The state Department of Health and Environmental Control board approved the 2008-2009 State Health Plan during their regularly scheduled monthly meeting. A summary of the main elements of the 2008 – 2009 Plan is provided in the following article. The full plan is available for download here (PDF, 8.63mb).

In approving the Plan, each member of the DHEC board commented about the need to improve the CON process and to fix a system which they consider to be broken.

Summary of 2008-2009 South Carolina Health Plan:

The projections of general hospital bed need have been reformatted to indicate the overall bed need in each county. Standards have been added to differentiate between situations when a county shows an overall need for additional beds and when the county shows a surplus of beds. The provision remains in the Plan to allow the greater of the actual bed need or 50 beds for the economic expansion of a facility.

A new standard was added that requires that any proposed new hospital must operate at least a Level III ER, accept all government reimbursement, provide indigent care, and provide daily services within at least six of the 25 major diagnostic categories recognized by Centers for Medicare and Medicaid Services (CMS).

Long Term Acute Care Hospitals (LTAC) have been inventoried separately from general acute care hospitals and are not included in the bed need calculations, as they do not provide the same services. LTAC beds no longer have to be converted from existing general hospital beds. The method by which a facility can re-acquire beds that are no longer certified for LTAC services has been clarified.

The Critical Access Hospital (CAH) section has been updated.

The Obstetrical and Neonatal Services section has been updated.

The Pediatric section was unchanged from the previous Plan.

The procedure codes information for cardiac catheterizations was updated. The capacity measurements were revised to reflect the additional amount of time required to perform procedures in pediatric cath labs.

The ratio of diagnostic cardiac caths to open heart surgeries used to project the need for open heart surgery was updated using more current South Carolina data. Utilization data were updated.

The megavoltage section has been entirely re-written. The terms “Radiotherapy” and “Stereotactic Radiosurgery” are now used to describe the available equipment. A definitions section and the relevant CPT procedure codes have been added. The previous single capacity measurement for linear accelerators has been revised to create three separate standards due to the longer treatment times required for more specialized equipment. The capacity measurement for a Gamma Knife has been decreased to reflect more current practice patterns and new service areas have been designated. Minor changes were made to clarify the standards for Positron Emission Tomography (PET) and PET/CT.

The definition of Ambulatory Surgery was updated to reflect the current DHEC Health Licensing standards and minor changes were made for clarification.

A new standard was added requiring that a freestanding emergency service must be an extension of an existing hospital’s emergency service in the same county, unless the applicant is proposing to establish a freestanding emergency service in a county that does not have a licensed hospital. Another new standard requires the applicant to document where the patients would come from and why they are not being served by the existing provider(s).

The psychiatric bed need methodology has been revised to take the greater of the bed need projected based on service area utilization or percentage of the statewide beds/population. The Local Crisis Stabilization Bed section has been re-written and new Standards adopted after consultation with the SC Department of Mental Health.

A proviso in the 2007 State Budget allows existing facilities licensed by DSS and enrolled with Medicaid as a High Management Group to be licensed by DHEC as a Residential Treatment Facility for Children and Adolescents and be exempted from CON review. As a result, the previous bed need projection methodology has been eliminated in this section.

The need methodologies for medical detoxification and inpatient treatment have been modified to take the greater of the bed need projected based on service area utilization or the statewide beds/population. All patient days are now included in the calculations for facilities that provide both social and medical detoxification in the same unit. Service areas without existing beds can be approved for a 10 bed unit.

The rehabilitation bed need methodology was revised to take the greater of the bed need projected based on service area utilization or the statewide beds/population.

Updated programmatic information from the Community Long Term Care program was incorporated into the nursing facility section. The standard allowing a facility to add beds to create economical nursing units was revised.

A new standard was added that would allow the establishment of pediatric home health agencies restricted to proving care to patients 14 year and under.

The entire inventory data was updated as needed to make the Plan as current as possible.

This Plan became effective for use in the CON progress on Friday, Sept. 12 and all applications received on or after that date.

• Download State Health Plan (PDF, 8.63mb)