10A NCAC 14C .1702. INFORMATION REQUIRED OF APPLICANT

(a)  An applicant that proposes to add an open heart surgery room or to acquire a heart-lung bypass machine shall use the acute care facility/medical equipment application form.

(b)  An applicant shall define the service area for the proposed project which shall be like the applicant's service area for other health services, unless the applicant documents that other providers are expected to refer patients to the applicant, including the methodology and assumptions used to define the service area.

(c)  An applicant shall provide the following information:

(1)           the number of procedures performed on each heart-lung bypass machine owned by or operated in the facility during the 12-month period prior to the submission of the application, identified by ICD-9, ICD-10, or CPT code;

(2)           a projection of the number of procedures using the applicant's existing, approved and proposed heart-lung bypass machines in each of the first three years following completion of the proposed project identified by ICD-9, ICD-10, or CPT code, including the methodology and assumptions used to make the projections;

(3)           the number of patients from the proposed service area who are projected to receive procedures using the applicant's existing, approved, and proposed heart-lung bypass equipment by patient's county of residence in each of the first three years following completion of the proposed project, including the methodology and assumptions used to make these projections;

(4)           the projected patient referral sources;

(5)           evidence of the applicant's capability to communicate efficiently with emergency transportation agencies and with all hospitals serving the proposed service area;

(6)           the number and composition of open heart surgical teams available to the applicant; and

(7)           evidence of the applicant's capability to perform both cardiac catheterization and open heart surgical procedures 24 hours per day, 7 days per week.

 

History Note:       

Authority G.S. 131E‑177(1); 131E-183;

Eff. January 1, 1987;

Amended Eff. November 1, 1989;

Temporary Amendment Eff. September 1, 1993 for a period of 180 days or until the permanent rule becomes effective, whichever is sooner;

Amended Eff. November 1, 1996; January 4, 1994;

Temporary Amendment January 1, 1999;

Temporary Eff. January 1, 1999 Expired on October 12, 1999;

Temporary Amendment Eff. January 1, 2000;

Temporary Amendment effective January 1, 2000 amends and replaces a permanent rulemaking originally proposed to be effective August 2000;

Amended Eff. January 1, 2013; April 1, 2001.