WVHCA: 2012 CON Capital Expenditure Minimum

The West Virginia Health Care Authority has announced the 2012 certificate of need capital expenditure minimum threshold of $2,916,104. The new threshold is effective beginning January 1, 2012. The threshold is used as a part of the analysis by health care providers who must determine whether or not a certificate of need is required for a proposed project or health care acquisition. 

Pursuant to W.Va. Code 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment isbased on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2011 is 2.9%.

WVHCA: Notice of Public Comment Period on Proposed Amendments to CON Standards for Megavoltage Radiation Therapy Services/Units

The West Virginia Health Care Authority has issued a Notice of Public Comment Period to obtain comments on proposed amendments to Certificate of Need Standards for Megavoltage Radiation Therapy Services/Units.

Here are the "proposed amendments" to the Megavoltage Radiation Therapy Services/Units. Here is a link to the current CON Standards for Megavoltage Radiation Therapy Services/Unit (Approved by Governor on October 9, 2002).

Written comments must be submitted to Tim Adkins, Director of Certificate of Need, at the West Virginia Health Care Authority, 100 Dee Drive, Charleston, West Virginia 25311, no later than July 15, 2011.

WVHCA: Proposed CON Standards for Megavoltage Radiation Therapy Services/Units

The West Virginia Health Care Authority has issued a Notice of Public Comment Period on a new Proposed Certificate of Need Standard for Megavoltage Radiation Therapy Services/Unit.

Written comments on the proposed Certificate of Need Standard must be filed with the Authority on or before July 30, 2010. Written comments should be directed to Timothy E. Adkins, Director of Certificate of Need Division.

WVHCA: Proposed Amendment to West Virginia CON Law Defintion of "Private Office Practice"

On June 15, 2010, the West Virginia Health Care Authority filed a Notice of a Comment Period on a Proposed Rule with the West Virginia Secretary of State amending West Virginia CSR 65-7, Certificate of Need Rule.

According to the Summary and Statement of Circumstances filed with the Proposed Rule the "amendment clarifies the definition of "private office practice" for purposes of administering the Certificate of Need Program. Those entities meeting this criteria may be eligible for an exemption from Certificate of Need review pursuant to West Virginia Code 16-2D-R(a)."

Written comments on the Proposed Rule are due on or before July 16, 2010.

WVHCA: 2010 CON Capital Expenditure Minimum

The West Virginia Health Care Authority announced that the capital expenditure minimum for calendar year 2010 is $2,767,500.

The capital expenditure minimum is typically used by the Authority when reviewing whether or not certain health relate projects require certificate of need review.

The Authority provided the following announcement via its website:

Pursuant to West Virginia Code §§ 16-2D-2(h) and (s), the Authority is required to adjust the expenditure minimum annually and publish an update of the amount on or before December 31 of each year. The expenditure minimum adjustment shall be based on the DRI inflation index published in the Global Insight DRI/WEFA Health Care Cost Review. The DRI inflation index as of December 31, 2009 is 2.5%.

The capital expenditure minimum for calendar year 2010 is $2,767,500.

West Virginia Health Care Authority Revises Fee Schedule for Certificate of Need Program

On July 15, 2009, the West Virginia Health Care Authority filed with the West Virginia Secretary of State proposed amendments to the its procedural rule regarding the schedule of fees for the filing of certificate of need applications and exemption requests under the West Virginia Certificate of Need Program.

The amendment revises the fee schedule pursuant to Senate Bill 321 passed during the 2009 Legislative Session. The amendment required the fee schedule contain a maximum amount or cap for certificate of need application fees.

The proposed rule, Fee Schedule for Certificate of Need Matters, CSR 65-10 (redline version showing amendments) has been filed with the West Virginia Secretary of State. Written comments to the proposed rule may be submitted to the Authority before August 14, 2009 at 5:00 p.m.

Proposed Certificate of Need Rule: Hospital Ambulatory Health Care Facility

On June 8, 2009, the West Virginia Health Care Authority filed a proposed legislative rule with the Secretary of State and Legislative Rule-Making Review Committee titled Hospital Ambulatory Health Care Facilities. CSR 65-27. The official notice can be found in the June 12, 2009 issue of the West Virginia Register.

The proposed rule impacts the procedure used by West Virginia hospitals to obtain approval prior to developing an ambulatory health care facility. The proposed legislative rule establishes the circumstances and procedures by which a certificate of need may not be required for the construction, development, acquisition or other establishment by a hospital of an ambulatory health care facility. The proposed rule sets out exemption criteria and the exemption procedure.

The Authority established a comment period for interested parties to submit comments concerning the  proposed rule. Written comments must be submitted to the Authority before July 8, 2009 at 5:00 p.m.

2009 Legislative Changes to WV Certificate of Need Law

On April 9, 2009, the West Virginia Legislature sent Senate Bill 321 to Governor Manchin for signature (see strikethru/underline Committee Substitute version). Senate Bill 321 makes substantive changes to the current certificate of need law in West Virginia overseen by the West Virginia Health Care Authority.

The certificate of need law requires health care providers, including hospital, physicians, long term care facilities, hospice providers, home health agencies and other health care providers to first seek approval prior to expanding health services, incurring capital expenditures above a particular threshold, purchasing certain medical equipment and developing or acquiring new health facilities or services.

Below is a summary of the major changes to the law that will go into effect 90 days from passage on April 3, 2009:

• The bill raises the capital expenditure threshold and major medical equipment threshold from $2,000,000 to $2,700,000.
• Eliminates lithotripsy from certificate of review.
  
• Amends the fee structure of the Health Care Authority for certificate of need reviews.
• Provides that in specified instances nonhealth-related projects are not subject to certificate of need review.
  
• Provides that in specified instances certain ambulatory health care facilities are not subject to certificate of review.
• Eliminates from certificate of review acquisition of any health care facility outside of West Virginia by a West Virginia health care facility.

Does the Certificate of Need Law Benefit West Virginia?

Joe Letnaunchyn, CEO of the West Virginia Hospital Association, responds to the continuing discussion on the pros and cons of certificate of need regulatory oversight in West Virginia. The commentary, Certificate of Need Program Benefits West Virginia, appears in the most recent edition of the State Journal.

Mr. Letnaunchyn responds to the commentary by Dashle Gunn Kelley, dated October 30 2008, State Doesn't Need Certificates of Need, asserting that West Virginia "doesn't need certificates of need" to deliver health care. Mr. Kelley is a doctoral student in economics at West Virginia University and is an associate fellow for the Public Policy Foundation of West Virginia.

Throughout the year the Select Committee D - Health (Subcommittee Certificate of Need) - Interim has been looking at the issues involving certificate of need in West Virginia. Highlights of the Interim Meetings can be found here. I suspect that the discussion and debate will continue at the upcoming West Virginia Legislative session.

UPDATE (12/19/08): The latest edition of the State Journal contains a follow up commentary on West Virginia's certificate of need program. The commentary, Who Really Benefits from the Certificate of Need Program? was written by Russell S. Sobel, Ph.D., is professor of economics, holder of the James Clark Coffman Distinguished Chair at West Virginia University and editor of the book "Unleashing Capitalism: Why Prosperity Stops at the West Virginia Border and How to Fix It."

WVHCA Examining Current CON Standards

The West Virginia Health Care Authority has scheduled various public meetings over the coming months to discuss and examine the current certificate of need standards for a variety of service areas.

As states on the Authority's website these meetings are being held as a part of the legislature's review of West Virginia's certificate of need statute.

The dates of the meetings scheduled to be held at the Authority's Charleston office are as follows. Most of the meetings are set for 1pm. Those interested can also participate by phone. Call-in information: 1.800.244.2500, Code #9271804.

September 25 - Renal Dialysis

October 7 - Hospice & Home Health

October 14 – Medical Rehabilitation

October 15 – Lithotripsy (2^nd meeting)

October 22 – Long Term Care

October 23 – Ambulatory Surgical Care

October 28 - Ambulatory Care Centers

November 5 - Radiation Therapy

November 12 - Imaging

November 13 - Behavioral Health

November 19 - In Home Personal Care

November 20 – Private Office Practices

John Stossel's Perspective on WV Certificate of Need Law

Yesterday's Daily Mail article reports that John Stossel, co-anchor of ABC's 20/20 speaking at the West Virginia Chamber of Commerce's Business Summit spoke out against West Virginia's Certificate of Need laws. Stossel argues that free market is better than regulation of health care.

Regulation vs. free market makes for great conversation. The debate as it relates to health care is made more complex when we have a largely single payor (government funded) health care reimbursement system in West Virginia. I don't know the actual statistics but well over half and probably near 75% of health care costs are paid in West Virginia by Medicare, Medicaid, PEIA and other government payors. As for private payors we only have a few that have any influence in West Virgina. This makes West Virginia close to a microcosm for a wwhat a single payor government run health care system might look like. What impact does this stagnation of competition on charges/costs have on the regulation vs. free market question. Is a single payor system better for West Virginia and the U.S.? Interesting questions as we approach the election in November.

Also, in my inbox this morning was an email from friend and health colleague, Mike Ryan, letting me know about the HealthDecisions '08: Obama and McCain on Health Care. Although I haven't had a chance to explore the site in detail I like the side by side comparison on the main page.

The press release indicates:

HealthDecision '08 by HealthCare.com is an initiative to inform, educate and deploy the power of the web to gather public opinion on the health care proposals put forth by Senators Barack Obama and John McCain. HealthDecision '08 provides a side-by-side comparison of Obama's and McCain's healthcare positions and proposals, along with interactive voting tools that enable users to vote for their preferred health care plan and offer their own comments after weighing through the issues.

What do others think? Post your comments.

Ongoing Debate Over Revised Cardiac Catheterization Standards

Larry Messina at Lincoln Walks at Midnight round up of latest links/articles discussing the ongoing debate over the revised certificate of need Cardiac Catheterization standards. The debate has pitted hospital against hospital and resulted in full page ads and a media blitz by both sides in the debate.

Governor Manchin has until Friday (tomorrow) to decide whether he will approve the revised standards developed by the West Virginia Health Care Authority or send them back with recommended modifications.

For more history on the standards with links to the revised standards see my previous post.

UPDATE (7/18/08): This morning Governor Manchin issued the following statement indicating that he is sending the proposed Cardiac Catheterization standards back to the West Virginia Health Care Authority to revise and clarify the "medical transport drive time" language.

The Daily Mail reports on the decision.

STATEMENT FROM THE GOVERNOR ABOUT HEALTH CARE AUTHORITY’S PROPOSED ANGIOPLASTY STANDARDS

Contact: Lara Ramsburg, 304-558-2000

Gov. Joe Manchin today released the following statement about his approval, WITH EXCEPTION, of new West Virginia Health Care Authority rules that would allow some smaller hospitals in the state to perform angioplasty and other cardiac catheterization procedures:

“Any time we’re charged with making a decision that affects the quality of health care for our citizens, it’s a decision that must be carefully considered. In this case, we’ve taken a very close look at data gathered over several years, and a number of other facts about the ability of our hospitals to perform heart angioplasty procedures that have the potential to save hundreds of lives, especially given our state’s high heart disease rates and rural nature.

“Based upon this research, and the recommendation of the Health Care Authority, I am approving the majority of the standards that will give our citizens easier access to important emergency heart procedures; however, I have directed the Health Care Authority to revise the rules as they pertain to elective cardiac catheterization service and return them to me for reconsideration as soon as possible.

“Due to the ambiguity in the term ‘medical transport drive time,’ the current language in the proposed standards does not make it clear as to which hospitals could provide the elective procedure to their patients, so I believe the standards should be written to make sure that the appropriate hospitals are allowed to provide this service, under the strict guidelines and monitoring of the Health Care Authority.

“This decision, in its entirety, is solely based upon one objective – to provide all of our citizens, regardless of their location, access to the best possible medical care in their time of need.”

– Gov. Joe Manchin

WVHCA Board Approves Modified Cardiac Catheterization Standards

Yesterday, the West Virginia Health Care Authority Board approved the changes to the Certificate of Need Standards for Cardiac Catheterization. The approved modification will now be delivered to Governor Manchin for review and approval.

Eric Eyre of the Charleston Gazette covers the story today in his article, Smaller hospitals get OK to offer heart procedures.

The new Standards will not go into effect until approved by the Governor. The current Cardiac Catheterization Standards were last updated and approved by the Governor on May 3, 2007.

For more on the process of modifying the standards check out my previous posts.

WVHCA: Proposed Amendments to Cardiac Catheterization Standards

The West Virginia Health Care Authority approved for public comment proposed revisions to the Certificate of Need Cardiac Catheterization Standards (current 3/19/2007 standards).

These revisions were made by the Authority after Governor Manchin rejected the previously proposed standards. The proposed standards continue to modify the requirements for the participants in the demo pilot project involving offering therapeutic cardiac catheterization.

The standards distinguish between Primary (Emergency) Percutaneous Coronary Intervention (Primary PCI) which involves providing cardiac catheterization services within 120 minutes of an emergency myocardial infarction and Elective Therapeutic Catheterizations. The proposed standards also set new need threshold levels for elective therapeutic catheterization.

Written comments on the proposed standards may be submitted to Dayle D. Stepp, Director of Certificate of Need, no later than May 23, 2008.

I previously reported on the modifications to the standards here, here and here.

WVHCA: Update on the Proposed Cardiac Catheterization Standards

I previously posted about the proposed amendments to the Certificate of Need Cardiac Catheterization Standards issued by the West Virginia Health Care Authority for public comment.

Today, Charleston Gazette reporter, Eric Eyre, reports on the current debate over the standards. To learn more you can read the comments submitted regarding the proposed standards.

WVHCA Grants Motion to Dissolve Stay in Manor Care CON

Yesterday the West Virginia Health Care Authority issued an Order Dissolving Stay. The Order granted MCHCR's (Carlyle Group) Motion to Dissolve Stay but denied the Motion to Affirm the Initial CON Decision.

The Authority set January 7 as the date for initial briefs to be submitted by both parties as a result of the Reconsideration Hearing held on December 14.

Governor Manchin Rejects New Certificate of Need CT Standards

Eric Eyre reports in today's Sunday Gazette-Mail that Governor Manchin has rejected the proposed new Certificate of Need CT Standards approved by the West Virginia Health Care Authority last month.

The article indicates Governor Manchin sent a letter to the Authority's Board on Friday, December 7, asking that they re-examine the imaging equipment proposal and submit a revised plan. The article also indicates that Governor Manchin rejected the proposed new standards on the basis that the standards did not require physicians to accept low income patients.

For more background on the proposed new standards see my previous posts - here and here.

UPDATE (12/10/07): Governor Manchin's December 7, 2007 letter to the WVHCA.

UPDATE (1/26/08): On January 18, 2008, Governor Manchin approved the Authority's revisions to the Certificate of Need Computed Tomography Services Standards.

WVHCA Reconsiders HCR Manor Care CON

The State Journal provides background on the pending reconsideration hearing set for December 14, 2007 (9am), before the the West Virginia Health Care Authority regarding the Authority's granting of a certificate of need for the $6.3 billion buyout of HCR Manor Care by The Carlyle Group, a private global investment firm.

The Authority granted HCR Manor Care a certificate of need on October 19, 2007, however, on November 15 the Service Employees International Union Local 1199 filed a Request for Reconsideration with the Authority along with an Appeal to the Office of Judges.

On November 20, the Authority issued its Decision on Request for Reconsideration granting the reconsideration and ordering a stay of its October 19, 2007 decision pending resolution of the request for reconsideration.

UPDATE (12/10/07): Jeff Mehalic at the West Virginia Business Litigation blog picks up on my post and includes uploaded links of some of the CON pleadings in the matter, including the:

• Authority's October 19, 2007 CON Decision approving the merger between Manor Care and Carlyle Group
  
• SEIU District 1199's Request for Reconsideration
• the Authority's Decision on Request for Reconsideration granting reconsideration, a hearing on the reconsideration and a stay of its October 19 Decision and
  
• the Amended Notice of Administrative Hearing set for December 14.

Thanks to Jeff for the link and for uploading some of the key public documents in this pending certificate of need matter.

WVHCA Issues Proposed Amendments to Cardiac CatheterizationStandards

The West Virginia Health Care Authority issued and approved on November 14, 2007, proposed amendments to the Cardiac Catheterization Standards.

The Notice of Public Comment Period indicates that comments must be submitted to the Authority by December 14, 2007.

WVHCA Approves New Certificate of Need CT Standards

Eric Eyre of the Charleston Gazette reports on the board decision by the West Virginia Health Care Authority approving new Computerized Tomography (CT) Standards under West Virginia's Certificate of Need Program. The proposed standards will now be sent to Governor Manchin for final approval.

Eyre reports:

A state agency cleared the way Wednesday for doctors across West Virginia to put diagnostic imaging equipment in their offices, a move hospital executives predict will drive up health costs and force them to raise rates.

West Virginia Health Care Authority members voted unanimously to approve standards that doctors’ offices must meet before the state allows them to buy and use computed tomography machines, also known as CT scanners.

The authority wrestled with the standards for nearly a year. “We tried to strike a balance between all of the competing interests,” said board chairwoman Sonia Chambers. “We tried to keep the best interests of the citizens of West Virginia in mind.”

The authority plans to send the standards to Gov. Joe Manchin, who has 30 days to give them final approval. . .

For more background information check out my previous post. Additional background information, including comments by various groups on the proposed standards, can be found on the the Authority's CT Services Workgroup Meeting site.