Senator Edward M. Kennedy regulations under P.L. 93-641. Therefore, we "(5) (A) The term 'institutional health service' Discontinuance and Conversion of Hospital Services. We applaud the requirement in S.2410 that any conversion receive a determination of need prior to its occurence. This determination will help assure that new services are developed only in needed sectors of the health care de-livery system. Hopefully this will prevent an over proliferation in any one area. However, we do recommend that section 1642(a)(1)(C), and (2)(A), be amended to include rehabilitation services as eligible services for conversion and incentive payments. As a corrolary it is important that existing rehabilitation services and facilities be recognized and assessed to determine total public need. We would appreciate your attention to this matter and will be pleased to provide any further information. So that you might review some documents prior to our discussion on the Health Planning Amendments, I have enclosed three pieces of information for your review. 1. 2. A brief issue paper developed by The Bennett Group for Homemakers Upjohn, the largest single provider of home health care in the United States. A Hunter College study on home health care regulation. 3. The recent GAO report on home health care. I hope these documents will convince you that Certificate-of-Need for home health agencies is premature at this time. Upjohn has testified on numerous occasions their stance on CON--they support it, perhaps two or three years down the road, but not at the present because: 1. 2. CON implies a balance between the health needs of the community and the resources available. CON will hamper and discourage the development of a resource that presently does not meet the need. 3. CON implies a cohesive and coordinated national home health policy which does not exist. Stuart Shapiro, M.D. March 22, 1978 Page 2 4. 5. 6. CON would preempt the home health study mandated by the Health The need at present is undeterminable because all figures are based on Medicare, where recent figures show home health expenditures total 1% of the Medicare budget. Home health care should first be incorporated into national Because the Congress will be on recess next week and markup is tentatively scheduled for April 7, perhaps we could talk early next week. I'll call to set up specifics. Looking forward to talking. Sincerely Phillip L. Porte PLP: 8g CERTIFICATE OF NEED 44 44 ISSUE 1 ISSUE 2 ISSUE 3 ISSUE 4 ISSUE PAPER WHAT IS THE DOCUMENTED NEED FOR HOME HEALTH CARE? ARE COSTS COMPARABLE AND WILL THE COST OF HOME HEALTH HOW CAN THE QUALITY OF HOME HEALTH SERVICES BE MEASURED? IS COMPETITION CRITICAL TO COST SAVINGS IN HOME HEALTH ISSUE 5 SHOULD CERTIFICATE-OF-NEED BE USED TO CONTROL PROVIDERS The Planning Act established certificate-of-need requirements for new institutional health services. The certificate-of-need requirements are administered by Health Systems Agencies (HSAs) serving more than 200 health service areas in the United States. P.L. 93-641 did not mention the explicit needs of home health care. Consequently, HEW excluded it from the regulations implementing the law. HEW excluded home health because total national expenditures in home health Nevertheless, a number of states have enacted CON laws which mandate In fact, certificate-of-need regulates only new services and facilities since the existing old, often inefficient and high cost facilities, are usually grandfathered into the CON program. "A new facility or service is measured for need against all existing services. Even if the new service can offer higher |