Alabama Administrative Code Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY
Alabama Administrative Code, Title 410, is dedicated to the Alabama State Health Planning and Development Agency (SHPDA). This agency is critically important in Alabama's healthcare landscape as it is the primary body responsible for health planning and the administration of the Certificate of Need (CON) program.
The fundamental mission of SHPDA, as reflected in its rules, is to ensure that quality healthcare facilities, services, and equipment are available and accessible to the citizens of Alabama in a manner that assures continuity of care at a reasonable cost. This is primarily achieved through the CON process, which requires state approval for certain new healthcare facilities, services, or significant capital expenditures.
Here's a breakdown of the key chapters and areas of regulation within Alabama Administrative Code Title 410:
Chapter 410-1-1 - GENERAL PROVISIONS:
Authority and Purpose: Establishes SHPDA's statutory authority (primarily Code of Alabama 1975, § 22-21-260 et seq.) and the overall goals of the agency, which include promoting cost-effective healthcare and preventing unnecessary duplication of services.
Sanctions: Outlines potential penalties for violating the CON statute or SHPDA's rules, which can include injunctive relief, denial of licenses to operate, denial of reimbursement for services, and revocation of a Certificate of Need.
Chapter 410-1-2 - DEFINITIONS:
Provides precise definitions for terms used throughout the CON rules, such as "health care facility," "health maintenance organization," "new institutional health service," "capital expenditure," "major medical equipment," "State Agency" (synonymous with SHPDA and the Certificate of Need Review Board), and various types of beds and services. These definitions are crucial for determining what projects require a CON.
Chapter 410-1-3 - GENERAL ORGANIZATION AND PROCEDURES:
Details the administrative structure and procedures of SHPDA and the Certificate of Need Review Board. This includes rules regarding public notice, electronic filing, and general administrative processes.
Chapter 410-1-4 - SCOPE OF REVIEW:
This is a core chapter that specifies what types of new institutional health services are subject to Certificate of Need review. This includes:
Construction, development, acquisition, or establishment of new healthcare facilities or HMOs.
Capital expenditures by healthcare facilities exceeding certain monetary thresholds (which are indexed annually for inflation, e.g., typically over $4 million for general capital, $2 million for major medical equipment, or $800,000 for new annual operating costs).
Changes in licensed bed capacity (addition, relocation, or reallocation of beds).
Offering new health services not regularly offered in the preceding 12 months.
Acquisition of major medical equipment, even if not located in a healthcare facility, if it will be used for inpatients.
It also lists certain exemptions from CON review (e.g., specific replacement equipment, certain rural hospitals, and particular mobile medical equipment like lithotripters or MRI scanners under certain conditions).
Chapter 410-1-5 - BATCHING CYCLES:
Outlines the scheduling and "batching" process for CON applications. Similar projects are often reviewed together in specific cycles to facilitate comparative review.
Chapter 410-1-6 - LETTER OF INTENT:
Mandates the submission of a Letter of Intent (LOI) to SHPDA at least 30 days before filing a formal CON application. This serves as a preliminary notification of a proposed project.
Chapter 410-1-7 - FORMAL REVIEW PROCESS:
Details the multi-step process for formal CON review, including:
Application submission requirements (e.g., electronic filing, specific forms, and fees based on project cost).
Public notice and advertisement requirements for applications.
Completeness review by SHPDA staff.
Opportunities for "affected parties" (e.g., competing healthcare providers) to request an intervention or participate in the review.
Public hearings and presentation to the Certificate of Need Review Board.
Criteria used by the Board for evaluating applications (e.g., consistency with the State Health Plan, community need, financial feasibility, quality of care, accessibility, cost-effectiveness, and impact on existing providers).
Issuance of the Board's ruling (approval, denial, or approval with conditions).
Chapter 410-1-8 - EXPEDITED REVIEW:
Outlines criteria and procedures for projects that may qualify for a faster, expedited CON review process due to their nature or limited scope.
Chapter 410-1-9 - FAIR HEARING PROCEDURES:
Details the process for appealing a decision made by the Certificate of Need Review Board. This provides due process for applicants or affected parties who disagree with the Board's ruling.
Chapter 410-1-10 - VALIDITY OF CERTIFICATE OF NEED:
Specifies the duration of a CON, conditions for its continued validity, and procedures for project modification or extension.
Chapter 410-1-11 - ANNUAL REPORTING:
Requires healthcare facilities to submit annual reports to SHPDA regarding their operations, services, and finances.
Chapter 410-2-1 to 410-2-6 - INTRODUCTION TO HEALTH PLANNING / ALABAMA STATE HEALTH PLAN:
These chapters relate to the broader health planning function, including the role of the Statewide Health Coordinating Council (SHCC) in developing and reviewing the Alabama State Health Plan. The State Health Plan serves as a foundational document that assesses healthcare needs and resources in Alabama and guides the Certificate of Need review process.
In essence, Alabama Administrative Code Title 410 empowers SHPDA and the CON Review Board to regulate the supply and distribution of healthcare facilities and services in Alabama. This is intended to prevent unnecessary duplication, control healthcare costs, and promote access to quality care across the state.
For the most current and detailed regulations, it is highly recommended to consult the official Alabama Administrative Code on the Alabama Legislature's website or the official website of the Alabama State Health Planning and Development Agency (SHPDA).
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