Report Title:

Certificate of Need Process

Description:

Limits the Certificate of Need process to acute care hospitals and long-term care facilities involving capital expenditures of not less than $150,000,000.  (HB2859 HD1)

HOUSE OF REPRESENTATIVES	H.B. NO.	2859
TWENTY-FOURTH LEGISLATURE, 2008		H.D. 1
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO CERTIFICATE OF NEED.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  Section 323D-1, Hawaii Revised Statutes, is amended to read as follows:

     "§323D-1  Purpose.  The purpose of this chapter is to establish a health planning and resources development program to promote accessibility for all the people of the [State] state to quality health care services at reasonable cost[.]; provided that this chapter shall only apply to acute care hospitals as defined under section 327-5.5 and long-term care facilities as defined under section 349-21 involving capital expenditures of not less than $150,000,000."

     SECTION 2.  Section 323D-2, Hawaii Revised Statutes, is amended by amending the definitions of "expenditure minimum," "health care facility," "health care service," and "substantially modify, decrease, or increase the scope or type of health service" to read as follows:

     ""Expenditure minimum" means [$4,000,000] $150,000,000 for capital expenditures, $1,000,000 for new or replacement medical equipment and $400,000 for used medical equipment.

     "Health care facility" and "health care service" [include] means any acute care hospitals as defined under section 327-5.5 and long-term care facilities as defined under section 349-21 and any acute care hospital's or long-term care facility's program, institution, place, building, or agency, or portion thereof, private or public, other than federal facilities or services, whether organized for profit or not, used, operated, or designed to provide medical diagnosis, treatment, nursing, rehabilitative, or preventive care to any person or persons.  [The terms include, but are not limited to, health care facilities and health care services commonly referred to as hospitals, extended care and rehabilitation centers, nursing homes, skilled nursing facilities, intermediate care facilities, hospices for the terminally ill that require licensure or certification by the department of health, kidney disease treatment centers including freestanding hemodialysis units, outpatient clinics, organized ambulatory health care facilities, emergency care facilities and centers, home health agencies, health maintenance organizations, and others providing similarly organized services regardless of nomenclature.]

     "Substantially modify, decrease, or increase the scope or type of health service" refers to the establishment of a new health care facility or health care service [or the addition of a clinically related (i.e., diagnostic, curative, or rehabilitative) service not previously provided or the termination of such a service which had previously been provided]."

     SECTION 3.  Section 323D-54, Hawaii Revised Statutes, is amended to read as follows:

     "§323D-54  Exemptions from certificate of need requirements.  Nothing in this part or rules with respect to the requirement for certificates of need applies to:

     (1)  Offices of physicians, dentists, or other practitioners of the healing arts in private practice as distinguished from organized ambulatory health care facilities[, except in any case of purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision for any private office or clinic involving a total expenditure in excess of the expenditure minimum];

     (2)  Laboratories, as defined in section 321-11(12)[, except in any case of purchase or acquisition of equipment attendant to the delivery of health care service and the instruction or supervision for any laboratory involving a total expenditure in excess of the expenditure minimum];

     (3)  Dispensaries and first aid stations located within business or industrial establishments and maintained solely for the use of employees; [provided such facilities do not regularly provide inpatient or resident beds for patients or employees on a daily twenty-four-hour basis;]

     (4)  Dispensaries or infirmaries in correctional or educational facilities;

     (5)  Dwelling establishments, such as hotels, motels, and rooming or boarding houses [that do not regularly provide health care facilities or health care services];

     (6)  Any home or institution conducted only for those who, pursuant to the teachings, faith, or belief of any group, depend for healing upon prayer or other spiritual means;

     (7)  Dental clinics;

     (8)  Nonpatient areas of care facilities such as parking garages and administrative offices;

     (9)  Bed changes [that involve ten per cent or ten beds of existing licensed bed types, whichever is less, of a facility's total existing licensed beds within a two-year period];

    (10)  Projects that are wholly dedicated to meeting the  State's obligations under court orders, including consent decrees, that have already determined that need for the projects exists;

    (11)  Replacement of existing equipment with its modern-day equivalent;

    (12)  Primary care clinics [under the expenditure thresholds referenced in section 323D-2];

    (13)  Equipment and services related to that equipment, that are primarily invented and used for research purposes as opposed to usual and customary diagnostic and therapeutic care;

    (14)  Capital expenditures that are required:

         (A)  To eliminate or prevent imminent safety hazards as defined by federal, state, or county fire, building, or life safety codes or regulations;

         (B)  To comply with state licensure standards;

         (C)  To comply with accreditation standards, compliance with which is required to receive reimbursements under Title XVIII of the Social Security Act or payments under a state plan for medical assistance approved under Title XIX of such Act;

    (15)  Extended care adult residential care homes and assisted living facilities; or

    (16)  Other facilities or services that the agency through the statewide council chooses to exempt, by rules pursuant to section 323D-62."

     SECTION 4.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun, before its effective date.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect upon its approval.