OAR 333-615-0030
Estimates of Need
(1)
Based on OAR 333-615-0020 (Principles)(1), service areas for general psychiatric beds shall be identified as follows:(a)
Geographic service areas for general acute, nonsubspecialty psychiatric beds, other than those directly operated by the state Addictions and Mental Health Division or the federal Veterans’ Administration, may be less than an entire health service are in order to maximize access provided there is sufficient projected population in the third year after the date of the letter of intent to make possible an economically feasible inpatient unit of acceptable quality, low capital cost and low operating costs. Thus, for example in health service area I, Clatsop-Columbia-Tillamook could be considered separately from Multnomah-Washington-Clackamas. Within a given health service area, all service areas shall be defined at one time, rather than proceeding application by application;(b)
The service areas described in subsection (a) of this section shall in general consist of single state administrative districts, or combinations of such areas. Available patient origin data may be interpreted by the division and taken into account in adding or deleting minor portions of such areas, or in combining districts. The division shall consider whether a lesser area, or a combination of areas, will better serve the policies and principles of this division; whether there are, or will be, enough clinicians in practice to staff the program; and whether there will be sufficient diversity of staff to meet the needs of the service area. The geographical units on which general psychiatric inpatient service areas shall be based will be the 14 state administrative districts, which are as follows:(A)
In health service area I: Clatsop-Columbia-Tillamook; Multnomah-Washington-Clackamas;(B)
In health service area II: Marion-Polk-Yamhill; Benton-Linn-Lincoln; Lane; Douglas; Coos-Curry; Jackson-Josephine;(C)
In health service area III: Hood River-Sherman-Wasco; Crook-Deschutes-Jefferson; Klamath-Lake; Gilliam-Grant-Morrow-Umatilla-Wheeler; Baker-Union-Wallowa; Harney-Malheur.(c)
The service areas identified in subsection (b) of this section shall be used for population-based review, as required by state and federal law. The methods of this division are intended to assure that population needs are met by the service or services within the service area. Different facilities within a given service area share the responsibility for meeting the needs of the population of that area;(d)
Based on OAR 333-615-0020 (Principles)(2), the geographic service areas for subspecialty psychiatric 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 the state as a whole;(e)
The geographic service areas for holding rooms shall be determined by the division on a case-by-case basis;(f)
Clinicians in each part of the state are encouraged to work with prospective applicants to develop proposals which meet the general psychiatric inpatient needs of individual service areas and/or subspecialty service areas.(2)
Need for beds per 1,000 population in the service area shall be evaluated in relation to availability of alternatives according to the following criteria. A complete description of all alternatives under subsection (a) or (b) of this section means more than a list; it means at least, for each type of alternative listed in OAR 333-615-0010 (Definitions)(1), an inventory with provider names, addresses, bed or slot capacity, and occupancy or utilization averages for each of the past several years:(a)
If a proposed project would result in up to .40 beds, other than those directly operated by the state Addictions and Mental Health Division or the federal Veterans’ Administration, per 1,000 population in the third year following the date of the letter of intent, a complete description of all alternatives, as defined in OAR 333-615-0010 (Definitions), available in the service area shall be required; there shall be substantial evidence that appropriate existing alternatives in the service area will be fully utilized; there shall be substantial evidence that further development of alternatives by the applicant is not feasible; and there shall be substantial evidence that further development of less costly or more effective alternatives by any other prospective provider is not feasible. In addition, with respect to the proposed project itself, there shall be substantial evidence that project design and program alternatives have been considered and evaluated comparatively, with the least costly one selected that will meet identified need without substantial adverse impact on the quality of patient care;(b)
If the consequence of approval of a project would be in excess of .40 beds per 1,000 population in the third year following the date of the letter of intent, evidence submitted by the applicant shall:(A)
Demonstrate an average occupancy of applicant’s existing capacity, if any, in excess of the appropriate criterion in Table 1, based on the method in section (3) of this rule, for the year ending September 30 prior to the formal application; and(B)
Be comprehensive with respect to the availability and feasibility of appropriate alternatives by meeting the requirements of subsection (a) of this section.(c)
The division may take into account evidence with respect to problems of quality or cost in other units serving the area in evaluations under subsection (b) of this section;(d)
In future years, by amendment of this rule, the division may raise the population-based limit at the same time as programmed decreases in utilization of state and federal beds serving the service area take place. This, however, may not be necessary if alternatives become more available and the scope of reimbursement is expanded. Because of the factors cited in OAR 333-615-0020 (Principles)(5), it may be appropriate, in future years, to reduce the population-based limit.(3)
When expansion of an existing unit is under consideration, an allowance for peak-to-average utilization ratios may be made:(a)
An average bed utilization consistent with the principles and methods of this division shall be evaluated for peak bed need by applying to the anticipated average census, a formula taking into account the anticipated peak demand, allowing for greater peak-to-average ratios for smaller units;(b)
The average census entered into the formula shall be consistent with the principles and methods of this division and justified by the applicant on the basis of historical utilization from the service area and any reasonably anticipated growth in the population at risk;(c)
The method to be used should be analogous to that found in OAR 333-590-0050 (Bed Need Methodology for Proposed New Hospitals), except that the standard deviation is estimated by raising the anticipated average census to the 0.468 power rather than taking its square root (the 0.500 power). The standard deviation is then multiplied by a factor of 2.06 (7.30 days/year at or above 100 percent occupancy) for units in service areas with other, interacting units, or a factor of 2.33 (3.65 days/year at or above 100 percent occupancy) or a unit which is the only one in its service area, or which can be shown not to interact with others in its service area;(d)
The results of calculations according to this method, for a range of values are shown in Table 1;(e)
The calculation in subsection (c) of this section does not take into account the extent to which elective admissions could be postponed, so as to smooth out the variations and reduce the peak-to-average ratio. This calculation only sets an upper limit of peak bed need for a given average bed need;(f)
The division will not automatically approve an application requesting the peak needs indicated by the formula without examining the schedulability of the proposed case load and the commitment to scheduling on the part of the applicant.(4)
General considerations applicable to review of need for psychiatric inpatient beds include the following:(a)
As with hospital inpatient beds in general and in other specialties, new psychiatric beds, whether general or subspecialty, except under unusual circumstances with respect to nonavailability, access and less costly alternatives, shall not be approved if the net effect of the project would be additional licensed short-term acute inpatient capacity (other than state Addictions and Mental Health Division operated or federal hospital beds) in the psychiatric service area, unless additional acute hospital beds are justified in that area by the criteria for acute inpatient beds in division 590 of this chapter. The principles and methods in division 590 shall apply in reviewing applications for psychiatric beds to the extent that the issues involved are not addressed in this division;(b)
Unusual circumstances shall be determined in relation to an evaluation of the feasibility of meeting service area needs by the higher priority methods indicated in OAR 333-615-0040 (Availability of Alternative Uses for Resource);(c)
Review of subspecialty beds other than chemical dependency inpatient beds, holding rooms, and freestanding mental health emergency centers shall take into account historical service area utilization and substantiated projections, rather than according to the population-based criteria for general psychiatric beds in this rule. The service areas for subspecialty beds are defined in subsections (1)(d) and (e) of this rule. Need for subspecialty units shall be evaluated with respect to population-based need; availability of existing capacity in the service area; effect on viability of existing quality providers; and proposed size of the unit in relation to economies of scale;(d)
Chemical dependency inpatient beds shall be reviewed according to the principles and methods of division 600 of this chapter;(e)
Need for holding rooms and freestanding mental health emergency centers shall be evaluated in relation to local considerations of access, demand and feasibility.
Source:
Rule 333-615-0030 — Estimates of Need, https://secure.sos.state.or.us/oard/view.action?ruleNumber=333-615-0030.