Section 1250.1320  Basic Considerations

a)         The State Agency in its performance of Appropriateness Review will utilize specific standards and criteria developed in this Part.  The service specific standards and criteria will establish the basis for evaluation of compliance with basic review considerations mandated to be addressed under P.L. 93-641, "The National Health Planning and Resources Development Act."  These basic considerations are as follows:

1)         Cost Effectiveness – The total economic value of resources required to provide services, including all financial expenditures, especially expenditures for capital and operating requirements in relation to the provision and quality of services.

2)         Availability – A measure of the appropriate supply and mix of health services and the capacity of resources for providing care.

3)         Accessibility – A measure of the degree to which the system inhibits or facilitates the ability of an individual or group to gain entry and receive appropriate services, including geographic, architectural, transportation, social, time and financial considerations.

4)         Quality – A measure of the degree to which health services delivered, regardless of by whom or in what setting, meet established professional standards and judgements of value to the consumer.  Quality is frequently described as having three dimensions:  quality of input resources, (e.g., certification and/or training of providers); quality of the process of service delivery; and quality of outcome of service use (actual improvement in condition or reduction of harmful effects).

5)         Need – A measure of the degree to which health services delivered meet the needs of the area's population for such services.

6)         Financial Viability – A measure of the ability of institutions to provide health services in a financially sound and appropriate manner.

b)         If in its findings the State Agency does not address any of the basic considerations the reason for not doing so will be reflected in the findings.