Alaska Dept. of Health: Alaska Certificate of Need Modernization Project Kickoff Meeting (October 29, 2026)

Well, thank you very much for attending today. Welcome. My name is Nicole Lebo, and I'm the Executive Director of the Office of Rate Review within the Department of Health. Little housekeeping, as you may have seen when you entered in, this meeting is being recorded, and we're doing that so that we can post it on our ORR website for those who have not been able to attend today. Some people have reached out to say that this wasn't a good time for them.

So, but I'm excited to open this kickoff meeting for the Methodology Modernization Project for the Certificate of Need program. At the highest level, I'd like to point out a few key features that will be unpacked throughout the course of the meeting. As the invite indicated, the purpose and the focus of the project is to gather input to modernize the adopted-by-reference methodology materials and the associated documents that inform the CON application process. As a note, full statute changes as well as wholesale regulatory changes are beyond the scope of the work at this time. So how will we modernize the methodologies?

First and foremost, Uh, we've contracted with Myers and Stauffer, uh, who has decades of a positive track record in Alaska supporting the department, as well as extensive experience, um, with other states' CON programs. Um, and then the general trajectory, uh, following this kickoff meeting from now through December will be a written survey, a listening session, followed by an analysis of those inputs, um, and all of that will result in some tailored focus groups starting in 2027. Uh, input gathered through those stakeholder engagements will eventually inform a draft of some updated methodology and review standards. Then there will be another round of input on that draft. And that will result in revised recommendations to eventually lead to a regulation package launching, launching, excuse me, sometime in, uh, state fiscal year '28.

Um, and of course that will then include a formalized public input, um, that's required through the regulatory process. So today, um, Oscar, if you could please advance the next slide.

Um, for today's agenda, we will, uh, introduce the whole team. We're gonna dig in deeper to the project, share more specific information about the process, and then end our time with taking questions, which, um, in the meanwhile, you are more than free to, um, throw your questions into the chat bar or to save them until the end because we'll have time.

And then also you may have noticed that the captions, closed captions, are at the bottom of your screen. If you're not seeing those, I'm sure you can turn them on at the bottom of your Zoom screen for yourself. All right. With that, if you can advance to the next slide and then the next one even still, I am pleased to turn the floor over to the ORR team leading this charge, and Maddie.

Thank you, Nicole. My name is Maddie Dawson. I'm the Certificate of Need Program Manager. I oversee the program and I'm leading this modernization project working closely with our team and Meyers and Stauffer. I've got the rest of the CON program with me.

We're a very small group. We've got Heidi Barnes. She's our CON subject matter expert. She's been with the state for several years and brings a wealth of historical departmental knowledge and is our go-to numbers person. And then we've got Soleil Logan Banta, who provides CON program support and keeps many of the behind-the-scenes processes and details moving.

She flawlessly manages our CON inbox and helps coordinate a lot of our program logistics. And then I will go ahead and turn it over to the Meyers and Stauffer team to jump in and introduce themselves.

Uh, hello everybody. My name is Tammy Martin. I'm a partner with Meyers and Stauffer out of our Boise, Idaho office. I have actually worked on Alaska projects since my very first day at Meyers and Stauffer in 1994. Fun fact, my very first business trip was to Anchorage, and I thought I hit the jackpot with work travel.

Julia, can you go next?

Hi, I'm Julia Kachiver. I'm a director at Meyers& Stafford. I oversee mostly behavioral health and home and community-based services, but I was— while I live in Oregon now, before that I was a state employee with the state of Nevada for over 18 years. Including being the state health official, and I oversaw Nevada's certificate of need program in addition to everything else. So I come with a lot of firsthand state experience on certificate of need.

Candice? Thanks, Julie. My name is Candice McDaniel. I'm a healthcare senior manager here with Meyers& Stauffer. I'm similar to Julie.

I actually was the program manager of the CON program in Nevada while working with Julia. So just bring that expertise here. For a gel manicure for Saturday.

Can we make sure we have everything muted for all our participants?

And move it over to Oscar.

Hi everyone, Oscar Fernandez. I'm a healthcare consultant with Meyerson Stafford. Just started with the firm about 3-4 months ago. Also come from Nevada, have extensive experience in data analysis, management, and program evaluation. So, a little history about Meyers& Stauffer and Alaska.

We have, as I mentioned before, we've been supporting Alaska since 1994. We have performed— I'm not going to read through this whole bullet list of items, but a whole slew of services. Our longest-standing project has been an audit program integrity and some compliance services. Some of you may have been invited by our team to get a review. I'm sure you had a great time.

In addition, we have been performing disproportionate share hospital audits since 2009. We've been regularly working with the state, and we have also conducted— we work with Jared's team on a Medicaid provider tax rate study. We've done some pharmacy work over the years, a lot of rate setting, and a lot of various consulting jobs. So we have been around for a long time and we're really looking forward to working on this new program with Alaska. Next slide.

I believe this is for me. Um, do you mind going to the next slide, Oscar? Thank you. Um, so before we get into the details of the project, I'll just take a minute to explain to explain the Certificate of Need program. I know some of you work with us regularly and others may be slightly less familiar with who we are.

Certificate of Need is a healthcare planning and regulatory program established under Alaska statutes and state regulations. The idea behind CON is to look at proposed healthcare projects in the context of community need, considering access to care, existing services, and the resources needed to support those services. That planning is particularly relevant in Alaska. We have many small communities spread across a large geographic area, and getting access to care can sometimes involve significant travel. Understanding where additional services are needed and how they would fit alongside Existing care is an important part of that picture.

The CON process gives the state a way to evaluate certain proposed projects within those— with those considerations in mind, looking at both current needs and what communities may need in the future. Our review standards and methodologies essentially guide that assessment. They lay out the criteria and calculations we use to evaluate a project. And those are really what we're taking a closer look at through this update we're working on with Meyers and Stauffer. Next slide, please.

So when does a project need Certificate of Need approval? I'll give a really high-level overview, but generally the requirement applies to projects with expenditures of $1.5 million or more for construction, renovation, or expansion of a healthcare facility, changes in bed capacity, or the addition of a category of health services. Additionally, if you're converting a building or part of one into a nursing home, that also requires Certificate of Need regardless of cost. Once a project requires review, the standard and methodologies guide our evaluation, and then that is going to bring us to why we're updating them. Next slide, please.

Our current review standards and methodologies were adopted in 2005, so more than 20 years ago. A lot has changed in how healthcare is delivered since then, and we want the tools we use to assess need to better reflect the modern healthcare landscape that exists today. That includes taking a fresh look at the assumptions behind the calculations, how services are used, how we define the areas they serve, and what data we have available. It also means looking at what those calculations tell us in practice. For example, the number of beds a facility has doesn't necessarily tell us how many patients it can care for.

Staffing and operating capacity matter too, and the current methodologies have limited ways to account for those factors. You all know firsthand how those factors affect care in your communities, from staffing challenges and patient travel to changes in how and where services are delivered. Your experience can help us understand where the current standards capture those realities and where they may miss something important. We're also updating the application materials, and your perspective can help us identify questions that are unclear, information that's difficult to provide, or places where the application doesn't give you a good way to explain your project.

That's kind of specific feedback we're hoping to hear throughout this work. You bring a range of expertise and perspectives that can help make the review standards, methodologies, and application more current and more practical to use.

Um, so with that, I'll hand it back over to Myers and Stauffer to walk through the project plan. Thank you, Maddie. Next slide, please. So what will this project involve? We're approaching it in 3 parts.

First, we're going to look at Alaska's current methodologies and how other states approach these reviews, not to simply copy another state's model, but to identify approaches that may be useful for Alaska's planning needs. And then we want to hear from you through the survey, through listening session and focus groups. We'll explore where you're seeing challenges with access what it takes to deliver services in your communities, and then we'll bring those pieces together to develop recommendations aimed at making the review process more clear, more consistent, and better aligned with healthcare delivery across Alaska. Next slide, please. Here's how we expect the work to unfold.

Uh, we're starting with today's kickoff, and the survey is planned to open tomorrow, October 30th, and then stay open through November 13th. We're tentatively planning a listening session for December 10th. During December, we'll also review the survey responses and identify the themes that will help shape the focus groups. Those smaller discussions are planned for January through March, and then in May we'll come back together for a webinar to share what we've heard, gather feedback before finalizing those recommendations in June. The important thing to note is that there are several opportunities to contribute along the way.

And not just through this initial survey you'll be receiving tomorrow. Next slide, please. Next, please. So let's spend a minute on these opportunities to participate. Uh, we know people have different preferences in sharing feedback, and so some would rather put their thoughts in writing while others would find it easier to talk through an experience.

So that's why we're using a combination of a survey, a broader listening session, and smaller focus groups. Each gives us a different way to hear what's working, uh, where you're running into challenges, and what you think could be improved upon. So our stakeholder input survey, uh, the survey is just a starting point. It will help us decide where to focus the conversations that follow. We'll ask a little bit about your organization, which topics matter to you the most, what meeting dates and times work best for you, You'll have the opportunity to express interest in the listening session and more provided— or provide more detailed written feedback through the optional questions.

We expect the main survey to take about 30 minutes or less. If you choose to answer those additional open-ended questions, you may want to allow a little more time. And one point worth emphasizing here, more than one person from an organization can respond. So different people may have different experiences with the process, and we welcome all of those perspectives. Um, this plan survey window is October 30th again through November 13th.

Next, please.

So the focus groups, um, that's where we'll have a chance to dig into specific details, um, with more time. We're not setting all of those topics today. We want to review the survey first so that the discussions really reflect the issues you all have identified as priorities. These will be smaller Zoom conversations, generally about 5 to 15 participants plus facilitators, and it'll run 1 to 2 hours depending upon the subject. We expect to begin in January with sessions planned through March.

If you'd like to participate, please indicate that in the survey and then let us know which topics you're most interested in discussing. Next, please.

So the listening session will be a broader conversation and another way to share your experience, particularly if you prefer speaking to providing detailed written comments. It will also give you a chance to hear perspectives from other providers. We're again tentatively planning for December 10th over Zoom and expect it to last 1 to 2 hours depending on participation. If that sounds like something you'd like to join, once again, please indicate your interest in the survey and that'll help us plan that session. So this slide gives you a preview of what we'd like to explore during that listening session conversation.

So think about a CON project we— you've worked on, considered, provided input on. What went smoothly? Where did you run into challenges? We'd also like to hear whether the requirements led you to delay a project, change its scope, or decide not to move forward, and really what that meant for the community that you serve. Another question, whether the methodology fit the service or community involved.

If it didn't, how was that handled? And then looking ahead, what would you change? Where could you— or where could the process be less burdensome while still providing really meaningful oversight? And what is working well enough that should be preserved? If you don't need to answer these questions right now, again, just sharing them so that you can start thinking about the experiences that you might want to share during that listening session.

So that brings us to the end of the overview. I'll pause here and open it up for questions. You're welcome to ask about the project, the timeline, or any of the participation opportunities that we've covered. Just please raise your hand, um, in the Zoom and we'll call on you. You can also put your questions in the chat.

Um, if you do want to speak, please lead with your name and organization so we know. Who we're hearing from.

Go ahead and open it up. Go ahead, Jared. I was asked someone this question the other day. I thought it was a reasonable question, but with the change in administrations, was there someone— they said, why now? This feels really strange at the tail end of an administration.

Why would we rush to do this now and not wait to see who's coming in? And I thought it was a reasonable question to ask, so I am echoing that question from the person that asked me it.

Thanks so much, Jared. I appreciate the opportunity to speak to that. As you can see, we have waited for a long time to, to move forward on learning about this one aspect of the CON program. And we are interested in taking I don't feel like the word rush to, first of all, describes our trajectory. I think that we're going to— we have a planful and process to gather some input and information to continue to update relevant people on what the draft methodology and alterations could look like, as well as then we're not even thinking about having any sort of regulatory suggestions until the, you know, we're in state fiscal year '28.

And so we're always, we're, that's the role of government, right? There are administrative changes and we're going to continue to do our projects and the work that we need to do. And this one is long overdue. So why now is like, thank goodness. Right?

I hope other people can applaud the why now, like finally is the thing there. Okay,. I'm not seeing any other questions in the chat or anybody raise their hands. Thank you, Oscar. So just thank you for making time to join us today.

We appreciate your willingness to share your experience, hear what the process is going to look like in practice, and being a really important part of this work. The next opportunity to weigh in is a survey planned to open tomorrow, remaining available through the November 13th, so please watch for that in your email. Use it, let us know your priorities and whether you'd like to participate in upcoming listening sessions. Hand it over to you, Nicole, to wrap up.

Thank you so much. And here are just some contact information to remind people of. So Candace is our point person at Meyers and Stauffer to reach out to, and then we've also listed our sort of general inbox for CON project questions. And so, for example, if you don't receive the invite for the survey, please let us know here. We've also said in the survey you can express your desire to participate in the, in the survey, I mean, in the listening session as well as in the focus groups.

If for some reason that's not how you communicate with us, you can always feel free to use that, that general inbox as well. And other than that, we'll stick on the line. We'll probably turn the recording off and stick on the line in case people have additional questions. But we thank you and we'll have this posted. You can certainly share this with your colleagues.