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From YouTube: Certificate of Need Task Force (6-19-23)
Description
Meeting start 00:00:00
Roll call 00:00:38
Introduction of Members 00:01:10
NSCL Discussion, Samantha Scotti – 00:04:54
Legislator Questions & Comments – 00:26:11
OIG Discussion, Adam Mather & Kara Daniel – 00:32:31
Legislator Questions & Comments – 00:54:56
A
Welcome
everyone
here
to
the
newly
formed
certificate
of
need
task
force
I
want
to
thank
all
my
fellow
senators
and
representatives
for
being
here
and
for
their
willingness
to
participate,
to
listen
and
to
evaluate
the
ideas
that
we
bring
forth
during
this
task
force.
Time.
I
also
want
to
thank
those
in
the
room
as
well
for
being
here
and
those
who
are
in
the
auditory
and
the
visual
audience
with
us
today.
I
hope
that
everybody
will
will
learn
something
today
and
with
that
being
said,
Mr
secretary,
would
you
please
call
the
roll.
B
A
C
F
John
John
shirkwai
serving
the
Senate
I'm
excited
to
be
on
the
committee.
This
is
a
topic
that
is
ver
that
my
constituents
are
very
concerned
about
so
I'm
here
to
learn
and
find
out
more
about
it
and
I
want
to
thank
leadership
for
appointing
me
on
the
committee
and
I
also
want
to
thank
them
for
creating
this
committee,
because
it
is
something
that
I
think
that
is
very
much
in
need.
H
H
Good
morning,
I'm
state
center
Steve
Meredith,
representing
the
fifth
district,
which
is
a
mead
Breckenridge,
Grayson
Butler
in
Ohio
counties
and
I,
have
40
Years
of
health
care
experience.
So
that's
why
I'm
not
quite
as
excited
this
Center
shickle
is
to
deal
with
this
topic,
but
I
know
it's
one
that
needs
some
great
examination.
Look
forward
to
the
discussions.
Thank
you.
I
A
We
also
plan
to
review
the
need
to
maintain
or
modify
certificate
of
Need
for
each
of
the
covered
health
services,
and
we
will
submit
any
findings
and
recommendations
that
we
have
regarding
the
certificate
of
need
to
the
legislative
research
commission
for
referral
to
the
appropriate
Committees
of
jurisdiction.
Now.
Ladies
and
gentlemen,
we
actually
have
two
groups
that
we'll
be
presenting
today
and
I
like
to
verbally
say
that
each
of
these
groups
are
aware
of
how
much
time
they
have
to
present
since
I
expect
everyone
on
our
committee
to
participate
and
take
notes.
A
I
will
respectfully
ask
them
to
withhold
their
questions
until
the
presenters
have
had
time
to
present,
but
I
also
will
respectfully
ask
our
presenters
that
when
they
are
asked
a
question,
if
they
will
hold
answers
to
those
questions
to
between
one
and
a
half
to
two
minutes,
I
want
to
do
this,
because
I
want
to
make
sure
that
everyone
stays
engaged
in
the
information
that's
being
presented.
I
also
will
respectfully
ask
that
no
acronyms
be
used.
A
J
A
J
Wonderful.
So,
as
I
said,
my
name
is
Samantha
Scotty
I'm,
a
project
manager
with
the
National
Conference
of
state
legislatures
and
we're
excited
today
to
help
provide
background
information
and
a
national
overview
related
to
certificate
of
need,
as
you
all
discuss
the
certificate
of
need
program
and
what
is
best
for
Kentucky.
J
So
just
a
quick
overview
of
what
I
will
be
covering
today.
I'll
start
with
a
very
brief
reminder
of
who
ncsl
is
and
then
provide
some
background
and
National
overview
related
to
certificate
of
need.
Programs
then
provide
a
deep
dive
into
certificate
of
need
by
sharing
some
State
examples,
highlight
recent
certificate
of
need,
legislation
and
then
wrap
up
by
referencing.
Various
research
and
research
and
studies
related
to
certificate
of
need
and
as
a
reminder.
J
So
listed
here
are
just
a
few
of
the
services
that
we
provide
to
you
all
state
legislators
as
members
of
ncso
and
before
I
dive
into
my
presentation.
I
did
want
to
just
note
that
any
policy
or
state
examples
that
I
will
reference
today
are
purely
informational
and
for
informational
purposes,
and
this
does
not
indicate
ncsl
supports
any
of
these
one
policies.
J
So
we
are
here
not
to
provide
recommendations,
but
rather
share
State
examples
and
other
information,
so
diving
into
a
certificate
of
need
background
and
a
national
overview,
and
what
is
certificate
of
need
and
I
know?
Some
of
you
all
might
be
familiar
with
this,
but
again
we're
here
to
provide
some
baseline
and
background
information.
So,
as
a
reminder,
certificate
of
need
laws
require
Health,
Care
Facilities
to
seek
State
approval
prior
to
Major,
Capital
expenditures
or
new
projects.
So
this
could
include
a
nursing
home,
expanding
their
bed
capacity
or
a
health
system.
J
So,
as
you
all
know,
certificate
of
need
is
a
debated
topic
and
a
proponents
argue
that
it
can
bolster
access
and
control
costs,
and
opponents
argue
that
these
programs
have
the
opposite
effect
on
access
and
costs.
So
proponents
contending
that
certificate
of
need
laws,
ensure
services
are
not
concentrated
in
more
affluent
areas
and
many
states
require
facilities
to
provide
certain
services
to
Indigent
patients
as
a
condition
of
certificate
of
need.
J
Approval
opponents,
however,
argue
that
certificate
of
need
laws
may
protect
incumbent
providers
and
could
be
overly
burdensome
in
the
approval
process
and
so
may
delay
or
inhibit
service
expansion
in
underserved
communities
and
a
quick
reference
to
some
of
the
history
around
certificate
of
need.
So
the
1975
Federal
National,
Health,
planning
and
resource
development
act
required
all
50
states
to
have
structures
involving
the
submission
of
proposals
and
obtaining
approval
from
State
health
planning
agencies
before
any
major
capital
projects
occurred.
J
So,
for
example,
many
states
regulate
a
handful
of
licensed
facilities
like
hospitals,
nursing
homes,
outpatient
clinics
or
other
facilities,
and
other
states
narrowly
apply
certificate
of
need
to
certain
facilities
like
long-term
care
facilities.
So
those
States,
including
Ohio,
Montana,
South,
Carolina
and
Florida
three
states,
as
indicated
here
in
Orange,
Arizona,
Minnesota
and
Wisconsin,
do
not
officially
operate
certificate
of
need
programs,
but
they
do
maintain
approval
processes
that
operate
somewhat
similarly
to
certificate
of
need.
Oversight
and
I
will
touch
on
these
variations
later
today.
J
As
you
continue
your
discussion,
the
oversight
entity
is
the
state
department
of
health
or
other
related
entity
that
operates
the
certificate
of
need
program
and
conducts
the
certificate
of
need
review
process.
The
regulated
facility
refers
to
the
real
property
or
equipment
owned
by
a
healthcare
institution
which
the
certificate
of
need
program
is
applied
to
regulated
Services
just
mean
the
clinically
related
Services
provided
through
Healthcare
facilities
and
capital
expenditure
is
an
expenditure
made
by
on
behalf
of
the
health
facility
that
is
not
chargeable
as
an
expensive
operation
or
maintenance
license
bed
or
bed
capacity.
J
Is
the
total
number
of
inpatient
beds
in
a
facility
licensed
by
their
respective
state
agency
and
review
cycle,
refers
to
the
time
frame,
set
for
review
and
initial
decision
on
the
certificate
and
need
application
and
service
area?
Is
the
current
or
projected
service
area
to
which
the
facility
is
or
will
be,
providing
services.
J
So
starting
with
Tennessee,
the
certificate
of
need
process
lives
within
the
Tennessee
Department
of
Health.
So
specifically,
the
health
services,
development,
Agency,
Reviews
certificate
of
need,
applications
and
the
division
of
health
planning
planning
sets
the
standards
and
requirements
for
demonstrating
certificate
of
need.
Tennessee
regulates
a
combined
total
of
26
facilities
and
activities
and
you'll
see
an
example
of
some
of
those
facilities
and
activities
listed
here.
J
Additionally,
Tennessee
provides
information
on
the
certificate
of
need
criteria
that
is
then
considered
for
the
different
facilities
and
through
the
application
process.
So,
for
example,
for
freestanding
emergency
departments
in
in
Tennessee.
Determination
is
based
upon
existing
access
to
emergency
services
within
the
proposed
area
and
whether
limited
access
is
currently
an
issue
when
determining
need
for
Hospice
Services.
The
criteria
in
Tennessee
is
based
on
a
hospice
need
formula,
and
this
formula
formula
looks
at
the
average
number
of
patients
in
a
service
area
annual
and
annual
deaths
over
the
past
two
years.
J
And
then
finally
pivoting
to
Ohio,
so
the
Ohio
certificate
of
need
oversight
entity
is
also
within
their
Department
of
Health,
specifically
the
office
of
Health
assurance
and
licensure,
and
the
healthcare
services
section
and
the
director
of
Health
in
Ohio
leads
the
review
and
Grant
certificate
of
need.
So
Ohio
certificate
of
need
program
only
applies
to
long-term
care
facilities,
as
defined
in
statute.
J
So
you'll
see
here,
two
bullets
related
to
how
they
Define
long-term
care
facilities
and
statutes
and
Ohio
regulates
seven
different
activities
related
to
long-term
care
facilities,
as
seen
here
so
Ohio
has
a
number
of
considerations
and
criteria
for
their
certificate
of
need.
Review
process,
which
includes
the
impact
of
the
activity
on
the
costs
of
long-term
care
services
in
relevant
Services
areas,
quality
of
services
to
be
provided
and
the
impact
of
the
reviewable
activity
on
the
availability
and
access
of
the
proposed
activities
in
that
application.
J
So
pivoting
to
those
three
states
I
referenced
during
the
beginning
of
my
presentation
that
operate
a
variation
on
a
certificate
of
need
program.
So
we
have
Arizona,
Minnesota
and
Wisconsin
here.
So
they
don't
again
officially
maintain
what
is
considered
a
certificate
of
need
programs,
but
they
do
have
similar
functions
in
the
state.
So
Arizona
maintains
a
program
that
they
have
terms
certificate
of
necessity
and
it
aims
to
regulate
just
ground
ambulance
services
in
the
state,
so
the
application
for
the
certificate
of
necessity
program.
J
So
in
Minnesota,
for
example,
the
exception
process
is
outlined
in
Minnesota
statute
and
it
is
termed
a
public
interest
review
process
to
exempt
from
this
moratorium,
and
the
legislature
actually
retains
the
decision
to
Grant
this
exception
in
Minnesota
I'm
now
pivoting
to
recent
certificate
of
need
legislation.
So
we
have
seen
a
good
deal
of
introduce
and
enacted
certificate
of
need
legislation
or
in
recent
sessions.
So
in
2023
alone,
we've
seen
five
states
enact
legislation
modifying
their
certificate
of
need
laws
in
some
capacity.
These
are
North
Carolina,
South,
Carolina,
Virginia,
West,
Virginia
and
Washington.
J
So
now,
to
just
highlight
a
couple
of
recent
certificate
of
need,
legislative
examples,
and
when
looking
at
some
of
these
sorts
of
legislation,
inactive
related
to
certificate
of
need,
we
can
categorize
State
actions
into
three
major
buckets
seen
here.
So
substantial
reforms,
targeted
modifications
and
establishing
additional
certificate
of
need
requirements
and
I've
included
examples
related
to
each
of
these
buckets
so
starting
with
major
reforms.
J
So
Florida,
Montana
and
South
Carolina
recently
enacted
legislation
limiting
certificate
of
needs,
oversight
to
long-term
care
facilities
and
so
essentially
exempting
hospitals
and
other
Healthcare
facilities
from
certificate
of
need
processes.
So,
most
recently
in
just
may
of
this
year,
South
Carolina
enacted
legislation
that
eliminates
certificate
of
need,
except
in
the
case
of
nursing
homes
and
the
state,
had
previously
regulated
facilities
included,
including
hospitals
and
hospice
care.
So
those
are
no
longer
subject
to
certificate
of
need
review.
J
Lastly,
some
states
have
enacted
legislation
to
bolster
certificate
of
need
oversight
in
certain
areas,
so
both
Illinois
and
Nevada,
enacted
legislation
requiring
Health
Facilities
to
seek
Co
and
approval
prior
to
closing
a
facility
and
and
just
to
note,
we
did
track
a
handful
of
bills
during
the
pandemic,
where
we
saw
some
states
that
operated
certificate
of
need.
Programs
pause
their
programs
during
the
pandemic,
but
those
were
all
temporary.
J
So
in
Georgia,
just
this
year,
Georgia
established
the
Senate
study
committee
on
certificate
of
need
reform,
with
the
goal
of
looking
at
the
effect
of
certificate
of
need
on
access
to
health
care
costs
and
specifically
how
con
affects
rural
areas.
So
the
committee
which
consists
both
of
legislators
and
citizens
representing
Health,
Systems,
Physicians
and
insurers
will
publish
findings
and
recommendations
again
that
was
just
established
this
year,
so
that
report
will
be
forthcoming.
J
Connecticut
established
a
task
force
consisting
of
five
work
groups,
with
also
with
the
goal
of
studying
and
recommending
effects
of
certificate
of
need,
and
specifically
in
response
to
10
matters
and
just
a
couple
of
examples
of
what
those
10
matters.
The
task
force
was
looking
at.
One
was
setting
standards
to
measure
quality
due
to
consolidation
in
Health,
Care,
Systems
and
enacting
higher
penalties
for
non-compliance
and
increasing
the
staff
need
for
enforcement
related
to
certificate
of
need.
J
So
this
is
the
the
only
task
force
so
far
that
we
are
aware
of
that
has
actually
published
recommendations,
and
this
was
very
recently
so
can
excuse
me.
Connecticut
did
publish
their
recommendations
and
it
is
important
to
note
that
these
are
very
Connecticut
specific,
so
they
included
a
lot
of
matters
that
were
very,
very
unique
to
Connecticut.
J
So
these
studies
that
are
out
there
tend
to
be
dense
and
the
methodologies
look
very
different
across
the
studies
and
so
I'm
providing
a
snapshot
of
a
couple
of
studies
published
from
various
journals,
and
we
know
that
there
are
more
studies
out
there
and
so
I'm,
not
an
expert
in
examining
research
methodologies.
So
I'm
not
going
to
summarize
all
of
the
outcomes
and
nuances
of
these
summaries
verbally
here
in
my
presentation,
but
generally
the
takeaway
is
the
evidence-related
certificate
of
need
is
somewhat
mixed
and
some
certificate
of
need.
J
Researchers,
specifically
the
team
conducting
the
meta-analysis,
which
is
the
first
study
referenced
here
in
the
First
Column,
found
that
literature
has
not
reached
a
definitive
conclusion
on
how
certificate
of
need
Laws,
affect
Health
expenditures,
outcomes
and
access
to
care
and
referencing
that
more
they
had.
They
have
suggested
that
more
research
is
needed.
J
So
I'd
also
like
to
note
just
some
important
considerations
when
examining
the
research
related
to
certificate
of
need,
so
comparing
two
State
certificate
of
need.
Programs
is
kind
of
like
comparing
apples
to
oranges,
just
because
some
programs
regulate
26,
Healthcare
Healthcare
facility
types
or
in
activities,
and
some
may
regulate
just
one
facility
type
also
when
looking
at
cost
and
quality
in
these
research
studies.
That
can
be
a
hard
thing
to
measure.
J
So,
looking
at
the
association
between
certificate
of
need
and
health
care
costs,
healthcare
costs
in
a
community
are
driven
by
a
number
of
factors
like
Health
Care
status,
for
example,
prevalence
of
chronic
disease
in
that
Community
average
age
or
in
that
Community
or
the
price
is
charged
by
the
hospitals
or
other
health
care
providers
in
that
community.
So
considering
all
those
factors
related
to
health
care
costs,
it
can
be
difficult
to
assert
causation
related
to
certificate
of
need
costs
as
far
as
opposed
to
correlation
and
then
looking
at
Healthcare
quality.
J
There
are
a
number
of
measurable
metrics
used
to
examine
Healthcare
quality,
and
these
studies
referenced
here
might
just
touch
on
one
or
a
handful
of
different
Healthcare
quality.
Metrics,
like
Hospital
readmissions
prevalence
of
facility
acquired
affections,
just
to
name
a
two
two
common
quality
metrics
related
to
health
care.
J
Our
health
care
cost
coverage
and
delivery
database
where
we
track
any
newly
enacted
legislation
related
to
this,
and
then
a
recent
magazine
article
that
we
wrote
highlighting
some
Trends
related
to
certificate
of
need,
and
of
course,
please
reach
out
anytime
and
I
will
turn
it
back
to
the
chair.
And
thank
you
again
so
much
for
inviting
us
to
be
part
of
this
discussion.
A
Thank
you,
Miss
Scotty
I
really
appreciate
the
information
that
you've
given
us
here
today
when,
when
I
mentioned
questions
after
the
presenter
I
meant
after
each
individual
presenter,
so
I
would
like
to
open
up
to
the
committee.
If
any
committee
members
have
any
questions
they
would
like
to,
they
would
like
to
bring
forth
this
morning.
C
C
J
A
J
I'm
not
sure,
if
I'm
following
your
question,
are
you
curious
how
many
include
EMS
or
ambulance
services?
Or
maybe
you
know
what
is
kind
of
the
average
number
of
facility
types
in
each
state,
both
both
so
so
great
question
and
I
I
will
not
give
you
a
definitive
answer
just
off
the
top
of
my
head,
because
I
don't
want
to
misquote.
The
number
we
do
on
our
web
page
include
all
the
facilities
and
activities
included
in
each
state
in
those
States,
the
35
States
in
DC
that
have
certificate
of
need.
J
D
J
That's
a
great
question:
to
my
knowledge,
a
lot
of
those
considerations
are
typically
left
to
the
regulating
or
the
oversight
entity.
I'm,
not
sure
if
the
legislation
is
getting
into
that
level
of
detail,
but
I
can
confirm
or
I
can
follow
up
on
that
to
figure
out
how
exactly
that
is
addressed
either
in
legislation
or
through
the
oversight
entity.
Okay,
okay,
thank.
D
E
J
Sure
that
is
another
good
question
and
I'm
not
sure
for
Kentucky.
For
that
specific
time
table
I
don't
want
to
misquote
the
date.
So
I
can
also
follow
up
on
that
and
I
know
that
you
all
are
hearing
from
Kentucky
agency
after
this.
So
they
might
be
aware
of
that
specifics
and,
if
not
I'm
happy
to
follow
up.
A
Thank
you
very
much.
I
do
have
a
couple
questions
I'd
like
to
to
bring
out
here,
or
at
least
a
couple
of
themes
that
I
heard
it
seems
it
seems
to
me
there
was
a
common
theme
regarding
concerns
about
rural
Health
Care
access.
Could
you
expand
on
that
or
or
did,
or
did
your
presentation
give
you
any
information
in
that
area?.
J
J
So
I
do
know
that
those
task
forces
and
study
committees,
both
South
Carolina
and
Georgia,
are
looking
more
into
that
I'm,
not
sure
if
any
state
has
issued
conclusive
findings
on
how
certificate
of
need
affects
role.
Healthcare
access,
but
I
do
know
that
that
is
something
states
are
trying
to
figure
out,
but
I'm,
not
aware
of
any
study.
That
specifically
has
come
to
a
conclusion
around
certificate
of
need
in
rural
areas.
If,
if
does
that
answer,
your
question.
A
A
A
A
We
do
have
our
second
set
of
presenters
and
they
they
are
in
the
room,
so
I
would
I
would
ask
them
to
step
up
to
the
table,
make
sure
that
your
little
green
lights
are
on,
so
that
we
can
hear
your
lovely
voices
and
we
will
proceed,
introduce
yourselves
to
to
the
committee
and
and
those
in
the
audience.
Please.
L
A
N
L
A
L
Yes,
yeah
I
do
apologize,
so
our
state
certificate
of
need
law
addresses
several
areas.
One
is
a
type
of
Health
Care
Facilities
that
require
a
certificate
of
need,
certain
activities
that
trigger
the
con
or
I'm;
sorry,
the
certificate
of
need
review
and
the
agency
that
reviews
the
applications
is
the
office
of
Inspector
General
and
then
the
information
that
we
need
during
a
certificate
of
need,
review
to
be
deemed
as
complete.
L
L
The
general
assembly
finds
that
the
licensure
of
Health,
Care,
Health,
Facilities
and
services
is
a
means
to
ensure
safe
and
efficient
Medical
Care.
The
proliferation
of
unnecessary
Health,
Care,
Facilities
health
services
and
equipment
results
in
duplicity
of
cost
and
under
use
and
proliferation
increases
the
cost
of
Quality
Health
Care
and
then
the
Kentucky
revised
Statute
chapters,
216b
authorizes
the
Cabinet
for
Health
and
Family
Services
to
provide
perform
any
need,
function
or
other
statutory
functions
necessary
to
to
those
three
charges
which
are
improved.
Quality,
increase
access
and
create
cost
efficient
care.
L
The
the
process
by
which
potential
Health
Care
Providers
can
obtain
a
certificate
of
need,
is
governed
by
both
statute
and
Regulation
and
so
KRS
chapter
216
B
requires
certain
types
of
Health
Care
Facilities
to
seek
a
con
in
order
to
apply
for
licensure
to
provide
services.
It
also
allows
for
the
process
by
which
affected
parties
can
request
a
hearing.
It
establishes
non-substative
review,
prohibits,
transfer
of
certificate
of
need
and
requires
notice
of
change
of
ownership
or
modification
on
entities
that
require
a
certificate
in
need.
L
L
The
co
the
certificate
in
need
review,
criteria
rest
under
five
criteria,
that
the
first
is
consistency
with
the
state
health
plan
that
it
matches
the
services
and
criteria
per
the
State
Health
Plan.
The
second
is
needs
need
and
accessibility.
It
meets
the
needs
based
on
an
annual
assessment
of
need,
through
formulas,
showing
a
need
in
a
geographical
area
for
that
service.
Inner
relationships
and
linkages
appropriately
complements
the
existing
current
health
care
providers
in
the
area
to
give
comprehensive,
efficient
care
cost
of
economic
feasibility
and
resource
availability.
L
All
right
and
I'll
walk
you
through
kind
of
we
created
this
I
think
for
another
Committee
hearing,
but
we'll
walk
you
through
as
best
we
can
please.
This
would
be
a
good
time
to
ask
questions
around
the
the
flow
of
the
house
certificate.
A
need,
app
or
search
yeah
certificate
of
need
operate,
so
it
originally
starts
with
the
application.
That's
Incorporated
by
reference
900,
KR,
6065
and
file
before
the
batching
cycle
deadline,
the
oig
reviews
the
application
and
will
share
with
that
entity
that
the
applications
deemed
complete.
L
If
it's
complete,
then
then
the
application
is
subject
to
formal
review
or
non-substantive
review.
If
we
find
that
it's
not
complete,
we
will
ask
the
applicant
to
submit
revisions
or
additional
information
in
order
to
deem
it
complete
and
then
so
I'll
go
through
the
formal
review
process.
First
for
you
and
then
we'll
go
through
the
non-substative
Prof
process
for
you
as
well
and
so
the
applicant.
If
it's
a
formal
review,
which
is
defined
by
KRS,
216b,
012,
12
and
set
forth
in
900k
are
6070.
L
The
cabinet
gives
notice,
via
a
newsletter
notice,
includes
an
affected
party
right
to
request
in
here
a
hearing.
If
no
hearing
is
requested,
then
the
administrative
hearings
officer
issues
a
final
decision.
If
a
hearing
is
requested
by
an
affected
party
within
15
days
after
the
public
notice,
in
accordance
with
case
law,
applicants
bear
the
burden
of
showing
the
proposal
meets
the
review
criteria
and
then
an
administrative
hearing
officer
issues,
a
final
decision
based
on
that.
L
Go
if
there
is
a
hearing
request
by
affected
party
within
10
days
after
public
notice,
then
there
is
a
a
hearing
held
and
the
the
presumption
of
need
is
is
already
in
place
unless
rebuted
by
clear
and
convincing
evidence
by
the
affected
party,
and
then
it
like
in
the
formal
review.
The
administrative
hearing
officer
makes
a
final
decision
on
that
as
well
and.
L
Let
me
think
of
a
non-sub
challenge,
or
does
it
matter
if
it's
formal
or
informal
review,
okay,
I'll
just
try
and
give
you
a
hypothetical
here
and
it
may
not
correlate
completely,
but
if
they're
already
providing
enough
MRI
services.
So
another
person
applies
for
MRI
services
within
that
catchment
area.
They
would
go
and
be
the
affected
party
to
say
we're
already
meeting
the
need
of
the
community.
Therefore,
there
shouldn't
be
another
MRI
service.
L
L
This
is
where
the
applicant
Bears,
the
burden
of
showing
the
proposed
Health
Service,
meets
all
five
criteria
established
by
by
krs-216b
0402a
and
that's
including
consistency
with
the
state
health
plan
and
then,
as
as
mentioned
previously,
the
decision
is
is
made
by
a
hearing
officer
and
that
takes
approximately
six
months
and
then
sorry
here
are
some
of
the
services
or
facilities
that
require
a
formal
review,
ambulance
services.
We
did
and
I'll
talk
about
this
more.
L
There
were
some
changes
made
with
House
Bill
777,
that
that
changed
that
somewhat
ambulatory,
surgical,
centers,
chemical
dependency
programs
or
larger,
obviously,
hospitals,
hospice,
long-term
care
facilities,
organ
transplant
programs
and
special
care
neonatal
beds,
and
just
to
give
you
a
definition
of
long-term
care
facilities.
Those
include
nursing
facilities,
Personal
Care,
Homes,
Intermediate,
Care,
Facilities,
Intermediate
Care
facilities
for
individuals
with
intellectual
or
developmental
disabilities.
L
A
M
M
L
L
And
so
the
statutory
Authority
for
non-substitute
review.
These
are
the
five
circumstances
with
which
the
non-stepsive
review
for
con
application
can
be
deemed
and
then
the
the
last
one
is
obviously
other
circumstances
that
the
cabinet
by
administrative
regulation,
May
prescribe,
and
so
the
first
is
a
change
in
location
for
a
health
care
facility,
the
second
to
replace
or
relocate
licensed
health
facility,
with
no
major
substantial
changes
in
both
health
services
and
or
bed
capacity.
L
L
So
acute
care
providers
seeking
to
transfer
acute
care
beds
to
a
new
facility
under
common
ownership
in
the
same
county.
So
if
you
have
two,
if
you
have
a
hospital
and
you
want
to
open
another
hospital
within
the
same
county,
you
can
transfer
some
of
those
your
beds
within
that
same
catchment
area
and
then
converting
us
existing
beds,
acute
care
beds
to
psychiatric
beds
for
adult
patients,
and
that
was
established
recently
in
our
emergency
reg.
L
That
was
due
to
a
need
post
pandemic
that
we're
seeing
a
lot
of
our
psychiatric
patients
sitting
in
emergency
departments
and
they
really
need
to
be
treated
in
their
acute
crisis.
And
so
this
is
to
help
alleviate
some
of
that,
specifically
in
some
of
the
rural
areas
and
then
Adult
Day
Health,
Centers,
House,
Bill
777,
which
I
mentioned
before
grants.
L
Certain
ambulance
providers
with
non-subsisive
review
status
and
Industrial
ambulance
providers
freestanding
birthing,
centers,
freestanding
emergency
departments
owned
by
Kentucky,
licensed
hospitals
and
located
off
campus
private
duty,
nursing
agencies
and
program
of
all
inclusive
care
for
the
elderly.
And
that's
I
know
you
don't
want
to
use
acronyms.
But
people
commonly
know
that
it's
the
PACE
program
so
and
moving
onto
the
next
slide
here
so
here
the
should
get
any
exemptions
off
authorized
by
state
law.
L
L
And
then
there
are
as
spoken
about
previously
House
Bill
777
is
pretty
comprehensive
and
that
really
worked
on
ground
ambulance
services,
and
so
this
exempt
city-owned
ambulance
services
that
provide
transport
in
a
counter
count:
hermanus
city
outside
of
its
service
area.
If
the
city
has
an
agreement
and
then
July
effective
until
July
2026,
the
hospital
owned
ambulance
services
can
provide
a
non-emergency
or
emergency
transport
originating
from
the
hospital,
so
that
could
be
inter-facility
transports
as
well
as
non-emergency
transports
to
a
skilled
nursing
facility
and
then
as
well
with
House
Bill
77.
L
There
was
a
certificate
of
need
exemption
for
cities
or
counties
seeking
to
provide
emergency
ambulance,
Transport
Services,
Under,
The,
Following
conditions,
and
that
was
the
city
or
county
government
had
conducted
a
public
hearing
to
demonstrate
an
imperative
need
to
provide
emergency
transport
within
the
city
or
county,
and
it
would
directly
provide
emergency
transport
with
it
within
its
jurisdiction
boundaries,
either
into
a
contract
or
enter
into
a
contract
with
Hospital
located
within
its
jurisdiction
or
Jason
County.
If
there's
no
hospital
in
that
county,
let's
see.
L
L
L
And
then
that's
through
900
KR
6130
section
three
one.
A
for
establishes
the
requirement
for
practitioners
to
have
overall
responsibility
for
patient
care,
and
so,
for
example,
of
a
physical
therapist
can
own
a
facility,
an
employee,
a
practitioner
outside
of
his
or
her
scope,
such
as
a
speech
therapist
and
and
still
qualify
for
the
Private
Practice
exemption.
L
L
And
currently,
pending
regulations,
we
have
the
annual
update
with
the
State
Health
Plan
oig
has
filed
900
Kar
5020
and
900k
r6075
on
March
15
2023.
The
proposed
changes
include
the
following:
it
allows
acute
care
hospitals
to
convert
the
existing
acute
beds
to
psychiatric
beds
as
I
mentioned
earlier,
and
that
would
for
non-sub
non-substitute
review.
It
deletes
outdated
language
referring
to
tuberculosis
beds
and
allows
a
long-term
care
pediatric
facility
to
add
50
or
fewer
beds.
L
Okay
and
then
our
emergency
circumstances,
we
have
a
pending
regulation
out
for
that
and
in
an
effort
to
help
address
situations
which
involve
an
ambulance
provider
that
surrendered
their
license.
We
were
working
with
Kentucky
Board
of
Emergency
Medical
Services,
two
providers
notified
them
that
they
would
be
ceasing
operations
and
in
order
to
continue
operations
within
not
in
Lewis
counties,
we
have
have
changed
our
emergency
circumstances
to
allow
a
provider
to
come
in
quickly
and
provide
those
services.
So
there
is
no
lapse
in
services
within
those
counties.
I.
L
K
L
I
will
actually
I
will
have
to
get
you
those
answers,
I
don't
have
them
and
I
I
think
it
would
vary.
I
think
it
might
be
easier
to
give
you
maybe
five
years
pre-pandemic
and
then
what
we've
got
so
you
can
see,
maybe
a
10-year
run
of
it.
So
you
can
kind
of
see
what
it
looks
like,
but
we're
happy
to
get
that
information
for
the
committee.
K
L
K
Does
the
proliferation
of
Medical
Services
actually
increased
the
cost
of
Quality
Health
Care,
which
is
an
assumption
that
we
made
back
in
1980
or
does
competition
decrease
the
cost
of
Quality,
Health,
Care
and,
and
those
are
I
mean
I
honestly
think
this
is
a
presumption
that
we
really
need
to
evaluate
and
see?
Is
it
a
correct
presumption
or
not?
Are
we
doing
a
service
I
always
thought
cons
were
basically
to
protect
providers
not
to
protect
patients,
but
that
may
be
backwards
in
my
head.
H
That
was
several
lifetimes
ago,
a
while
back
and
I
think
we
have
to
acknowledge
how
different
the
health
care
delivery
system
was
back
in
1980
at
that
time
is
still
predominantly
cost-based
reimbursement
and
really,
at
least
from
a
former
provider's
standpoint.
The
intent
of
certificate
need
was
control,
the
expenses
that
were
being
passed
on
to
Medicare
and
Medicaid
because
they
were
cost
based.
There
were
no,
there
were
no
risk
involved
for
providers.
For
the
most
part,
you
buy
a
CT
scanner.
If
it
didn't
have
the
number
of
procedures,
you
thought
it
would
didn't
matter.
H
The
cost
is
going
to
be
picked
up,
at
least
at
that
time,
80
to
85
percent
by
Medicare
Medicaid,
so
really
in
1980,
the
intent
was
to
control
the
the
growth
of
Medicare
and
Medicaid
expansions
and
when
I
look
at
these
particular
bullets
under
here
that
the
general
assembly
finds
is
a
means
to
ensure
safe,
adequate
and
efficient
medical
care.
I,
don't
think
it's
done
that
the
proliferation
of
unnecessary
Health,
Care,
Facilities,
Health
Services
in
order
for
costly
duplication
under
use,
don't
think
it's
done
that.
H
Increases
in
cost
of
quality
of
health
care,
I,
don't
think
it's
done,
that
the
final
three
bills
improve
the
quality
of
Health
Care.
Don't
think
he's
done
that
increase
Access
to
Health,
Care
Facilities.
Certainly
hadn't
done
that,
particularly
in
rural
areas,
and
we
know
we
have
some
Urban
Healthcare
deserts,
but
lasted
to
create
a
cost,
effective,
Health,
Care
delivery
system.
It
certainly
has
not
done
that
and
that's
not
a
criticism.
Ufos,
there's
a
criticism
of
the
system,
so
the
point
I'm
trying
to
make
is
I.
H
Don't
think
that
the
findings
and
purpose
that
we
adopted
in
1980
are
appropriate
for
today
and
Mr
chair.
What
I
would
encourage
is
I
think
we
have
to
look
more
basic
at
this
is
what
is
our
intent
for
certificate
need
I,
think
it
has
its
place.
I
think
it
has
some
value,
but
I
think
we
really
need
to
do
a
real
drill
down
on
this
in
terms
of
what
are
we
trying
to
accomplish
so
Tiffany
has
historically
been
very
prescriptive.
H
H
Something
else
is
to
ensure
an
adequate
Health,
Care
delivery
system
for
all
kentuckians,
just
not
for
some,
but
again,
if
these
findings
and
purposes
of
what
we
have
from
1980
I,
don't
think
it's
is,
is
no
longer
adequate
for
the
state
of
Kentucky
and,
for
instance,
some
real
obstacles
to
having
the
type
of
Health
Care
delivery
system
that
we
all
want
and
need.
So
I
don't
know
if
that's
a
question
as
much
as
it
was
a
sermon
I'm.
Sorry
for
that.
M
L
H
C
C
N
C
C
M
M
L
I
think
I
can
give
you
an
example
if
you're
constructing
something
and
you've
given
us
a
certain
total
expend
capital
expenditure
and
you
get
into
the
project
and
you
realize
it's
going
to
be
double
the
cost,
as
many
hospitals
doing
construction
realize
that,
instead
of
going
through
the
process
all
over
again,
you
would
just
submit
that
cost
increased
to
us.
Okay,.
C
C
M
M
Sure
my
hearing
is
pretty
good
it
also.
It
also
includes
people
who
provide
who
who
receive
Health
Care
in
that
area,
but
is
statutorily
defined
and,
as
you
can
imagine,
that
gets
argued
about
a
fair
amount,
but
it
would
be
the
hearing
officer
in
the
same
way
that
in
a
dispute
before
a
court,
the
judge
would
make
that
decision
about
whether
a
party
has
standing
it's
very
similar,
so
the
hearing
officer
would
have
to
sort
out
whether
the
The
Entity
that
is
challenging
hasn't
is
an
affected
party
or
not.
M
There
is
an
exception
to
that
I.
Think
for
there
was.
We
made
a
change
for
the
PACE
program.
The
all-inclusive
care
for
the
elderly.
That
affected
party
is
a
bit
more
narrowly
defined,
and
so
because
it
is
very
very
spelled
out,
our
office
can
can
look
at
that
initially
and
and
if
that
person
or
whoever's,
true
or
What
entity,
trying
to
make
that
challenge
does
not
fit
within
that
more
narrow
definition,
and
it's
very
very
clear,
then
then
we
could
make
that
determination.
But
generally
it's
the
hearing
and.
C
Regarding
the
charge,
so
we
have
on
the
formal
review
any
decision,
whether
it's
appealed
or
whether
there's
a
hearing
or
there's
no
hearing
ends
with
the
administrative
hearing
officer
on
the
non-subsitive
review.
If
there
is
a
hearing
it
ends
with
the
administrative
hearing
officer
making
a
final
decision.
If
there's
no
hearing,
then
the
oig
makes
that
determination.
Can
you
explain
to
us
the.
N
E
My
fella,
so
if
you
have
an
entity
I
guess
what
I'm
asking
it.
If,
when
you
have
an
area,
that's
rapidly
growing
independent
of
pandemic,
there
is
a
demonstrated
need
to
have
more
services.
Would
another
entity
that
wanted
to
come
in
be
denied
that
or
would
preference
be
given
to
the
entity
that
already
exists
to
expand.
A
I'm
going
to
follow
up,
I
I,
know,
representative
Burke.
You
have
something
but
I'm
going
to
follow
up
on
that
I
I,
don't
I,
don't
think
there
was
any
suggestion
that
there
was
preferential
treatment
given,
but
I'm
not
sure
that
we
answered
the
question.
The
question
was:
how
do
you
determine
whether
you
have
a
pre-existing
entity
that
who
is
there
who
will
continue
to
operate
versus
a
new
entity
who
is
seeking
to
operate
in
that
space?
Is
that
I.
L
Think
I
I
think
there
would
have
they
would
have.
There
would
have
to
be
need
either.
If
it's
non-non
substitute
there
would
have
to
be
a
presumed,
there
would
be
a
presumed
need
in
that
Community.
If
it
was
formal
review,
then
it
would
have
to,
depending
on
the
level
of
care,
it
would
have
to
follow
the
criteria
within
the
State
Health
Plan,
and
they
would
be
able
to
show
that
they
were
able
to
provide
those
service.
L
There
was
a
need
for
those
services
to
be
provided
and
that
it's
whoever
were
to
file
their
certificate
of
need
application.
We
don't
really
look
at
it
as
if
you
already
have
an
existing
facility
there
or
not.
It's
just
whoever
files
that
application
did
that.
Did
that
help
answer
that
a
little
more
clearly.
E
I
Thank
you.
My
first
question
references,
Slide
Five,
the
five
review
criteria
for
certificate
of
need
and
I'm
thinking
about
the
State
Health
Plan.
My
question
is:
who
creates
the
State
Health
Plan
using
what
data
and
do
we
audit
that
to
ensure
that
we
are
constructing
a
good
State,
Health
Plan
sure.
M
M
We
do
as
far
as
like
there
are
need
calculations
that
are
within
the
state
health
plan.
We
also
conduct
annual
data
surveys
and
those
are
available
and
those
are
relied
on
to
see.
You
know
how
the
numbers
that
were
the
services
that
were
provided
in
each
area
by
what
facility
in
the
prior
year
and
then
just
the
process
of
of
adopting
it
each
year
there
is
a
statutory
requirement
for
an
annual
update.
M
We
solicit
comments
from
the
provider
Community
before
we
even
draft
the
first
version
of
the
regulation
each
year,
so
it
goes
out
in
the
con
newsletter.
I
think
the
this
last
time
it
went
out
last
fall,
probably
October.
We
give
them
a
month
and
a
half
or
so
to
submit
suggestions
for
changes
then,
and
look
at
those
within
the
office
talk
to
policy
Specialists
and
make
some
decisions
about
what
should
go
in
the
next
version
and
then
it
gets.
L
I
So
the
initial
data
primarily
or
exclusively
comes
from
providers
and
then
there's
an
opportunity
for
public
comment.
Is
that
my
correct
right?
Thank
you.
My
second
question
relates
to
the
application
flow
chart
in
slide.
Six
and
the
question
is
this:
what
percentage
of
effective
affected
parties
in
the
formal
review
or
the
non-substantive
review
are
patients,
as
opposed
to
health
care
providers.
I
A
A
There
are
a
couple
of
places
where
it
says:
proliferation
increases
the
cost
and
the
quality
of
care
they're.
Also,
if
we
look
under
KRS
chapter
216
B,
it
says
improved
quality
of
Health
Care
Facilities
I'm,
trying
to
find
out
what
we
use:
quality
of
care
and
quality
of
healthcare
facilities
and
I'm,
not
sure
that
we
have
a
way
that
is
written
or
in
statute
or
that
I've
been
able
to
find
that
defines
that.
L
Yeah,
thank
you.
You
know.
Center
for
Medicare
Medicaid
services
obviously
has
several
metrics
that
they
work
from
the
state
of
Kentucky
does
not
have
a
specific
set
of
metrics.
Where
we're
we're
measuring
those.
We
rely
heavily
on
centers
for
Medicare,
Medicaid
services,
I,
didn't,
say,
CMS,
I'm,
really
proud
of
myself.
A
Thank
you.
I
have
a
second
question
going
back
to
the
CEO
or
the
certificate
of
need
application
flow
chart.
If
we
move
to
the
bottom
under
where
it
says,
hearing
requests
affected
by
party
within
15
days,
the
darker
box,
it
says
in
accordance
with
case
law,
could
you
help
me
out
with
that
I'm
I'm,
a
physician
I'm,
not
an
attorney.
M
A
Who
selects
the
hearing
officers
and
how
are
those
particular
hearing
officers
selected
to
review
a
particular
certificate
of
need
application?
Is
there
a
round
robin?
Is
there
a
you
know,
you
just
you
know,
put
a
bunch
of
names
in
a
hat
and
somebody
closes
their
eyes
and
picks
them
out
how
so
there
are
two
questions
there
I
hope,
I.
If
you
could
I.
M
Can
only
answer
probably
a
part
of
that
I
do
know
there
are
lots
and
lots
of
different
types
of
hearings
that
the
cabinet
is
involved
in
and
in
a
wide
range
of
topics.
So
there's
a
separate
office
within
the
office
in
a
separate
division
of
hearing
officers,
and
this
is
all
they
do
and
they
go
through
specialized
administrative
law
judge
training
because
they
essentially
act
like
judges
and
I.
A
Once
you
find
out,
could
you
could
you
deliver
that
information?
If
you
send
it
to
my
office,
then
I
can
distribute
it
to
the
rest
of
the
committee.
There.
There's
no
need
to
you
know,
send
all
that
paperwork
out,
we'll
we'll
take
care
of
some
of
those
things.
Are
there
any
other
Senator
sensorberg?
First
thank.
K
Know
I'm
a
traditionally
a
hospital-based
physician,
so
Joint
Commission.
You
know
we
have
Joint
Commission
surveys,
we
participate
them.
We
do
well
God
willing.
We
do
well
enough
that
we
get
you
know
for
five
years.
They
don't
have
to
come
back
so
that
I'm
very
familiar.
You
know,
as
chief
of
staff
and
as
a
hospital-based
physician.
What
joint
commission
requires
for
these
outpatient
facilities?
L
It
depends
on
the
facility,
obviously
office
of
Inspector
General
off
also
surveys,
different
facilities
as
well,
and
so
I
would
say
that
is,
is
comparable.
I
know
that
you
know
that
is
the
closest
thing
to
an
accreditation,
accrediting
body
such
as
Joint
Commission.
There
are
several
other
ones
within
the
state
of
Kentucky,
so.
L
H
Thank
you,
Miss
Sharon.
This
is
kind
of
a
procedural
type
of
question.
If
an
organization
is
granted
certificate
need-
and
they
start
operation
facility,
but
sometime
down
the
road
they
decide,
they
don't
want
to
continue
that
service.
Do
they
retain
that
certificate
need
or
who
does
the
certificate
belong
to
so.
L
When
they
start
operating
and
they
get
a
license,
the
certificate
of
need
goes
away.
That's
really
kind
of
a
placeholder
for
them
to
get
the
license
under
the
provisions
of
the
certificate
of
need.
So
if
they're
going
to
be
a
hundred
bad
acute
care
hospital,
the
certificate
I
need
would
say
that
and
then
they
would
be
licensed
for
that
100
bed,
acute
care
and
that
certificate
of
need
is
no
longer
really
a
valid
document
anymore.
L
A
E
Thank
you.
I
just
want
to
follow
the
question
so
I'm,
looking
at
a
recently
granted
certificate
of
need
that
establishes
a
24
bed,
Nursing
Facility,
but
this
hospital
has
relocated
them
and
specifically
out
of
my
counties,
what
happens
to
them
when
they're
relocated
are
those
beds
gone?
Are
they
just
closed.
L
I
would
have
to
look
at
the
because
we'll
need
to
look
at
what
the
needs
are
within
the
county.
If
you
can
send
me
that
I'm
happy
to
look
at
it
and
we
can
go
through
it,
it's
it's
a
little
dependent
on
a
couple
different
factors,
so
it
may
change
at
the
next
survey
cycle
based
on
those
like
did
they
move,
they
can
move
to
a
contiguous
County,
but
they
can't
move.
You
know
from
Paducah
to
Pikeville,
let's
say
so.
I
Thank
you,
Mr,
chair
referencing,
back
to
the
presentation
from
ncsl.
We
were
informed
that
Illinois
and
Nevada
have
legislation
that
requires
Health
Facilities,
to
seek
certificate
of
need,
approval
to
close
services
and
I
think
this
dovetails
with
representative
Proctor's
question:
do
we
require
Health
Facilities
to
seek
a
certificate
of
need
if
they're
going
to
close
a
facility
or
stop
providing
certain
services
in
an
area.
D
M
In
if
you
look
in
the
State
Health
Plan
under
each
category
of
service,
it
will
you
know
sometimes
it's
formulas.
Sometimes
it's
not
a
formula,
but
if
you
look
at
it
and
I
probably
should
have
brought
you
a
copy.
But
if
you
look
at
the
State
Health
Plan
it'll
help
explain
that
a
little
better
great,
because.
L
M
A
A
For
the
for
the
members
of
the
committee,
we'll
be
we'll
be
taking
information
for
further
topics
that
that
we
can
look
at
in
the
future,
my
co-chair
will
be
chairing
the
the
next
meeting
on
July
17th
again
I
want
to
thank
you,
Mr
inspector
and
and
Miss
Deputy
inspector.
For
for
your
time.
Thank
you
very
much.