HB 187: "An Act relating to the certificate of need program for nursing care facilities and other facilities; and providing for an effective date."
00HOUSE BILL NO. 187 01 "An Act relating to the certificate of need program for nursing care facilities and 02 other facilities; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. FINDINGS. The legislature finds that 05 (1) ch. 84, SLA 1996, placed a two-year moratorium on the issuance or 06 modification of certificates of need under AS 18.07 for nursing beds and created a working 07 group to analyze issues relating to long-term care and the certificate of need program; 08 (2) it is anticipated that the long-term care system in Alaska will face a crisis 09 in its ability to provide services to a growing and increasingly aging population by the twenty- 10 first century unless the system can provide services in a more efficient and appropriate 11 manner; 12 (3) in 1996, the state spent $120,000,000 in long-term care services for 13 approximately 5,000 Alaskans; approximately two-thirds of these expenditures, $80,000,000, 14 were made from the state general fund;
01 (4) moderate assumptions about population and inflation would project that 02 more than $545,000,000 will be needed to pay for long-term care services in Alaska by the 03 year 2015; 04 (5) a shift from the current significant reliance on costly institutional care to 05 a more balanced continuum of home-based and community-based services is needed; 06 (6) a two-year moratorium on the issuance or modification of a certificate of 07 need for the addition of nursing home beds was enacted into law in 1996 to 08 (A) encourage the development of home-based and community-based 09 services; 10 (B) direct the state's resources toward the services that can best meet 11 the needs of the clients; and 12 (C) facilitate actions to provide a more balanced system of care and 13 more appropriate placement of clients, enlarge client choice, and avoid unnecessary 14 new long-term care costs; 15 (7) appropriate planning is necessary to ensure that a certificate of need for 16 new or replacement nursing home beds is not approved without a 17 (A) demonstrated long-term need for those beds on a regional basis; 18 (B) demonstration that the project is financially feasible and fosters the 19 least reliance on the state general fund for provision of the most appropriate service; 20 (C) demonstration of public participation in the planning process and 21 support by affected groups; and 22 (D) showing that the approval or modification of the certificate of need 23 is consistent with existing state plans for delivery of care in Alaska; and 24 (8) this Act provides a minimum framework to ensure that the approval of new 25 or replacement nursing home beds enhances access to the appropriate level of care to meet 26 the needs of Alaskans and does not foster reliance on the state general fund to finance the 27 operating and capital costs. 28 * Sec. 2. AS 18.07.021 is amended to read: 29 Sec. 18.07.021. Administration [OFFICE OF PLANNING AND 30 RESEARCH]. The [OFFICE OF PLANNING AND RESEARCH IN THE] 31 department shall administer the certificate of need program under this chapter and
01 perform other functions prescribed in this chapter. 02 * Sec. 3. AS 18.07.031 is amended to read: 03 Sec. 18.07.031. Certificate of need required. (a) A person may not make 04 an expenditure of $1,000,000 or more for any of the following unless authorized under 05 the terms of a certificate of need issued by the department [OFFICE]: 06 (1) construction of a health care facility; 07 (2) alteration of the bed capacity of a health care facility; or 08 (3) addition [OR ELIMINATION] of a category of health services 09 provided by a health care facility. 10 (b) Notwithstanding the expenditure threshold in (a) of this section, a person 11 may not convert a building or part of a building [THAT IS LICENSED AS AN 12 ASSISTED LIVING FACILITY UNDER AS 47.33] to a nursing home that requires 13 licensure under AS 18.20.020 unless authorized under the terms of a certificate of need 14 issued by the department [OFFICE]. 15 * Sec. 4. AS 18.07.041 is amended to read: 16 Sec. 18.07.041. Standard of review for applications for certificates of need 17 relating to non-nursing home beds and services . The department [OFFICE] shall 18 grant a sponsor a certificate of need or modify a certificate of need that authorizes 19 beds other than nursing home beds or that is for a health care facility other than 20 a nursing home if the availability and quality of existing health care resources or the 21 accessibility to those resources is less than the current or projected requirement for 22 health services required to maintain the good health of citizens of this state. 23 * Sec. 5. AS 18.07 is amended by adding a new section to read: 24 Sec. 18.07.043. Standard of review for applications for certificates of need 25 relating to nursing homes and nursing home beds. (a) The department shall 26 develop review standards for an application for a certificate of need, or for a 27 modification of a certificate of need, issued under this chapter for a health care facility 28 that is a nursing home or has nursing home beds. 29 (b) In developing the review standards under (a) of this section, the department 30 shall consider whether 31 (1) a public process and existing appropriate statewide, regional, and
01 local plans were included in planning and designing the additional nursing home beds 02 or the health care facility; 03 (2) the additional nursing home beds or the health care facility meets 04 minimum required use rates for new nursing beds, and the effect on use rates for 05 existing nursing home beds; 06 (3) the additional nursing home beds or the health care facility 07 demonstrates consideration of the community, regional, and statewide needs for new 08 nursing home beds; 09 (4) the additional nursing home beds or the health care facility meets 10 the minimum number of new nursing beds that should be required in a facility to 11 ensure efficiency and economies of scale; 12 (5) the additional nursing home beds or the health care facility 13 demonstrates the proposed service will provide a quality of care equivalent to existing 14 community, regional, or statewide services; 15 (6) the additional nursing home beds or the health care facility 16 demonstrates financial feasibility, including long-term viability, and what the financial 17 effect will be on consumers and the state; and 18 (7) the sponsor has demonstrated cost effectiveness through considering 19 the availability of appropriate, less costly alternatives of providing the services 20 planned. 21 (c) The department shall grant a sponsor a certificate of need or modify a 22 certificate of need that authorizes nursing home beds or that is for a health care facility 23 that is a nursing home if the department finds that the sponsor meets the standards 24 established in or under this chapter. 25 * Sec. 6. AS 18.07.061 is amended to read: 26 Sec. 18.07.061. Modification and termination of activities. The certificate 27 holder shall apply to the department [OFFICE] for a modification of the certificate 28 before terminating part of the activities authorized by the terms of issuance, but the 29 certificate holder is not required to obtain the acquiescence of the department 30 [OFFICE] before terminating all the activities authorized by the certificate. If a 31 certificate holder terminates all of the activities authorized by a certificate, the
01 certificate holder is required to notify the department [OFFICE] 60 days before 02 termination and to surrender the certificate to the department [OFFICE] within 30 03 days of termination. 04 * Sec. 7. AS 18.07.071 is amended to read: 05 Sec. 18.07.071. Temporary and emergency certificates. (a) The 06 department [OFFICE] shall grant a sponsor an emergency certificate for the 07 construction of a health care facility for which a certificate is required under 08 AS 18.07.031 if the sponsor shows, by affidavit or formal hearing, that the act of 09 construction consists of effecting emergency repairs. 10 (b) The department [OFFICE] may grant a sponsor a temporary certificate for 11 the temporary operation of a category of health service [,] if the sponsor shows by 12 affidavit or formal hearing 13 (1) the necessity for early, immediate, or temporary relief ; [,] and 14 (2) adverse effect to the public interest by reason of delay occasioned 15 by compliance with the requirements of AS 18.07.041 , 18.07.043, and application 16 procedures prescribed by regulations under this chapter. 17 (c) A temporary certificate granted under (b) of this section does not confer 18 vested rights on behalf of the applicant. The department [OFFICE] shall impose 19 those special limitations and restrictions concerning duration and right of extension that 20 the department [OFFICE] considers appropriate. A temporary certificate may not be 21 granted for a period longer than necessary for the sponsor to obtain review of the 22 action certified by the temporary certificate under AS 18.07.051. Application for a 23 certificate of need under AS 18.07.041 or 18.07.043 must commence within 60 days 24 of the date of issuance of the temporary certificate. 25 * Sec. 8. AS 18.07.081(a) is amended to read: 26 (a) The department [OFFICE], a member of the public who is substantially 27 affected by activities authorized by the certificate, or another applicant for a certificate 28 of need may initiate a hearing to obtain modification, suspension, or revocation of an 29 existing certificate of need by filing an accusation with the commissioner as prescribed 30 under AS 44.62.360. A revocation, modification, or suspension of an outstanding 31 certificate may not be undertaken unless it is in accordance with AS 44.62.330 -
01 44.62.630. 02 * Sec. 9. AS 18.07.081(c) is amended to read: 03 (c) A certificate of need shall be suspended if an accusation is filed before the 04 commencement of activities authorized under AS 18.07.041 or 18.07.043 that charges 05 that factors upon which the certificate of need was issued have changed [,] or new 06 factors have been discovered that significantly alter the need for the activity 07 authorized. A suspension of a certificate may not exceed 60 days. At the end of this 08 period or sooner, the department [OFFICE] shall revoke or reinstate the certificate. 09 * Sec. 10. AS 18.07.081(d) is amended to read: 10 (d) A certificate of need may be revoked if 11 (1) the sponsor has not shown continuing progress toward 12 commencement of the activities authorized under AS 18.07.041 or 18.07.043 after six 13 months of issuance; 14 (2) the applicant fails, without good cause, to complete activities 15 authorized by the certificate; 16 (3) the sponsor fails to comply with the provisions of this chapter or 17 regulations adopted under this chapter; 18 (4) the sponsor knowingly misrepresents a material fact in obtaining the 19 certificate; 20 (5) the facts charged in an accusation filed under (c) of this section are 21 established; or 22 (6) the sponsor fails to provide services authorized by the terms of the 23 certificate. 24 * Sec. 11. AS 18.07.101 is amended to read: 25 Sec. 18.07.101. Regulations. The commissioner shall adopt, in accordance 26 with AS 44.62 (Administrative Procedure Act), regulations that establish procedures 27 under which sponsors may make application for certificates of need required by this 28 chapter and that govern the review of those applications by the department [OFFICE], 29 establish requirements for a uniform statewide system of reporting financial and other 30 operating data, and otherwise carry out the purposes of this chapter. 31 * Sec. 12. AS 18.07.111(2) is amended to read:
01 (2) "certificate" means a certificate of need issued by the department 02 [OFFICE] under AS 18.07.041 , 18.07.043, or 18.07.071 [AS 18.07.071]; 03 * Sec. 13. AS 18.07.111 is amended by adding a new paragraph to read: 04 (13) "nursing home bed" means a bed not used for acute care in which 05 nursing care and related medical services are provided over a period of 24 hours a day 06 to individuals admitted to the health care facility because of illness, disease, or 07 physical infirmity. 08 * Sec. 14. AS 18.07.111(11) is repealed. 09 * Sec. 15. TRANSITION. (a) A matter described in former AS 18.07.031 that is 10 authorized under a certificate of need issued before the effective date of this Act shall be 11 reviewed and completed in accordance with the applicable statutes and regulations as they 12 existed on the day before the effective date of this Act. 13 (b) Except as provided in (a) of this section, pending applications and any other 14 matters described in former AS 18.07.031 or in AS 18.07.031, as amended by this Act, shall 15 be reviewed and completed in accordance with the provisions of this Act. 16 * Sec. 16. This Act takes effect immediately under AS 01.10.070(c).