Mississippi

Certificate of Need (CON) Overview

Like many other states, Mississippi has an extensive CON process in place for healthcare services and facilities. Winning approval for a CON application is often a time consuming and difficult undertaking. Working with RPC provides clients with a team of consultants with experience working with CON projects.

When working on a CON project, RPC can prepare the entire CON application or sections of the application as the client prefers. When the client is defining the project and deciding whether to file an application, RPC can help assess the market and regulatory situation to determine the relative likelihood of success for a project. RPC not only works to create a thorough market, need and financial analysis, but also works seamlessly with the client’s staff, architects, engineers and, other outside consultants to create a solid CON application.

RPC is led by Ron Luke, JD, PhD, who has prepared CON applications and presented testimony in CON hearings since 1981 in more than 20 states.  RPC’s work on CON projects includes the opening of new acute care hospitals, hospices, physical rehabilitation and psychiatric specialty hospitals, and nursing homes, the relocation and addition of beds, and the acquisition of major medical equipment. Working with RPC during the CON process gives the applicant the advantage of a skilled expert team that can provide expert advice and produce an effective CON application.

State Agencies

Mississippi Department of Health
The Mississippi Department of Health “The Department” administers the CON application process and reviews all CON applications and publishes the Staff Analysis and recommendations. This is done through their Division of Health Planning and Resource Development.

Mississippi Department of Health (MSDH)
Health Planning and Resource Development Division
570 East Woodrow Wilson
Jackson, MS 39215-1700
(601) 576-7400

State Health Officer 
Mississippi’s State Health Officer is responsible for reviewing the Department’s recommendations and analyses (as well as any information presented at a Public Hearing, when applicable) and issuing the Department’s Recommendation and Final Order

Chancery Court
Should the ruling of the State Health Officer be contested, CON applicants may request to be heard in front of the appropriate Chancery Court.

Facilities and Services that Require CON

Mississippi’s CON program is designed to assure access to essential health services for all people, while also balancing the growth of health services and facilities with the need for the services.  CON projects include:

• Any capital expenditure over $1,500,000 for equipment, $2,000,000 for operation of a clinical health service, or $5,000,000 for operation and maintenance of a non-clinical health service
• Construction or establishment of a new health care facility
• Reopening of a health care facility
• Relocation of a health care facility or a portion thereof
• Addition or conversion of beds
• Open Heart Surgery Services
• Cardiac Catheterization Services
• Inpatient Rehabilitation Services
• Psychiatric Services
• Chemical Dependency Services
• Radiation Therapy Services
• Invasive Diagnostic Imaging Services
• Nursing home care (skilled nursing facility, intermediate care facility, intermediate care facility for the mentally retarded)
• Home Health
• Swing Beds
• Ambulatory Surgery Services
• End Stage Renal Disease Facilities
• MRI
• PET
• Long-Term Care Hospitals
• Acquisition of Major Medical Equipment
• Change of Ownership
• Acquisition of a Medical Office Building
• Acquisition of a Skilled Nursing Facilities (currently SNFs are under a moratorium)
• Freestanding Emergency Departments (currently a pilot program)

Certificate of Need Process Milestones

The text in this section outlines the CON review milestones for standard applications. Projects reviewable under the Expedited Review or Emergency Review processes have different time frames and review milestones

1. File Notice of Intent
   A notice of intent must be filed at least 15 days prior to the published batching cycle date, but should be filed as soon as possible. The notice of intent is valid for 180 days. The letter must contain a description of the general scope of the project
2. .CON Application Filing The application and three additional copies must be filed by the date indicated in the published batching cycle, along with the appropriate fees.  There are four review cycles per year, beginning on January 1, April 1, July 1, and October 1.  Applications must be filed by the first of the month preceding the beginning of the review cycle.
3. Review for Completeness
   Within 15 days after filing, the applicant will receive notice if their application is deemed incomplete. If an application is incomplete, the applicant has 15 days to file all missing information.
4. Complete Application/Public Comment Period
   After an application is deemed complete, any affected parties, payors or members of the public may submit written comments on any and all applications during the first 15 days after the application is complete. The Department will also send a notice to any affected parties that the application(s) is complete.
5. Staff Analysis Published
   A Staff Analysis approving or disapproving an application will be published within 45 days of the date the application was filed or within 15 calendar days of receipt of any requested information, whichever is later.(If the staff is recommending disapproval, the applicant is allowed 5 calendar days in which to provide additional material on its own application for further analysis.
6. Public Hearing
   Any affected party may request a public hearing within 10 days of the Staff Analysis publication. If requested, the public hearing will be held no later than 60 days after the hearing request is received by the Department, unless the time period is waived by all parties. The requestor must pay a fee of $3,000 a day for each day of the hearing. During the hearing, interested or affected parties may submit written or oral testimony as well as hearing exhibits. If more there is more than one applicant for the same service during a batching cycle, all related hearings will be consolidated into one hearing. Hearing Officer will issue a recommendation no later than 45 days after the hearing is closed.
7. Decision and Final Order
   The State Health Officer will review all applicable materials submitted during the course of the application process and the public hearing (if held). Unless a hearing is requested, the State Health Officer’s final order will be issued within 90 calendar days the application was filed. The State Health Officer’s written decision shall become the Department’s final order.
8. Appeals
   An appeal may be filed with Mississippi’s Chancery Court within 20 days of receipt of the State Health Officer’s Final Order.
9. Progress Reports
   A CON holder must submit CON progress reports to the document every six months, or as requested by the department, as well as one final report when the project is completed.  A CON holder must request a six-month extension 30 calendar days prior to the expiration of the original period for a $250 fee.  Proper documentation is necessary to demonstrate progress and completion.

What criteria are used to review a CON?

Mississippi has service-specific review criteria which are published in the State Health Plan. The review criteria categories are: Mental Health, Long-Term Care, Perinatal Care, Acute Care, Comprehensive Medical Rehabilitation Services, and Other Health Services.

However, all projects are reviewed against the criteria set forth in Chapter 8 §100 of the Mississippi CON Review Manual. An outline of these criteria is included below.

1. Consistency with State Health Plan
2. Consistency with Applicant’s Long Range Plan
3. Availability of less costly or more effective alternatives
4. Project is Financially Feasible in the Short and Long-Term

• • Proposed costs are comparable with other facilities in the area
  • Utilization is consistent with similar facilities
  • If the project is $2,000,000 or more, the applicant must submit a financial feasibility study prepared by an accountant, CPA or the facility’s financial offier.

5. Need for the Project

• • Underserved, low income, minority, women, and handicapped persons will have access to services
  • Effect on existing facilities
  • Community reaction to proposal

6. Access to Facility or Service—increases access to underserved groups (and Medicare and Medicaid patients)

7. Applicant must Maintain Information on Charity, Medically Indigent Care and Medicaid Population

8. Relationship to Existing Health Care Providers

9. Resource Availability—personnel, physicians and funds

10. Ancillary and Support Services

11. Health Professional Training

12. Access by Health Schools

13. Special Circumstances for Applicants providing a substantial portion of services to individuals residing outside of the health service area where the facility or service will be located

14. Construction Projects must maximize cost containment, environmental protection and energy conservation.  The Manual includes equations for cost for square foot calculations.

15. Competing Applications—the most appropriate applicant will be approved

16. Applicant must show Quality of Care