OAR 333-615-0020
Principles
(1)
Service areas for general psychiatric beds other than those directly operated by the state Addictions and Mental Health Division or the federal Veterans’ Administration, shall be delineated so as to encourage the greatest feasible utilization of community hospitals, and of alternatives to hospitalization, by both private and public patients. The division will use as a basis for general psychiatric inpatient service areas the state administrative districts. The districts are based on natural market areas defined by geographical barriers, transportation networks and historical patterns of general trade. In addition, community mental health services in Oregon are organized on a county or multicounty basis, compatible with these districts, thus facilitating planning and coordination with, and access to, local inpatient services in such districts.(2)
Service areas for psychiatric specialty beds, other than those directly operated by the state Addictions and Mental Health Division or the federal Veterans’ Administration, as defined in OAR 333-615-0010 (Definitions)(2), other than holding rooms, shall be delineated so as to assure availability of quality service at reasonable cost in economically viable subspecialty units:(a)
Factors to be considered in delineating such service areas shall include the sizes of the respective populations at risk in Oregon; the current rates of inpatient hospitalization in Oregon for those groups; and the availability, accessibility, quality and levels of utilization of existing inpatient services addressing the needs of those groups in Oregon. These factors will generally lead to delineation of subspecialty service areas according to health service area, multiple health service area or statewide boundaries;(b)
In order to assure viable, quality subspecialty units, economies of scale shall be given greater weight than geographical distribution;(c)
In estimating subspecialty need, the state will consider the population ratios proposed in “total system” models such as Nebraska (1981) and California (1981);(d)
For each subspecialty service, an applicant will be expected to indicate the anticipated percentage and origins of utilization from outside the general psychiatric service area, based on section (1) of this rule, in which the facility is, or will be located, and to provide the evidence and assumptions related to the analysis.(3)
Service areas for holding rooms shall be based on local considerations of access, demand and feasibility.(4)
The development of a number of psychiatric units, of economically and programmatically viable size, in general hospitals, rather than the development of a few large, multispecialty, freestanding facilities, shall be emphasized. The division recognizes that equivalent programs, in terms of quality, can be developed in either setting, to meet the needs of particular populations; that, in order to attract and retain staff, as well as for quality program design and economic efficiency, consideration must be given to minimum feasible unit size; but that, nonetheless, programs located within acute general hospitals have the advantage of close administrative relationships and proximity to acute medical and surgical consultation, diagnosis and treatment. Among the considerations leading to an emphasis on geographically decentralized psychiatric units in general hospitals, are the following:(a)
Improved geographic access in the various regions of the state, and therefore;(b)
Greater likelihood of reduced utilization of state and federal hospitals for short-stay intensive inpatient care;(c)
Reduced separation of psychiatric patients and staffs from specialty medical care for psychiatric patients at a reasonable cost, substantial numbers of whom have that need;(d)
Improved access to quality psychiatric staff for general medical patients;(e)
Greater access to diversity in medical and support staff, and extent of ancillary services available;(f)
Possibility of reduced construction and operating costs, through development of economically and programmatically viable sized units by conversion of small amounts of existing licensed capacity, where available, rather than new, large scale freestanding construction;(g)
Relative ease of reconversion of the unit at minimal cost, to other hospital associated use if psychiatric utilization is so low as to necessitate closing the unit;(h)
Smaller size of unit necessary to maintain quality at reasonable cost per treatment, because indirect costs are spread over a larger base; and reduced impact of smaller unit on ability of other, existing units, serving the same population, to maintain quality at reasonable cost per treatment.(5)
Demonstration of need for general psychiatric beds will be population based, rather than facility based. According to Office for Oregon Health Policy and Research studies of actual utilization in Oregon, taken together with legislative reduction of the number of inpatient days mandated for coverage under group health insurance policies in Oregon, the “range of need” criteria based on the then available literature and consultant advice, together with existing provisions in this chapter, provide adequate safeguards against overbedding, but the legislative policy requires more stringent standards for demonstration that any proposed beds are the appropriate response to need for psychiatric care. Therefore, there shall be a moderate standard of evidence of need if a project would result in up to .40 beds per 1,000 population in a service area in the third year after the date of the letter of intent; and a high standard, if the result would exceed .40. The bed-to-population ratio shall not be taken, by itself, as evidence justifying a certain number of beds in a service area. In determining need, the division shall take into account and the applicant shall supply, for each factor in subsections (a) to (f) of this section, a numerical, descriptive and analytic response sufficient for the division to take each factor into account:(a)
The historical utilization of psychiatric inpatient beds by persons in the service area involved;(b)
The historical utilization in other Oregon service areas of comparable size, population and characteristics; and(c)
Based on the level of placement criteria developed by the Office for Oregon Health Policy and Research or developed by insurers under ORS 743.556(16)(b), findings that, with limited exceptions based on clinical judgment in individual cases, inpatient beds are needed for immediate, short-range control of symptoms and protection of the patient when less intensive or supportive placement will not suffice; or for immediate, short-range protection of the community;(d)
The major portion of nonstate, nonfederal inpatient stays are expected to be 12 to 15 days. Approximately 10 percent of stays, at most, are expected to be longer term: Seriously disturbed, usually younger, patients for whom the benefits of 30 to 40 days of hospitalization exceed those of brief hospitalization followed by systematic, long-term residential or outpatient care; and a limited number of chronically mentally ill persons who cannot be maintained safely in the community;(e)
Inpatient beds are not considered the major resource for continued treatment of the typical schizophrenic patient, which, according to the literature, is usually most effective and economical when provided in other ways;(f)
Alternatives, as defined in OAR 333-615-0010 (Definitions)(1), do not replace necessary inpatient utilization as described in subsections (c), (d) and (e) of this section, but are usually more effective and economical for meeting other needs for mental health treatment and care.
Source:
Rule 333-615-0020 — Principles, https://secure.sos.state.or.us/oard/view.action?ruleNumber=333-615-0020.