PHHPC Meeting on Health Equity CON Regulations Prompts Additional Comment from LeadingAge NY
The Public Health and Health Planning Council's (PHHPC) Codes Committee reviewed draft regulations to implement health equity impact assessments (HEIAs) of certificate of need (CON) applications on March 30th and welcomed the additional information that the assessments would bring to the Council. The discussion focused primarily on major hospital projects, and PHHPC members noted that the Council would have broad discretion to approve or disapprove projects as appropriate. However, the impact of the HEIA requirements on modest nursing home projects that do not come before the PHHPC was largely overlooked.
Responding to the discussion at the PHHPC meeting, LeadingAge NY submitted supplemental comments providing some examples of actual limited review CON applications that would be subject to HEIA requirements under the draft regulations, if submitted after the regulations' effective date:
- Addition of dialysis services for nursing home residents (either at bedside or in a “dialysis den”).
- Decertification of two nursing home beds to create a single room for a hospice patient.
- Decertification of two beds, reducing overall capacity from 362 beds to 360, by reducing a 22-bed unit to 16 beds and creating 12 single resident rooms and two double rooms with fully Americans with Disabilities Act (ADA)-compliant bathrooms; relocating four beds to other floors; and installing a new heating, ventilation, and air conditioning (HVAC) system.
- Adding a second shift to an adult day health care program.
- Renovating space to create an expanded rehabilitation therapy suite and decertify diagnostic radiology and clinical lab space (services that had not been provided by the facility in over 10 years).
- Decertification of three beds and renovation to develop a Geriatric-Psychiatric Skilled Nursing Program.
- Constructing an addition to create a specialty unit for bariatric residents.
The association noted that the HEIA requirements would not likely lead to a different outcome than a determination in the absence of an HEIA, but the requirements would increase the expense and delays associated with projects like these. Moreover, the regulations do not disclose the standards that the Department would apply in making CON determinations in light of HEIAs; how the HEIA would be weighed in relation to other public health, quality, and safety considerations; the degree of the equity impact that would necessitate mitigation measures; or how mitigation proposals would be evaluated. The comments called for inclusion in the regulations of the standards that would be applied by the Department of Health (DOH) in its reviews of the HEIAs.
In its initial comments and supplemental comments, LeadingAge NY sought broader exemptions from the HEIA requirements for nursing homes, noting that the requirements are likely to delay nursing home projects that promote the quality of care, quality of life, and safety of older adults and people with disabilities, most of whom are Medicaid beneficiaries. In some cases, the requirements may hinder projects that are intended to preserve the financial viability of a not-for-profit or public nursing home.
The regulations will be published for public comment and return to the PHHPC for adoption in June 2023. LeadingAge NY will keep members updated as these regulations proceed through the adoption process. More information is available here.
Contact: Karen Lipson, klipson@leadingageny.org