N.Y. Comp. Codes R. & Regs. tit. 10, § 765-1.16 – Determinations of public need.

(a) The process of determining need in this section will be used in the evaluation of certificate of need applications requiring a review of the public need by the Public Health and Health Planning Council.
1. (1) There shall be a rebuttable presumption of no need for additional licensed home care service agencies in a planning area if there are five or more licensed home care service agencies (LHCSA) actively serving patients within the planning area as of April 1, 2020. Beginning in 2021, the commissioner shall have the authority to adjust the target date for determining need for additional LHCSAs in a planning area, in subsequent years.
2. (2) Applications for licensure based on change of ownership for licensed home care service agencies actively serving at least 25 patients will not be subject to public need review and shall be evaluated only on financial feasibility and the character and competence of the proposed operator unless the proposed operator seeks to serve patients outside of the approved planning area.
3. (3) The determination of need for licensed home care service agencies in accordance with this subdivision does not include licensed home care services agencies affiliated with an assisted living program (ALP), program of all-inclusive care for the elderly (PACE), nurse family partnership (NFP), or continuing care retirement community (CCRC). ALP, PACE, NFP, or CCRC-affiliated agencies are not subject to the public need review unless the agency seeks to serve patients outside the ALP, NFP, or CCRC programs or who are not PACE members. For the purpose of this paragraph, affiliated shall mean common ownership. Any limitation on the population an agency is allowed to serve resulting from an exemption made under this paragraph shall be noted on the LHCSA’s license.
4. (4) The department shall review the adequacy of the need methodology set forth under paragraph (1) of this subdivision and issue a report to the commissioner, the Public Health and Planning Council, and other interested parties at the discretion of the Department of Health no later than three years from adoption.
(b) Planning areas.
The commissioner shall designate each county as a separate planning area.
(c) Determination of need.
(d) Notwithstanding any other provision of this section, factors to be considered when determining need for licensed home care service agencies shall include, but are not limited to:
1. (1) the demographics and/or health status of the residents in the planning area or the State, as applicable;
2. (2) documented evidence of the unduplicated number of patients on waiting lists who are appropriate for and desire admission to a licensed home care service agency but who experience a long waiting time for placement;
3. (3) the number and capacity of currently operating licensed home care services agencies;
4. (4) the quality of services provided by existing agencies;
5. (5) the availability and accessibility of the workforce;
6. (6) personnel and resources dedicated to adding and training additional members of the workforce including committed resources in an organized training program;
7. (7) cultural competency of existing agencies; and
8. (8) subpopulations requiring specialty services.
  When making recommendations to the Public Health and Health Planning Council concerning the impact of the factors set forth above, the department shall, to the extent practicable, indicate the relative priority of such factors.
(e) In addition to meeting the other applicable provisions of this section, an applicant for initial certification shall be approved as meeting public need only if the applicant agrees to serve population groups in the planning area that have difficulty gaining access to appropriate licensed home care service agency care due to minority status, age, medical history, case complexity, payment source, or geographic location.
(f) Any application wherein a determination of public need is made pursuant to this section shall be subject to the following:
1. (1) The Public Health and Health Planning Council and/or the commissioner, as appropriate, may, during the processing of an application, propose to disapprove the application solely on the basis of a determination of public need in advance of the consideration of the other review criteria required by article 36 of the Public Health Law without, however, waiving the right to consider such other criteria at a later date.
2. (2) In the event the Public Health and Health Planning Council and/or the commissioner proposes to disapprove an application on the basis of a lack of public need and the applicant requests a hearing according to the provisions provided in section 765-1.9 of this Subpart, the Public Health and Health Planning Council and/or the commissioner, as appropriate, may direct the completion of the other reviews required by article 36 of the Public Health Law. The application shall then be returned to the Public Health and Health Planning Council and/or the commissioner as appropriate, to consider such reviews, the results of which may then be included as grounds for the proposed disapproval to be considered at the hearing. If the Public Health and Health Planning Council and/or the commissioner, as appropriate, directs the completion of such reviews, a copy of the report containing the results of the reviews shall be mailed to the applicant at least 60 days prior to the date set for hearing.
3. (3) In the processing of an establishment application, the commissioner may recommend disapproval based on a review limited to a determination of public need. In the event the Public Health and Health Planning Council does not concur with the commissioner's recommendation of disapproval, it shall return the application to the department at which time all other required reviews shall be completed. When all other reviews are completed, the application shall be returned to the Public Health and Health Planning Council for action.