the future of CON in SC

controversial issues last session

Loser pays Equipment threshold Behavioral health bed conversion Bamberg issue CON exemptions Grandfathering

legislative attitude toward CON

CON fights are public Why doesn’t free market apply? Which legislator can explain a bill on the floor?

next session

Repeal effort? Reform effort? United or split?

CON components in state law

DefinitionsWhen CON’s requiredWhen CON’s not requiredHealth planning committee & state health planUse of project review criteriaPublic notification in newspaperReview procedure and contested casesProhibited communication during reviewUse of ALC and Court of AppealsLimitations on CON

what else defines when CON is required?

Regulation 61-15 State Health Plan

Regulation 61-15: Establishes capital expenditure threshold Establishes medical equipment expenditure threshold Defines total project cost

regulation 61-15

Also provides details of the process:Specifies when written determinations of exemptions and non-applicability are required and what is requiredCreates timelines and processes for public notificationSpecifies contents and format of CON applicationCreates timelines for additional informationProcess for relative importance project review criteriaReview time frames, notification of affected person, and public hearingsPeriodic reporting requirements

south carolina health plan / general contents

Projections of need for additional healthcare facilities, beds, health services & equipment

Standards for distribution of healthcare facilities, beds, health services & equipment

Project review criteria

specific facilities, beds, health services and equipment in south carolina health plan

Inpatient health facilities and beds Acute care hospital CAH LTAC, PLTAC

Psychiatric hospitals and psychiatric beds Rehab hospitals and rehab beds Residential treatment facilities for children,

adolescents Long term care facilities and beds  

specific facilities, beds, health services and equipment in south carolina health plan Health services connected with hospitals:

obstetrical and neonatalpediatriccardiac cathopen heartfreestanding emergency services

Other health services and equipment:PETPET/CTPEMlinear acceleratorASCinpatient hospicehome health agencies

who responded?

(n=47 respondents)

is it important to maintain CON?

(n=47 respondents)

should the CON law be?

(n=39 respondents)

limited or broad by type

(n=40 respondents)

lf limited, when should it be required?

New general acute hospital 19 (100%)

New specialty hospital (psych, rehab, single service such as cardio, ortho, etc.)

18 (95%)

New ASC 17 (89%)

New services not previously offered 8 (42%)

Purchases (or lease) of new major medical equipment not previously owned

7 (37%)

Expansion of existing services offered at a facility 3 (16%)

(n=19 respondents)

if broad, when should it be required for facilities?

(n=19 respondents)

Facilities

Acute Care Beds 18 (95%)

Psychiatric Beds 15 (79%)

Ambulatory Surgery Center-Single Specialty 15 (79%)

Ambulatory Surgery Center-Multi Specialty 15 (79%)

LTAC Beds 14 (74%)

Nursing Home Beds 14 (74%)

Rehabilitation Beds 14 (74%)

In-Patient Hospice Beds 13 (68%)

Alcohol and Drug Abuse 7 (37%)

Residential Treatment/Intermediate Care Facility 5 (26%)

Medical Office Building 2 (11%)

Residential Care/Assisted Living 2 (11%)

if broad, when should it be required for equipment?

(n=12 respondents)

Equipment

PET Scanners 12 (100%)

PET/CT 12 (100%)

MRI Scanners 9 (75%)

Gamma Knives 9 (75%)

Emerging Technology 8 (67%)

CT Scanners 7 (58%)

Mobile High Tech 6 (50%)

Lithotripsy 4 (33%)

Ultra Sound 1 (8%)

if broad, when should it be required for services?

(n=16 respondents)

Services

Open Heart 15 (94%)

Linear Accelerator 13 (81%)

Therapeutic Cath 13 (81%)

Organ Transplant 13 (81%)

Neonatal Services (Level III and Level IV) 11 (69%)

Burn Care 9 (56%)

Home Health 9 (56%)

Diagnostic Cardiac Cath 9 (56%)

Obstetrical 8 (50%)

Air Ambulance 7 (44%)

Subacute Care 6 (38%)

if broad, should SC have a capital threshold?

If yes, which range seems appropriate?

if broad, should SC have an equipment threshold?

If yes, which range seems appropriate?