Hospital system presidents from across the state met last week to learn details on the issues KHA is addressing on behalf of member hospitals.

Attendees heard a summary of the findings from KHA’s Value of Certificate of Need (CON) report. KHA will provide the results of the CON study to all members at the upcoming District Meetings, so please plan to attend one of those meetings.

The system presidents also received an update on the Medicaid Hospital Rate Improvement Program (HRIP) — formerly known as the upper payment limit (UPL) program. Carl Herde, KHA vice president of financial policy and Wes Butler, KHA’s legal counsel, will be conduct a webinar for all members on Wednesday, September 25 at 10:00 a.m. (ET) to discuss HRIP. Every hospital should attend this webinar to hear an update on the timetable and process for implementation....

On July 13, the Cabinet for Health and Family Services (CHFS) filed changes to the State Health Plan – the guiding methodology for formal review under the Certificate of Need (CON) program. These changes were filed in two regulations – ordinary and emergency. The E-reg deletes the Post Acute Transitional Care pilot project (passage of SB 123) and an Ordinary Regulation combines required changes from the passage of HB 444 as well as other recommendations received during the pre-comment period. (Click the bill numbers above for full text of the regulations.) KHA's summary of the changes identifies if these were KHA-supported or...

The 2017-2019 State Health Plan will go into effect on January 5, 2018. The Office of Health Policy issued the proposed State Health Plan in July and the final State Health Plan with the statement of consideration was released on October 13.

Overall, KHA and its member hospitals were pleased with the outcome. The Cabinet accepted KHA’s comments to allow hospitals to establish home health services if they can demonstrate difficulty in placing patients. Unfortunately, no changes were made to the PRTF Level II criteria; although, when KHA staff met with the Cabinet, they acknowledged the need for more access to this level of care and indicated a desire to continue to work on this with KHA.

The Cabinet modified, but retained, the exception to the nursing facility bed need formula to allow for the development of short-term post acute care/rehabilitation services, as a pilot program – two in urban areas and two in rural areas. The beds will be licensed as NF, which would permit...

The Office of Health Policy (OHP) has updated the State Health Plan to include a Pilot program to allow for the establishment of short- term transitional care beds. The Pilot limits approval of a total of four programs - two urban-based applicants and two rural-based applicants. The service would be licensed as a nursing facility bed and is open to any type of applicant. The new service could be created within an existing health facility, like a hospital, or it could be a free-standing facility.

ACTION NEEDED on TRANSITIONAL CARE BED SERVICE

The changes to the State Health Plan could go into effect as soon as December 15, which means applicants interested in applying for the pilot program would be required to meet the December 27 application filing deadline. It is anticipated the application process will include a competitive hearing process and there will be multiple applicants. KHA urges members interested in the service to review the criteria and begin drafting...

The KHA Certificate of Need (CON) Committee is in the process of reviewing the State Health Plan and CON regulations, and discussing the need to update and improve portions of the program in order to streamline and modernize CON in Kentucky. Two events have prompted this thorough review.

First, the Bevin administration and the Office of Health Policy are focusing on reducing red tape which impedes appropriate growth and business activities. KHA member hospitals would like to be proactive partners in this effort. Secondly, the Office of Health Policy announced in the February CON Newsletter that comments on the 2017 State Health Plan will be accepted between March 1 and March 31. KHA is working towards this deadline in getting final recommendations from the CON Committee and reviewed for approval by the KHA Board of trustees. The KHA Board did approve some CON Committee recommendations during the February 23 Board meeting, but there are other areas of the plan that are being reviewed and discussed....

The Cabinet for Health and Family Services (CHFS) has issued an emergency regulation, 900 KAR 5:020E, to reverse changes made to Certificate of Need (CON) criteria for ambulatory surgery centers (ASCs) in the 2015 update to the State Health Plan. KHA counts this as a major victory and commends Governor Matt Bevin and CHFS Secretary Vickie Yates Brown Glisson for their leadership on this issue.

In 2015, significant and problematic changes were made to the State Health Plan under the Beshear administration, which created numerous exceptions to the ASC criteria. These exceptions allowed for the unnecessary proliferation of ASCs regardless of existing capacity available in ASCs and hospital outpatient surgery departments or need for new services identified in the population. KHA expressed grave concern about those changes in 2015 to the Beshear administration and before the Administrative...

KHA is pleased to share that the problematic proposed Certificate of Need (CON) Formal Review regulation, 900 KAR 6:070, has been withdrawn! Thank you to all hospital leaders that responded to the Action Alert last week and made calls to your legislators! You were very effective.

The proposed regulation would have weakened Kentucky’s CON process substantially. In summary, the proposed changes would have defied statutory law requiring the State Health Plan criteria and population/geographic need to be considered as separate criteria in an application. Under the proposed regulation, if an applicant had met the State Health Plan Criteria (even under an exception to need criteria) they would have been consistent with overall need. This change would have shifted the burden of proving need from the applicant to disproving need by a challenger.

The formal review regulation will revert back to the language in place prior to the proposal, which KHA supports.

If you have any questions, please...

On May 15, the Cabinet for Health and Family Services (CHFS) published proposed changes to the State Health Plan (SHP) – the state Certificate of Need (CON) criteria regulation. The Cabinet proposes to make significant changes to the technical notes section, remove several services from formal review including MRA, adult day, chemical dependency beds, ambulance services and outpatient Health Centers. Additionally, the Cabinet makes changes to the ambulatory surgery center (ASC) criteria, home health, inpatient physical rehabilitation and megavolt radiation therapy allowing for exceptions to the need criteria for hospitals and other providers. KHA is particularly concerned about proposed changes to ASC criteria which would include exceptions to population need-based methodology. For details, view this brief summary of the proposed changes.

The KHA CON Committee, chaired...

On May 14, the Cabinet for Health and Family Services (CHFS) released proposed changes to the State Health Plan (SHP). There are significant and comprehensive changes included and many of them are of concern to Kentucky hospitals. Of particular concern are changes to the Ambulatory Surgery Center (ASC) criteria.

Please review KHA's high-level summary of the changes, and the red-lined version of the SHP for information on the proposed changes.

KHA will be analyzing the proposal in much more detail and looks forward to hearing comments from members.

If you wish to share comments, please contact Elizabeth Cobb at KHA (502-426-6220 or 800-945-4542 or via email at ecobb@kyha.com) before the June 10 Certificate of Need Committee meeting.

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The Office of Health Policy has announced it will host Certificate of Need (CON) “listening sessions” on March 16 and 17 to allow for further comments regarding the interest in modernizing CON. KHA will have staff at each of the meetings and encourages every hospital to send a representative to one of the two sessions and to make comments briefly at the session. As a reminder, you must register to attend and to speak.

Comments must be brief but should emphasize the importance of CON and the role of CON in stabilizing the health care delivery system in a time when significant change is taking place regarding payment and delivery incentives. Additionally, it is important to maintain CON for the existing services covered under the program, especially ambulatory surgical centers (ASCs).

A study on CON that was completed last Fall is available for your review.

The announcement on the sessions is below, with emphasis added on the registration information. If you have any questions, please...