VILLA MARIA RESIDENTIAL

* IN THE MATTER OF * BEFORE THE * VILLA MARIA RESIDENTIAL * MARYLAND HEALTH * CENTER TREATMENT * CARE COMMISSION * DOCKET NO. 09-03-2297 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Staff Report and Recommendation May 20, 2010

TABLE OF CONTENTS I. INTRODUCTION... 1 Project Description...1 Summary and Staff Recommendation...3 II. PROCEDURAL HISTORY... 3 Review Record...3 Local Government Review and Comment...3 Interested Parties in Review...4 III. DEMOGRAPHIC BACKGROUND... 4 IV. PROJECT CONSISTENCY WITH REVIEW CRITERIA AND STANDARDS... 5 Page A. COMAR 10.24.01.08G(3)(a)-THE STATE HEALTH PLAN...5 COMAR 10.24.07 General Plan Standards, pages 11 to 15...5 2a. Ability to pay...5 2b. Eligibility for uncompensated care...6 2c. Public notice of uncompensated care...6 3. Public information on charges...6 4. New or expanded...6 5. Health and safety regulations...7 6. In-service and orientation programs...7 7a. Transfer and referral agreements...7 7b. Utilization review and treatment protocols...8 B. COMAR 10.24.01.08G(3)(b) NEED...8 C. COMAR 10.24.01.08G(3)(b) AVAILABIL ITY OF MORE COST-EFFECTIVE ALTERNATIVES...9 D. COMAR 10.24.01.08G(3)(d)-VIABILITY OF THE PROPOSAL...10 E. COMAR 10.24.01.08G(3)(e)-COMPLIANCE WITH CONDITIONS OF PREVIOUS CERTIFICATES OF NEED...11 F. COMAR 10.24.01.08G(3)(f)-IMPACT ON EXISTING PROVIDERS...12 V. STAFF RECOMMENDATION... 12 FINAL ORDER... 13 Appendix A. Site Plan B. Floor Plan

I. INTRODUCTION Project Description Villa Maria is a residential treatment center ( RTC ) located at 2300 Dulaney Valley Road in Timonium, Maryland (Baltimore County) and is licensed to serve 95 residents. It is owned and operated by Associated Catholic Charities, Inc. This organization also owns and operates St. Vincent s Center ( SVC ), a residential child care facility licensed for 70 beds located at 2600 Pot Spring Road in Timonium, less than one mile from the current Villa Maria site. A residential treatment center, such as Villa Maria, is defined in COMAR 10.24.07 under Psychiatric Services (p. AP-2) as, a related institution as defined in Health General Article, Section 19-301 et seq., Annotated Code of Maryland, and licensed under COMAR 10.07.04, that provides campus-based intensive and extensive evaluation, and treatment of children and adolescents with severe and chronic emotional disturbance or mental illness who require a selfcontained therapeutic, educational, and recreational program in a residential setting whose average length of stay averages between 12 and 18 months. RTCs typically also offer outpatient day treatment services and schooling for children and adolescents who are able to live at home. RTCs in Maryland do not serve adults. Villa Maria is one of eleven RTCs in Maryland and is the only RTC to serve children aged 12 years and younger. St. Vincent s Center is a diagnostic, evaluation and treatment center licensed by the Maryland Department of Human Resources providing residential, diagnostic, and treatment programming for children with emotional and behavioral problems. It is accredited by the Council on Accreditation. According to its website, St. Vincent s provides services ranging from emergency placement to comprehensive diagnosis, evaluation, and treatment. St. Vincent s admits children between the ages of 3-14 who have the involvement of the local department of social services. Children must demonstrate moderate to severe emotional/behavioral problems which necessitates 24-hour supervision within a structured residential program because of the level of acuity. Children must have the intellectual and physical capacity to participate in the social, recreational, and educational programs. Children of borderline intelligence whose potential for higher functioning has been compromised by their emotional state may be accepted. Children admitted must have a full scale IQ above 60. The Villa Maria physical facilities are described by the applicant as a 50 year-old oversized structure in need of significant renovation. In response to Staff questions with respect to the suitability of continuing to use the Villa Maria campus for the provision of RTC services, the applicant stated that Villa Maria is not in poor condition but the desired upgrading of this campus would be conversion to an all single bed room facility. The St. Vincent s campus is comprised of six resident cottages, an administration building, a multi-purpose space/gymnasium, a chapel, and a nursing building. It has 77 patient rooms. All are private rooms. A renovation of the St. Vincent s Center, at an estimated cost of $250,000, is proposed. Villa Maria proposes to relocate 52 of its 95 beds to the renovated SVC facilities. SVC is 1

reducing its resident population, making this relocation of RTC bed capacity to the SVC campus possible. The Villa Maria campus will continue as the site for operation of the remaining 43 RTC beds. The proposed shift of RTC residents and the facilities and staff to serve this resident census from the Villa Maria campus to the SVC campus is related to two policy initiatives. First, SVC has been planning, in cooperation with the Maryland Department of Human Resources ( DHR ), the agency that licenses SVC, for a diminution of its resident population and, possibly, an eventual total elimination of licensed residential child care services at SVC. The State of Maryland is striving to reduce utilization of group home care for children in favor of facilitating more traditional family living arrangements for the children that have historically used facilities such as St. Vincent s. Therefore, SVC is planning to see a reduction in its census as a result of this initiative and may eventually cease to offer group child care services. Additionally, Villa Maria is anticipating reduced demand for its services as a result of a recent Medicaid waiver that the Department of Health and Mental Hygiene received to serve RTC-eligible children in community settings supported by wrap-around services. The original CON application filed by Associated Catholic Charities in 2009 called for relocating 66 of the 95 beds at Villa Maria to an SVC campus that was fully vacated. It proposed limiting continued provision of RTC services to this single, smaller facility at the new location No RTC services would continue to be provided at the Villa Maria campus. Subsequent to the filing of this CON application, DHR issued a Request for Proposals ( RFP ) to provide 25 residential child care treatment slots. This request caused ACC to reconsider how best to reconfigure the Villa Maria and SVC facilities and review of the application was suspended until recently while ACC reconsidered the project. ACC decided to respond to the RFP and anticipates that DHR will award a contract as early as August, 2010. To accommodate the potential for 25 children continuing to receive residential child care treatment at the SVC campus. In modifying its original CON application, it scaled back the proposed move of RTC beds from Villa Maria to the SVC campus from 66 to 52 RTC beds, allowing it to operate SVC as a dual RTC/residential child care campus, if awarded the DHR contract. ACC also changed its plan by now proposing to keep the remainder of the 95 RTC beds at Villa Maria in operation at the Villa Maria campus, rather than vacating that campus. While the applicant does not characterize the project it this way, its utilization projections and statements concerning staffing suggest that it proposes to operate this smaller RTC to accommodate overflow from the primary RTC, the 52-bed center at the SVC campus, and staff it as required by the census maintained there. ACC has indicated that, if this proposal of Villa Maria is approved, it may return to the Commission at a later date with a modified plan, similar to the original plan concept of operating only a single RTC and no residential child care treatment facility on the SVC campus if the option of residential child care does not materialize. However, it has asked for the Commission to proceed with review of the modified application at this time, because it anticipates being able to complete renovations and beginning the transition to the SVC campus for RTC services in the Summer of 2010, prior to the decision date on the DHR contract. 2

Staff Recommendation Staff s evaluation of the proposed project indicates that it complies with applicable State Health Plan standards, that Villa Maria is a needed facility, that the project can be implemented on a cost effective basis, that the project is viable, and that the project will not have a negative impact on other providers or the health care delivery system. Approval of the project is recommended. II. PROCEDURAL HISTORY Review Record On June 16, 2009, a letter of intent was filed on behalf of Associated Catholic Charities to relocate Villa Maria residential treatment facility to the Saint Vincent Center campus. (D.I. #1) On July 13, 2009, a Certificate of Need application was filed. (D.I. #2). The filing was acknowledged by the Commission on July 16, 2009 and assigned Matter Number 09-03-2297. (D.I. #3) Also on July 16, 2009, the Commission requested that The Baltimore Sun and Maryland Register publish legal notice of this application. (D.I. #4 and #5) On July 27, 2009, Commission staff posed completeness questions on the application. (D.I. #6) On July 22, 2009, The Baltimore Sun confirmed that the requested legal notice had been published. (D.I. #7) On August 10, 2009, responses to the completeness question were received. (D.I. #8) On September 11, 2009, The Baltimore Sun and the Maryland Register were asked to publish notice of the docketing of the Villa Maria application. (D.I. #9 and #10) The Baltimore Sun provided proof of publication to the Commission on September 11, 2009. (D.I. #11) On September 28, 2009, Commission staff posed additional information questions. (D.I. #12) The applicant responded on October 16, 2009. (D.I. #13) Further questions were asked by the Commission on October 20, 2009. (D.I. #14) The applicant responded on October 30, 2009 (D.I. #15) On November 3, 2009, the applicant wrote, expressing the view that the standards identified as interim standards at COMAR 10.24.07G, are not applicable to this CON application. (D.I. #16) In discussing this matter with the applicant, agreement was reached on which standards were applicable and which were not. The applicant contacted the Commission during the second week in December, 2009, and informed Commission Staff that pending action by the Department of Human Resources had prompted the applicant to reconsider whether the application, as proposed, should go forward. 3

Therefore, the applicant asked the Commission Staff to suspend review of the application pending their review of the new situation. On March 8, 2010, counsel for Villa Maria wrote to the Commission in advance of a planned meeting on March 9, 2010. The letter provided background on the Request for Proposals by DHR that had prompted ACC to reconsider future plans for the SVC campus. (D.I. #17). On April 26, 2010, the applicant submitted modifications to its CON application. (D.I. #18) On that same day, The Baltimore Sun was asked to publish notice of the modifications (D.I. #19) and the modifications were posted on the Commission s website. (D.I. #20) #21) On May 4, 2010, The Baltimore Sun provided proof of publication on May 3, 2010. (D.I. A letter of support for the project was received from the Deputy Secretary for Behavioral Health and Disabilities, Department of Health and Mental Hygiene, on May 6, 2010. (D.I. #22) Staff posed additional information questions to the applicant on May 4, 2010 (D.I. #23) which were answered by the applicant on May 10, 2010. (D.I.#24) Local Government Review and Comment No comments on this project have been received from Baltimore County Health Department or other local government entities. Interested Parties in Review There are no interested parties in this review. III. DEMOGRAPHIC BACKGROUND Residential Treatment Center Facilities in Maryland There are currently 11 RTCs operating in Maryland. Villa Maria is the only RTC that serves children aged 12 years old or less. At the time of the completeness question responses, Villa Maria had 86 children aged 5-14 in nine residential apartments. The current census is comprised mostly of males; one-fourth of the residents are female. Approximately 60% of all residents admitted are referred from a hospital and have a lead agency such as a Core Service Agency. The remaining residents are already in the custody of Department of Social Services ( DSS ). Villa Maria reports that its average length of stay ( ALOS ), in FY 2008 and 2009, was approximately 13 months; it projects a much reduced ALOS (approximately 9 months) in the future. The State Health Plan, which has not been recently updated, indicates an ALOS for Maryland RTCs of 12 to 18 months. 4

The other RTCs in the State are located in Anne Arundel (1), Baltimore City (2), Baltimore County (3), Dorchester (1), Frederick (1), and Montgomery (2). Utilization of Villa Maria Residential Treatment Facility Beds Villa Maria reports that in FY 2008 and FY 2009, its 95 RTC beds operated at 92% and 85% average annual occupancy, respectively. It reported 60 and 48 admissions, respectively, in those years. It projects 50 admissions in FY 2010 and 80 admissions in FY 2011 and FY 2012, but with a substantially shorter ALOS in these out years; 9 months compared to 13 months in 2008 and 2009. Thus, even though admissions to the Villa Maria RTC beds are project to increase, average daily census is projected to decline, from an average of 83.1 residents in 2008-09 to an average of 65.4 patients in 2011-12. IV. PROJECT CONSISTENCY WITH REVIEW CRITERIA AND STANDARDS A. STATE HEALTH PLAN COMAR 10.24.01.08G(3)(a)State Health Plan. An application for a Certificate of Need shall be evaluated according to all relevant State Health Plan standards, policies, and criteria. The applicable section of the State Health Plan for this review is COMAR 10.24.07, the State Health Plan for Facilities and Services: Overview, Psychiatric Services, and Emergency Medical Services, General Standards. This plan chapter is dated and includes some standards for RTCs that are not applicable to this project, in that these standards were developed as interim standards at a time when Maryland mental health authorities were actively engaged in transitioning children and adolescents to residential treatment settings from more intensive hospital settings of care. Only the standards applicable to this project are reviewed below. PART ONE: STATE HEALTH PLAN STANDARDS COMAR 10.24.07 General Standards 2a. Ability to pay must not be a barrier to services. Each facility and organized service provider must document, if requested by the Commission, that it has established and maintained access to all services regardless of an individual s ability to pay. Requested data must list the number of patients presenting for and served by each of the following methods of assistance: (i) Uncompensated care (the facility s or provider s own policy and also, in the case of a hospital, its applicable Hill-Burton policy); (ii) (iii) Referrals for financial assistance to charitable and other special interest groups with whom the facility or provider has established formal arrangements; Special payment plans (including sliding fee scales) provided by the facility or provider for individuals who are unable to make payment in full for services to be rendered; and 5

(iv) For a facility or provider not otherwise supplying patient discharge data to the Commission, services reimbursed by Medicare and Medicaid. This standard does not apply to institutional long term care facilities or to life care communities. 2b. Each facility and organized service provider must inform patients and/or their responsible parties at the time of preadmission or admission about their possible eligibility for services under its policies for uncompensated services, the facility must make a determination of eligibility uncompensated care. This standard does not apply to institutional long term care facilities. 2c. Each facility and organized service provider must publicize information concerning the availability of uncompensated services. Public notice of availability of uncompensated services must include, at a minimum, the following: (i) annual publication in a newspaper serving the facility s or provider s area; (ii) (iii) posted notices in the admission, business office, and (if existing) emergency room areas within the facility; and individual notice provided to each person who seeks services in the facility or from the provider. This standard does not apply to institutional long term care facilities or to life care communities. With respect to this standard, Medicaid, the Maryland Medical Assistance Program, is the payor for more than 99% of all patient days at Villa Maria. It is not a facility that serves, in any practical sense, a private pay or privately insured population, or that has capacity available to serve other classes of payor. Therefore, to the extent that this standard is applicable, it is met. 3. Each facility and organized service provider must provide to the public, upon inquiry, information concerning charges for and the range and type of services provided. This standard does not apply to institutional long term care facilities or to life care communities. The applicant states that it provides this information to the public, on request, in compliance with this standard. 4. The Commission will not approve a Certificate of Need unless a facility seeking to establish or expand a service (or construct a new facility) documents that the proposal will not duplicate existing services beyond that allowed by this Plan, and that will not adversely affect existing similar services within the target community. 6

Villa Maria does not intend to expand residential treatment care; rather, it intends to split its current RTC bed capacity between two sites, that are in relatively close proximity. Villa Maria seeks to establish a second RTC facility on the SVC campus with 52 RTC beds currently operating at Villa Maria, and continue to operate the remaining beds at the Villa Maria campus as a smaller RTC. It is not duplicating or expanding service capacity and it is not constructing a new facility (although it is, presumably, developing a separately licensed RTC 1 ). Thus, this standard is not strictly applicable to this project. 5. Each organized facility must be able to demonstrate upon request by the Commission, compliance with all mandated federal, state, and local health and safety regulations, and applicable Joint Commission on Hospital Accreditation, other appropriate national accrediting organization standards, or applicable state certification standards unless otherwise exempted by an appropriate waiver. Staff notes that the Joint Commission on Hospital Accreditation, referenced in the regulation above, is currently known as The Joint Commission. The applicant provided a copy of its most recent accreditation survey summary letter from the The Joint Commission, from November 13, 2007. The accreditation is valid for up to 39 months. MHCC staff contacted the staff of the Office of Health Care Quality of the Department of Health and Mental Hygiene and this office confirmed that there are no serious complaints or issues relating to their licensure oversight of Villa Maria. The applicant noted it is also accredited by the Council on Accreditation. This standard is met. 6. Each facility and organized service provider must institute and/or maintain, and be able to document upon request by the Commission, standardized in-service orientation and continuing education programs, with specified minimum information content, for all categories of direct service personnel, whether paid or volunteer. This standard does not apply to institutional long term care facilities or to life care communities. The applicant provided documentation of its standard in-service orientation and noted that continuing education requirements for major clinician types are governed by their respective national accreditation standards which are available to the public on-line or through written or phone request. The applicant complies with this standard. 7a. Each facility and organized service provider must have written transfer and referral agreements with: (i) Facilities capable of managing cases which exceed its own capabilities; and 1 Department of Health and Mental Hygiene rules require separate licenses for RTC facilities located on separate premises. 7

(ii) Facilities which provide inpatient, outpatient, long-term, home health, aftercare, follow up, and other alternative treatment programs appropriate to the types of services it offers. The applicant provided copies of patient transfer agreements with the following hospitals: University of Maryland Medical System Corporation; Johns Hopkins Hospital; St. Joseph Medical Center; Greater Baltimore Medical Center; St. Agnes HealthCare; Union Memorial Hospital; and James Lawrence Kernan Hospital. Agreements with downstream service providers have not been executed because the applicant indicates that RTC residents are usually discharged to independent living arrangements rather than health care facilities or programs. Older residents needing continued RTC services who are no longer within the age group served by Villa Maria are provided with discharge planning services to assist them in identifying options, but are not transferred to other RTCs by Villa Maria in a manner that would require a formal agreement. This standard is met. 7b. All inpatient and residential facilities and organized service providers must participate in or have utilization review programs and treatment protocols, including written policies governing admission, length of stay, and discharge planning and referral, and must document such programs and protocols when applying for Certificate of Need for new or expanded services and when otherwise required by the Commission. This standard does not apply to institutional long term care facilities or to life care communities. Villa Maria s previously noted accreditation by The Joint Commission serves to document that the facility has the programs and protocols specified in this standard and is accepted as sufficient evidence of compliance with this standard. B. NEED COMAR 10.24.01.08G(3)(b) Need. The Commission shall consider the applicable need analysis in the State Health Plan. If no State Health Plan need analysis is applicable, the Commission shall consider whether the applicant has demonstrated unmet needs of the population to be served, and established that the proposed project meets those needs. The State Health Plan does not contain a need projection methodology or applicable capacity standards that provide quantitative guidance with respect to the need for RTC or RTC beds. Villa Maria has operated as an RTC for 28 years and has, in recent years, experienced a level of demand for its RTC beds that has produced relatively high average annual bed occupancy; an average of 87.5% over the two year period of FY 2008-2009. As previously noted, Villa Maria is anticipating reduced demand for its services in the future based on an assumption that Maryland will be better positioned to use community settings supported by wrap-around services for many children and adolescents who have historically been served by 8

RTCs and/or have historically experienced long stays in the RTC setting. In 2009, Villa Maria planned to downsize its RTC operations from 95 to 66 beds and projects that RTC ALOS at Villa Maria will decline by approximately 30% in coming years. If these utilization projections are accurate, Villa Maria will not need to continue to operate 95 RTC beds. However, Staff believes that it reasonable to allow Villa Maria, at this time, in which the transition to lower demand for RTC beds is still in flux, to proceed with its current proposal to move the bulk of its RTC operations to the superior, renovated facilities of the SVC campus and allow Villa Maria to maintain the ability to utilize its full current bed complement by operating a smaller number of RTC beds at the Villa Maria campus. If census declines as expected, Villa Maria is likely, based on the information it has provided in the review of this application, to ultimately transition to a single, smaller RTC campus, over time. Because of the overwhelming level of support for this facility provided by the State, the support for Villa Maria s plan expressed by the Deputy Secretary for Behavioral Health and Disabilities is an important indicator of need. For all practical purposes, Medicaid is the single payor for this facility s services. For these reasons, Staff recommends a positive finding by the Commission with respect to the need for this proposed project. C. AVAILABILITY OF MORE COST-EFFECTIVE ALTERNATIVES COMAR 10.24.01.08G(3)( c) Availability of More Cost-Effective Alternatives. The Commission shall compare the cost effectiveness of the proposed project with the cost effectiveness of providing the service through alternative existing facilities, or through an alternative facility that has submitted a competitive application as part of a comparative review. Villa Maria presented an overview of the options it considered before choosing to renovate facilities at St. Vincent s and transfer residents to this campus. Villa Maria was described by the applicant as over-sized and in need of significant renovation. However, it was also described as not in poor condition. The applicant indicated an approximate cost of $10 million to convert the Villa Maria campus to all private rooms. The estimated cost of renovating facilities at St. Vincent s Center for use by Villa Maria as an RTC is $250,000. As previously noted, the proposal before the Commission is of an interim nature, in that the applicant is projecting that it may obtain funding from DHR to continue operation of a portion of the SVC campus as a smaller residential child care facility. This potential led ACC to modify its planned movement of RTC beds to the SVC campus from 66 to 52 beds and it has also proposed keeping the balance of its RTC beds in operation at the Villa Maria campus for the present, staffing those facilities as needed, but acknowledging that its current RTC demand projections do not indicate that it will achieve a significant census at this smaller RTC. The proposal to split RTC beds between the two sites is bound to be at least somewhat less cost effective than the original proposal submitted by ACC, to operate a single, relocated RTC at the SVC campus. The applicant notes that it does not anticipate needing to staff all 95 beds based on current utilization projections, leading to the conclusion that the 43 beds 9

remaining at Villa Maria will tend to function as overflow capacity for the superior facilities relocated to the SVC site. However, given that this facility is not functioning in an environment in which it can dictate prices for its services, the higher unit cost that may occur by operating in two locations is not going to alter the reimbursement provided by the Maryland Medicaid program that Villa Maria will rely on to cover its costs, at a supportable level. For this reason, Commission staff recommends that the Commission find that the applicant has provided adequate information on the cost and effectiveness of alternative for meeting its objectives, which are to provide better physical facilities for its RTC services and transition to a lower level of demand for these services in the future. D. VIABILITY OF THE PROPOSAL COMAR 10.24.01.08G(3)(d) Viability of the Proposal. The Commission shall consider the availability of financial and nonfinancial resources, including community support, necessary to implement the project within the time frames set forth in the Commission s performance requirements, as well as the availability of resources necessary to sustain the project. Villa Maria estimates that the renovation of residential facilities at SVC that will accommodate its movement of 52 beds to that campus will cost $250,000 with building renovations estimated to cost $150,000 and fixed equipment at $100,000. ACC will fund the project with cash. The applicant submitted audited financial statements indicating the availability of sufficient cash for this purpose. The actual financial results of operations were submitted for 2008 and 2009 and revenues and expenses were projected for 2010 through 2012. These projections were submitted as follows: 10

Revenues and Expenses Villa Maria RTC 2008 2009 2010 2011 2012 Net revenues $12,965,773 $12,755,306 $10,705,700 $12,273,820 $12,632,550 Other operating revenue* 318,134 442,016 259,240 178,850 178,850 Net operating revenue $13,283,907 $13,197,322 $10,964,940 $12,452,670 $12,811,400 Operating expenses $13,801,875 $13,979,341 $12,381,680 $12,575,100 $12,886,350 Income ($517,968) ($782,019) ($1,416,740) ($122,430) ($74,950) Licensed beds 95 95 95 95 95 Admissions 60 48 50 80 80 Patient days 31,722 29,515 23,730 24,055 24,045 Avg. annual occupancy rate 91.5% 85.1% 68.4% 69.4% 69.3% Average length of stay 13 months 13 months 12 months 9 months 9 months Net revenue/patient day $418.76 $447.14 $462.07 $517.67 $532.81 Expenses/patient day $435.09 $473.64 $521.77 $522.76 $535.93 Net revenue/admission $221,398 $274,944 $219,299 $155,658 $160,143 Expense/admission $230,031 $291,236 $247,634 $157,189 $161,079 *Other operating revenues include contributions,interfund transfers,nutrition grant revenue, HVAC grant revenue, prior year revenue adjustments, interprogram rental income, and miscellaneous revenue [Submission dated April 26, 26,2010 Exhibit 3] Source: Submission dated April 26, 2010, Modified CON Application, Table 1, Statistical Projections, pages 12-3; ; Table 3, Revenues and Expenses Entire Facility, pages 19-21.. Villa Maria does not generate excess revenue over expenses and operating losses are projected to continue, albeit at lower levels than in the past. The year 2012 is the first full year of full utilization for the proposed project. ACC, its parent organization, has historically provided the subsidy support needed to continue operation of this facility and there is no basis for finding that this support will not continue to provide long-term viability, especially if the level of loss can be reduced as projected. Staff recommends a finding that the proposed project is viable. E. COMPLIANCE WITH CONDITIONS OF PREVIOUS CERTIFICATES OF NEED COMAR 10.24.01.08G(3)(e)Compliance with Conditions of Previous Certificates of Need. An applicant shall demonstrate compliance with all terms and conditions of each previous Certificate of Need granted to the applicant, and with all commitments made that earned 11

preferences in obtaining each previous Certificate of Need, or provide the Commission with a written notice and explanation as to why the conditions or commitments were not met. A review of Commission records indicates that the Association of Catholic Charities has not applied for any Certificate of Need in the past fifteen years. F. IMPACT ON EXISTING PROVIDERS AND THE HEALTH CARE DELIVERY SYSTEM COMAR 10.24.01.08G(3)(f)Impact on Existing Providers and the Health Care Delivery System. An applicant shall provide information and analysis with respect to the impact of the proposed project on existing health care providers in the health planning region, including the impact on geographic and demographic access to services, on occupancy, on costs and charges of other providers, and on costs to the health care delivery system. Because of the nature of this service and the project, it is not likely to have any negative impact on other providers of RTC services, on access to services, or on cost and charges of other providers or the health care delivery system, in general. Villa Maria is not expanding service capacity and projects reduced demand for its services going forward. It will provide better physical facilities for most of its RTC residents through this project. It is a unique provider of RTC services to younger residents. For these reasons, Staff recommends that the Commission finds that the proposed project will not have a negative impact on existing providers or the health care delivery system. V. STAFF RECOMMENDATION Staff s evaluation of the proposed project indicates that it complies with applicable State Health Plan standards, that Villa Maria is a needed facility, that the project can be implemented on a cost effective basis, that the project is viable, and that the project will not have a negative impact on other providers or the health care delivery system. Approval of the project is recommended. 12

* IN THE MATTER OF * BEFORE THE * VILLA MARIA RESIDENTIAL * MARYLAND HEALTH * CENTER TREATMENT * CARE COMMISSION * DOCKET NO. 09-03-2297 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * FINAL ORDER Based on Staff s review of the applicable standards and criteria, it is this 20th day of May, 2010, ORDERED that: The application for a Certificate of Need by Villa Maria, Docket No. 09-03-2297, to: 1) Renovate facilities at the St. Vincent s Center campus at an estimated cost of $250,000 and relocate 52 Residential Treatment Center beds to establish a Residential Treatment Center on that campus; and 2) Continue to operate a 43-bed Residential Treatment Center at the existing Villa Maria campus is APPROVED. MARYLAND HEALTH CARE COMMISSION May 20, 2010 13

APPENDIX A Site Plan

APPENDIX B Floor Plan