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Home My WebLink About09/29/2021 SPECIAL MEETING AGENDA PACKET ____________________________________________________________________________ CITY COUNCIL 345 6th Street, Suite 100, Bremerton, WA 98337 (360) 473-5280 WEDNESDAY, SEPTEMBER 29, 2021 CITY COUNCIL “SPECIAL MEETING” 5:00 PM – Via Zoom Webinar Washington State Department of Health “Certificate of Need Overview” Presented by Christie Spice, Acting Assistant Secretary Health Systems Quality Assurance Division and John Williams, Executive Director Office of Community Health Systems To help reduce the spread of COVID-19, and until the Norm Dicks Government Center is open to the public, the City Council will continue to hold their meetings via Zoom Webinar. The Special Meeting is open for the public to listen in, but there will be no opportunities for input. ➢ Members of the public are invited to join the Zoom webinar by clicking on the following link: https://us02web.zoom.us/j/84144083605?pwd=YzlOYXQ3Q0ZWbkxCNVpFamQvWHpHZz09 ➢ Or iPhone one-tap: US: +12532158782,,84144083605#,,,,*408318# or +16699006833,,84144083605#,,,,*408318# ➢ Or Telephone: Dial (for higher quality, dial a number based on your current location): US: +1 253 215 8782 or +1 669 900 6833 or +1 346 248 7799 or +1 929 205 6099 Webinar ID: 841 4408 3605 Passcode: 408318 CERTIFICATE OF NEED (CN) PROGRAM OVERVIEW September 29, 2021 Christie Spice John Williams Acting Asst. Secretary Executive Director Health Systems Quality Assurance Facilities, Construction, Certificate of Need Washington State Department of Health | 3 Agenda Overview of DOH’s role in heath care regulation History of Certificate of Need (CN) General goals of CN Process and timeline Kitsap County specific information What is outside of CN scope Q & A Washington State Department of Health | 4 Our Mission, Role and Values Department of Health’s mission: Protect and improve the health of people in Washington. Health System Quality Assurance Division role: Assure people have access to safe, equitable, and high quality health care services through regulation and education. Our values: Patient safety, access to care, equity, innovation and engagement. Washington State Department of Health | 5 Health Professions Community Health Systems Customer Service Health Systems Oversight Investigative and Legal Services Health Systems Quality Assurance Office of the Assistant Secretary H Washington State Department of Health | 6 Community Health Systems Construction Review •Building science solutions •Safe and healthy physical environments. •Code compliance Certificate of Need/Facilities •Hospitals •Behavioral Health •Ambulatory surgery •Hospice care •Nursing homes •Kidney dialysis Emergency Care Systems •Emergency Medical Services •Trauma System •Cardiac & Stroke System Rural Health •Improve access to healthcare for rural residents. Washington State Department of Health | 7 Capacity Development Pipeline Certificate of Need Construction Review Facility Licensing Certificate of Need (CN) History Washington State Department of Health | 9 History of CN 1960 1970 1980 1990 2000 2010 2020 1st CN program NY State National Health Planning and Resources Development Act •Federal Funding •Mandate Effectively all states have CN Federal program sunsets 1974 -WA State passes legislation creating CN. 1989 -WA State healthcare planning system sunsets. •CN moves from DSHS to DOH •Legislature removes capital expenditures from CN review 2010 -WA State Courts found that CN does not violate Anti-trust laws 2015 -WA State Courts found that CN cannot consider merger as reviewable Centers for Medicaid/Medicare begins to shift reimbursement structure to contain cost Washington State Department of Health | 10 34 states currently have CN laws. A few others have laws with similar approaches. Temple University Center for public Health Law–CN states in yellow CN States Non-CN States CN in Washington People in communities have access to needed, safe and affordable healthcare. Washington State Department of Health | 12 “Access to Needed, Safe, Affordable Care” $ $ •Transparent and public process •Projects are financially viable •Applicant provide high quality care •Best Alternative for community Washington State Department of Health | 13 Laws and Rules pertaining to CN RCW 70.38 Health Planning and Development WAC 246-33 Health Planning and Development Washington State Department of Health | 14 Establish new Expand capacity Hospitals (Acute and Psychiatric)X X Nursing Homes X X Kidney Dialysis X X CMS cert. Home Health & Hospice X X Non-CMS Health & Hospice Ambulatory Surgery Centers X X Office Based Surgery Center Hospice Care centers X X Outpatient clinics Assisted Living Facilities Residential Treatment Facilities Facilities Regulated by CN Washington State Department of Health | 15 Tertiary Services •Intense Inpatient Rehabilitation •Open Heart Surgery and PCI •Organ Transplant •Some Intensive Care: •Specialty Burn Units •Intensive Obstetrics •Intensive Nursery Services •Intensive Pediatric Services Complex services… needing sustained volumes… …to maintain quality. Washington State Department of Health | 16 Core Tenets of CN Need Financial Feasibility Structure & Process of Care Cost Containment Washington State Department of Health | 17 General Process Need Financial Feasibility Structure & Process of Care Cost ContainmentApplicantApplication CN Screening and Review Opportunity for public comment/hearing Application Approved or Denied X Legal challenge possible Health law judge, appellate, superior courts Washington State Department of Health | 18 CN compliance monitoring Need Financial Feasibility Structure & Process of Care Cost Containment Applicant Application CN Screening and Review Opportunity for public comment/hearing Application Approved or Denied X Legal challengepossible Health law judge, appellate, superior courts Project completed on time, in budget Monitor complaints if capacity is exceeded CN compliance Kitsap County Hospitals St. Michaels •Silverdale Campus •Bremerton Campus •336 beds Naval Hospital Bremerton •25 beds •Not regulated by DOH Washington State Department of Health | 20 Hospital History in Kitsap Co. 1960 1970 1980 1990 2000 2010 2020 1903 Puget Sound Naval Shipyard 1918 City General incorporates (later Olympic then Harrison) 1943 FDR Hospital opens (later Puget Sound Hospital) 1956 Puget Sound and Harrison merge Silverdale campus opens 1974 -WA State passes legislation creating CN. New campus In East Bremerton West Wing added Beds moved between campuses New Silverdale Tower complete Orthopedic tower construction 1981 –CN adds 72 beds 1976 –CN adds 18 beds 1998 –DOR for Silverdale campus not reviewable Affiliation With CHI VM/CHI Merger 2009 -CN approved 2013 –DOR for affiliation not reviewable 2017 -CN addition of all beds at Silverdale campus Washington State Department of Health | 21 Out of scope of CN program •Whether a provider wants to stand up a facility •Whether a provider closes a facility •Emergency surge pressures •Personnel disputes Washington State Department of Health | 22 Capacity Development Pipeline Certificate of Need Construction Review Facility Licensing Washington State Department of Health | 23 Facilities Licensing programComprehensive approach Construction Review Certificate of Need Technical Assistance Available •All aspects of licensing process •Any stage of development •Process •Q&A •Tips •Feasibility •Construction •Re-use and adaptation •Licensing issues •Facility types •Process Washington State Department of Health | 24 Issues/Questions from Council Overview of CN and history •How it pertains to hospitals in Kitsap •Impacts to quality and healthcare Are providers (facilities) required to provide a level of service Concerns over temporary ED closure Concerns over staffing issues Concerns over working conditions Questions? John Williams john.williams@doh.wa.gov 360-236-2950