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    Document Summary
    - Report Published -

    Report Document No. 43
    View PDF Version*

    Document Title
    Annual Report on the Status of Virginia’s Medical Care Facilities Certificate of Public Need Program - 2008

    Department of Health

    Enabling Authority

    Executive Summary
    This annual report to the Governor and the General Assembly of Virginia on the status of Virginia’s Certificate of Public Need (COPN) program has been developed pursuant to 32.1-102.12 of the Code of Virginia. The report is required to address the activities of the program in the previous fiscal year; review the appropriateness of continued regulation of at least three specific project categories; and to discuss the issues of access to care by the indigent, quality of care within the context of the program, and health care market reform. A copy of the enabling Code section is reproduced at Appendix A. This report includes data for the most recent fiscal year (FY 2008).

    Program activity for the period covered in this report includes the issuance of 96 decisions. The State Health Commissioner authorized 56 projects with a total expenditure of $1,091,191,529 and denied 10 projects with proposed capital expenditures of $356,221,200. Appendix D summarizes the authorization decisions. Additional program activities are described in the “Summary of the State Health Commissioner’s Actions” beginning on page 1.

    The following project categories are analyzed in this report: Computed Tomography, Magnetic Resonance Imaging, Positron Emission Tomography, Nuclear Medicine Imaging, and Magnetic Source Imaging. The section on project analysis addresses the history of COPN regulation for these project categories, the nature of the specific services, the current state of the service in the Commonwealth and three potential options for the future of each of the categories with a recommended action. The Virginia Department of Health (VDH) recommends maintaining the current COPN review process for the review of each of these project types except for nuclear medicine imaging, which VDH recommends supporting efforts to deregulate.

    Applicants that have not demonstrated a historical commitment to charity care, consistent with other providers in their health service area, may have a “condition” to provide some level of indigent care placed upon any COPNs they are awarded. Compliance with the conditions to provide indigent care has improved considerably. Historically, many conditioned COPN holders have either not reported their compliance with conditions or have reported that they have been unable, for various reasons, to reach the required level of indigent care. Language for the “conditioning” of COPNs is now being augmented to include the second type of condition allowed in the Code, namely that the applicant facilitate access through the development and operation of primary health care services for special populations. A guidance document was issued to clarify the conditioning process and provide definition to the elements of a condition. These initiatives helped remove the barriers to compliance most often cited by facility managers as their reason for failing to satisfy indigent care conditions. Aggressive follow-up with non-reporting holders of conditioned COPNs has improved compliance.

    During FY 2008 the application review process was completed as directed by the Code. There were no delays in receiving recommendations from regional health planning agencies that adversely affected timely decision-making.