HAWAII STATE HEALTH PLANNING AND DEVELOPMENT AGENCY

CONTENTS

The CON Process:

Popular "myth" has it that the CON process takes eons to complete. In reality, the CON review process takes approximately 2 months. It takes the Agency approximately one month to review applications for completeness and research/write the staff report. The second month is spent with the councils at public meetings.

In the first seven months of this year, the Agency reviewed over 30 applications. A well earned accomplishment with the smallest staff - there are just eight of us total - in Agency history! Normally, the Agency reviews 20 to 30 applications per year.

There are 38 states plus Washington, D.C. with an active CON process in place. Of these, Hawaii has amongst the most user friendly CON processes. In our State, a project's dollar value threshold is high -- only capital projects exceeding $4 million, new equipment exceeding $1 million and service changes need a CON. Other states require expenditures at much lower thresholds to apply for a CON. For example, the State of Vermont, a state often ranking near the top of national health rankings, had their thresholds at $300,000 for capital and $250,000 for equipment till this year when they changed capital thresholds to $1.5m for hospitals; $750,000 for other health care facilities; and $500,000 for equipment.

Hawaii's certificate of need criteria have been established by law and rules, and they have been grouped into six categories for ease of review:

• 1. need and accessibility
• 2. cost and finances
• 3. quality
• 4. relationship to the State plan
• 5. relationship to the existing health care system; and
• 6. availability of resources.

The Hawaii State Health Services and Facilities Plan (HSFP) is the document by which the CON planning tool is guided. The HSFP is undergoing a complete overhaul this year to contemporize its philosophy and thereby improve its ability to provide council members with the information they need to make CON recommendations.

* CON: HSHCC met in June and July. In June, the HSHCC reviewed the home health applications undergoing standard review. Their recommendations: Disapprove-- CASHA and Hale Omao. HSHCC forwarded applications from Health Resources and West Hawaii Home Health Services, Inc. to the Administrator with no recommendations.

In July, the HSHCC met to review the Pediatric MRI application from Kapiolani Medical Center. The HSHCC voted to recommend approval.

* Membership: Nancy McGuckin-Smith was confirmed as the HSHCC's CON Review Panel Chair. Craig Kadooka, M.D. was welcomed as the new member from the Big Island. New member Margaret Nielsen resigned due to a recent career development relocating her to the Mainland.

The following are updates from the SAC chairpersons of their activities since the May SHPDA Update News.

Hawaii County SAC Update -- Al Nakaji, Chairperson:

In July, this SAC reviewed more CON applications. They were all administrative applications. All were recommended for approval: Hilo Medical Center for conversion of beds; Lucy Henriques Medical Center for dialysis and closure of ER services; Honokaa Hospital for bed conversion, Hawaii Radiologic Associates for acquisition of West Hawaii Imaging Services.

* Membership: new Chair Marni Herkes and Vice-Chair John Lipscomb. Welcome new members: Karen Norris, Ida Otake, Clifford Motta, Beverly Withington, Craig Kadooka, MD, and Wayne Shirota.

* Mental Health/Substance Abuse Committee: updating progress of CAMHD's managed care pilot project for the Big Island, following progress of the local mental health services corporation discussions, looking at potential legislative matters.

Tri-Isle SAC Update -- Catherine Nobriga-Kim, Chairperson:

* Membership: new Chair Cathy Nobriga-Kim and Vice-chair Guy Sugino, M.D. Welcome new members: Larry Hart and Glenn Izawa.

* CON: In June, the SAC reviewed two home health applications (CASHA and Hale Omao.) Both received recommendations for disapproval.

In July, the SAC begin review of an application from Dr. Stodd for a freestanding surgicenter on Maui. The SAC requested further information and voted to continue their review of this standard application at their August meeting.

Waianae SAC Update -- Bette Larrabee, Chairperson:

* CON: The SAC reviewed the administrative application from Kaiser Permanente to relocate their clinic. The SAC voted to recommend that this application go through the standard review process.

Also participated in two Oahu-wide CON Committees.

* Membership: new Chair Bette Larrabee and Vice-chair Agnes Lucero. Welcomed new member: Marge Shepherd. New member Norman Jensen resigned as her husband has accepted a position on the mainland.

Windward SAC Update -- Ron Hayashi, Chairperson:

* A letter of concern was sent to Councilperson Felix regarding the City Council Resolution 96-20 which proposes to merge EMS with the Honolulu Fire Department.

* A letter of support was sent to the DOH Alcohol and Drug Abuse Division for a grant they are applying for.

* Site visit to the Hawaii State Hospital to visit recently CON approved projects and tour the facility.

* CON: participated on two Oahu-wide CON Committees.

* Membership: new Chair Ron Hayashi and vice chair Harvey Smith. Welcomed new members: Noella Kong and Les Chinen.

Honolulu SAC Update -- Lane Uchimura, Chairperson:

* Membership: new Chair Lane Uchimura and vice-chair Elizabeth Holmes. Welcome new members: Steve Kula, Jim Walsh, and Mimi Brown. New member Margaret Nielsen resigned due to a recent career development relocating her to the Mainland. Kathryn Smith Ripper resigned to have more time for family.

* CON: participated on two Oahu-wide CON Committees.

Central Oahu SAC Update -- Jake Ng, Chairperson:

* Membership: New Chair - Jake Ng, Vice-chair - Janet Ohta. Welcome new members: David Hill, C. Mike Kido and Wendy Abe.

* CON: Reviewed Kaiser Permanente's application to establish a Kapolei Medical Building. Recommended approval.

* In a meeting with the state's emergency medical services branch chief, COSAC continued its support of the DOH position regarding the City and County of Honolulu's proposed changes to county emergency services.

Kauai SAC Update -- Able Medeiros, Chairperson:

* CON: Reviewed home health applications from CASHA and Hale Omao. Both received recommendations for approval.

1. Mobile Care Project - Outreach services to the homeless (Big Island)

2. Gumapac & Associates - Free standing surgery center (Big Island)

3. Lanakila Education & Development Services, Inc. - ICF-MRC for DD/MR adults. (Maui)

4. DASH - methadone clinic in W. Hawaii. (Big Island)

5. EffiCare - home health agency. (Maui)

6. Elder Spa ARCH - convert ARCH to SNF. (Kauai)

7. Black Konishi & Nishimura - air ambulance service between Big Island and Oahu.

8. Upcountry Medical Clinic - Methadone/rehabilitation maintenance type clinic. (Maui)

9. Kauai Veterans' Memorial Hospital - purchase of a CT scanner. (Kauai)

10. Po`ailani, Inc. - exploring options for changing current residential STF for dually diagnosed adults and increase bed capacity. (Oahu)

11. Hawaii Radiologic Associates, Inc. - additional outpatient radiology & change of ownership proposed. (Big Island)

12. Medecon -- for mobile MRI services (Kauai)

13. Wilcox Memorial Hospital -- for MRI services at its hospital (Kauai)

14. Kona Coast Plastic Surgery -- for a free-standing outpatient surgical facility. (Big Island)

15. Wailua Care Home -- to increase from a 24-bed care home to a 40-bed intermediate care facility. (Kauai)

Undergoing CON Completeness Review:

1. #96-22: Pacific Limited Partnership - mobile extracorporeal shock wave lithotripter service. $1,402,014. (Oahu)

2. #96-24A: Maui Memorial Hospital - 18 acute medical/surgical beds. No capital cost. (Maui)

3. #96-30A: Marimed Hale Kipa for the establishment of an 8 bed special treatment facility. $872,489. (Oahu)

4. #96-32: Kaiser Permanente for an outpatient clinic in Kihei Maui. Capital cost of $4,362,581. (Maui)

5. #96-33a through #96-42A (ten applications) from Hawaii Center for Children for the establishment of 8-bed special treatment facilities for children and adolescents. These facilities are being established through contracts with the Dept. of Health and are part of the programs resulting from the "Felix case" consent decree. The applicant is proposing 3 facilities for the island of Hawaii; 3 for Maui; 3 for Molokai; and 1 for Kauai. (Hawaii, Maui, Molokai, Kauai)

Scheduled for Review:

1. #96-16 from Tomscott, Inc. for the establishment of a freestanding surgicenter on Maui. $2,259,276. Review by: Tri-Isle SAC (August 6, 1996, 1:00 pm at the J. Walter Cameron Center), CON Review Panel (August 8, 1996 at 9:00 am at 335 Merchant St Rm. 365 and the HSHCC on August 22, 1996 at 335 Merchant St. rm 365.

2. #96-27 from Punahele Associates, Inc. for the establishment of a freestanding surgicenter in Hilo. $2,416,000. Review by: the Hawaii SAC, CON Review Panel and HSHCC. Tentatively set for September with dates/places to be determined.

3. 96-28A from Kauai Hospice Inc. for the establishment of a certified hospice agency on Kauai. Review by: Kauai SAC August 13, 1996, 3:00 pm at Wilcox Hospital, conference Rm 1.

Review Completed:

The first seven are results of the home health care applications batched for review during the month of June.

1. #95-24 CASHA Resources Home Health, Inc. for a statewide home health network. Kauai SAC recommendation: approval Disapproval recommendations from: Tri-Isle SAC, Hawaii SAC, Oahu-wide Review Committee, CON Review Panel, HSHCC Administrator's decision: disapproval

2. #96-10 West Hawaii Home Health Services, Inc. for a new home health agency in West Hawaii (Big Island) Hawaii SAC recommendation: approval CON Review Panel recommendation: approval HSHCC recommendation: no recommendation Administrator's decision: conditional approval

3. #96-19 Hale Omao Home Health Hawaii for statewide services, later amended to Oahu expansion only. Kauai SAC recommendation: approval Disapproval recommendations from: Tri-Isle SAC, Hawaii SAC, Oahu-wide Review Committee, CON Review Panel, HSHCC Administrator's decision: disapproval

4. #96-23 MLW Health Services Inc, dba Health Resources, an existing private duty agency for the establishment of a fully certified home health agency (Oahu) Oahu-wide CON Committee recommendation: disapproval CON Review Panel recommendation: approval HSHCC recommendation: no recommendation Administrator's decision: disapproved

5. #96-13A CareResource Hawaii to reorganize and merge with Comprehensive Home Care (Oahu) Oahu-wide CON Committee recommendation: approval Administrator's decision: approval

6. #96-14A Comprehensive Home Care reorganize and merge with CareResource (Oahu) Oahu-wide CON Committee recommendation: approval Administrator's decision: approval

7. #96-15A Kohala Home Health Care to expand to other districts on the Big Island. Hawaii SAC recommendation: approval Administrator's decision: conditional approval

8. #96-05 Kapiolani Medical Center's Pediatric MRI, $4,090,850 Oahu-wide CON Committee recommendation: approval CON Review Panel recommendation: approval HSHCC recommendation: approval Administrator's decision: pending

9. #96-08A Hilo Medical Center for the conversion of all its 108 long-term care beds to the SNF/ICF "swing bed" category. Hawaii SAC recommendation: approval Administrator's decision: approved

10. #96-20A Kaiser Permanente relocation of Maili outpatient clinic. $6,088,793. Waianae SAC recommendation: standard review Administrator's decision: approved administrative application (see also topic heading "Other CON Matters")

11. #96-21A Lucy Henriques Medical Center for the establishment of dialysis services and closure of emergency room services. $425,000 Hawaii SAC recommendation: approval Administrator's decision: approved

12. #96-25A Kula Hospital for the addition of 6 SNF/ICF beds. $101,274 Tri-Isle SAC recommendation: approval Administrator's decision: approved

13. #96-29A Honokaa Hospital for the conversion of 2 SNF/ICF beds to 2 medical/surgical beds. Hawaii SAC recommendation: approval Administrator's decision: approved

14. #96-31A Hawaii Radiologic Associates for the acquisition of West Hawaii Imaging Services in Kona. $750,000 (Big Island) Hawaii SAC recommendation: approval Administrator's decision: approved

Other CON Matters:

1. #96-01: Punahele Surgicenter - ambulatory surgi-center. $2,416,00. (Big Island) Applicant withdrew application and has now resubmitted it (see #96-27)

2. #96-20A Kaiser Permanente's relocation of their Maili outpatient clinic. The Administrator called an additional public meeting after the Waianae SAC meeting to discuss concerns. At this meeting: the Waianae SAC Chair (Bette Larrabee), the HSHCC Chair (David Gire), Kaiser Permanente (Dee Jay Mailer, Cathy Camp, et. al.), Waianae Coast Comprehensive Health Center (Richard Bettini, Merrie Aipoalani). Based on the results of this meeting, the administrative application was approved.

3. Requests for Reconsideration:

A. From Henry Blakely regarding CON #96-18A the Plastic Surgery Center of Maui (Dr. Leonard Yu) Reconsideration meeting scheduled for: August 6, 1996, 8:30 am at the J. Walter Cameron Center

See our Web page at: http://www.hawaii.gov/health/index.htm

* NEW: Home Health Care In Hawaii: 1995 Utilization and Estimation of Need, May 1996

* NEW: A Home Health Care Data Table

* State of Hawaii Utilization of Inpatient Facilities by County

* State of Hawaii Certificate of Need

* The Health Services and Facilities Plan for the State of Hawaii

* Big Island Health Care Needs Assessment and Recommendations

* Central Oahu Health Care Needs Assessment and Recommendations

* Garden Island Health Care Needs Assessment and Recommendations

* Tri-Isle Health Care Needs Assessment

* Acute Care Bed Projections for Years 1995 - 2010

* Long Term Care Bed Projections 1995 - 2010

* Certificate of Need - A Hawaii Review