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Gerd W. Clabaugh, MPA Director

Kim Reynolds Adam Gregg Governor Lt. Governor

MINUTES

STATE HEALTH FACILITIES COUNCIL

Wednesday, February 20, 2019

ICN Room, 6th Floor

Lucas State Office Building

321 East 12th Street

Des Moines, Iowa

ELECTRONIC MEETING This electronic meeting of the State Health Facilities Council was held in accordance with Iowa Code section 21.8

entitled “Electronic Meetings.” The Code states that a governmental body may conduct a meeting by electronic

means only if circumstances are such that a meeting in person is impossible or impractical and access is provided

to the public. An in-person meeting of the Council was impractical due to inclement weather. The electronic

meeting originated in the ICN Room, 6th Floor, Lucas State Office Building, 321 E. 12th Street, Des Moines and

public access to the meeting was provided at this location. Notices and agendas were posted in the building and

posted on the Department’s web site under the Certificate of Need Program.

9:00 AM Roll Call

MEMBERS PRESENT VIA PHONE: Dr. Harold Miller, Chairperson; Roberta Chambers; Steve Dengle;

and Connie Schmett

STAFF PRESENT: Becky Swift (present in conference room)

STAFF PRESENT VIA PHONE: Heather Adams, Counsel for the State

I. APPROVAL OF MINUTES OF PREVIOUS MEETING

A motion by Schmett, seconded by Chambers, to approve the minutes of January 16, 2019, carried

unanimously by voice vote.

II. EXTENSION OF PREVIOUSLY APPROVED PROJECTS

1. UIHC, Iowa City, Johnson County: Purchase of a bi-plane angiography system,

$3,666,000 (Approved 2/21/2017; Second Extension Request)

Staff report by Becky Swift. The applicant was represented by Luke Leyden, University of Iowa

Hospitals and Clinics. The applicant made remarks and answered questions posed by the Council.

A motion by Chambers, seconded by Dengle, to grant a 12 month extension carried 4-0.

2. UIHC, Iowa City, Johnson County: Purchase of a PET/CT scanner, $3,415,068 (Approved

2/21/2018; First Extension Request)

Staff report by Becky Swift. The applicant was represented by Luke Leyden, University of Iowa

Hospitals and Clinics. The applicant made remarks and answered questions posed by the Council.

A motion by Dengle, seconded by Chambers, to grant a three (3) month extension carried 4-0.

3. Cottage Grove Place, Cedar Rapids, Linn County: Addition of 12 skilled nursing facility beds,


Staff report by Becky Swift. A motion by Chambers, seconded by Schmett to grant a six (6)

month extension carried 4-0.

4. The Views CCRC of Marion, Marion, Linn County: Construction of 40 skilled nursing facility

beds, $8,100,000 (Approved 2/25/2016; Third Extension Request)

Staff report by Becky Swift. The applicant was represented by Ed McIntosh, Dorsey & Whitney.

The applicant made remarks and answered questions posed by the Council. A motion by Schmett,

seconded by Dengle, to grant a six (6) month extension carried 4-0.

5. Prairie Crossing of Winterset: Construction of a 40-bed skilled nursing facility,


Staff report by Becky Swift. The applicant was represented by Linda Juckette of Capstone

Management, LLC. The applicant made remarks and answered questions posed by the Council. A

motion by Chambers, seconded by Schmett, to DENY the extension request carried 4-0.

III. REQUEST FOR DETERMINATION OF NON-REVIEWABILITY AND THE DEPARTMENT’S

RESPONSE

1. Stewart Memorial Community Hospital, Lake City, Calhoun County – Modernization of the

hospital

Staff report by Becky Swift. A motion by Dengle, seconded by Schmett, to affirm the

Department’s decision carried 4-0.

2. Dr. Lindsay Sturm, Ames, Story County –Establishment of a private physician’s office

Staff report by Becky Swift. A motion by Chambers, seconded by Dengle, to affirm the

Department’s decision carried 4-0.

IV. PROJECT REVIEW

1. Meth-Wick Health Center (The Woodlands), Cedar Rapids, Linn County – Addition of four (4)

nursing facility beds

$650,000

Staff report by Becky Swift. The applicant was represented by Ed McIntosh, Dorsey & Whitney;

and Robin Mixdorf, Samantha Ryan and Amber Jedlicka, Meth-Wick. The applicant made a

presentation and answered questions posed by the Council. A motion by Chambers, seconded by

Schmett, to enter exhibits, which were provided by the applicant via e-mail in advance of the

meeting, in support of oral testimony into the record carried unanimously by voice vote.

There were no affected parties present.

A motion by Dengle, seconded by Chambers, to grant a Certificate of Need carried 4-0.

2. REM Iowa, Inc., 16th Avenue SW, Cedar Rapids, Linn County – Construction and lease of an

eight (8) bed ICF/ID

$60,000-$72,000 per year lease

Staff report by Becky Swift. The applicant was represented by Kendall Watkins, Attorney at Law;

Lisa Pakkebier and Dawn Steffen, REM Iowa, Inc.; and Marjie Carson Zach, parent. The

applicant made a presentation and answered questions posed by the Council. A motion by

Dengle, seconded by Chambers to enter exhibits, which were provided by the applicant via e-mail

in advance of the meeting, in support of oral testimony into the record carried unanimously by

voice vote.


A motion by Dengle, seconded by Chambers, to grant a Certificate of Need carried 4-0.

3. REM Iowa, Inc., 33rd Avenue SW, Cedar Rapids, Linn County – Construction and lease of an

eight (8) bed ICF/ID

$60,000-$72,000 per year lease

Staff report by Becky Swift. The applicant was represented by Kendall Watkins, Attorney at Law;

Lisa Pakkebier and Dawn Steffen, REM Iowa, Inc.; and Marjie Carson Zach, parent.


A motion by Schmett, seconded by Dengle, to grant a Certificate of Need with the submission of

a progress report in six (6) months carried 4-0.

Chairperson Miller thanked Roberta Chambers and Connie Schmett, whose terms expire on April 30, for their

service on the Council. He stated that there would be the need for a brief electronic meeting prior to April 30 to

ensure a quorum. He indicated that Becky Swift would provide some potential dates and times for that meeting.

Chairperson Miller also reminded the Council that the next in-person meeting will be held at the Ankeny location

on May 22 and 23, 2019, if there is a quorum. He noted that the next meeting after that would held July 17 and 18

at the Ankeny location.

A motion by Schmett, seconded by Dengle, to adjourn carried unanimously by voice vote.

The meeting adjourned at 11:18 AM.

4/15/2019 Tiff005.jpg

IOWA DEPARTMENT OF PUBLIC HEALTH


IN THE MATTER OF THE CERTIFICATE OF NEED EXTENSION FOR

COTTAGE GROVE PLACE

CEDAR RAPIDS. IOWA

) )

) DECISION ) ) )

This matter came before the State Health Facilities Council for review on Wednesday, February 20, 2019.

The project, the addition of 12 nursing beds as part of an expansion of the existing facility, was originally approved February 21, 2017, at an estimated cost of $4,375,000. The original completion date for the project was October 2018; it is now July 2019. Seventy-five percent of the interior work has been done and 90 percent of the exterior work is complete. Yet to be completed are the installation of the carpet, painting, finish work, testing of nurse call, IT, HVAC balancing of airflow, and furniture installation. Delays to the project include weather, design challenges and not enough workers on site. Financing agreements were signed in August 2017. To date $4,014,300 has been spent on the project.

The Council, after reading the extension request and hearing comments by staff, voted 4-0 to Grant an Extension of Certificate of Need per 641 Iowa Administrative Code 202.13. The decision is based upon a finding that sufficient progress has been made in developing the project.

The extension is valid for six (6) months.

Dated thisil R day, of April 2019

H. . Miller, M.D., Chairpefson State Health Facilities Council Iowa Department of Public Health

cc: Health Facilities Council Department of Inspections & Appeals, Health Facilities Division

https://mail.google.com/mail/u/0/?tab=rm&zx=ix6wx4m1r16z#inbox/jrjtXPVITzcFPrhWzQSDTTRGzsszTGvxgRVfCjsSdNHqWQcgqGHsRRFDsNCArD... 1/1



IN THE MATTER OF THE APPLICATION OF

METH-WICK HEALTH CENTER DECISION

CEDAR RAPIDS, IOWA

This matter came before the State Health Facilities Council for review on Wednesday, February 20, 2019.

The applicant proposes the addition of four (4) nursing facility beds at an estimated cost of $650,000.

Meth Wick Health Center applied through the Iowa Department of Public Health for a Certificate of Need.

The record includes the application prepared by the project sponsor and written analysis prepared by Iowa Department of Public Health staff and all the testimony and exhibits presented at the hearing. Becky Swift of the Iowa Department of Public Health summarized the project in relation to review criteria. Ed McIntosh, Dorsey & Whitney; and Robin Mixdorf, Samantha Ryan and Amber Jedlicka, Meth-Wick, were present representing the applicant. The applicant made a presentation and answered questions.

No affected parties appeared at the hearing.

The Council, after hearing the above-mentioned testimony and after reading the record, voted 4-0 to grant a Certificate of Need. As a basis for their decision the Council, considering all the criteria set forth pursuant to Iowa Code Section 135.64 (1 and 2) (2017) made the following findings of fact and conclusions of law:

FINDINGS OF FACT

1. Meth-Wick Health Center -The Woodlands is part of the Meth-Wick Community, a not-

for-profit CCRC in Cedar Rapids that, according to testimony presented, has been

providing services since 1961.

2. Meth-Wick Health Center — The Woodlands ("The Woodlands") will increase their

licensed nursing facility capacity by four beds, from 65 to 69 beds.

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3. Due to high census The Woodlands has requested a waiver from the Department of

Inspections and Appeals eight times since January 2018 to increase their licensed bed

count by one. This allowed Meth-Wick Community residents to receive nursing care at

The Woodlands. No non-resident admissions were accepted into a waivered room.

4. The additional beds will be for both short and long term care and will be equipped for

bariatric residents or those who are non-weight bearing. According to testimony, The

Woodlands staff expressed a strong desire for this type of bed due to the increasing

weight of residents, which was crucial in the decision to request them.

5. The rooms will be outfitted with bariatric specific furnishing and ceiling mounted lifts

and will have additional floor space to accommodate the furnishings. According to

testimony, The Woodlands has three rooms that are retrofitted with ceiling lifts, but the

new rooms would be outfitted with Hoyer lifts, which would track to the toilet and

shower, something the current lifts do not do.

6. During testimony it was noted that on average The Woodlands has three skilled

admissions who need the lifts.

7. All of the beds will be Medicare and Medicaid certified.

8. The primary service area for The Woodlands is Linn County, and more specifically, the

current Meth-Wick Community independent and assisted living resident populations.

9. The Woodlands must frequently turn down admissions from people in Linn County

because it operates at full capacity. In the past 15 months they've had 63 inquiries that

they were not able to accommodate.

10. The census for The Woodlands was 96.4% in the year ending March 31, 2018. At the

time of a staff survey conducted in February 2019 they had 98% occupancy. Meth-Wick

forecasted 95% utilization in each of the three years following the addition of the new

beds.

11. The calculated bed need formula indicates a current underbuild in all of the seven

counties around Linn County. The underbuild for Linn County is 703 beds. Overall the eight-county area, as calculated by the bed need formula, is underbuilt by 2,124 beds. See

the following table for additional bed information.

2

Nursing Facility Beds by County Number Needed by CON Formula/Number Licensed/Difference

County

Projected 2023 Population Age 65+

# of NF Beds needed per bed need formula

# of licensed & approved

Difference — Formula vs. Licensed & Approved*

NF Beds as of Feb 2019

Linn 37,170 2,122 1,4191 -703 Benton 5,391 380 1822 -198 Buchanan 4,051 280 136 -144 Cedar 3,938 276 210 -66 Delaware 3,989 278 191 -87 Iowa 3,603 252 237 -15 Johnson 22,685 1,324 5593 -765 Jones 4,619 322 176 -146 Totals 85,446 5,234 3,110 -2,124

*A positive (+) number means the county is overbuilt and a negative (-) indicates an underbuild ' Approved October 2015 CCRC of Cedar Rapids, Linn County: 40 beds; The Views CCRC of Marion, Linn County: 40 beds; Approved February 2017 Cottage Grove Place, Linn County; 12 beds. 2 Approved October 2017 Keystone Nursing Care Center, Inc., Benton County: 10 beds. 3 Approved October 2017 Solon Nursing Care Center, Johnson County: 4 beds. All of these beds are included in their respective county counts.

12. Over the span of the last three years, the total number of beds in the eight county area has

increased by 84 beds. There has been an increase of 104 beds in the past three years for

Linn County. See the following table for additional details.

Nursing Facility Beds by County Difference in Number Between February 2016 and February 2019

County # of NF Beds (facilities) as of February 2016

# of NF Beds (facilities) as of February 2019*

Difference in # of NF Beds

Linn 1,223 (14) 1,327 (16) +104 Benton 172 (3) 172 (3) 0 Buchanan 136 (2) 136 (2) 0 Cedar 238 (4) 210 (4) -28 Delaware 191 (2) 191 (2) 0 Iowa 237 (4) 237 (4) 0 Johnson 547 (7) 555 (7) +8 Jones 176 (2) 176 (2) 0 Totals 2,920 (38) 3,004 (40) +84

'Numbers do not include the hospital based nursing facilities nor approved but not yet licensed beds.

13. There are 3,170 licensed and approved nursing facility beds in the eight-county area, with

225 licensed beds in dedicated CCDI units. Additionally, there are 155 SNF or NF beds

in hospital-based settings.

3

Number of CCDI Beds by Coun

County # of CCDI Beds (facilities)

94 (4) Linn Benton 19 (1) Buchanan 0 Cedar 0 Delaware 36 (1) Iowa 15 (1) Johnson 37 (2)

Jones 24 (1) Totals 225 (10)

Data Source: Department of Inspections & Appeals — Summary of Long Term Care Facilities

14. There are 16 free-standing nursing facilities and two in hospital settings in Linn County, ranging in occupancy from 98% at Meth-Wick to 50% at Northbrook Manor Care Center,

42% Living Center East and 19% at Mercy Medical Center — CR SNF for an average of

75%. Northbrook reported a transition from semi-private to private rooms as a reason for their low census. Living Center East is in the process of switching to transitional care and reducing their license to 46 beds. Mercy Medical Center SNF is currently limiting the number of residents they serve to four (out of 21) due to construction on the floor where

the unit resides. If Northbrook Manor Care Center, Mercy Medical Center and Living

Center East are suppressed the average for the county increases to 80%. The seven

contiguous counties report occupancies ranging from 63% (Buchanan County) to 93%

(Cedar County). In the phone survey conducted in February, there were several facilities that reported a low daily census. The primary reason provided was using semi-private as private rooms. Also noted was a low census for the past year, Buchanan County being close to Waterloo and Cedar Rapids and people choosing to reside in those communities

instead of Independence, and sharing of residents between the two facilities in Buchanan

County based on acuity of the individual.

Phone Survey of Nursing Facilities Located in Linn County & Counties Contiguous to Linn County

Conducted February 2019

Facility by County Licensed

Beds Current

Occupancy Percent

Occupied

LINN COUNTY COTTAGE GROVE PLACE-THE CLUB 52 50 96% CRESTVIEW ACRES 100 84 84% HALLMARK CARE CENTER MT. VERNON 55 37 67% HERITAGE SPECIALTY CARE 201 126 63% HIAWATHA CARE CENTER 109 95 87%

4

LINN MANOR CARE CENTER 38 32 84% LIVING CENTER EAST 67 28 42% LIVING CENTER WEST 100 87 87% MANORCARE HEALTH SERVICES 105 84 80% MERCY MEDICAL CENTER CR - HALLMAR UNIT

55 46 84%

MERCY MEDICAL CENTER CR -SNF 21 4 19% METH WICK HEALTH CENTER 65 64 98% NORTHBROOK MANOR CARE CENTER 130 65 50% REHABILITATION CENTER OF LISBON 64 44 69% THE GARDENS OF CEDAR RAPIDS 40 35 88% WEST RIDGE CARE CENTER 60 46 77% WILLOW GARDENS CARE CENTER 91 72 79% WINSLOW HOUSE CARE CENTER 50 47 94% TOTALS 1,403 1,056 75%

BENTON COUNTY BELLE PLAINE SPECIALTY CARE 66 38 58% KEYSTONE NURSING CARE CENTER 45 42 93%

THE VINTON LUTHERAN HOME 61 60 98% VIRGINIA GAY HOSPITAL NF 40 34 85% TOTALS 212 174 82% BUCHANAN COUNTY ABCM REHAB CTR OF INDEPENDENCE EAST 50 36 72%

ABCM REHAB CTR OF INDEPENDENCE WEST 86 37 43%

BUCHANAN COUNTY HEALTH CENTER NF 39 38 97% TOTALS 175 111 63% CEDAR COUNTY CEDAR MANOR NURSING HOME 60 58 97% CLARENCE NURSING HOME 46 44 96% CRESTVIEW SPECIALTY CARE 65 62 95% MECHANICSVILLE SPECIALTY CARE 39 31 79% TOTALS 210 195 93% DELAWARE COUNTY EDGEWOOD CONVALESCENT HOME 58 52 90% GOOD NEIGHBOR HOME 133 111 83% TOTALS 191 163 85% IOWA COUNTY COLONIAL MANOR OF AMANA 60 49 82% ENGLISH VALLEY CARE CENTER 60 42 70% HIGHLAND RIDGE CARE CENTER 59 56 95% ROSE HAVEN NURSING HOME 58 54 93% TOTALS 237 201 85%

5

JOHNSON COUNTY BRIARWOOD HEALTHCARE CENTER 62 45 73% IOWA CITY REHAB & HEALTH CARE CTR. 89 63 71% LANTERN PARK SPECIALTY CARE 90 87 97% LONE TREE HEALTH CARE CENTER 44 35 80% OAKNOLL RETIREMENT RESIDENCE 58 50 86% SOLON NURSING CARE CENTER 92 90 98%

WINDMILL MANOR 120 101 84% TOTALS 555 471 85% JONES COUNTY ANAMOSA CARE CENTER 76 56 74% MONTICELLO NURSING & REHAB CENTER 100 67 67% TOTALS 176 123 70%

15. The following table displays other levels of service available in the eight-county area.

County RCF Beds (Facilities)

Home Health Agencies

Adult Day Services

Assisted Living Units (Facilities)

ALP/D

Linn 247 (5) 7 115,(2} 762 (9) 577 (10) Benton 78 (2) 3 0 84 (3) 72 (1) Buchanan 0 0 20 (1) 84 (2) 104 (1)

Cedar 0 0 0 36 (1) 70 (1) Delaware 60 (1) 1 25 (1) 128 (2) 0 Iowa 2 (1) 1 0 174 (3) 0 Johnson 104 (1) 2 111 (2) 442 (5) 515 (8) Jones 51 (1) 2 0 80 (2) 0 TOTALS 542 (11) 16 271 (6) 1,790 (27) 1,338 (21)

Data source: DIA web site

16. There were seven letters of support received. These letters, from current and past

residents and family members of The Woodlands; Meth-Wick Community Medical

Director; the President of Mercy Medical Center — Cedar Rapids; and the President of

UnityPoint Health — Cedar Rapids cite the quality care and exceptional patient

experiences provided by Meth-Wick, the lack of beds at The Woodlands for non-Meth-

Wick Community residents, and the increasing need for bariatric/non-weight bearing

beds in the community as reasons for their support.

17. There were no letters of opposition submitted.

18. The Woodlands accepts residents from its independent living and assisted living

communities as well as the Linn County community if there is availability. According to

testimony offered during the meeting, in the past 15 months The Woodlands accepted

only four new admissions from the greater Linn County community.

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19. Meth-Wick utilizes hospice services from several organizations in the community

including UnityPoint St. Luke's and Mercy Medical Center. Millennium Therapy

supplies rehab services on a contract basis.

20. Meth-Wick will increase the staff at The Woodlands from 61.10 to 63.90, adding 2.8

nurses' aides. Meth-Wick is a preferred employer in the Cedar Rapids area, providing a

benefit plan that includes insurance, paid leave, flex spending, and educational

reimbursement. They do not anticipate any difficulty hiring the additional staff.

21. Meth-Wick has $325,000 in gifts and contributions, and will borrow $325,000. They

provided a letter from US Bank in Cedar Rapids indicating that they would provide

financing for the proposed project.

22. Meth-Wick will add 1,470 square feet to The Woodlands for a total of 49,491 square feet.

The four 435 square feet new rooms will be located on the south side of the existing

building. The applicant notes $108,300 in site costs and $541,700 in facility costs. They

also note $5,200 in interest expense during construction. Meth-Wick indicate a turn-key

cost of $163,800.

23. The applicant does not anticipate an operating deficit as a result of this project.

CONCLUSIONS OF LAW

In determining whether to issue a certificate of need, the Council considers the eighteen criteria listed in Iowa Code § 135.64(1)(a)-(r). In addition, the legislature has provided that the Council may grant a certificate of need only if it finds the following four factors exist:

a. Less costly, more efficient or more appropriate alternatives to the proposed institutional health service are not available and the development of such alternatives is not practicable;

b. Any existing facilities providing institutional health services similar to those proposed are being used in an appropriate and efficient manner;

c. In the case of new construction, alternatives including but not limited to modernization or sharing arrangements have been considered and have been implemented to the maximum extent practicable;

d. Patients will experience serious problems in obtaining care of the type which will be furnished by the proposed new institutional health service or changed institutional health service, in the absence of that proposed new service.

7

1. The Council concludes that less costly, more efficient or more appropriate alternatives to the proposed health service are not available and the development of such alternatives is not practicable. The Council notes The Woodlands operated at 96.4% in the year ending March 31, 2018, and at 98% at the time of the staff survey in February. The Council also notes that The Woodlands sought a waiver from the Department of Inspections and Appeals on four separate occasions since January 2018 to increase their bed count by one to accommodate Meth-Wick residents who needed nursing care. The Council also noted that in the past 15 months they have had 63 inquiries from people in Linn County that they have not been able to accommodate. Council concludes that Meth-Wick Health Center -The Woodlands is operating at capacity and that alternatives are not available. Iowa Code Sections 135.64(1) and 135.64(2)a.

2. The Council concludes that existing facilities providing health services similar to those proposed will continue to be used in an appropriate and efficient manner and will not be impacted by this project. The calculated bed need formula indicates a current underbuild in all seven of the counties around Linn County. The underbuild for Linn County is 703 beds. Overall the eight-county area, as calculated by the bed need formula, is underbuilt by 2,124 beds. The phone survey conducted by Department staff indicates an overall occupancy in Linn County of 75%. Three facilities in Linn County, Northbrook Manor Care Center, Living Center East and Mercy Medical Center — CR SNF reported censuses of 50%, 42% and 19% respectively. If these facilities are suppressed, the census for Linn County increases to 80%. The Council traditionally requires utilization over 85% to indicate appropriate occupancy rates of long term care facilities. Here, the county utilization rate of 80% (with three facilities suppressed), no opposition from existing facilities, no affected parties in opposition appearing at the hearing, the need for bariatric beds in the community, the addition of only four beds, and 98% occupancy at Meth-Wick, supports a conclusion that existing facilities are being utilized in an efficient manner. Iowa Code Sections 135.64(1) and 135.64(2)b.

3. The Council concludes that the project involves the addition of four 435 square foot private rooms on the south side of the existing Woodlands building. This will add a total of 1,470 square feet to the building. The Council further concludes that the rooms will be built to accommodate bariatric furnishings and overhead patient lifts. The Council further concludes that alternatives including modernization and sharing arrangements have been considered and implemented to the maximum extent practicable. Iowa Code Sections 135.64(1) and 135.4(2)c.

4. The Council concludes that patients will experience serious problems in obtaining care of the type which will be furnished by the proposed health service, in the absence of that proposed service. The Council notes that The Woodlands was able to take only four residents from the greater Linn County area in the past 15 months, and that it is turning away potential residents due to its high census. The Council also notes a lack of bariatric/non weight bearing beds in the community, and the need for these larger beds with specialized equipment. The Council concludes those from within the Meth-Wick continuum, as well as those in the community seeking bariatric nursing care in particular will experience problems obtaining the type of care proposed by Meth-Wick in absence of the proposed project. Iowa Code Sections 135.64(1) and 135.64(2)d.

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Dated this day of April 2019

H. iller, M.D., Chairperson

The facts, considered in light of the criteria contained in Iowa Code Section 135.64 (1 and 2) (2017), led the Council to find that a Certificate of Need should be awarded.

The decision of the Council may be appealed pursuant to Iowa Code Section 135.70 (2017).

It is required in accordance with 641 Iowa Administrative Code 202.12 that a progress report shall be submitted to the Iowa Department of Public Health six (6) months after approval. This report shall fully identify the project in descriptive terms. The report shall also reflect an amended project schedule if necessary.

The Certificate of Need is valid for a twelve (12) month period from the date of these findings. This is subject to the meeting of all requirements of the Iowa Department of Public Health. Requests for extension of a Certificate of Need must be filed in writing to the Iowa Department of Public Health from the applicant no later than forty-five (45) days prior to the expiration of the Certificate. These requests shall fully identify the project and indicate the current status of the project in descriptive terms.

No changes that vary from or alter the terms of the approved application including a change in the approved dollar cost shall be made unless requested in writing to the department and approved. Failure to notify and receive permission of the department to change the project as originally approved may result in the imposition of sanctions provided in Iowa Code section 135.73 (641 Iowa Administrative Code 202.14).

•

State Health Facilities Council Iowa Department of Public Health


9




DECISION PRAIRIE CROSSING OF WINTERSET

WINTERSET, IOWA

This matter came before the State Health Facilities Council for review on Wednesday, February 20, 2019. The applicant was represented by Linda Juckette of Capstone Management.

The project, construction of a 40 bed nursing facility, was originally approved on February 25, 2017, at an estimated cost of $8,178,892. The original completion date was January 2019; the new completion date is spring 2022. This project has changed significantly since it was approved and to date no construction on the nursing facility has begun. In addition, the location and ownership have changed. The applicant states that a portion of the land for the project was donated to the City of Winterset for a senior center, which has required them to change the Planned Unit Development to accommodate this center. The applicant also stated that the project as originally planned does not meet the needs of the Winterset community now or in the future. They have started a redesign of the CCRC campus including the nursing facility. They anticipate the design to be complete in the fall, at which time they will start with the construction of the independent and assisted living units followed by the nursing facility. They do not expect the construction of the nursing facility to begin until spring 2021, with completion in spring 2022. To date $539,488 has been spent on the project.

The Council, after reading the extension request and hearing comments by staff and the applicant voted 4-0 to DENY an Extension of Certificate of Need per 641 Iowa Administrative Code 202.13. The decision is based upon a finding that the project has changed significantly since its original approval and that insufficient progress has been made in developing the project.

The applicant has the right to appeal under the provisions of Iowa Code section 135.70 (2017)

Dated this 10 day of April 2019

rrui . Miller, M.D., Chairperson



IOWA DEPARTMENT OF PUBLIC HEALTH STATE HEALTH FACILITIES COUNCIL


REM IOWA, INC. 16TH AVENUE SW

CEDAR RAPIDS, IOWA

) ) ) DECISION ) ) )

This matter came before the State Health Facilities Council for hearing on Wednesday, February 20, 2019.

The applicant applied through the Iowa Department of Public Health for a Certificate of Need to build an eight bed Intermediate Care Facility for the Intellectually Disabled ("ICF/ID") home on 16th Avenue SW in Cedar Rapids. There will be a $5,500-$6,500 per month lease payment for this home, with a one year lease payment of $66,000-$78,000.

The record includes the application prepared by the project sponsor and written analysis prepared by Iowa Department of Public Health staff and all the testimony and exhibits presented at the hearing. Becky Swift of the Iowa Department of Public Health summarized the project in relation to review criteria. Kendell Watkins, Attorney at Law; Lisa Pakkebier and Dawn Steffen, REM Iowa, Inc.; and Marjie Carson Zach, parent, represented the applicant. The applicant made a presentation and answered questions.



FINDINGS OF FACT

1. REM Iowa, Inc. ("REM") has been providing services for people with intellectual disabilities since 1979. REM currently operates 11 eight-bed homes across the state, of which 10 serve adults and one serves children. Six of the 10 homes serving adults are in Linn County. Each of the six homes is at capacity and cannot take new residents.

2. REM proposes to build an eight bed ICF/ID home for adults on l6th Avenue SW in Cedar Rapids, Linn County, Iowa.

3. REM serves people with all levels of intellectual disability, ranging from mild to profound. Many of these individuals also have a variety of mental, physical, medical and/or other complex challenges.

4. REM provides individualized services to help the individuals they serve become more independent, including specialized support for those with behavioral challenges.

5. REM is a member of The MENTOR Network, a national network of local health and human service providers offering an array of quality, community-based services across the country.

6. According to Iowa Code section 135C.1(9), an Intermediate Care Facility for the Intellectually Disabled means "an institution or distinct part of an institution with a primary purpose to provide health or rehabilitative services to three or more individuals, who primarily have an intellectual disability or a related condition and who are not related to the administrator or owner within the third degree of consanguinity, and which meets the requirements of this chapter and federal standards for intermediate care facilities for persons with an intellectual disability established pursuant to the federal Social Security Act, §1905(c)(d), as codified in 42 U.S.C. §1396d, which are contained in 42 C.F.R. pt. 483, subpt. D, §410 — 480."

7. Eligibility for requiring the ICF/ID level of care is determined by the Iowa Medicaid Enterprise based on Iowa Foundation for Medical Care criteria.

8. Level of Care is approved by the Iowa Medicaid Enterprise, then the selected Managed Care Organization is responsible for the per diem for each approved individual. Individuals are recertified every 120 days by their MCO as needing the ICF/ID Level of Care.

9. Iowa Code section 135.63(4)(a) states "The department shall not process applications for and the council shall not consider a new or changed institutional health service for an intermediate care facility for persons with an intellectual disability unless... the new or changed beds shall not result in an increase in the total number of medical assistance certified intermediate care facility beds for persons with intellectual disability in the state, exclusive of those beds at the state resource centers or other state institutions, beyond one thousand six hundred thirty-six beds."

10. There are currently a total of 2,965 ICF/ID beds in the state, including the beds at Glenwood and Woodward Resource Centers, the state institutions. If these beds, 851 and 639 respectively, are excluded there are a total of 1,475 beds in the state, leaving 161 bed slots available.

11. This project will not add any new beds to the overall count.

12. UnityPoint Living Center East — New Horizons ("New Horizons"), was a 26 bed ICF/ID in Linn County that closed February 1, 2019. At that time, REM took over the license and operation of the facility. The New Horizons building has been sold to the Catherine McAuley Center, which will take over ownership in the fall of 2019.

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13. REM has commitments from 15 of the New Horizons residents to move to the new 16th Avenue SW home and another eight bed home that will be constructed on 33rd Avenue SW. Residents of New Horizons who will not move into REM housing made alternate living arrangements.

14. REM has an agreement with the Catherine McAuley Center to lease and occupy the building if the 16Avenue SW home is not completed by the time the Center takes over ownership.

15. There was one letter of support received for the project. This letter, from the CEO of the Mental Health/Disability Services East Central Region cited REM being the only ICF/ID provider in the county that supports adults; the housing available in Linn County insufficient to meet the specific needs of the ICF/ID population; the quantity of services being insufficient; and that the project will not result in an overconcentration of community based ICF/ID homes in the county.

16. There was also a letter of support received from the Linn County Board of Supervisors, as required by Iowa Code section 135.63(4)(b).

17. According to the Department of Inspections and Appeals (DIA) Entities Book there were, at the time of the REM application, two other ICF/ID providers in Linn County, New Horizons, which closed in February, and Tanager Place, which serves children and youth. Neither of these providers submitted a letter of support or opposition.

18. There were no letters opposition received.

19. The 16th Avenue SW home will house adults with varying degrees of intellectual disability as well as other challenges.

20. The total cost of the 16th Avenue SW home, which will be built, owned and funded by Ahmann Companies, is estimated to be $750,000-$900,000. REM will lease the home from the Ahmann Companies and hold the license for the home. Preliminary terms include a 20-year lease with two five year renewal options, base rent to be between $5,500 and $6,500 per month, and rent and possession of the home occurring in the fall of 2019.

21. The home will be 4,572 square feet, and will contain eight private bedrooms ranging from 177 to 190 square feet each. The home will also contain living/dining space, a kitchen, offices, four toilet rooms and a bathing room, among other features.

22. The primary source of operating revenue will be the Managed Care Organization and additional revenue sources may include the Iowa Department of Human Services - Iowa Medicaid Enterprise and the Health Insurance Premium Payment (HIPP) program.

23. REM does not project an operating deficit as a result of this project.

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CONCLUSIONS OF LAW

In determining whether to issue a certificate of need, the Council considered the eighteen criteria listed in Iowa Code § 135.64(1)(a)-(r). In addition, the legislature has provided that the Council may grant a certificate of need only if it finds the following four factors exist:





1. The Council concludes that less costly, more efficient or more appropriate alternatives to the proposed health service are not available and the development of such alternatives is not practicable. The Council concludes that the population to be served by REM have significant intellectual and physical disabilities, and that other homes operated by REM in Linn County are at capacity, and that there are no more appropriate, less costly services available in the area. Iowa Code Sections 135.64(1) and 135.64(2)a.

2. The Council concludes that existing facilities providing health services similar to those proposed are being and will continue to be used in an appropriate and efficient manner and will not be impacted by this project. The Council concludes that REM provides services to a specific population needing specialized care and supervision and that there is currently only one other provider in Linn County (Tanager Place) and they provide services only to children and youth, while the 16th Avenue SW home will serve adults only. The Council also notes that there are a total of 161 ICF/ID beds slots available in the state and that this project will not add new beds as the applicant is taking over licensure of existing beds. The Council notes that that no letters of opposition were received. Iowa Code Sections 135.64(1) and 135.64(2)b.

3. The Council concludes that this is new construction. The 16th Avenue SW home will be built, owned and funded by Ahmann Companies, a third party builder. The home, which will be 4,572 square feet, will contain eight private rooms and is projected to cost between $750,000 and $900,000. REM will lease the home from Ahmann Companies and hold the license for the home. The Council further concludes that alternatives including modernization and sharing arrangements have been considered and implemented to the maximum extent practicable. Iowa Code Sections 135.64(1) and 135.4(2)c.

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4. The Council concludes that patients will experience problems in obtaining care of the type which will be furnished by the proposed health service, in the absence of that proposed service. The Council notes that the six homes that REM currently operates in Linn County are at capacity, that there are no other providers of adult ICF/ID services in the county and that the residents displaced by New Horizons closure would have to leave the county to find appropriate services. The Council concludes that REM serves individuals with intellectual disabilities and significant physical and behavioral disabilities and that individuals needing services would experience serious difficulty finding another appropriate placement. Iowa Code Sections 135.64(1) and 135.64(2)d.







Miller, M.D., Chairp rson Health Facilities Council

Iowa Department of Public Health

cc: State Health Facilities Council Iowa Department of Inspections and Appeals, Health Facilities Division

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IOWA DEPARTMENT OF PUBLIC HEALTH STATE HEALTH FACILITIES COUNCIL


REM IOWA, INC. 33rd AVENUE SW

CEDAR RAPIDS, IOWA

) ) ) DECISION ) ) )

This matter came before the State Health Facilities Council for hearing on Wednesday, February 20, 2019.

The applicant applied through the Iowa Department of Public Health for a Certificate of Need to build an eight bed Intermediate Care Facility for the Intellectually Disabled ("ICF/ID") home on 33rd Avenue SW in Cedar Rapids. There will be a $5,500-$6,500 per month lease payment for this home, with a one year lease payment of $66,000-$78,000.

The record includes the application prepared by the project sponsor and written analysis prepared by Iowa Department of Public Health staff and all the testimony and exhibits presented at the hearing. Becky Swift of the Iowa Department of Public Health summarized the project in relation to review criteria. Kendell Watkins, Attorney at Law; Lisa Pakkebier and Dawn Steffen, REM Iowa, Inc.; and Marjie Carson Zach, parent, represented the applicant. The applicant made a presentation and answered questions.



FINDINGS OF FACT

1. REM Iowa, Inc. ("REM") has been providing services for people with intellectual disabilities since 1979. REM currently operates 11 eight-bed homes across the state, of which 10 serve adults and one serves children. Six of the 10 homes serving adults are in Linn County. Each of the six homes is at capacity and cannot take new residents.

2. REM proposes to build an eight bed 1CF/ID home for adults on 33rd Avenue SW in Cedar Rapids, Linn County, Iowa.

3. REM serves people with all levels of intellectual disability, ranging from mild to profound. Many of these individuals also have a variety of mental, physical, medical and/or other complex challenges.

4. REM provides individualized services to help the individuals they serve become more independent, including specialized support for those with behavioral challenges.

5. REM is a member of The MENTOR Network, a national network of local health and human service providers offering an array of quality, community-based services across the country.

6. According to Iowa Code section 135C.1(9), an Intermediate Care Facility for the Intellectually Disabled means "an institution or distinct part of an institution with a primary purpose to provide health or rehabilitative services to three or more individuals, who primarily have an intellectual disability or a related condition and who are not related to the administrator or owner within the third degree of consanguinity, and which meets the requirements of this chapter and federal standards for intermediate care facilities for persons with an intellectual disability established pursuant to the federal Social Security Act, §1905(c)(d), as codified in 42 U.S.C. §1396d, which are contained in 42 C.F.R. pt. 483, subpt. D, §410 — 480."

7. Eligibility for requiring the ICF/ID level of care is determined by the Iowa Medicaid Enterprise based on Iowa Foundation for Medical Care criteria.

8. Level of Care is approved by the Iowa Medicaid Enterprise, then the selected Managed Care Organization is responsible for the per diem for each approved individual. Individuals are recertified every 120 days by their MCO as needing the ICF/ID Level of Care.

9. Iowa Code section 135.63(4)(a) states "The department shall not process applications for and the council shall not consider a new or changed institutional health service for an intermediate care facility for persons with an intellectual disability unless... the new or changed beds shall not result in an increase in the total number of medical assistance certified intermediate care facility beds for persons with intellectual disability in the state, exclusive of those beds at the state resource centers or other state institutions, beyond one thousand six hundred thirty-six beds."

10. There are currently a total of 2,965 ICF/ID beds in the state, including the beds at Glenwood and Woodward Resource Centers, the state institutions. If these beds, 851 and 639 respectively, are excluded there are a total of 1,475 beds in the state, leaving 161 bed slots available.

11. This project will not add any new beds to the overall count.

12. UnityPoint Living Center East — New Horizons ("New Horizons"), was a 26 bed ICF/ID in Linn County that closed February 1, 2019. At that time, REM took over the license and operation of the facility. The New Horizons building has been sold to the Catherine McAuley Center, which will take over ownership in the fall of 2019.

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13. REM has commitments from 15 of the New Horizons residents to move to the new 33rd Avenue SW home and another eight bed home that will be constructed on 16th Avenue SW. Residents of New Horizons who will not move into REM housing made alternate living arrangements.

14. REM has an agreement with the Catherine McAuley Center to lease and occupy the building if the 33rd Avenue SW home is not completed by the time the Center takes over ownership.

15. There was one letter of support received for the project. This letter, from the CEO of the Mental Health/Disability Services East Central Region cited REM being the only ICF/ID provider in the county that supports adults; the housing available in Linn County insufficient to meet the specific needs of the ICF/ID population; the quantity of services being insufficient; and that the project will not result in an overconcentration of community based ICF/ID homes in the county.

16. There was also a letter of support received from the Linn County Board of Supervisors, as required by Iowa Code section 135.63(4)(b).

17. According to the Department of Inspections and Appeals (DIA) Entities Book there were, at the time of the REM application, two other ICF/ID providers in Linn County, New Horizons, which closed in February, and Tanager Place, which serves children and youth. Neither of these providers submitted a letter of support or opposition.

18. There were no letters opposition received.

19. The 33rd Avenue SW home will house adults with varying degrees of intellectual disability as well as other challenges.

20. The total cost of the 33rd Avenue SW home, which will be built, owned and funded by Ahmann Companies, is estimated to be $750,000-$900,000. REM will lease the home from the Ahmann Companies and hold the license for the home. Preliminary terms include a 20-year lease with two five year renewal options, base rent to be between $5,500 and $6,500 per month, and rent and possession of the home occurring in the fall of 2019.

21. The home will be 4,572 square feet, and will contain eight private bedrooms ranging from 177 to 190 square feet each. The home will also contain living/dining space, a kitchen, offices, four toilet rooms and a bathing room, among other features.

22. The primary source of operating revenue will be the Managed Care Organization and additional revenue sources may include the Iowa Department of Human Services - Iowa Medicaid Enterprise and the Health Insurance Premium Payment (HIPP) program.

23. REM does not project an operating deficit as a result of this project.

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CONCLUSIONS OF LAW

In determining whether to issue a certificate of need, the Council considered the eighteen criteria listed in Iowa Code § 135.64(1)(a)-(r). In addition, the legislature has provided that the Council may grant a certificate of need only if it finds the following four factors exist:





1. The Council concludes that less costly, more efficient or more appropriate alternatives to the proposed health service are not available and the development of such alternatives is not practicable. The Council concludes that the population to be served by REM have significant intellectual and physical disabilities, and that other homes operated by REM in Linn County are at capacity, and that there are no more appropriate, less costly services available in the area. Iowa Code Sections 135.64(1) and 135.64(2)a.

2. The Council concludes that existing facilities providing health services similar to those proposed are being and will continue to be used in an appropriate and efficient manner and will not be impacted by this project. The Council concludes that REM provides services to a specific population needing specialized care and supervision and that there is currently only one other provider in Linn County (Tanager Place) and they provide services only to children and youth, while the 33rd Avenue SW home will serve adults only. The Council also notes that there are a total of 161 ICF/ID beds slots available in the state and that this project will not add new beds as the applicant is taking over licensure of existing beds. The Council notes that that no letters of opposition were received. Iowa Code Sections 135.64(1) and 135.64(2)b.

3. The Council concludes that this is new construction. The 33rd Avenue SW home will be built, owned and funded by Ahmann Companies, a third party builder. The home, which will be 4,572 square feet, will contain eight private rooms and is projected to cost between $750,000 and $900,000. REM will lease the home from Ahmann Companies and hold the license for the home. The Council further concludes that alternatives including modernization and sharing arrangements have been considered and implemented to the maximum extent practicable. Iowa Code Sections 135.64(1) and 135.4(2)c.

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4. The Council concludes that patients will experience problems in obtaining care of the type which will be furnished by the proposed health service, in the absence of that proposed service. The Council notes that the six homes that REM currently operates in Linn County are at capacity, that there are no other providers of adult ICF/ID services in the county and that the residents displaced by New Horizons closure would have to leave the county to find appropriate services. The Council concludes that REM serves individuals with intellectual disabilities and significant physical and behavioral disabilities and that individuals needing services would experience serious difficulty finding another appropriate placement. Iowa Code Sections 135.64(1) and 135.64(2)d.






day of April 2019

ler, .D., Chairperson State Health Facilities Council Iowa Department of Public Health

Dated this

cc: State Health Facilities Council Iowa Department of Inspections and Appeals, Health Facilities Division

5




DECISION THE VIEWS HOLDING, LLC

MARION, IOWA

This matter came before the State Health Facilities Council for review on Wednesday, February 20, 2019. The applicant was represented by Ed McIntosh of Dorsey & Whitney.

The project, construction of a 40 bed skilled nursing facility, was originally approved on February 25, 2016, at an estimated cost of $8,100,000. The original completion date was June 2017; the new completion date is May 2019. The building is nearing completion, with 87.5% of the building being completed. Painting, flooring and installation of furnishings, which have been purchased, have yet to be completed. Weather issues early in the project and in October 2018 delayed the project. Delays in HUD 232 funding also pushed back the original start date. The Views closed on the HUD funding in October 2017. To date approximately $7,100,000 has been spent on the project.

The Council, after reading the extension request and hearing comments by staff and the applicant voted 4-0 to Grant an Extension of Certificate of Need per 641 Iowa Administrative Code 202.13. The decision is based upon a finding that sufficient progress has been made in developing the project.

The extension is valid for six (6) months. /=\

Dat d this 1(-) day of April 2019

irriA 10eA . Miller, M.D.,—Chairperson






DECISION UNIVERSITY OF IOWA HOSPITALS AND CLINICS

IOWA CITY, IOWA

This matter came before the State Health Facilities Council for review on Wednesday, February 20, 2019. The applicant was represented by Luke Leyden, UIHC.

The project, the purchase and installation of an interventional neuroradiology bi-plane angiography unit, was originally approved February 21, 2018, at an estimated cost of $3,666,000. The original completion date for the project was December 2018, it is now December 2019. In 2018 the University instituted a mandated moratorium on all construction projects, and this project was placed on hold for five months. The moratorium was lifted in September 2018 and the design documents were finalized in November 2018. The purchase order for the new system was issued in September 2016 contingent upon CON approval for its purchase. A request to revise the project budget will be sent to the Iowa Board of Regents for approval in February 2019 and if required again in April 2019. Upon approval of the revised budget, construction will begin in late spring 2019. The moratorium and budget revisions have led to an 11 month delay in the installation of the equipment. The agreement with the architect is complete, and the construction contract will be signed in the spring. To date $155,000 has been spent on the project.

The Council, after reading the extension request and hearing comments by staff and the applicant, voted 4-0 to Grant an Extension of Certificate of Need per 641 Iowa Administrative Code 202.13. The decision is based upon a finding that sufficient progress has been made in developing the project.

The extension is valid for 12 months.


Rae, F. . Miller, M.D., Chairperson State Health Facilities Council Iowa Department of Public Health





DECISION UNIVERSITY OF IOWA HOSPITALS AND CLINICS

IOWA CITY, IOWA

This matter came before the State Health Facilities Council for review on Wednesday, February 20, 2019. The applicant was represented by Luke Leyden, UIHC.

The project, the purchase and installation of an RO biograph Vision 600 PET-CT Unit, was originally approved February 21, 2018, at an estimated cost of $2,982,000. The completion date for the project is April 2019. In 2018 the University instituted a mandated moratorium on all construction projects, and this project was placed on hold for five months. The moratorium was lifted in September 2018 and the project was immediately released for construction. The agreement with the architect was signed in August 2018 and an equipment purchase order was issued in July 2018. The construction contract was signed in November 2018. The majority of the construction work is complete. Finishes and equipment installation remain. To date $85,000 has been spent on the project.

The Council, after reading the extension request and hearing comments by staff and the applicant, voted 4-0 to Grant an Extension of Certificate of Need per 641 Iowa Administrative Code 202.13. The decision is based upon a finding that significant progress has been made in developing the project.

The extension is valid for three (3) months.

Dates this day of April 2019

/144 /44, WO ler, M.D., hairperson



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