EXPLANATION: CAPITALS INDICATE MATTER ADDE D TO EXISTING LAW .
[Brackets] indicate matter deleted from existing law.
*hb0810*
HOUSE BILL 810
J3 3lr1669
By: Delegates Ghrist, Grammer, and Schmidt
Introduced and read first time: February 8, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Hospice Care Programs – Certificate of Need – Repeal 2
FOR the purpose of repealing the requirement that a hospice care program obtain a 3
certificate of need to build or expand a facility; and generally relating to certificates 4
of need and hospice care programs. 5
BY repealing and reenacting, with amendments, 6
Article – Health – General 7
Section 19–114, 19–120, and 19–906 8
Annotated Code of Maryland 9
(2019 Replacement Volume and 2022 Supplement) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12
Article – Health – General 13
19–114. 14
(a) In this Part II of this subtitle the following words have the meanings 15
indicated. 16
(b) “Ambulatory surgical facility” means any center, service, office, facility, or 17
office of one or more health care practitioners or a group practice that: 18
(1) Has three or more operating rooms; 19
(2) Operates primarily for the purpose of providing surgical services to 20
patients who do not require overnight hospitalization; and 21
(3) Seeks reimbursement from payors as an ambulatory surgical facility. 22 2 HOUSE BILL 810
(c) “Certificate of need” means a certification of public need issued by the 1
Commission under this Part II of this subtitle for a health care project. 2
(d) (1) “Health care facility” means: 3
(i) A hospital, as defined in § 19–301 of this title; 4
(ii) A limited service hospital, as defined in § 19–301 of this title; 5
(iii) A related institution, as defined in § 19–301 of this title; 6
(iv) An ambulatory surgical facility; 7
(v) An inpatient facility that is organized primarily to help in the 8
rehabilitation of disabled individuals, through an integrated program of medical and 9
other services provided under competent professional supervision; 10
(vi) A home health agency, as defined in § 19–401 of this title; 11
[(vii) A hospice, as defined in § 19–901 of this title; 12
(viii)] (VII) A freestanding medical facility, as defined in § 19–3A–01 13
of this title; and 14
[(ix)] (VIII) Any other health institution, service, or program for 15
which this Part II of this subtitle requires a certificate of need. 16
(2) “Health care facility” does not include: 17
(i) A hospital or related institution that is operated, or is listed and 18
certified, by the First Church of Christ Scientist, Boston, Massachusetts; 19
(ii) For the purpose of providing an exception to the requirement 20
for a certificate of need under § 19–120 of this subtitle, a facility to provide comprehensive 21
care constructed by a provider of continuing care, as defined in § 10–401 of the Human 22
Services Article, if: 23
1. Except as provided under § 19–123 of this subtitle, the 24
facility is for the exclusive use of the provider’s subscribers who have executed continuing 25
care agreements, including continuing care at home agreements, and paid entrance fees 26
that are at least equal to the lowest entrance fee charged for an independent living unit, 27
an assisted living unit, or a continuing care at home agreement before entering the 28
continuing care community, regardless of the level of care needed by the subscribers at 29
the time of admission; 30
HOUSE BILL 810 3
2. The facility is located on the campus of the continuing 1
care community; and 2
3. The number of comprehensive care nursing beds in the 3
community does not exceed: 4
A. 24 percent of the number of independent living units in a 5
community having less than 300 independent living units; or 6
B. 20 percent of the number of independent living units in a 7
community having 300 or more independent living units; 8
(iii) For the purpose of providing an exception to the requirement 9
for a certificate of need under § 19–120 of this subtitle, a facility to provide comprehensive 10
care that: 11
1. Is owned and operated by the Maryland Department of 12
Veterans Affairs; and 13
2. Restricts admissions to individuals who meet the 14
residency requirements established by the Maryland Department of Veterans Affairs and 15
are: 16
A. Veterans who were discharged or released from the 17
armed forces of the United States under honorable conditions; 18
B. Former members of a reserve component of the armed 19
forces of the United States; or 20
C. Nonveteran spouses of eligible veterans; 21
(iv) Except for a facility to provide kidney transplant services or 22
programs, a kidney disease treatment facility, as defined by rule or regulation of the 23
United States Department of Health and Human Services; 24
(v) Except for kidney transplant services or programs, the kidney 25
disease treatment stations and services provided by or on behalf of a hospital or related 26
institution; [or] 27
(vi) The office of one or more individuals licensed to practice 28
dentistry under Title 4 of the Health Occupations Article, for the purposes of practicing 29
dentistry; OR 30
(VII) A HOSPICE CARE PROGRAM . 31
4 HOUSE BILL 810
(e) “Health care practitioner” means any individual who is licensed, certified, or 1
otherwise authorized under the Health Occupations Article to provide health care 2
services. 3
(f) “Health service area” means an area of this State that the Governor 4
designates as appropriate for planning and developing of health services. 5
(g) “Local health planning agency” means the health department of a 6
jurisdiction or a body designated by the local health department to perform health 7
planning functions. 8
(h) “State health plan” means the State health plan for facilities and services. 9
19–120. 10
(a) (1) In this section the following words have the meanings indicated. 11
(2) “Consolidation” and “merger” include increases and decreases in bed 12
capacity or services among the components of an organization that: 13
(i) Operates more than one health care facility; or 14
(ii) Operates one or more health care facilities and holds an 15
outstanding certificate of need to construct a health care facility. 16
(3) (i) “Health care service” means any clinically related patient 17
service. 18
(ii) “Health care service” includes a medical service. 19
(4) “Hospital capital threshold” means the lesser of: 20
(i) 25% of the hospital’s gross regulated charges for the 21
immediately preceding year; or 22
(ii) $50,000,000. 23
(5) “Limited service hospital” means a health care facility that: 24
(i) Is licensed as a hospital on or after January 1, 1999; 25
(ii) Changes the type or scope of health care services offered by 26
eliminating the facility’s capability to admit or retain patients for overnight 27
hospitalization; 28
(iii) Retains an emergency or urgent care center; and 29
HOUSE BILL 810 5
(iv) Complies with the regulations adopted by the Secretary under § 1
19–307.1 of this title. 2
(6) “Medical service” means: 3
(i) Any of the following categories of health care services: 4
1. Medicine, surgery, gynecology, addictions; 5
2. Obstetrics; 6
3. Pediatrics; 7
4. Psychiatry; 8
5. Rehabilitation; 9
6. Chronic care; 10
7. Comprehensive care; 11
8. Extended care; 12
9. Intermediate care; or 13
10. Residential treatment; or 14
(ii) Any subcategory of the rehabilitation, psychiatry, 15
comprehensive care, or intermediate care categories of health care services for which need 16
is projected in the State health plan. 17
(b) The Commission may set an application fee for a certificate of need for 18
health care facilities not assessed a user fee under this subtitle. 19
(c) The Commission shall adopt rules and regulations for applying for and 20
issuing certificates of need. 21
(d) The Commission may adopt, after October 1, 1983, new thresholds or 22
methods for determining the circumstances or minimum cost requirements under which a 23
certificate of need application must be filed. 24
(e) (1) A person shall have a certificate of need issued by the Commission 25
before the person develops, operates, or participates in any of the health care projects for 26
which a certificate of need is required under this section. 27
(2) A certificate of need issued before January 13, 1987, may not be 28
rendered wholly or partially invalid solely because certain conditions have been imposed, 29 6 HOUSE BILL 810
if an appeal concerning the certificate of need, challenging the power of the Commission 1
to impose certain conditions on a certificate of need, has not been noted by an aggrieved 2
party before January 13, 1987. 3
(f) Except as provided in subsection (g)(2)(iii) of this section, a certificate of need 4
is required before a new health care facility is built, developed, or established. 5
(g) (1) A certificate of need is required before an existing or previously 6
approved, but unbuilt, health care facility is moved to another site. 7
(2) This subsection does not apply if: 8
(i) The Commission adopts limits for relocations and the proposed 9
relocation does not exceed those limits; 10
(ii) The relocation is the result of a partial or complete replacement 11
of an existing hospital or related institution, as defined in § 19–301 of this title, and the 12
relocation is to another part of the site or immediately adjacent to the site of the existing 13
hospital or related institution; 14
(iii) Subject to the provisions of subsections (i) and (j) of this section, 15
the relocation is of an existing health care facility owned or controlled by a merged asset 16
system and is to: 17
1. A site within the primary service area of the health care 18
facility to be relocated if: 19
A. The proposed relocation is not across county boundaries; 20
and 21
B. At least 45 days prior to the proposed relocation, notice is 22
filed with the Commission; 23
2. A site outside the primary service area of the health care 24
facility to be relocated but within the primary service area of the merged asset system if: 25
A. At least 45 days prior to the proposed relocation, notice is 26
filed with the Commission; and 27
B. The Commission in its sole discretion, and in accordance 28
with the criteria adopted by regulation, finds that the relocation is in the public interest, 29
is not inconsistent with the State health plan, and will result in the more efficient and 30
effective delivery of health care services; or 31
3. For a limited service hospital, a site within the 32
immediate area as defined in regulation by the Commission; or 33
HOUSE BILL 810 7
(iv) The relocation involves moving a portion of a complement of 1
comprehensive care beds previously approved by the Commission after January 1, 1995, 2
for use in a proposed new related institution, as defined in § 19–301 of this title, but 3
unbuilt on October 1, 1998, if: 4
1. The comprehensive care beds that were originally 5
approved by the Commission in a prior certificate of need review were approved for use in 6
a proposed new related institution to be located in a municipal corporation within Carroll 7
County in which a related institution is not located; 8
2. The comprehensive care beds being relocated will be used 9
to establish an additional new related institution that is located in another municipal 10
corporation within Carroll County in which a related institution is not located; 11
3. The comprehensive care beds not being relocated are 12
intended to be used to establish a related institution on the original site; and 13
4. Both the previously approved comprehensive care beds 14
for use on the original site and the relocated comprehensive care beds for use on the new 15
site will be used as components of single buildings on each site that also offer independent 16
or assisted living residential units. 17
(3) Notwithstanding any other provision of this subtitle, a certificate of 18
need is not required for a relocation described under paragraph (2)(iv) of this subsection. 19
(h) (1) A certificate of need is required before the bed capacity of a health 20
care facility is changed. 21
(2) This subsection does not apply to any increase or decrease in bed 22
capacity if: 23
(i) For a health care facility that is not a hospital, during a 2–year 24
period the increase or decrease would not exceed the lesser of 10 percent of the total bed 25
capacity or 10 beds; 26
(ii) 1. The increase or decrease would change the bed capacity 27
for an existing medical service; and 28
2. A. The change would not increase total bed capacity; 29
B. The change is maintained for at least a 1–year period; 30
and 31
C. At least 45 days prior to the change, the hospital provides 32
written notice to the Commission describing the change and providing an updated 33
inventory of the hospital’s licensed bed complement; 34
8 HOUSE BILL 810
(iii) 1. At least 45 days before increasing or decreasing bed 1
capacity, written notice of intent to change bed capacity is filed with the Commission; 2
2. The Commission in its sole discretion finds that the 3
proposed change: 4
A. Is pursuant to the consolidation or merger of two or more 5
health care facilities, or conversion of a health care facility or part of a facility to a 6
nonhealth–related use; 7
B. Is not inconsistent with the State health plan or the 8
institution–specific plan developed by the Commission; 9
C. Will result in the delivery of more efficient and effective 10
health care services; and 11
D. Is in the public interest; and 12
3. Within 45 days of receiving notice, the Commission 13
notifies the health care facility of its finding; 14
(iv) The increase or decrease in bed capacity is the result of the 15
annual licensed bed recalculation provided under § 19–307.2 of this title; or 16
(v) 1. The increase or decrease in bed capacity will occur in[: 17
A. An] AN intermediate care facility that offers residential 18
or intensive substance–related disorder treatment services and has a current license 19
issued by the Secretary[; or 20
B. An existing general hospice program that has a current 21
license issued by the Secretary]; and 22
2. At least 45 days before increasing or decreasing bed 23
capacity, written notice of the intent to change bed capacity is filed with the Commission. 24
(i) (1) Except as provided in paragraph (2) of this subsection, for a hospital 25
located in a county with three or more hospitals, a certificate of need is not required 26
before the bed capacity is increased or decreased if the change: 27
(i) Occurs on or after July 1, 2000; 28
(ii) Is between hospitals in a merged asset system located within 29
the same health service area; 30
(iii) Does not involve comprehensive or extended care beds; and 31
HOUSE BILL 810 9
(iv) Does not occur earlier than 45 days after a notice of intent to 1
reallocate bed capacity is filed with the Commission. 2
(2) A hospital may not create a new health care service through the 3
relocation of beds from one county to another county pursuant to this subsection. 4
(j) (1) A certificate of need is required before the type or scope of any health 5
care service is changed if the health care service: 6
(i) Is offered: 7
1. By a health care facility; 8
2. In space that is leased from a health care facility; or 9
3. In space that is on land leased from a health care facility; 10
or 11
(ii) Results in a change in operating room capacity in a hospital, a 12
freestanding medical facility, or an ambulatory surgical facility. 13
(2) This subsection does not apply if: 14
(i) The Commission adopts limits for changes in health care 15
services and the proposed change would not exceed those limits; 16
(ii) The proposed change and the annual operating revenue that 17
would result from the addition is entirely associated with the use of medical equipment; 18
(iii) The proposed change would establish, increase, or decrease a 19
health care service and the change would not result in the: 20
1. Establishment of a new medical service or elimination of 21
an existing medical service; 22
2. Establishment of a cardiac surgery, organ transplant 23
surgery, or burn or neonatal intensive health care service; 24
3. Except as provided in § 19–120.1 of this subtitle, 25
establishment of percutaneous coronary intervention services; 26
4. Establishment of a home health program [, hospice 27
program,] or freestanding ambulatory surgical center or facility; or 28
5. Expansion of a comprehensive care, extended care, 29
intermediate care, residential treatment, psychiatry, or rehabilitation medical service, 30 10 HOUSE BILL 810
except for an expansion related to an increase in total bed capacity in accordance with 1
subsection (h)(2)(i) of this section; or 2
(iv) 1. At least 45 days before increasing or decreasing the 3
volume of one or more health care services, written notice of intent to change the volume 4
of health care services is filed with the Commission; 5
2. The Commission in its sole discretion finds that the 6
proposed change: 7
A. Is pursuant to: 8
I. The consolidation or merger of two or more health care 9
facilities; 10
II. The conversion of a health care facility or part of a 11
facility to a nonhealth–related use; 12
III. The conversion of a hospital to a limited service hospital; 13
or 14
IV. The conversion of a licensed general hospital to a 15
freestanding medical facility in accordance with subsection [(o)(3)] (N)(3) of this section; 16
B. Is not inconsistent with the State health plan or the 17
institution–specific plan developed and adopted by the Commission; 18
C. Will result in the delivery of more efficient and effective 19
health care services; and 20
D. Is in the public interest; and 21
3. Within 45 days of receiving notice under item 1 of this 22
item, the Commission notifies the health care facility of its finding. 23
(3) Notwithstanding the provisions of paragraph (2) of this subsection, a 24
certificate of need is required: 25
(i) Before an additional home health agency, branch office, or home 26
health care service is established by an existing health care agency or facility; 27
(ii) Before an existing home health agency or health care facility 28
establishes a home health agency or home health care service at a location in the service 29
area not included under a previous certificate of need or license; 30
(iii) Before a transfer of ownership of any branch office of a home 31
health agency or home health care service of an existing health care facility that 32 HOUSE BILL 810 11
separates the ownership of the branch office from the home health agency or home health 1
care service of an existing health care facility which established the branch office; or 2
(iv) Before the expansion of a home health service or program by a 3
health care facility that: 4
1. Established the home health service or program without 5
a certificate of need between January 1, 1984 and July 1, 1984; and 6
2. During a 1–year period, the annual operating revenue of 7
the home health service or program would be greater than $333,000 after an annual 8
adjustment for inflation, based on an appropriate index specified by the Commission. 9
(k) (1) A certificate of need is required before any of the following capital 10
expenditures are made by or on behalf of a hospital: 11
(i) Any expenditure that, under generally accepted accounting 12
principles, is not properly chargeable as an operating or maintenance expense, if: 13
1. The expenditure is made as part of an acquisition, 14
improvement, or expansion, and, after adjustment for inflation as provided in the 15
regulations of the Commission, the total expenditure, including the cost of each study, 16
survey, design, plan, working drawing, specification, and other essential activity, is more 17
than the hospital capital threshold; 18
2. The expenditure is made as part of a replacement of any 19
plant and equipment of the hospital and is more than the hospital capital threshold after 20
adjustment for inflation as provided in the regulations of the Commission; 21
3. The expenditure results in a substantial change in the 22
bed capacity of the hospital; or 23
4. The expenditure results in the establishment of a new 24
medical service in a hospital that would require a certificate of need under subsection (i) 25
of this section; or 26
(ii) Any expenditure that is made to lease or, by comparable 27
arrangement, obtain any plant or equipment for the hospital, if: 28
1. The expenditure is made as part of an ac quisition, 29
improvement, or expansion, and the total expenditure, including the cost of each study, 30
survey, design, plan, working drawing, specification, and other essential activity, is more 31
than the hospital capital threshold; 32
2. The expenditure is made as part of a replacement of any 33
plant and equipment and is more than the hospital capital threshold after adjustment for 34
inflation as provided in the regulations of the Commission; 35 12 HOUSE BILL 810
3. The expenditure results in a substantial change in the 1
bed capacity of the hospital; or 2
4. The expenditure results in the establishment of a new 3
medical service in a hospital that would require a certificate of need under subsection (i) 4
of this section. 5
(2) A certificate of need is required before any of the following capital 6
expenditures are made by or on behalf of a health care facility other than a hospital: 7
(i) Any expenditure that, under generally accepted accounting 8
principles, is not properly chargeable as an operating or maintenance expense, if: 9
1. The expenditure results in a substantial change in the 10
bed capacity of the health care facility other than a hospital; or 11
2. The expenditure results in the establishment of a new 12
medical service in a health care facility other than a hospital that would require a 13
certificate of need under subsection (i) of this section; or 14
(ii) Any expenditure that is made to lease or, by comparable 15
arrangement, obtain any plant or equipment for the health care facility other than a 16
hospital, if: 17
1. The expenditure results in a substantial change in the 18
bed capacity of the health care facility other than a hospital; or 19
2. The expenditure results in the establishment of a new 20
medical service in a health care facility other than a hospital that would require a 21
certificate of need under subsection (i) of this section. 22
(3) A certificate of need is required before any equipment or plant is 23
donated to a health care facility, if a certificate of need would be required under 24
paragraph (1) or (2) of this subsection for an expenditure by the health care facility to 25
acquire the equipment or plant directly. 26
(4) A certificate of need is required before any equipment or plant is 27
transferred to a health care facility at less than fair market value if a certificate of need 28
would be required under paragraph (1) or (2) of this subsection for the transfer at fair 29
market value. 30
(5) A certificate of need is required before a person acquires a health care 31
facility if a certificate of need would be required under paragraph (1) or (2) of this 32
subsection for the acquisition by or on behalf of the health care facility. 33
(6) This subsection does not apply to: 34 HOUSE BILL 810 13
(i) Site acquisition; 1
(ii) Acquisition of a health care facility if, at least 30 days before 2
making the contractual arrangement to acquire the facility, written notice of the intent to 3
make the arrangement is filed with the Commission and the Commission does not find, 4
within 30 days after the Commission receives notice, that the health services or bed 5
capacity of the facility will be changed[, provided that, for a merger with or acquisition of 6
an existing general hospice, the purchaser of the general hospice may only acquire the 7
authority to provide home–based hospice services in jurisdictions in which the seller of 8
the general hospice is licensed to provide home–based hospice services]; 9
(iii) Acquisition of business or office equipment that is not directly 10
related to patient care; 11
(iv) Capital expenditures to the extent that they are directly related 12
to the acquisition and installation of major medical equipment; 13
(v) A capital expenditure made as part of a consolidation or merger 14
of two or more health care facilities, or conversion of a health care facility or part of a 15
facility to a nonhealth–related use if: 16
1. At least 45 days before an expenditure is made, written 17
notice of intent is filed with the Commission; 18
2. Within 45 days of receiving notice, the Commission in its 19
sole discretion finds that the proposed consolidation, merger, or conversion: 20
A. Is not inconsistent with the State health plan or the 21
institution–specific plan developed by the Commission as appropriate; 22
B. Will result in the delivery of more efficient and effective 23
health care services; and 24
C. Is in the public interest; and 25
3. Within 45 days of receiving notice, the Commission 26
notifies the health care facility of its finding; 27
(vi) A capital expenditure by a nursing home for equipment, 28
construction, or renovation that: 29
1. Is not directly related to patient care; and 30
2. Is not directly related to any change in patient charges or 31
other rates; 32
14 HOUSE BILL 810
(vii) A capital expenditure by a hospital, as defined in § 19–301 of 1
this title, for equipment, construction, or renovation that: 2
1. Is not directly related to patient care; and 3
2. Does not increase patient charges or hospital rates; 4
(viii) A capital expenditure by a hospital, as defined in § 19–301 of 5
this title, for a project in excess of the hospital capital threshold and is for construction or 6
renovation that: 7
1. May be related to patient care; 8
2. Does not require, over the entire period or schedule of 9
debt service associated with the project, a total cumulative increase in patient charges or 10
hospital rates of more than $1,500,000 for the capital costs associated with the project as 11
determined by the Commission, after consultation with the Health Services Cost Review 12
Commission; 13
3. At least 45 days before the proposed expenditure is made, 14
the hospital notifies the Commission; 15
4. A. Within 45 days of receipt of the relevant financial 16
information, the Commission makes the financial determination required under item 2 of 17
this item; or 18
B. The Commission has not made the financial 19
determination required under item 2 of this item within 60 days of the receipt of the 20
relevant financial information; and 21
5. The relevant financial information to be submitted by the 22
hospital is defined in regulations adopted by the Commission, after consultation with the 23
Health Services Cost Review Commission; 24
(ix) A plant donated to a hospital, as defined in § 19–301 of this 25
title, that does not require a cumulative increase in patient charges or hospital rates of 26
more than $1,500,000 for capital costs associated with the donated plant as determined 27
by the Commission, after consultation with the Health Services Cost Review Commission, 28
if: 29
1. At least 45 days before the proposed donation is made, 30
the hospital notifies the Commission; 31
2. A. Within 45 days of receipt of the relevant financial 32
information, the Commission makes the financial determination required under this item 33
(ix) of this paragraph; or 34
HOUSE BILL 810 15
B. The Commission has not made the financial 1
determination required under this item (ix) of this paragraph within 60 days of the 2
receipt of the relevant financial information; and 3
3. The relevant financial information to be submitted by the 4
hospital is defined in regulations adopted by the Commission after consultation with the 5
Health Services Cost Review Commission; or 6
(x) A capital expenditure made as part of a conversion of a licensed 7
general hospital to a freestanding medical facility in accordance with subsection [(o)(3)] 8
(N)(3) of this section. 9
(7) Paragraph (6)(vi), (vii), (viii), (ix), and (x) of this subsection may not be 10
construed to permit a facility to offer a new health care service for which a certificate of 11
need is otherwise required. 12
(l) (1) A certificate of need is not required to close any health care facility or 13
part of a health care facility if at least 90 days before the closing or if at least 45 days 14
before the partial closing of the health care facility, including a State hospital, a person 15
proposing to close all or part of the health care facility files notice of the proposed closing 16
or partial closing with the Commission. 17
(2) A hospital shall hold a public informational hearing in the county 18
where the hospital is located if the hospital: 19
(i) Files a notice of the proposed closing of the hospital with the 20
Commission; 21
(ii) Requests an exemption from the Commission under subsection 22
[(o)(3)] (N)(3) of this section to convert to a freestanding medical facility; or 23
(iii) Is located in a county with fewer than three hospitals and files 24
a notice of the partial closing of the hospital with the Commission. 25
(3) The Commission may require a health care facility other than a 26
hospital described in paragraph (2) of this subsection that files notice of its proposed 27
closing or partial closing to hold a public informational hearing in the county where the 28
health care facility is located. 29
(4) A public informational hearing required under paragraph (2) or (3) of 30
this subsection shall be held by the health care facility, in consultation with the 31
Commission, within 30 days after: 32
(i) The health care facility files with the Commission a notice of its 33
proposed closing or partial closing; or 34
16 HOUSE BILL 810
(ii) The hospital files with the Commission a notice of intent to 1
convert to a freestanding medical facility. 2
(5) (i) The Commission shall establish by regulation requirements for 3
a public informational hearing required under paragraph (2) or (3) of this subsection. 4
(ii) For a hospital proposing to close, partially close, or convert to a 5
freestanding medical facility, the regulations shall require the hospital to address: 6
1. The reasons for the closure, partial closure, or 7
conversion; 8
2. The plan for transitioning acute care services previously 9
provided by the hospital to residents of the hospital service area; 10
3. The plan for addressing the health care needs of the 11
residents of the hospital service area; 12
4. The plan for retraining and placing displaced employees; 13
5. The plan for the hospital’s physical plant and site; and 14
6. The proposed timeline for the closure, partial closure, or 15
conversion to a freestanding medical facility. 16
(6) Within 10 working days after a public informational hearing held by a 17
hospital under this subsection, the hospital shall provide a written summary of the 18
hearing to: 19
(i) The Governor; 20
(ii) The Secretary; 21
(iii) The governing body of the county in which the hospital is 22
located; 23
(iv) The local health department and the local board of health or 24
similar body for the county in which the hospital is located; 25
(v) The Commission; and 26
(vi) Subject to § 2–1257 of the State Government Article, the Senate 27
Finance Committee, the House Health and Government Operations Committee, and the 28
members of the General Assembly who represent the district in which the hospital is 29
located. 30
HOUSE BILL 810 17
(m) (1) Notwithstanding any other provision of this section, the Commission 1
shall consider the special needs and circumstances of a county where a medical service, as 2
defined in this section, does not exist; and 3
(2) The Commission shall consider and may approve under this 4
subsection a certificate of need application to establish, build, operate, or participate in a 5
health care project to provide a new medical service in a county if the Commission, in its 6
sole discretion, finds that: 7
(i) The proposed medical service does not exist in the county that 8
the project would be located; 9
(ii) The proposed medical service is necessary to meet the health 10
care needs of the residents of that county; 11
(iii) The proposed medical service would have a positive impact on 12
the existing health care system; 13
(iv) The proposed medical service would result in the delivery of 14
more efficient and effective health care services to the residents of that county; and 15
(v) The application meets any other standards or regulations 16
established by the Commission to approve applications under this subsection. 17
(n) [The Commission may not issue a certificate of need or a determination with 18
respect to an acquisition that authorizes a general hospice to provide home–based hospice 19
services on a statewide basis. 20
(o)] (1) Except as provided in paragraphs (2) and (3) of this subsection, a 21
person shall have a certificate of need issued by the Commission before a person 22
establishes or operates a freestanding medical facility. 23
(2) A certificate of need is not required for the establishment or operation 24
of a freestanding medical facility pilot project established under § 19–3A–07 of this title. 25
(3) (i) A certificate of need is not required to establish or operate a 26
freestanding medical facility if: 27
1. The freestanding medical facility is established as the 28
result of the conversion of a licensed general hospital; 29
2. Through the conversion, the licensed general hospital 30
will eliminate the capability of the hospital to admit or retain patients for overnight 31
hospitalization, except for observation stays; 32
18 HOUSE BILL 810
3. Except as provided in subparagraph (ii) of this 1
paragraph, the freestanding medical facility will remain on the site of, or on a site 2
adjacent to, the licensed general hospital; 3
4. At least 60 days before the conversion, written notice of 4
intent to convert the licensed general hospital to a freestanding medical facility is filed 5
with the Commission; 6
5. The Commission in its sole discretion finds that the 7
conversion: 8
A. Is consistent with the State health plan; 9
B. Will result in the delivery of more efficient and effective 10
health care services; 11
C. Will maintain adequate and appropriate delivery of 12
emergency care within the statewide emergency medical services system as determined 13
by the State Emergency Medical Services Board; and 14
D. Is in the public interest; and 15
6. Within 60 days after receiving notice under item 4 of this 16
subparagraph, the Commission notifies the licensed general hospital of the Commission’s 17
findings. 18
(ii) The Commission may approve a site for a freestanding medical 19
facility that is not on the site of, or on a site adjacent to, the licensed general hospital if: 20
1. The licensed general hospital is: 21
A. The only hospital in the county; or 22
B. One of two hospitals in the county that are part of the 23
same merged asset system, and are the only two hospitals in the county; and 24
2. The site is within a 5–mile radius and in the primary 25
service area of the licensed general hospital. 26
(iii) Notwithstanding subparagraph (i) of this paragraph, a licensed 27
general hospital located in Kent County may not convert to a freestanding medical facility 28
in accordance with subparagraph (i) of this paragraph before July 1, 2020. 29
19–906. 30
(a) To qualify for a license, an applicant and the hospice care program and its 31
medical director shall meet the requirements of this section. 32 HOUSE BILL 810 19
(b) An applicant who is an individual, and any individual who is applying on 1
behalf of a corporation, association, or government agency shall be: 2
(1) At least 18 years old; and 3
(2) Of reputable and responsible character. 4
(c) [(1) Except for a limited licensee, the applicant shall have a certificate of 5
need, as required under Subtitle 1 of this title, for the hospice care program to be 6
operated. 7
(2) The Secretary, in consultation with the Maryland Health Care 8
Commission, shall specify those jurisdictions in which a general hospice is authorized to 9
provide home–based hospice services. 10
(3) A general hospice may not be licensed to provide home–based hospice 11
services in a jurisdiction unless the general hospice or an entity acquired by the general 12
hospice provided home–based hospice services to a patient in the jurisdiction during the 13
12–month period ending December 31, 2001. 14
(4) Notwithstanding paragraph (3) of this subsection: 15
(i) A general hospice may provide home–based hospice services to 16
a specific patient outside of the jurisdictions in which the hospice is licensed if the 17
Maryland Health Care Commission approves the service provision; and 18
(ii) A general hospice that is a hospital–based hospice or that had 19
an affiliation agreement before April 5, 2003 with a health care facility or health care 20
system may serve patients immediately upon discharge from the hospital, health care 21
facility, or health care system, regardless of the jurisdiction in which the patient resides. 22
(5) Upon the notification by the Maryland Health Care Commission of the 23
issuance of a certificate of need to a general hospice, the Secretary shall append to the 24
general hospice license any additional jurisdictions in which the general hospice may 25
provide home–based hospice services. 26
(6)] The hospice care program to be operated and its medical director shall 27
meet the requirements that the Secretary adopts under this subtitle. 28
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 29
October 1, 2023. 30