Illinois

1
Open Meeting on Rules Redevelopment Illinois
Health Facilities Planning Board April 23, 2007
Long-Term (Acute) Care Hospitals Follow-up
Meeting
2
Rules Process

• Open Meetings/Public Participation-Input
• Draft Rules Reviewed and Approved by Board
• Submission to JCAR
• Publication in the Illinois Register
• Formal Public Hearings and Comment Period
• Reconsideration by the Board
• Consideration and approval by JCAR

3
Meeting Protocols

• Comments/Discussion Limited to Current Topic
• All Interested Parties Invited to Participate
• Written Comments Requested
• Time Limitations - As Required
• Check with website http//www.idph.state.il.us/abo
  ut/hfpb/hfpbrules.htm

4
Statutory Authority

• Health Facilities Planning Act - 2004
• Purpose of the Act
• Establish a procedure designed to reverse the
  trends of increasing costs of health care
  resulting from unnecessary construction or
  modification of health care facilities.
• Improve the financial ability of the public to
  obtain necessary health services.
• Establish an orderly and comprehensive health
  care delivery system which will guarantee the
  availability of quality health care to the
  general public.
• The Procedure
• Requires a person establishing, constructing or
  modifying a health care facility to have the
  qualifications, background, character and
  financial resources to adequately provide a
  proper service for the community,
• Promotes orderly and economic development of
  health care facilities that avoids unnecessary
  duplication of such services.
• Promotes planning for and the development of
  health care facilities needed for comprehensive
  health care, especially in areas where the health
  planning process has identified needs.
• Carries out these purposes in coordination with
  the Agency and the comprehensive State health
  plan developed by that Agency.

5
Meeting Objectives

• Review characteristics and utilization statistics
  of Long-Term (Acute) Care Hospitals in Illinois.
• Discuss working draft of proposed LTCH rules.
• Definition
• Planning Policies
• Category of Service Review
• The discussion will be limited to the topic
  identified.

6
LTCHs in Illinois (Beds by Category of Service)

• Regency Hospital Rockford received permit
  September 12, 2006.
• Kindred Hospital Springfield received permit
  August 4, 2005.
• Holy Family received permit to discontinue OB
  November 1, 2005.
• (4) Advocate Bethany received permit to
  discontinue OB and AMI September 12, 2006.

7
Hospital Discharges (by DRG) to LTCH
8
Hospital Discharges (by DRG) to LTCH
9
Hospital Discharges (by DRG) to LTCH
Notes Kindred North has 48 AMI beds therefore,
a high volume of cases ( DRG 430 Pyschoses) are
discharged to this LTCH . Total Illinois Cases
all hospitals in Illinois with the exclusion of
LTCH facilities. Utilization statistics for
Kindred-Lakeshore were not included. This
facility is a sub-acute care facility and is
considered a remote facility of
Kindred-Central. Source Illinois Discharge
Dataset
10
LTCH 2005 Utilization
Note Kindred Lakeshore is considered a subacute
facility therefore, utilization information is
not available. Source Illinois Discharge
Dataset (Calendar Year 2005)
11
CMS Proposed Rule for LTCHs 2008

• Extension of the threshold to freestanding LTCHs
  proposed.
• LTCHs cannot accept more than 25 of its patients
  from a single hospital.
• 50 threshold for rural hospitals.
• Propose LTCH PPS Federal rate be updated by 0.71
  percent to 38,356 for Medicare discharges.
• Changes to short-stay outliers and high-cost
  outlier threshold.

12
LTCH Definition - Draft

• Long-Term (Acute) Care Hospital means a
  category of service provided in a
  Medicare-certified acute care hospital with an
  average Medicare length of inpatient stay greater
  than 25 days that is primarily engaged in
  providing long-term medical care to patients who
  are clinically complex and may suffer multiple
  acute or chronic conditions. Services typically
  include respiratory therapy, head trauma
  treatment, and pain management.

13
LTCH Planning Policies - Draft

• Planning Areas
• HSA 1
• HSAs 2 and 10
• HSAs 3 and 4
• HSAs 5 and 11
• HSAs 6, 7, 8 and 9 

14
LTCH Planning Policies - Draft
15
LTCH Planning Policies - Draft

• Accessibility
• One hour travel time
• Occupancy Target
• 85
• Need Determination
• Minimum Use Rate 60 of State
• Experienced Use Rate Base Year
• Apply Minimum or Experienced, whichever is higher
• Population projections

16
LTCH Planning Policies - Draft

• Authorized Bed Capacity
• No Long-Term (Acute) Care Hospital category of
  service shall be established without approval by
  the HFPB. Beds in long-term (acute) care
  hospitals certified by CMS, shall be reclassified
  by the HFPB in its inventory.

17
LTCH Category of Service Review - Draft

• Facility Size
• An applicant must document that the project will
  result in a facility capacity of at least 50
  Long-Term (Acute) Care beds.
• Continuity of Care
• An applicant proposing to establish a Long-Term
  (Acute) Care Hospital category of service shall
  provide a signed, written transfer agreement with
  an acute care hospital. Documentation shall
  consist of copies of all such agreements.
• Conversion of Existing Acute Care Beds
• Address Section 1110.130 for discontinuation of
  categories of service.
• Identify modifications in scope of services or
  elimination of clinical service areas, not
  covered in Section 1110.130 (e.g. Emergency
  Department classification, Surgical Services,
  Outpatient Services, etc.).
• Document that changes in clinical service areas
  will not have an adverse impact upon the health
  care delivery system.

18
LTCH Category of Service Review - Draft

• Assurances
• Achieve occupancy target by second year of
  operation
• Certify intent to be Medicare-classified as a
  long-term (acute) care hospital within twelve
  (12) months from the date of project completion
  and
• Certify that the proposed facility will meet all
  requirements of the Illinois Hospital Licensing
  Act.