N.Y. Comp. Codes R. & Regs. tit. 10 § 709.11

Current through Register Vol. 46, No. 45, November 2, 2024

Section 709.11 - Inpatient rehabilitation programs for traumatic brain-injured patients

(a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of inpatient rehabilitation programs for traumatic brain-injured patients. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of inpatient rehabilitation programs for traumatic brain-injured patients. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of inpatient traumatic brain-injured rehabilitation programs and beds are available to provide access to care and avoid the unnecessary duplication of resources.

(b) Inpatient rehabilitation programs for traumatic brain-injured patients are intensive rehabilitation programs designed to prevent and/or minimize chronic disabilities while restoring the individual to the optimal level of physical, cognitive, and behavioral functioning. These programs are applicable to those individuals who have severe disabling impairments of recent onset and are able to participate daily (at least five days per week) in multi-disciplinary programs for a minimum of three hours per day.

(c) The factors and methodology for determining the public need for inpatient rehabilitation programs for traumatic brain-injured patients shall include, but not be limited to, the following:

(1) The service area for determining the public need for inpatient rehabilitation programs for traumatic brain-injured patients shall be the designated health systems agency regions.

(2) The maximum number of inpatient rehabilitation beds for traumatic brain-injured patients in each health systems agency region required to meet the public need shall be determined by dividing the projected annual patient days for the service by 365, and dividing the result by 0.90 to allow for 90-percent occupancy. The projected inpatient rehabilitation patient days for traumatic brain-injured patients used in this calculation shall be determined as follows:

(i) The diagnostic categories used in computing the need for inpatient rehabilitation beds for traumatic brain-injured patients shall be: brain dysfunction, traumatic brain dysfunction and skull fracture.

(ii) The annual number of potential candidates for inpatient rehabilitation programs for the traumatic brain-injured shall be determined by calculating the total numbers of annual general hospital discharges from the categories considered, plus an additional 10 percent, and multiplying the resulting figure by 0.155.

(iii) The number of potential candidates for inpatient rehabilitation programs for the traumatic brain-injured shall be multiplied by an 85-day rehabilitation length-of-stay to project the annual number of inpatient rehabilitation days for traumatic brain-injured patients.

(iv) A traumatic brain-injured rehabilitation program that is organized as a specialized unit within a comprehensive inpatient physical medicine and rehabilitation program shall have a minimum of 10 beds. A traumatic brain-injury rehabilitation program that is organized as a freestanding inpatient rehabilitation program shall have a minimum of 20 beds.

(v) The Health Systems Agencies may make adjustments to these bed need estimates to address patient migration patterns and other regional planning issues.

(3) Where public need is established herein, and in addition to meeting the operating requirements of either section 405.18(e) of this Title (traumatic head-injury programs of general hospitals) or section 415.36 of this Title (long-term inpatient rehabilitation program for head-injured residents in nursing homes), priority consideration will be given to applicants that:

(i) Demonstrate a commitment to developing and participating in an area-wide network of service organizations which provide and coordinate a full array of rehabilitation, support, education, vocational rehabilitation, recreation, housing, case management and social services for persons with traumatic brain injuries.

(ii) Have a coma recovery care program for brain-injured patients who are unable to participate in an active rehabilitation program or have a transfer agreement with a facility that has a coma recovery care program for traumatic brain-injured patients. The number of coma recovery care beds needed in each health systems agency region shall be determined by the ratio of six beds per 1.5 million population.

(iii) Have an extended care program for traumatic brain-injured patients who are unable to participate in an active rehabilitation program or a transfer agreement with a facility that has an extended care program for traumatic brain-injured patients.

(iv) Will provide access to New York State Medicaid recipients or to patients or residents who are likely to become Medicaid-eligible.

(v) Demonstrate a commitment to serve the medically indigent and patients regardless of the source of payment.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 709.11