History

1946    Hill-Burton Act, encouraging states to develop planning structures

The first health planning efforts in the United States began in 1946 with the enactment of the Hill-Burton Act. This legislation authorized funds for the construction of new hospitals thereby encouraging states to develop a planning structure for the allocation of these federal funds.

Health planning, development, and implementation was fragmented prior to 1966 with several overlapping programs attempting to address health and health related problems from the national level. Some of these programs were directed to specific diseases, such as cancer, heart, and stroke. Others concentrated on specific areas of the country. The effectiveness of this health planning effort, however, was limited due to the lack of enforcement authority, adequate funding, and direction.     

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1966  CHPA 89-749, states must expand or establish local and state health planning agencies.

The second major legislative act aimed at health planning occurred in 1966 with the enactment of the Comprehensive Health Planning Act Public Law 89-749. States receiving funds from Hill-Burton, other public health acts, or social security programs were required to expand or establish local and state health planning agencies.

Alabama elected to divide the state into six (6) Comprehensive Health Planning (CHP) regions known as 314(b) agencies and a state agency known as the 314(a) agency which was located in the Alabama Department of Public Health. A CHP Advisory Council was created which was the forerunner of the Statewide Health Coordinating Council (SHCC) today.

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1972   Medicare and Medicaid, Section 1122, granted states authority to deny reimbursements.

In 1972, with health care costs rapidly increasing after the implementation of Medicare and Medicaid, Section 1122 of the Social Security Act was enacted to grant states the authority to deny Medicare, Medicaid, and Title V (Maternal and Child Health Program) reimbursement to facilities whose capital expenditures were not approved by a state health planning agency. Over 30 states, including Alabama, used Section 1122 provisions to review capital expenditures over $100,000, changes in facility bed capacity, or substantial changes in services of health facilities. The effectiveness of Section 1122 agreements was questioned because facilities could use private revenues to offset any imposed reductions in public reimbursements.

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1974  Public Law 93-641, improve health, access, costs, and prevent unnecessary duplication

The last major legislative act by Congress in an effort to correct the inadequacies of the CHP program passed Public Law 93-641, the National Health Planning and Resource Development Act of 1974. Public Law 93-641 had four main goals: (1) to improve the health of residents within a health service area; (2) increase the accessibility of quality of health services; (3) contain health care costs; and (4) prevent unnecessary duplication of health services. This legislation required states to establish regional Health Systems Agencies, State Health Planning and Development Agencies and State Health Coordination Councils. In addition to these planning bodies, P.L. 93-641, made grants from Public Health Service contingent upon having a Certificate of Need (CON) program. CON laws were the main tools available to state planning agencies to achieve the goals set by P.L. 93-641. This law had amendments, such as Public Law 96-79 passed in 1979. It was based on the premise of creating local planning areas with a council for overall planning and coordination and a state agency to make regulatory decisions. These local planning areas were known as Health Service Areas. They generally followed the old CHP lines.

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1977  Act Number 82, regulated and promoted public health

House Bill Number 28 in the First Special Session, 1977 was approved as Act Number 82 June 16, 1977. This legislation regulated and promoted public health and brought the laws of Alabama into conformity with Public Law 93-641, the "National Health Planning and Resources Development Act of 1974". Also to designate the State Board of Health as the State Agency to administer a Certificate of Need program relating to the provisions of health care facilities and services in Alabama; to control and regulate the development of certain health care facilities and services in such manner and to such degree as to meet the needs of the people of Alabama; to provide a method of cost containment of health care costs; to authorize the State Board of Health to adopt necessary rules, regulations and standards for the review of proposed health care facilities and services for the issuance of Certificates of Need to those persons proposing health care facilities and services; to designate the Statewide Health Coordinating Council as the agency to advise and consult with the State Board of Health in the promulgation and adoption of rules, regulations and standards, and for the administration of the Certificate of Need program; to establish a Health Facilities Review Council to conduct public hearings required and make recommendations to the State Board of Health on project applications and on rules, regulations and standards adopted pursuant thereto; to authorize the collection of application fees and to authorize appropriations for the administration of the Act. This Act repealed all laws and parts of laws which conflict with this Act including Section 13 of Act Number 530, H. 635 of the Regular Session of 1949.

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1979  Act Number 79-577, bring AL in conformity with regulations

On July 30, 1979 House Bill Number 52 was approved to become Act Number 79-577 during the Regular Session of 1979. This Act was to bring the laws of Alabama in conformity with Public Law 93-641 and Federal regulations by amending Section 22-21-260 relating to definitions, Section 22-21-265 relating to Certificates of Need required for new institutional health service, Section 22-21-274 relating to the review procedures, and Section 22-21-275 relating to application review for Certificates of Need; and to repeal Section 22-21-262 which exempts certain acquisitions from Certificates of Need and Section 22-21-273 relating to the Health Facilities Review Council.

The Alabama State Board of Health had been designated as the single agency for Comprehensive Statewide Health Planning (Act 446, Special Session 1966). The Alabama Department of Public Health, as the department of state government, was responsible for carrying out the administrative functions of the Board of Health. The Agency had a formal arrangement with the Alabama Development Office, which was the overall planning organization of the state government for the project notification and review system under U. S. Bureau of the Budget Circular A-95.

The state agency, which was renamed the State Health Planning and Development Agency (SHPDA), was the State Committee of Public Health. It was operationally administered by the State Department of Public Health. The council that replaced the CHP is the Statewide Health Coordinating Council (SHCC).

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1979  Executive order number 7, SHPDA made within Governor's office

By Executive Order Number Seven on June 16, 1979 Governor Fob James designated that the SHPDA for the State of Alabama be located within the Governor’s Office and shall be composed of the following people: three (3) providers, three (3) consumers, one (1) designee of the Governor, and two (2) cabinet heads. These nine (9) members were appointed by the Governor and had staggered terms established by the Governor. The SHPDA was designated to have all authority to administer the Certificate of Need law and Social Security Act, Section 1122, all authority to comply with state and federal laws, all authority to administer SHPDA staff personnel, job assignments, and budgets, and all authority to advise the Governor in the areas of health planning as it related to any area of health care. A copy of the executive order can be found at the link below.

Executive Order 7  

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1979 Full designation of state comm of public health as AL SHPDA disapproved by HEW

This action was taken due to notification that "full designation of the State Committee of Public Health as Alabama State Health Planning and Development Agency," was disapproved by the Department of Health Education and Welfare (HEW) of the United States on June 8, 1979.

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1980 SHPDA designated as state statistical agency

The State Health Planning and Development Agency was designated as the State Health Statistics Agency by Executive Order Number 36 on December 15, 1980 by Governor Fob James. Public Law 95-623, the Health Services Research, Health Statistics and Health Care Technology Act of 1978 provided for designation of a single state agency to administer or be responsible for administering statistical activities under the Cooperative Health Statistics System.A copy of the executive order can be found at the link below.

Executive Order 36  

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1981 Terminated Health Service Agencies in Alabama

In the fall of 1981, Governor Fob James requested the Department of Health and Human Services (DHHS), formerly known as HEW, to terminate all health system agencies in Alabama at the end of their funded year. DHHS did so, and Alabama became what is known as a 1536 state. The 1536 refers to the section of the law for states without health systems agencies.

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1982 Act 82-770, amended law relating to sections 22-21-260 through 22-21-270

Senate Bill Number 81 was approved July 8, 1982 and became Act Number 82-770. This Act amended Sections 22-21-260 through 22-21-270 relating to the control and regulation of development of certain health care facilities; changing the designated agency from the State Board of Health to the State Health Planning and Development Agency and identifying composition thereof; removing from law the designated health system agency; making changes in the State Health Plan by removing from law the State Medical Facilities Plan; raising the thresholds for expenditures; restricting use of tax money for advertising; raising the cost of filing for a Certificate of Need; and changing the period of validation.

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1984  Executive Order Number 22, relocated SHPDA to within Dept. of Public Health

By Executive Order Number 22 dated February 3, 1984 Governor George C. Wallace relocated the State Health Planning and Development Agency from the Governor’s Office to the State Department of Public Health and under the administrative supervision of the State Health Officer. All duties and responsibilities heretofore delegated to the SHPDA Board regarding the issuance of Certificates of Need in the health care system were transferred to the Certificate of Need Review Board. All other duties and responsibilities delegated to the SHPDA Board were transferred to the State Department of Public Health under the supervision of the State Health Officer. The Certificate of Need Review Board created was to be composed as follows: the Alabama Hospital Association shall nominate three (3) persons from which the State Committee of Public Health shall select one (1) member; the Alabama Nursing Home Association shall nominate three (3) persons from which the State Committee of Public Health shall select one (1) member; the Medical Association of the State of Alabama shall nominate three (3) persons from which the State Committee of Public Health shall select and nominate one (1) member; and the State Committee of Public Health shall nominate six (6) other members of which at least three (3) shall be consumers and not providers of health care. The nine (9) members of the Certificate of Need Review Board shall be appointed to staggered terms of office as established by the State Committee of Public Health.A copy of the executive order can be found at the link below.

Executive Order 22  

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1984  Executive Order Number 23, relocated SHPDA to within Governor's office

Shortly thereafter on March 20, 1984 Governor George C. Wallace signed Executive Order Number 23. This Order created a Certificate of Need Review Board which was empowered to consider applications for Certificates of Need and have the authority to administer the Certificate of Need law (Act Number 82-770) and which shall be the State Health Planning and Development Agency. The State Committee of Public Health shall nominate to the Governor nine (9) persons to be appointed to the Board. The State Committee shall select these nominees as follows: the Alabama Hospital Association shall recommend three (3) persons from which the State Committee of Public Health shall select and nominate one (1) member; the Alabama Nursing Home Association shall recommend three (3) persons from which the State Committee of Public Health shall select and nominate one (1) member; the Medical Association of the State of Alabama shall recommend three (3) persons from which the State Committee of Public Health shall select and nominate one (1) member; and the State Committee of Public Health shall nominate six (6) other members of which at least three (3) shall be consumers and not providers of health care. The nine (9) members of the Certificate of Need Review Board shall be appointed to staggered terms of office. A copy of the executive order and its amendment can be found at the link below.

Executive Order 23 (and amendment)  

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1984 Executive Order Number 23 , created CON Review Board to administer CON  law

It was further ordered that SHPDA be under the supervision of the CONRB staff by the Executive Director and professional staff of the former SHPDA.

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1987 Executive Order Number 23 Amended, reinstated appointment process in Act 82-770

Governor Guy Hunt signed the first amendment to Executive Order Number 23 on June 23, 1987. The Governor, through this amendment, reinstated the appointment process originally set forth in Act Number 82-770. Therefore, the Governor would make all nine appointments with no nominees from any organization. In addition, this amendment ordered that all-operative appointments to the Certificate of Need Review Board heretofore constituted under the authority of Executive Order Number 23 be rescinded.

Executive Order 23 (and amendment)  

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1987 Executive Order Number 13, changed appointment procedure for SHCC

Executive Order Number 13 signed by Governor Guy Hunt on July 9, 1987 changed the procedure by which appointments of the Statewide Health Coordinating Council are made. This was due to Title XV of the Public Health Service Act being repealed, effective January 1, 1987; the health systems agencies to which reference is made in Section 22-4-7 Code of Alabama, 1975 and which were required by that section to make nominations for and represented on the Statewide Health Coordinating Council are no longer in existence. In addition, the composition of the Council prescribed by Section 22-21-260 and 22-4-7 Code of Alabama, 1974 is no longer viable by virtue of changes in the law.

This Order required the SHCC have not less than 16 members appointed by the Governor, a majority of whom shall be consumers of health care who are not also providers of health care. The remaining members of the Council shall be providers of health care; however, not less than one-third of the providers of health care who are members of the SHCC shall be direct providers of health care. The State Health Officer shall be an ex officio member of the SHCC.

One-third of the members of the SHCC shall be initially appointed for a period of one (1) year, one-third shall be initially appointed for a period of two (2) years, and one-third shall be initially appointed for a period of three (3) years. All subsequent appointments shall be made by the Governor for a period of three years. Any vacancy shall be filled for the unexpired term and in the same manner as the original appointment and in the same manner as the original appointment was made. Members shall serve for the terms of appointment, and until their replacements have been appointed.

The SHCC shall elect from its members a Chairman and shall meet at least once a calendar quarter of each year. The SHCC may from time to time appoint persons other than members of the SHCC to special task forces to perform specifically designated functions and duties for the SHCC with a limited time period.

This Order rescinded all operative appointments to the SHCC theretofore constituted under the authority of Title XV of the Public Health Service Act and Section 22-4-7, Code of Alabama, 1975. A copy of the executive order can be found at the link below.

Executive Order 13  

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1990 Executive Order Number 35, Rural Health Care Council formed

Executive Order Number 35 was signed by Governor Guy Hunt on July 10, 1990. This Order created the Alabama Council on Rural Health Care (Council) for the implementation of a cohesive and unified program to ensure quality health care to citizens of rural Alabama.

The Council was to consist of seven members: the Governor’s Administrative Assistant for Agriculture and Rural Development, or designee; the Director of SHPDA, or designee; the Commissioner of the Alabama Medicaid Agency, or designee; the Director of the Alabama Department of Economic and Community Affairs, or designee; the Commissioner of the Alabama Department of Human Resources, or designee; the State Health Officer, or designee; and the Commissioner of the Department of Mental Health and Mental Retardation, or designee.

The Director of SHPDA would serve as Chairman of the Council and the State Health Officer as Vice Chairman. The Council shall report to the Governor the needs that are identified by the Council and the recommendations made to meet those needs. The Council shall meet at the call of the Chairman.

The Chairman shall cause to be established a separate office within the SHPDA, to be known as the Alabama Office of Rural Health Care which shall provide the resources and staff support required to facilitate and coordinate the activities of the Council. The member agencies of the Council shall participate by providing such funding, staff, and other resources to the SHPDA as may be required to maintain the Office.

To foster timely and complete information, the Chairman of the Council shall appoint a Technical Support Committee which shall include, but need not be limited to, the following members: three representatives from the Board of Censors of the Alabama Medical Association, the Chairman of the Small and Rural Hospital Constituency Group of the Alabama Hospital Association, a representative of the Alabama Primary Health Care Association, and a representative of the Alabama Nursing Home Association.

The primary function of the Council shall be to facilitate the improvement of the rural health care delivery system in Alabama by coordinating inter-agency efforts in the public sector together with the efforts of various entities in the private sector. The Council shall identify the health care needs of each rural community, and formulate recommendations to meet those needs in a cost-effective manner. A copy of the executive order can be found at the link below.

Executive Order 35 (and amendment)  

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1993 Executive Order Number 4, transferred State Health Statistics Agency to Dept. of Public Health and rescinded Executive Order 36.

On May 25, 1993, Governor Jim Folsom signed Executive Order Number 4. This Order transferred the functions of the SHPDA with respect to operating a State Health Statistics Agency to the Board of Health as provided in Code of Alabama, 1975 Section 22-9A-2 and that Executive Order Number 36, dated December 15, 1980 by Governor Fob James be rescinded. A copy of the executive order can be found at the link below.

Executive Order 4  

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1994 Executive Order Number 23, Rural Health Care Council transferred to Dept. of Public Health.

Executive Order Number 23 was signed by Governor Jim Folsom July 8, 1994. This Order transferred the Office of Rural Health from SHPDA to the Alabama Department of Public Health. The State Health Officer shall create an Advisory Council composed of providers from rural areas to further define the mission of the Office of Rural Health using the basis as outlined in Executive Order Number 35 dated July 10, 1990 and amended on April 19, 1991 for direction.

The legislation, both federal and state, along with Executive Orders by the Governors of Alabama noted above show the executive and statutory authority for health planning in Alabama. Other Executive Orders and legislation that do not specifically address the authority or responsibility for health planning are not identified or discussed

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1999 Executive Order Number 3, Moratorium on all Certificate of Need Applications or Statewide Health Coordinating Council or ALJ Rulings on Certificate of Need.

Executive order 3 done and ordered 25th day of January, 1999 by Governor Don Siegelman placed a moratorium upon the acceptance and processing of any and all Certificate of Need Applications until May 15, 1999.  A copy of the executive order and its amendments can be found at the link below.

Executive Order 3 (and amendments)  

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1999 Executive Order Number 3 Amendment No. 1, Moratorium on all Certificate of Need Applications or Statewide Health Coordinating Council or ALJ Rulings on Certificate of Need.

Executive order 3 Amendment No. 1 done and ordered 14th day of May, 1999 by Governor Don Siegelman placed a moratorium upon the acceptance and processing of any and all Certificate of Need Applications until August 13, 1999.

Executive Order 3 (and amendments)  

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2003 Act 2003-331 amended law relating to section 22-21-260 Code of Alabama 1975

Repealed language regarding Magnetic Resonance Imaging Equipment (MRI) and extracorporeal shock wave lithotripter or positron emission tomography (PET)

Additionally this amended language set fees for the CON program to be adjusted annually for inflation based upon the Consumer Price Index Market Basket Professional Medical Services Index as published by the U.S. Department of Labor, Bureau of Labor Statistics.

Finally this amended language requires that the Statewide Health Coordinating Council shall meet at least annually to determine whether revisions for the State Health Plan are necessary. If the State Health Coordinating Council fails to meet and to review or revise the State Health Plan on an annual basis, there shall be no fees required on all certificate of need applications filed with the Certificate of Need Board until the State Health Coordinating Council meets and reviews or revises the State Health Plan. For purposes of this paragraph, the annual meeting of the Statewide Health Coordinating Council shall occur on or before August 1 of each calendar year.

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2003 Executive Order Number 14, Moratorium regarding Nursing Home

Executive order 14 done and ordered 21st day of November, 2003 by Governor Bob Riley placed a moratorium upon the Certificate of Need Review Board, and the Statewide Health Coordinating Council regarding additional Nursing Home beds statewide. A copy of the executive order and its amendments can be found at the link below.

Executive Order 14 (and amendments)  

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2004 Joined National Network of Health Libraries (NNLM)

SHPDA joined the National Network of Health Libraries. http://www.nnlm.gov

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2005 Executive Order Number 26, Moratorium regarding Inpatient Hospice Facilities

Executive order 26 done and ordered 15th day of March, 2005 by Governor Bob Riley placed a moratorium upon the Certificate of Need Review Board, and Administrative Law Judges regarding any Inpatient Hospice Facilities.

This executive order also appointed a study committee consisting of the Alabama Medicaid Commissioner, State Health Officer, Executive Director of the State Health Planning and Development Agency, Alabama Hospice Association, Alabama Hospital Association, Alabama Nursing Home Association, Alabama Arise, and other appropriate parties as appointed by the Alabama Medicaid Commissioner or the Governor, to review and examine the current delivery system for hospice services with particular attention to ensuring services are provided to appropriate individuals in a safe and cost efficient manner and to make a report of such findings to the Governor's Office no later than November 30, 2005. A copy of the executive order and its amendment can be found at the link below.

Executive Order 26 (and amendment)  

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2005 Executive Order Number 26 Amendment No. 1, Revision of Moratorium regarding Inpatient Hospice Facilities

Executive order 26 Amendment No.1 done and ordered 3rd day of June, 2005 by Governor Bob Riley amended executive order 26 to allow the processing and consideration of any Certificate of Need applications to add new inpatient hospice services or inpatient hospice facilities which had been filed and were considered complete by the State Health Planning and Development Agency prior to March 15, 2005.

Executive Order 26 (and amendment)  

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2005 Executive Order Number 14 Amendment No. 1 regarding Nursing Homes

Executive order 14 Amendment No.1 done and ordered 12th day of August, 2005 by Governor Bob Riley amended executive order 14 to allow the Certificate of Need application for twelve (12) skilled nursing home beds in Mobile County, Alabama for the limited purpose of the emergency relocation of patients resulting from the unexpected closing of a skilled nursing facility operated by the Sisters of the Poor in New Orleans, Louisiana.

Executive Order 14 (and amendments)  

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2005 Executive Order Number 14 Amendment No. 2 regarding Nursing Homes

Executive order 14 Amendment No.2 done and ordered 26th day of September, 2005 by Governor Bob Riley amended executive order 14 to allow the processing and consideration of CON applications for eight (8) additional skilled nursing home beds in Montgomery County, Alabama for the limited purpose of the emergency relocation of special needs children displaced by Hurricane Katrina.

Executive Order 14 (and amendments)  

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2005 Act 2005-40 Open Meetings Section 36-25A-1 through 36-25A-11

Except for executive sessions permitted in Section 36-25A-7(a) or as otherwise expressly provided by other federal or state statutes, all meetings of a governmental body shall be open to the public and no meetings of a governmental body may beheld without providing notice pursuant to the requirements of Section 36-25A-3.

October 3, 2005 Secretary of State Nancy L. Worley assigned access for the posting of agendas for both the Certificate of Need Review Board and the Statewide Health Coordinating Council.

These agendas can be found at: www.openmeetings.alabama.gov as well as on the SHPDA site.

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2005 Nursing Home 10% bed exemption null and void 22-21-264 (6)

As of December 31, 2005 the language in section 22-21-265 (6) that allowed a Nursing Home to apply for additional beds under the 10% exemption automatically terminated and became null and void.

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2008 Act 2005-40 Open Meetings Section 36-25A-1 through 36-25A-11

Section 36-25A-2(4) requires the posting of all boards with the Secretary of State.

April 24, 2008 Secretary of State Beth Chapman assigned access for the posting of board members for both he Certificate of Need Review Board and the Statewide Health Coordinating Council.

The boards can be found at: www.boards.alabama.gov as well as on the SHPDA site.

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2009 Attorney General Opinion (Hospice)

Conclusion below Click on Link for full text of Opinion

Attorney General Opinion (Hospice) 08-17-09

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2011 Executive Order Number 14 Amendment 3

Executive Order Number 14 (and amendments)

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2011 Executive Order Number 3

Executive Order Number 3

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2011 Executive Order Number 6

Executive Order Number 6

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2011 Executive Order Number 23

Executive Order Number 23

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2012 Act 2012-294

This act amended Sections 22-21-265, 22-21-270, 22-21-271, and 22-21-275, Code of Alabama 1975, relating to the State Health Planning and Development Agency and the Certificate of Need Review Board, to further provide for fees, a temporary surcharge on certificate of need applications, and costs associated with the processing of cases.  The act also provides for direct appeals to the Court of Civil Appeals of any final decision of the State Health Planning and Development Agency.

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2015 Act 2015-471 - Alabama Health Planning Facilitation Act

The Alabama Health Planning Facilitation Act was written to "...provide for certain mandatory health care reporting to SHPDA; to designate the SHPDA as the agency to collect, compile, and analyze the collected reports; to establish and provide for the membership of the Health Care Information and Data [Advisory] Council; to require that the SHPDA, after receiving advice and guidance from the council, adopt rules to implement this act; to provide for penalties for failure [to] make the required reports; and to require the SHPDA to meet certain deadlines or lose its authority to require the reporting."

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2021 Executive Order Number 583 Amendment 4

Executive Order Number 583, Amendment 4

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