Each year, the governor, assisted by the State Health Coordinating Council (SHCC) and members of the N.C. Department of Health and Human Services' Health Planning Section, produces a State Medical Facilities Plan (SMFP) that identifies all health care facilities and services subject to CON that are “needed” in the state. The SMFP covers nursing facilities, assisted living communities, hospices, home health agencies, inpatient psychiatric services and most other health care services including hospital beds, operating rooms and technology (lithotriptors, gamma knives, linear accelerators, etc.).
You know the process – the SMFP identifies a need (like new nursing home beds), it sets a date for all interested applicants to apply, everyone files their CON applications, someone wins and someone loses (except where all applications are denied, which happens fairly frequently of late), and the losers usually appeal the results.
For providers looking to expand, and attorneys like those of us at Poyner Spruill who handle CON matters, the SMFP is the road map to what will or might happen in the next two to three years in terms of facility/service development and potential CON appeals. Most years, the SMFP is chock full of good stuff.
But the 2010 SMFP is noticeably thin in terms of identifying additional “needed” health care facilities and services, leading some of us to pose the question I chose as this article's title – is North Carolina essentially saturated with needed health care services and facilities? To be fair, there are some new things identified as needed in the 2010 SMFP but on the whole, the plan has precious little to offer providers looking to expand their services or get into new lines of service.
Some of the needed services the 2010 SMFP does include, pertinent to long term care, include:
- 60 SNF beds for Johnston County;
- 10 SNF beds for Camden County;
- 20 SNF beds for Perquimans County;
- 340 adult care home (assisted living) beds for Mecklenburg County – this is the BIG bonanza in the 2010 SMFP and should create some interesting applications, decisions and probably appeals;
- 40 adult care home beds each for Dare and Gates counties;
- 30 adult care home beds for Hyde and Jones counties (maybe enough to justify some new development versus expansions of existing facilities);
- Adult care home bed allotments of 20 for Camden, 20 for Tyrell and 10 for Washington counties – just enough to allow expansions of existing facilities or small freestanding units as part of multilevel campuses such as independent living;
- Only one Medicare-certified home health agency is shown as needed, but it's in Wake County, so that one will be hotly contested for certain; and
- A smattering of inpatient hospice beds (between three and seven) for Alexander, Buncombe, Macon, Randolph, Sampson, and Craven Counties.
So, back to my original question – is there no real room at the inn for new health care development? We'll have to wait and see. In fairness, the SHCC is looking at the methodologies used to project need for several services, so these estimates of need could change dramatically in future years' SMFPs, or maybe not at all. Either way, we all – providers, regulators and, of course, the lawyers – will be watching eagerly to see who applies, who wins, who loses, who appeals, and how our state health planners respond to the changing shape of North Carolina's health care needs.