall be issued.

(1)        (See note) Theproposed project shall be consistent with applicable policies and needdeterminations in the State Medical Facilities Plan, the need determination ofwhich constitutes a determinative limitation on the provision of any healthservice, health service facility, health service facility beds, dialysisstations, operating rooms, or home health offices that may be approved.

(2)        Repealed by Session Laws 1987, c. 511, s. 1.

(3)        The applicant shall identify the population to be served bythe proposed project, and shall demonstrate the need that this population hasfor the services proposed, and the extent to which all residents of the area,and, in particular, low income persons, racial and ethnic minorities, women,handicapped persons, the elderly, and other underserved groups are likely tohave access to the services proposed.

(3a)      In the case of a reduction or elimination of a service,including the relocation of a facility or a service, the applicant shalldemonstrate that the needs of the population presently served will be metadequately by the proposed relocation or by alternative arrangements, and theeffect of the reduction, elimination or relocation of the service on theability of low income persons, racial and ethnic minorities, women, handicappedpersons, and other underserved groups and the elderly to obtain needed healthcare.

(4)        Where alternative methods of meeting the needs for theproposed project exist, the applicant shall demonstrate that the least costlyor most effective alternative has been proposed.

(5)        Financial and operational projections for the project shalldemonstrate the availability of funds for capital and operating needs as wellas the immediate and long‑term financial feasibility of the proposal,based upon reasonable projections of the costs of and charges for providinghealth services by the person proposing the service.

(6)        The applicant shall demonstrate that the proposed projectwill not result in unnecessary duplication of existing or approved healthservice capabilities or facilities.

(7)        The applicant shall show evidence of the availability ofresources, including health manpower and management personnel, for theprovision of the services proposed to be provided.

(8)        The applicant shall demonstrate that the provider of theproposed services will make available, or otherwise make arrangements for, theprovision of the necessary ancillary and support services. The applicant shallalso demonstrate that the proposed service will be coordinated with theexisting health care system.

(9)        An applicant proposing to provide a substantial portion ofthe project's services to individuals not residing in the health service areain which the project is located, or in adjacent health service areas, shalldocument the special needs and circumstances that warrant service to theseindividuals.

(10)      When applicable, the applicant shall show that the specialneeds of health maintenance organizations will be fulfilled by the project. Specifically,the applicant shall show that the project accommodates:

a.         The needs of enrolled members and reasonably anticipated newmembers of the HMO for the health service to be provided by the organization;and

b.         The availability of new health services from non‑HMOproviders or other HMOs in a reasonable and cost‑effective manner whichis consistent with the basic method of operation of the HMO. In assessing theavailability of these health services from these providers, the applicant shallconsider only whether the services from these providers:

1.         Would be available under a contract of at least five years'duration;

2.         Would be available and conveniently accessible throughphysicians and other health professionals associated with the HMO;

3.         Would cost no more than if the services were provided by theHMO; and

4.         Would be available in a manner which is administrativelyfeasible to the HMO.

(11)      Repealed by Session Laws 1987, c. 511, s. 1.

(12)      Applications involving construction shall demonstrate that thecost, design, and means of construction proposed represent the most reasonablealternative, and that the construction project will not unduly increase thecosts of providing health services by the person proposing the constructionproject or the costs and charges to the public of providing health services byother persons, and that applicable energy saving features have beenincorporated into the construction plans.

(13)      The applicant shall demonstrate the contribution of theproposed service in meeting the health‑related needs of the elderly andof members of medically underserved groups, such as medically indigent or lowincome persons, Medicaid and Medicare recipients, racial and ethnic minorities,women, and handicapped persons, which have traditionally experienceddifficulties in obtaining equal access to the proposed services, particularlythose needs identified in the State Health Plan as deserving of priority. Forthe purpose of determining the extent to which the proposed service will beaccessible, the applicant shall show:

a.         The extent to which medically underserved populationscurrently use the applicant's existing services in comparison to the percentageof the population in the applicant's service area which is medicallyunderserved;

b.         Its past performance in meeting its obligation, if any,under any applicable regulations requiring provision of uncompensated care,community service, or access by minorities and handicapped persons to programsreceiving federal assistance, including the existence of any civil rightsaccess complaints against the applicant;

c.         That the elderly and the medically underserved groupsidentified in this subdivision will be served by the applicant's proposedservices and the extent to which each of these groups is expected to utilizethe proposed services; and

d.         That the applicant offers a range of means by which a personwill have access to its services. Examples of a range of means are outpatientservices, admission by house staff, and admission by personal physicians.

(14)      The applicant shall demonstrate that the proposed healthservices accommodate the clinical needs of health professional trainingprograms in the area, as applicable.

(15)      through (18) Repealed by Session Laws 1987, c. 511, s. 1.

(18a)    The applicant shall demonstrate the expected effects of theproposed services on competition in the proposed service area, including howany enhanced competition will have a positive impact upon the costeffectiveness, quality, and access to the services proposed; and in the case ofapplications for services where competition between providers will not have afavorable impact on cost effectiveness, quality, and access to the servicesproposed, the applicant shall demonstrate that its application is for a serviceon which competition will not have a favorable impact.

(19)      Repealed by Session Laws 1987, c. 511, s. 1.

(20)      An applicant already involved in the provision of healthservices shall provide evidence that quality care has been provided in thepast.

(21)      Repealed by Session Laws 1987, c. 511, s. 1.

(b)        The Department is authorized to adopt rules for the reviewof particular types of applications that will be used in addition to thosecriteria outlined in subsection (a) of this section and may vary according tothe purpose for which a particular review is being conducted or the type ofhealth service reviewed. No such rule adopted by the Department shall requirean academic medical center teaching hospital, as defined by the State MedicalFacilities Plan, to demonstrate that any facility or service at anotherhospital is being appropriately utilized in order for that academic medicalcenter teaching hospital to be approved for the issuance of a certificate ofneed to develop any similar facility or service.

(c)        Repealed by Session Laws 1987, c. 511, s. 1. (1977, 2nd Sess., c. 1182, s. 2; 1981, c. 651, s. 7; 1983, c. 775, s.1; c. 920, s. 2; 1983 (Reg. Sess., 1984), c. 1002, s. 10; 1985, c. 445, s. 1;1987, c. 511, s. 1; 1991, c. 692, s. 6; c. 701, s. 2; 1993, c. 7, s. 6; 2001‑242,s. 3.)