1. (1) Definition. Inpatient physical rehabilitation services are those designed to be provided on an integrated basis by a multidisciplinary rehabilitation team to restore the disabled individual to the highest physical usefulness of which he is capable. These services may be provided in a distinct part unit of a hospital, as defined in the Medicare and Medicaid Guidelines, or in a free-standing rehabilitation hospital.
2. (2) General. Rehabilitation can be viewed as the third phase of the medical care continuum, with the first being the prevention of illness, the second, the actual treatment of disease, and the third, rehabilitation or a constructive system of treatment designed to enable individuals to attain their highest degree of functioning. In many cases, all three phases can occur simultaneously. For the purposes of this section of the State Health Plan, only the need for and inventory of inpatient rehabilitation beds will be addressed.
3. (3) Need Determination. The Statewide Health Coordinating Council (SHCC) has determined that there is a need for 15 rehabilitation beds per 100,000 population for each region.

4. (4) Planning Policies

   1. (a) Planning Policy.  Regional occupancy for the most recent reporting year should be at least seventy-five percent (75%) before the SHCC considers any requests for plan adjustments for additional bed capacity.
   2. (b) Planning Policy.  Conversion of existing hospital beds to rehabilitation beds should be given priority consideration over new construction when the conversion is significantly less costly, and the existing structure can meet licensure and certification requirements.

5. (5) Bed Availability Assurance

   1. (a) Over the last three (3) years, on behalf of the SHCC, SHPDA has collected additional data from hospitals with Certificate of Need (CON) authority to operate inpatient rehabilitation beds and from skilled nursing facilities providing inpatient rehabilitation care. This data was collected specifically to review and analyze certain claims made before the SHCC by both groups related to the acuity levels of patients treated in each type of facility. This review and analysis was also to take into account the fact that certain patients can only be treated in one specific type of facility, while others can be treated in either based in large part on the patient’s diagnosis.

   2. (b) SHPDA, working under the instruction of the Health Care Information and Data Advisory Council, and in cooperation with the Alabama Hospital Association (AlaHA) and the Alabama Nursing Home Association (ANHA), amended the annual reports for both facility types to collect additional data on the provision of inpatient rehabilitation services similar in nature to information submitted to the Centers for Medicare and Medicaid Services (CMS) for reimbursement. This data was collected for each of the last three (3) reporting years. SHPDA has reviewed and analyzed the data submitted and has reported the results of that analysis to the SHCC. This bed availability rule is the result of the analysis and recommendation provided to the SHCC by SHPDA, with additional comment and testimony from AlaHA, ANHA, and other interested parties.

      1. 1. The occupancy rate of the applicant shall have been a minimum of 80% for each of the two (2) most recent annual reporting periods as defined by SHPDA;
      2. 2. The acuity rate, a value derived by SHPDA using the same formulas and rules used by CMS to determine compliance with the “60% Rule”, with the noted exception of those related to BMI (Body Mass Index), shall have been a minimum of 60% for each of the two (2) most recent annual reporting periods as defined by SHPDA; and
      3. 3. The average of the occupancy rate and the acuity rate shall be a minimum of 80% for each of the two (2) most recent annual reporting periods as defined by SHPDA.
      4. 4. For (i) through (iii) above, the condition defined shall need to have been met for each reporting period separately, and not as a combination of the two reporting periods together.

      (c)An inpatient rehabilitation facility (IRF), or an inpatient rehabilitation unit of an existing acute care hospital, shall qualify to add additional beds above and beyond any need projections shown in this plan should all of the following conditions be met. If any single condition is not met, any application filed to expand under this provision shall be deemed inconsistent with this Plan and shall be removed from the review cycle. For the purposes of this rule, all CON authorized inpatient rehabilitation beds shall be counted in the determination of the provider’s occupancy rate.

   3. (d) Should all of the conditions listed in (c) above be met, the applicant may seek to add either 10% of their existing CON authorized bed capacity or up to 10 beds, whichever is greater. Any inpatient physical rehabilitation beds granted under this section shall only be added at or upon the existing campus of the applicant facility and cannot be sold or transferred to another provider or location. The only exception to this rule is in the case of an IRF or acute care hospital with an inpatient rehabilitation unit applying for a Certificate of Need to relocate or otherwise create a replacement facility that is consistent with all other parts of this Plan. Furthermore, once beds are granted to a facility under this Bed Availability Assurance policy, no additional beds may be granted to that facility utilizing this policy for a minimum of two (2) years following initial ADPH licensure of those beds to allow for the impact of the addition of those beds to be shown.
   4. (e) The provisions of Bed Availability Assurance shall not become effective until the first statistical update is published for inpatient rehabilitation beds following the effective date of this plan. Furthermore, the provisions of Bed Availability Assurance shall not apply in a region where need is shown for inpatient rehabilitation beds according to the methodology defined in (3) above

6. (6) The SHCC requires that the Data Council maintain any changes made to the Annual Reports filed by hospitals necessary to capture the data used by Medicare Administrative Contractors to determine presumptive compliance with the inpatient rehabilitation facility compliance threshold requirement, also known as the “60% Rule”, including the diagnosis, comorbidities and impairment for each patient. The SHCC requires that the Data Council maintain any changes made to the Annual Reports filed by nursing homes to include comparable patient origin level data to allow for comparison between hospital and nursing home providers. The data supplied should continue to allow for an analysis of current utilization in such a manner as to reflect all inpatient rehabilitative services being offered, regardless of location or facility type, and should therefore be collected from both hospitals and nursing homes. The data collected should not only provide information related to occupancy rate but should also provide information related to the acuity of patients treated at each facility and should, as closely as possible, collect data that is similar in both type and format to allow for as accurate a comparison as possible, while representing as many patients receiving inpatient rehabilitation services as possible. The data collected by SHPDA shall allow for the Agency to produce an analysis of patients served in a manner consistent with the formulas and rules used by CMS to determine compliance with the “60% Rule”, with the noted exception of the collection of data related to a patient’s BMI (Body Mass Index), which has not been and will continue to not be collected by SHPDA. Further, this data should allow SHPDA to confirm the contention of an applicant for additional beds under section (5) above that they meet each of the individual conditions required to allow for the grant of additional beds under that section.

   1. (a) Any IRF or acute care hospital that does not substantially comply with any data request made on behalf of SHPDA related to this section shall not be allowed to apply for additional beds under the provisions set forth in paragraph (5) above. Any such application shall be deemed to be inconsistent with this Plan.
   2. (b) Any IRF, acute care hospital or nursing home that does not substantially comply with any data request on behalf of SHPDA related to this section shall not be allowed to oppose any application filed on behalf of an IRF or an acute care hospital for additional beds under the provisions set forth in paragraph (5) above.

   3. (c) Such barriers to an application for a Certificate of Need, or inability to intervene or oppose an application for a Certificate of Need, shall be applied in a manner consistent with the provisions set forth in Ala. Admin Code r. 410-1-3-.11.

      For a listing of inpatient rehabilitation facilities or the most current statistical need projections in Alabama you may contact the Data Division as follows:

      MAILING ADDRESS                    STREET ADDRESS
      (U.S. Postal Service)             (Commercial Carrier)
      PO BOX 303025                      100 N. UNION STREET SUITE 870
      MONTGOMERY, AL 36130-3025          MONTGOMERY, AL 36104

      TELEPHONE:                         FAX:
      (334) 242-4103                    (334) 242-4113

      EMAIL:                             WEBSITE:
      data.submit@shpda.alabama.gov   http://www.shpda.alabama.gov

      INPATIENT REHABILITATION BED REGIONS

      REGION I                    REGION IV                REGION VI

      Lauderdale                  DeKalb                   Choctaw
      Limestone                   Etowah                   Washington
      Madison                     Cherokee                 Mobile
      Jackson                     Calhoun                  Baldwin
      Colbert                     Cleburne                 Escambia
      Franklin                    Clay                     Conecuh
      Lawrence                    Randolph                 Monroe
      Morgan                                               Clarke
      Marshall

      REGION II                   REGION V                 REGION VII

      Lamar                       Perry                    Covington
      Fayette                     Marengo                  Coffee
      Pickens                     Wilcox                   Dale
      Tuscaloosa                  Dallas                   Geneva
      Sumter                      Autauga                  Houston
      Greene                      Lowndes                  Barbour
      Hale                        Butler                   Henry
      Bibb                        Crenshaw
      Pike
      Montgomery
      REGION III                  Elmore
      Marion                      Macon
      Winston                     Bullock
      Cullman                     Lee
      Blount                      Russell
      Walker                      Tallapoosa
      Jefferson                   Chambers
      Shelby
      Chilton
      Coosa
      Talladega
      St. Clair

Author: Statewide Health Coordinating Council (SHCC)

Statutory Authority: Code of Ala. 1975, §22-21-260(4).

History: Effective March 11, 1993. Amended: Filed June 19, 1996; effective July 25, 1996. Repealed and New Rule: Filed October 18, 2004; effective November 22, 2004. Amended: Filed June 30, 2006; effective August 4, 2006. Amended (SHP Year Only): Filed December 2, 2014; effective January 6, 2015. Repealed and New Rule: Published March 31, 2020; effective May 15, 2020. Amended: Published June 30, 2020; effective August 14, 2020. Repealed and New Rule: Published April 30, 2024; effective June 14, 2024.