Section 127200 Of Chapter 1. Health Planning From California Health And Safety Code >> Division 107. >> Part 2. >> Chapter 1.
127200
. Taking into consideration the basis for decision set forth
in Section 127165:
(a) The office may, in individual cases, grant certificates of
need for projects when it determines that one of the following is
applicable:
(1) The applicant has provided evidence that the project will meet
the needs or reasonably anticipated needs of a special population
including members of a religious body or denomination who desire to
receive care and treatment in accordance with their religious
convictions.
(2) The applicant has provided evidence that the project is or
will be necessary to meet the health needs or reasonably anticipated
health needs of adult residents of a nonprofit community care
facility, as defined by subdivision (a) of Section 1502, that is
owned by the applicant.
(3) The applicant has provided evidence that, as a health
facility, it has developed community support for its services as
indicated by its current utilization patterns, and has provided
health care services for at least five years.
(4) The applicant has provided evidence, when the project is for a
new health facility or an increase in bed capacity, that there will
be an equal or greater reduction in bed capacity in other health
facilities in the area.
(5) The applicant has provided evidence that it will deliver the
service proposed to be offered as a result of the project in an
innovative and more competitive manner, or at a lower cost than the
service is provided by other facilities in the area, and has provided
evidence that the quality of care offered will be comparable to that
offered by other facilities in the area; or that as a health
facility, it serves a disproportionate volume of publicly funded
patients, or patients for whom the cost of health care is
uncompensated. The office director shall, as he or she deems
appropriate, ensure fulfillment of the requirements of this
subdivision through conditions mutually agreed upon by the applicant
and the office. This paragraph does not apply to projects for the
addition of licensed skilled nursing beds by construction or
conversion.
If an applicant is requesting the exercise of discretion by the
office director pursuant to this paragraph, prior to granting a
certificate of need, the office director shall receive an evaluation
from the department assessing the potential negative financial impact
upon any county owned or operated general acute care hospital. If
there is a significant negative potential financial impact, a
certificate of need shall not be granted.
Nothing in this subdivision requires the office to grant
certificates of need as authorized by this section in any of the
above categories.
(b) In the case of a project for a service to be provided by or
through a health maintenance organization for which assistance may be
provided under Title XIII, the office shall grant a certificate of
need for the project unless the office director finds that the
project is not needed by the enrolled or reasonably anticipated new
members of the HMO or proposed HMO or the beds or services to be
provided are available from non-HMO providers or other HMO's in a
reasonable and cost-effective manner that is consistent with the
basic method of operation of the HMO.
For the purposes of subdivision (b), beds or services shall not be
considered available if they are any of the following:
(1) Dispersed in more than one facility when the HMO's basic
method of operation is to provide services through medical centers
that consist of a hospital and medical offices at the same site.
(2) Not available under a contract of at least five years'
duration, with an option to extend the contract for an additional
time period as is reasonably necessary for the HMO to obtain a
certificate of need and to construct and equip and begin operating
alternative beds or service, in the event the non-HMO provider or
other HMO gives notice that it intends to terminate the contract.
(3) Not available under circumstances that would grant full and
equal staff privileges to an adequate number of physicians associated
with the HMO in appropriate specialties, or otherwise not
conveniently accessible through physicians and other health care
professionals associated with the HMO.
(4) Not available in a manner that is administratively feasible to
the HMO.
(5) More costly than if the services were provided by the HMO.
In order to qualify under this section, a project that is proposed
to be provided by or through a health maintenance organization for
which assistance may be provided under Title XIII, and that consists
of or includes the construction, development, or establishment of a
new inpatient health care facility, shall be a facility that the
office determines will be utilized by members of the health
maintenance organization for at least 75 percent of the projected
annual inpatient days, as determined in accordance with the
recommended occupancy levels under the applicable health systems
plan.
(c) In the case of a project for a service to be provided by or
through an HMO, the office shall not deny a certificate of need with
respect to the service (or otherwise make a finding that the service
is not needed) in those cases (1) when the office has granted a
certificate of need that authorized the development of the service,
or expenditures in preparation for the offering or development (or
has otherwise made a finding that the development or expenditure is
needed), and when the offering of this service will be consistent
with the basic objectives, time schedules, and plans of the
previously approved application. However, the office may impose a
limitation on the duration of the certificate of need that shall
expire at the end of this time unless the health service is offered
prior thereto, or (2) solely because there is an HMO of the same type
in the same area, or solely because the services are not discussed
in the applicable health systems plan, annual implementation plan,
state health plan, or state medical facilities plan.
(d) A project for a service to be provided by, or through, an HMO
that is subject to review under this chapter shall remain subject to
that review, unless the federal law states that an approved state
program shall not require a certificate of need for the project.
The office shall establish uniform procedures and criteria for
approving applications under this section.