Section 83-2.5 - Review process

83-2.5 Review process. The Department shall review applications pursuant to this Subpart, in consultation with the Attorney General and, as appropriate, the mental hygiene agencies. The factors to be considered in evaluating applications shall include, but shall not be limited to:

(a) the financial condition of the parties to the Cooperative Agreement, including whether any health care provider party is experiencing financial distress and may be forced to cease operations or eliminate a service in the absence of the Cooperative Agreement;

(b) the dynamics of the relevant primary service area, including the availability of suitable and accessible health care services and the level of competition in the primary service area, the likelihood that other health care providers will enter or exit the primary service area, the health care workforce and the existence of unique challenges such as difficulties in recruiting and retaining health care professionals;

(c) the potential benefits of a Cooperative Agreement or planning process, including but not limited to the likelihood that one or more of the following may result from such Cooperative Agreement or planning process:

(1) Preservation of needed health care services in the relevant primary service area that would be at risk of elimination in the absence of a Cooperative Agreement;

(2) Improvement in the nature or distribution of health care services in the primary service area, including expansion of needed health care services or elimination of unnecessary health care services;

(3) Enhancement of the quality of health care provided by the parties to the Cooperative Agreement;

(4) Expansion of access to care by medically-underserved populations;

(5) Lower costs and improved efficiency of delivering health care services, including reductions in administrative and capital costs and improvements in the utilization of health care provider resources and equipment; or

(6) Implementation of payment methodologies that control excess utilization and costs, while improving outcomes;

(d) the potential disadvantages of a Cooperative Agreement or planning process, including but not limited to the likelihood that one or more of the following may result from such Cooperative Agreement or planning process:

(1) Increased costs or prices of health care in the primary service area resulting from the Cooperative Agreement, after taking into consideration improvements in quality and outcomes;

(2) Diminished quality, availability, and efficiency of health care services;

(3) Inability of health care payers or health care providers to negotiate reasonable payment and service arrangements; or

(4) Reduced competition among physicians, allied health professionals, other health care providers, or other persons furnishing goods or services to, or in competition with, health care providers and the potential for adverse health system quality, accessibility and cost consequences;

(e) the availability of arrangements that are less restrictive to competition and achieve the same benefits or a more favorable balance of benefits over disadvantages attributable to any reduction in competition;

(f) other benefits or disadvantages identified in the course of review; and

(g) the extent to which active supervision is likely to mitigate the disadvantages.

Effective Date: 
Wednesday, December 17, 2014
Doc Status: 
Complete