Comparison of State CON Standards, Criteria and Bed Need Inpatient Rehabilitation

Transcription

1 Comparison of State CON Standards, Criteria and Bed Need Inpatient Rehabilitation State Code Last Updated Planning Policy Alabama /31/10 (4) (b) Conversion of beds given priority over new construction when conversion is less costly and existing structure can still meet licensure and certification District of (i) and? See 4050 for general criteria and Columbia general standards for review DC has an annual implementation Plan (AIP) Florida 59C (5) ( c) Priority consideration for: applicant that is a disproportionate share hospital; proposing to serve Medicaid-eligible persons; a designated trauma center 59C (5) (g) Priority considerations 1. applicant is a disproportionate share hospital 2.aplicant proposing to serve Medicaideligible persons 3.applicant that is a designated trauma center 59C (6) (10) (6) Access Standard Comprehensive medical rehabilitation inpatient services should be available within a maximum ground travel time of two hours under average travel conditions for at least 90% of the district s total population. Bed Need 12 beds per 100,000 population per region; 7 regions. 75% occupancy expected before new beds are considered. No specific occupancy or rate for acute rehab noted. Need formula for each District Net Need for IP Beds=((Days/Population) x Projected Pop. / (365 x.85)) Licensed Beds Approved Beds Max. Facility # Net # of Need Beds Allowed= ((Hospital Patient Days/District Patient Days) x (Rate of Patient Days x Proj. Pop.) / (365 x.85)) Hospital Licensed Beds Hospital Approved Beds Most recent average annual district occupancy rate Regardless of whether bed need is shown under need formula in paragraph (5)( c), no additional comprehensive medical rehabilitation inpatient beds shall normally be approved for a district unless the average annual occupancy rate of the licensed comprehensive medical rehabilitation inpatient beds in the district was at least 80 percent for the 12 month period ending six months prior to the beginning date of the quarter of the publication of the fixed bed need pool. 1

2 (7) Quality of Care (a) compliance with licensing Accreditation new or additional units must meet CARF or meet Medicare if not yet eligible for CARF (8) Services Description (a) age groups (b) specialty services proposed staffing (d) plan for recruiting staff (e) expected source of patient referral (f) projected number of comp rehab ip services inpatient days by payer type, including Medicare, Medicaid, private insurance, self-pay, and charity acre patient days for first two years of operation after completion of project (g) admissions policies of the facility with regard to charity care (9) applications from existing providers of comp med rehab must provide: a. # of comp med rehab IP service admissions, patient days for 12 month period ending six months prior rto the beginning date of the quarter of the publication of the fixed bed need pool. b. number of comp rehab ip services inpatient days by payer type, including Medicare, Medicaid, private insurance, self-pay, and charity acre patient days for the 12 month period ending six months prior to the beginning date of the quarter of the publication of the fixed bed need pool c. gross revenue by payer source for 12 month period ending six months prior to beginning date of the quarter of - Beds should be available within 2 hours under average travel conditions for 90 % of the district s total population - Special Circumstances for Approval of Expanded Capacity at Hospitals with Licensed Comprehensive Medical Rehabilitation Inpatient Services (1) if the occupancy rate of the hospital s licensed comprehensive medical rehabilitation inpatient beds was at least 90 percent for at least two consecutive calendar quarters during the 12 month period ending six months prior to the beginning date of the quarter of the publication of the fixed bed need pool ; and at least one of the following conditions is also met: a. Applicant submits evidence that it has a specialty inpatient rehabilitation service, accredited as a specialty by the Commission on Accreditation of Rehabilitation Services (CARF), that is not available elsewhere in the district, and the applicant s high occupancy occurred in the specialty service beds; or, b. The applicant is a disproportionate share hospital as determined consistent with the provisions of section , Florida statutes, and the applicant submits evidence that it has been providing both Medicaid and charity care days in its comprehensive medical rehabilitation beds. (2) The maximum number of additional comprehensive medical rehabilitation beds which may be approved at an applicant s facility under the provisions of sub-paragraph1 shall not normally exceed the number determined in accordance with the following formula: 2

3 the publication of the fixed bed need pool. d. current staffing e. specialty services (10) Utilization Reports (11) Applicability of the Amended Rule ADD = ((HPD/PD x PPD / (365x.85)) HLB HAB.85 = desired annual comprehensive medical rehabilitation inpatient bed occupancy rate for the hospital at the planning horizon Other Factors (1) Applicants shall provide evidence in their applications that their proposal is consistent with the needs of the community and other criteria contained in: a.local health Council District Plans, icludingthe CON allocation factors reports and b.state Health Plan (2) Applications for new or expanded comprehensive medical rehabilitation inpatient beds shall not normally be approved unless the applicant converts a number of acute care beds. Excluding specialty beds.unless the applicant can reasonably project an annual occupancy rate of 75% for the applicable planning horizon..(see more) Georgia March 2007 Utilization rate per 1,000 for current year for each planning region for patients aged 18 and older; Calculate average daily census; Divide by 85% Georgia used to use DRGs to project possible need for IP Rehab (early 1990 s), but decided 3

4 that setting a standard based on actual utilization makes more sense. With regard to impact, criteria say that if the proposed project will reduce occupancy below 75% at a facility at or above 85%, then project is regarded as having an adverse impact. For facilities below 75%, if the project will result in a 10% decrease in occupancy, then the project is also regarded as having an adverse impact. Charity Care is required 3% of gross revenue after Medicare, Medicaid and bad debt have been excluded, in the future plus evidence of previous history of charity care. Exceptions to standards: The need and impact criteria can be ignored if: an applicant is proposing a program to located in a county with a population of less than 75,000 and at least at 50 miles away from any existing program. Or if cost, quality, financial access or geographic accessibility are barriers or 30 percent of utilization is from out of state for the two previous years. Or If there is no existing provider in a planning area and the applicant demonstrates need based on patient origin data. There are minimum standard regarding adult IP rehab: 20 beds for adult programs in a freestanding rehab hospital already offering another comprehensive IP rehab program; 20 beds in an acute care hospital; 40 beds in a 4

5 freestanding hospital not already offering another comprehensive IP rehab program. There is a ten bed minimum for pediatric beds in a freestanding rehab hospital already offering another comprehensive IP program. Ten is also the minimum for acute care hospitals, and 40 beds for a new freestanding hospital not already offering another comprehensive IP rehab program. Hawaii SHP 2009 Thresholds may be modified to: incorporate current and best clinical practices; allow for the cost-effective transition and capital investment in moving traditional IP services to OP modalities; allow for the cost-effective introduction of modern technology to replace existing technology; address the documented needs of an actual population rather than basing care design on statistical generalizations. Min annual occupancy rate is service area is 85% based on licensed beds Illinois Title 77, Chapter II, Subchapter a, Part 1100, section.550 Working draft 4/20/09 Sub-optimum utilization may be proposed if the benefits clearly outweigh the costs Benefits are defined as the form of improved access for the service area(s) population combined with significant improvement in quality and/or significant reduction in cost to public. Comprehensive Physical Rehabilitation mincode/077/ d05500r.html Annual minimum occupancy rate 85% 1.Divide base year experienced rehab patient days by the base year population estimate to determine planning area s experienced use rate. If use rate is<60% of State base rate, adjust planning area s use rate to 60% of the state base rate to establish a minimum use rate 5

6 2.multiply planning area s experienced, or minimum use rate, by population projection for 10 years from base year to determine projected patient days for planning area 3.divide projected patient days by number of days in projected year to obtain projected ADC 4.Divide projected ADC by.85 to obtain projected planning area bed need 5.subtract number of existing beds in planning area bed need to determine projected number of excess (surplus) or project need (deficit) for additional beds in the area The minimum # of beds for an inpatient hospital unit is 16. The minimum # of beds for a freestanding acute rehab hospital is 100. Kentucky SHP 10/13/10 ADD means Area Development District The Kentucky Cabinet for Health and Family Services may approve more rehab beds than indicated by need formula to allow for a presence of a hospital that provide a higher intensity of services Notwithstanding criteria 1,2,3 an applicant proposing to establish an IP rehab unit within an acute care facility with at least 100 beds.if, no other licensed or CON authorized IP rehab beds in proposed ADD or no other IF NEW CAPACITY, is proposed, demonstrate that the overall occupancy for comprehensive physical rehabilitation beds in the ADD exceeds 75% IF EXPANDING, >75% in ADD If criterion for either new or expansion is not met, maximum number of beds that may be computed is as follows: N = [(PD/P) x PP / (365 x 0.75)] (LB+AB) N= Need for Rehab beds in ADD PD = IP rehab patient days, most recent published data 6

7 Maine Massachusetts DHHS, Bureau of Medical Services Chapter 503 CON Manual - 12/23/04 Determination of Need regs 105 CMR DON dated 3/6/09 licensed or CON authorized IP rehab beds within 45 highway miles of proposed site.in these two situations, the maximum # bheds will be determined on volume projections for five years out and will be the higher of two methods reasonable forecast or regression analysis of patient day trends over five year timeframe. Minimum size for a freestanding rehab hospital shall be 40 beds. And minim number for a new rehab unit in an acute care hospital shall be 10 beds. SHP developed pursuant to 2 MRSA c.5. section h/quality/determination_need/250donkit.pdf P = estimated population for period used to derive patient days PP = projected 2009 population for ADD 0.75 = desired average annual occupancy rate for rehab beds in ADD LB = licensed IP rehab beds in ADD AB = # IP rehab beds in ADD for which a CON has been granted Exceptions: More rehab beds can be approved than what the need formula indicates see adjacent left column. There does not a specific formula regarding capacity/need. It doesn t appear that there are specific criteria for IP rehab beds. Mississippi Chapter 6 Sections , , Mississippi Code 1972 annotated as 2011 CON applications should state if they intend to serve children If a health care facility voluntarily delicenses some of its existing bed complement, it may later re-license some or all of its bed complement without a CON those beds continue to count in state total bed count for planning purposes Under Need Criterion: projects which do not involve additional CMR beds document need may consist of citing Level I: 0.08 beds per 1,000 Level II:.0623 beds per 1,000 Minimum size freestanding facility size is 60 beds Level I units in acute facilities shall not be <20 New Level II in hospitals are limited to maximum of 20 beds New level II rehab units must not be within a 45 mile radius of any other CMR facility Occupancy of 80% for twelve months or at least 70% most recent two years Priorities in competing applications: hospital having 160 licensed acute beds as of January 1, 7

8 amended of licensure or regulatory code deficiencies, institutional long term plans, recommendations by consultant firms, deficiencies noted by accreditation agencies Specify 1 or more of services for level 1 Level II prohibited from certain services Levels I and II include in annual report of hospitals: total admissions, ALOS by DX; patient age; sex, race, zip code, payer source, length of stay by DX. Does specify staffing and services: for free standing, Director of Rehabilitation and types of services delivered by professionals on a full-time basis; for hospital units, level I and II same thing. Explicitly states that until child-specific IP rehab facilities are implemented, that those types of proposals will be evaluated with current IP rehab criteria and standards. 2000; highest average daily census; location more than 45 mile radius from existing provider; proposed range f services; patient base needed to sustain CMR services Level I facilities offer a full range of services. Level II facilities offer services to treat disabilities other than spinal cord injury, congenital deformity, and brain injury. No sub-geographic areas for calculations Missouri 19 CSR p. 11 2/28/07 Replacement equipment there is a list of questions For new equipment units in the area Unmet Need = (R x P) U R = community need rate of one unit per population listed P = year 2005 population in area U = number of service units in service area For new hospital See above, IP rehab beds R is one bed per 9,090 population (which is about 11 beds per 100,000 population) ofneed/laws.php 8

9 19c60-50.pdf (see page 12). New Hampshire Chapter He-Hea 700 Comprehensive Physical Rehabilitation Services Access to care is simply nondiscrimination The board shall approve a petition for the temporary conversion of a maximum of 3 beds to comp physical rehab beds once per year for acute care hospital such conversion only good for three months Any acute care hospital or specialty hospital holding a CON for comprehensive physical rehabilitation beds in a region may transfer all or a portion of those beds to another licensed acute care hospital or specialty hospital in the same region provided notice is given to the board. Notice in writing, LOI shall approve any complete letter, if beds are comp physical rehab provider needs to comply with He-Hea beds per 100,000 persons per region There appear to be 5 regions. There is a minimum of 20 beds for a unit. There is no mention of freestanding IP rehab centers or minimum beds for them. Determination of unmet need done biennially after adoption of regulation; unmet need is calculated by subtracting number of licensed or approved comp rehab beds from the number calculated to be needed under He-Hea Facilities receiving beds must comply with RSA 151-C:5, II(e) He-Hea Administrative requirements>>>> 1.intake screenings Admissions Transfers Patient discharges Individualtx plans Availability of services provided by 9

10 hospitals, through contractual agreements, or both, which shall include at a minimum of (there s a list) Staffing requirements DON Med Dir Pharmacist Dir Soc Services RD OT PT ST RT Other nursing staff and aides trained to provide services QA program See list Impact See list Criteria Nebraska CON statutes to Statutes relating to health care facilities rehab bed defined rehab beds; moratorium; exceptions to 2049 [ rehab hospital defined, one sentence, abridged? See below ] Rehabilitation beds; moratorium; exceptions, as follows: all beds requiring a CON are on moratorium except: average occupancy for all rehab beds in NE>90% occupancy for most recent three quarters reported as of time of filing; if average occupancy for a health planning region >80% for most recent three quarters reported as of filing and no other comparable services are otherwise available in the health planning region, 10

11 New Jersey N.J.A.C. 8:33 CON-general N.J.A.C. 8:43H licensing of rehab hosp. Planning standards and criteria re found at (?) the dep t can grant an exception to moratorium for up to three beds 60 bed minimum for new freestanding rehab hospital 30 bed minimum for a non-freestanding rehab hospital located within another licensed facility In regions with a need for beds, priority is given those who will improve geographic access for residents. Factors to consider are proximity to existing rehab hospitals, population density of the service area, and drive-time to existing & proposed rehab hospitals. Exceptions: Renovations required to meet federal/state safety codes and no change in the # of beds is proposed or needed. If there is a need for fewer than 30 adult or pediatric beds, based on the need methodology, then fewer beds may be considered, but absolutely no fewer than 20 beds total can be approved. In regions with a net need, if a hospital has less than 85% occupancy but can show that it will reach 85% occupancy within a year of project implementation, then it may be approved for more beds. However documentation of specific factors that prevented 85% occupancy must be provided and a description of how obstacles for will be eliminated. Age groups for need: 20-44, 45-64, and 75 plus. Rate of use calculated by dividing for population 11

12 A minimum acceptable rate of patients per population will be set for each group. The minimum will be the rate that is 20% less than the Statewide average for each group. Projections are made for each county for age group based on rate of use and statewide average LOS is used. 85% occupancy is expected. For pediatric patients age groups of 0-4, 5-9, and are used. New York IP rehab for TBI patients 5/5/ (3) Priority given to applicants that: (i) (ii) (iii) (iv) (v) commitment to develop and participate in an areawide network of services have a coma recovery program or transfer agreement with a facility that has coma recovery for brain injured patient unable to participate in active rehab program. It is assumed that 6 coma recovery beds per 1.5 million pop are needed. Have an extended care program for TBI\ provide access to MA patients or MA eligible show a commitment to serve medically indigent patients and other patients regardless of source of Facilities located in regions that have a projected need for beds must be at 85% occupancy before additional beds may be approved (1) service are =health system agency areas (2) divide projected annual patient days by 365, divide result by.90 to allow 90% occ. 3 Dx = brain dysfunction, traumatic brain dysfunction, skull fracture (3) total n of hospital discharges in categories plus 10% then divided by.155 (4)Number of potential candidates for IP Rehab TBI shall be multiplied by 85 LOS to project annual # of IP Rehab-TBI days (5) health systems agencies may make adjustments to bed need estimates to address patient migration patterns and other regional planning issues Minimum Bed Requirements: A TBI rehab program within a comprehensive IP program must have a minimum of 10 beds. A TBI rehab program in a freestanding IP rehab program must have 20 beds at least. 12

13 payment North Carolina G.S. 131E-176(22) is facility definition G.S. 131E-176 From 2011, SHP: mfp.pdf Need for IP rehab beds is based on 3 year average growth rate in IP days of care using four most recent years of data by health service area; there are 6 service areas. Calculate the projected days by multiplying the 3 year average by the most recent year s days of care. Oregon OAR Adjustments to the need standard are possible where a specialty rehabilitation service is proposed, if the applicant submits information demonstrating the size of the population at risk in the proposed service area; the current and historical rate of use for those groups; and the availability, accessibility, quality, and levels of utilization of existing IP services for those groups. Rhode Island Title is DON Expansion of existing rehab units is given priority over the creation of new units for comparable services, unless the applicant for new services is offering the least costly service. 80% use is assumed Need shall not exceed 7 beds per 100,000 population Service area should be consistent with OAR or historical use patterns. Occupancy rates should be at least 85% for expansion. At least 75% of occupancy should be demonstrated as possible within one and a half years of CON approval. Need to find SHP ased/pdf/doh/5342.pdf The criteria appear to be general. No formula of need for IP rehab or projection of need. 13

14 South Carolina Reg CON Bill Act 278 Relative importance of project review criteria: a. Compliance with Need outline in Plan b. B. Community Need c. Distribution (Accessibility) d. Projected Revenue e. Projected Expenses f. Cost Containment g. Resource Availability The benefits of improved accessibility will be equally weighed with the adverse effects of duplication in evaluating Certificate of Need applications for this service. p. V-2 SHP see Chapter V Rehabilitation Facilities p. V-1-3 CON Standards 1. The need for beds is calculated based on rehabilitation service areas. 2. The methodology takes the greater of the actual utilization of the facilities in the service area or the state-wide average number of beds per 1,000 population to project need. 3. For service areas without existing rehabilitation units and related utilization data, 75% of the overall state use rate was used in the projections [which are included in the SHP, p. V-3] Tennessee 2000 SHP -10 beds per 100,000 -Need based on current year population and projected four years out -Applicants use a geographic service area appropriate to inpatient rehabilitation -IP rehab units shall have min of 8 beds -freestanding Rehab hospitals shall have min 50 beds -additional ip rehab beds should not be approved unless occupancy as follows bed units 75% bed units/facility 80% 51 bed plus unit/facility 85% Applicant must document the availability of adequate professional staff, as per licensing requirements, to deliver all designated services in the proposal. It is preferred that the medical director of a rehabilitation hospital be a board 14

15 certified physiatrist Vermont Health Resource Allocation Plan 2009 I didn t see anything in the health resource allocation plan specific to IP acute rehab. These seem to be treated like any other acute hospital bed. Virginia 12 VAC Amended 4/1/09 Proposals for new medical rehabilitation beds should be considered when the applicant can demonstrate that: 1. The rehab specialty is not currently offered in the health planning district and 2. 2.There is a documented need for the service or beds in the health planning district Preference given to a project to expand rehab beds by converting underutilized med/surg beds p VAC Need for new service ((UR x PROPOP/365)/365)/.80 UR means use rate by district. Projections are made for five years into the future, to determine the need for new services. 12VAC Expansion of Services Average annual occupancy must be 80% or greater 12VAC Staffing Medical rehabilitation facilities should be under the direction or supervision of one or more qualified physicians Other Criteria: Medical rehab services should be available within 60 minutes drive time under normal conditions for 95% of the pop. In the health planning district. Washington Ch WAC No need methodology specific to IP Rehab. It appears IP beds in hospitals are treated like other beds in hospitals 15

16 West Virginia 10/5/92 IV. Quality. V. Continuum of Care (coordination with service network as appropriate) VI. Cost VII. Accessibility ( document linkages in service area; transportation for patients who need it) VIII. Alternatives (demonstrate that other alternatives that assure availability of rehab services have been addressed) not differentiated at all. No more than 13 med rehab beds per 100,000 for the service area Total number of beds for me rehab shall not exceed the upper range except under either condition: 1. Med rehab hospitals located on borders of WVA may request additional beds to provide service for out-of-state populations. The hospital will need to document through patient flow studies that it is currently caring for patients in the out-of-state service area ; or 2. An existing rehab facility may add beds if the facility has maintained an average occupancy rate of 85% for the prior 12 month period and the facility has a documented waiting list. The number of new beds shall be based on a need methodology that is reliable, probative and substantial Definitions and Items of Interest Alabama (1) Inpatient physical rehabilitation services are those designed to be provided on an integrated basis by a multi-disciplinary rehabilitation team to restore the disabled individual to the highest physical usefulness of which he is capable. These services may be provided in a distinct part of the hospital, as defined in the Medicare and Medicaid Guidelines, or in a free-standing rehabilitation District of Columbia hospital. See (a) Shared services, applicants need to address in their discussion of alternatives Florida Georgia Hawaii Report out # IP Rehab days by principal ICD-9 Dx. Within 45 days of year end Terrific overview of Reimbursement and National Trends 16

17 Illinois Kentucky SHP, C. p. 7 For the purposes of this Plan there shall be one category of rehabilitation beds called comprehensive physical rehabilitation beds which may be located in free-standing facilities or as units in acute care hospitals that provide therapy and training for rehabilitation. Such facilities offer a range of services that may include occupational therapy, physical therapy, and speech therapy to aid in the restoration of an individual to normal or near normal function after a disabling disease or injury. Maine Massachusetts Mississippi DHHS, Bureau of Medical Services Chapter 503 CON Manual - 12/23/ SHP, Chapter 6, p. 1 Very orderly, well laid out plan. p. 11 #40 REHABILITATION FACILITY means an inpatient facility that is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of medical and other services that are provided under competent professional supervision. 22 MRSA Sec 328 (25) Comprehensive medical rehabilitation (CMR) services are defined as intensive acre providing a coordinated multidisciplinary approach to patients with severe physical disabilities that require an organized program of integrated services. Level I facilities offer a full range of CMR services to treat disabilities such as spinal cord injury, brain injury, stroke, congenital deformity, amputations, major multiple trauma, polyarthritis, fractures of the femur, and neurological disorders. Level II facilities offer CMR services to treat disabilities other than spinal cord injury, congenital deformity, and brain injury. Nebraska Rehabilitation bed, defined. Rehabilitation bed means a bed in a health care facility that is or will be licensed under the Health Care Facility Licensure Act if the bed is in an inpatient facility which is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of medical and other services which are provided under professional supervision and if the bed is part of a hospital or unit of a hospital that is excluded from the prospective payment system under Title XVIII of the federal Social Security Act as a rehabilitation hospital or rehabilitation unit. New Hampshire Chapter He-Hea 700 Comprehensive Physical Rehabilitation Services (i) Comprehensive physical rehabilitation facility means (1) a facility licensed as a specialty hospital in accordance with RSA 151 to offer comprehensive physical rehabilitation services and is certified by CMS or accredited by JCAHO or other accreditation agency that has received deemed status by CMS: or (2)A facility that has been licensed as an acute care hospital in accordance with RSA 151 and approved by CMS or accredited by JCAHO or other accreditation 17

18 agency that has received deemed status by CMS to provide comprehensive physical rehabilitation services in a distinct unit. New Jersey (j) Comprehensive physical rehabilitation services means those specialized medical, social, educational, vocational, physical, occupational, speech, hearing, psychological, respiratory and recreational therapies and prosthetic and orthotic services offered in or as a part of a comprehensive physical rehabilitation facility for the purposes of restoring an individual disabled by disease or injury to the highest physical, vocational and economic usefulness of which he or she is capable. See N.J.A.C. 8:43H Licensing Standards for Rehabilitation Hospitals (but this is not SHP.see 8:Chapter 33 M-1.1 (b) A rehabilitation hospital may be either a freestanding inpatient health care facility or one or more separate and distinct inpatient units within a health care facility that is licensed by the Department of Health and Senior Services to provide comprehensive rehabilitation services, as defined in N.J.A.C. 8:33M-1.2. The facility shall provide both inpatient and outpatient rehabilitation services. The coordinated, multidisciplinary services provided in rehabilitation hospitals shall be aimed at ameliorating the effects of disabilities by maximizing individual and family functional capacities for independent, productive living. 8:33M-2.1 Relationship between licensure and certificate of need requirements The provisions of N.J.A.C. 8:43H, the Manual of Standards for Licensure of Comprehensive Rehabilitation Hospitals, are hereby incorporated by reference. Applicants receiving certificate of need approval for comprehensive rehabilitation beds shall comply with all applicable requirements of N.J.A.C. 8:43H. New York (b) Inpatient rehabilitation programs designed to prevent and/or minimize chronic disabilities while restoring the individual to the optimal level of physical, cognitive, and behavioral functioning. These programs are applicable to those individuals who have severe disabling impairments of recent onset and are able to participate daily (at least five days per week) in multi-disciplinary programs for a minimum of three hours daily. North Carolina G.S. 131E-176(22) is facility definition Rhode Island Title is DON Rehabilitation facility means a public or private inpatient facility which is operated for the primary purpose of assisting in the rehabilitation of disabled persons through an integrated program of medical and other social services which are provided under competent, professional supervision. R23-17-REHAB are the licensing reg s 18

19 Vermont West Virginia 2009 Health Resource Allocation Plan p. 66 COPN standard 3.2 specifically calls for applicants to consider availability and access to both instate and out-of-state service capacity Also has consideration of out-of-state persons seeking service in WVa 19