Maryland 2023 Regular Session

Maryland House Bill HB810 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MATTER ADDE D TO EXISTING LAW .
4	4	[Brackets] indicate matter deleted from existing law.
5	5	hb0810
6	6
7	7	HOUSE BILL 810
8	8	J3 3lr1669
9	9
10	10	By: Delegates Ghrist, Grammer, and Schmidt
11	11	Introduced and read first time: February 8, 2023
12	12	Assigned to: Health and Government Operations
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Hospice Care Programs – Certificate of Need – Repeal 2
19	19
20	20	FOR the purpose of repealing the requirement that a hospice care program obtain a 3
21	21	certificate of need to build or expand a facility; and generally relating to certificates 4
22	22	of need and hospice care programs. 5
23	23
24	24	BY repealing and reenacting, with amendments, 6
25	25	Article – Health – General 7
26	26	Section 19–114, 19–120, and 19–906 8
27	27	Annotated Code of Maryland 9
28	28	(2019 Replacement Volume and 2022 Supplement) 10
29	29
30	30	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
31	31	That the Laws of Maryland read as follows: 12
32	32
33	33	Article – Health – General 13
34	34
35	35	19–114. 14
36	36
37	37	(a) In this Part II of this subtitle the following words have the meanings 15
38	38	indicated. 16
39	39
40	40	(b) “Ambulatory surgical facility” means any center, service, office, facility, or 17
41	41	office of one or more health care practitioners or a group practice that: 18
42	42
43	43	(1) Has three or more operating rooms; 19
44	44
45	45	(2) Operates primarily for the purpose of providing surgical services to 20
46	46	patients who do not require overnight hospitalization; and 21
47	47
48	48	(3) Seeks reimbursement from payors as an ambulatory surgical facility. 22 2 HOUSE BILL 810
49	49
50	50
51	51
52	52	(c) “Certificate of need” means a certification of public need issued by the 1
53	53	Commission under this Part II of this subtitle for a health care project. 2
54	54
55	55	(d) (1) “Health care facility” means: 3
56	56
57	57	(i) A hospital, as defined in § 19–301 of this title; 4
58	58
59	59	(ii) A limited service hospital, as defined in § 19–301 of this title; 5
60	60
61	61	(iii) A related institution, as defined in § 19–301 of this title; 6
62	62
63	63	(iv) An ambulatory surgical facility; 7
64	64
65	65	(v) An inpatient facility that is organized primarily to help in the 8
66	66	rehabilitation of disabled individuals, through an integrated program of medical and 9
67	67	other services provided under competent professional supervision; 10
68	68
69	69	(vi) A home health agency, as defined in § 19–401 of this title; 11
70	70
71	71	[(vii) A hospice, as defined in § 19–901 of this title; 12
72	72
73	73	(viii)] (VII) A freestanding medical facility, as defined in § 19–3A–01 13
74	74	of this title; and 14
75	75
76	76	[(ix)] (VIII) Any other health institution, service, or program for 15
77	77	which this Part II of this subtitle requires a certificate of need. 16
78	78
79	79	(2) “Health care facility” does not include: 17
80	80
81	81	(i) A hospital or related institution that is operated, or is listed and 18
82	82	certified, by the First Church of Christ Scientist, Boston, Massachusetts; 19
83	83
84	84	(ii) For the purpose of providing an exception to the requirement 20
85	85	for a certificate of need under § 19–120 of this subtitle, a facility to provide comprehensive 21
86	86	care constructed by a provider of continuing care, as defined in § 10–401 of the Human 22
87	87	Services Article, if: 23
88	88
89	89	1. Except as provided under § 19–123 of this subtitle, the 24
90	90	facility is for the exclusive use of the provider’s subscribers who have executed continuing 25
91	91	care agreements, including continuing care at home agreements, and paid entrance fees 26
92	92	that are at least equal to the lowest entrance fee charged for an independent living unit, 27
93	93	an assisted living unit, or a continuing care at home agreement before entering the 28
94	94	continuing care community, regardless of the level of care needed by the subscribers at 29
95	95	the time of admission; 30
96	96	HOUSE BILL 810 3
97	97
98	98
99	99	2. The facility is located on the campus of the continuing 1
100	100	care community; and 2
101	101
102	102	3. The number of comprehensive care nursing beds in the 3
103	103	community does not exceed: 4
104	104
105	105	A. 24 percent of the number of independent living units in a 5
106	106	community having less than 300 independent living units; or 6
107	107
108	108	B. 20 percent of the number of independent living units in a 7
109	109	community having 300 or more independent living units; 8
110	110
111	111	(iii) For the purpose of providing an exception to the requirement 9
112	112	for a certificate of need under § 19–120 of this subtitle, a facility to provide comprehensive 10
113	113	care that: 11
114	114
115	115	1. Is owned and operated by the Maryland Department of 12
116	116	Veterans Affairs; and 13
117	117
118	118	2. Restricts admissions to individuals who meet the 14
119	119	residency requirements established by the Maryland Department of Veterans Affairs and 15
120	120	are: 16
121	121
122	122	A. Veterans who were discharged or released from the 17
123	123	armed forces of the United States under honorable conditions; 18
124	124
125	125	B. Former members of a reserve component of the armed 19
126	126	forces of the United States; or 20
127	127
128	128	C. Nonveteran spouses of eligible veterans; 21
129	129
130	130	(iv) Except for a facility to provide kidney transplant services or 22
131	131	programs, a kidney disease treatment facility, as defined by rule or regulation of the 23
132	132	United States Department of Health and Human Services; 24
133	133
134	134	(v) Except for kidney transplant services or programs, the kidney 25
135	135	disease treatment stations and services provided by or on behalf of a hospital or related 26
136	136	institution; [or] 27
137	137
138	138	(vi) The office of one or more individuals licensed to practice 28
139	139	dentistry under Title 4 of the Health Occupations Article, for the purposes of practicing 29
140	140	dentistry; OR 30
141	141
142	142	(VII) A HOSPICE CARE PROGRAM . 31
143	143	4 HOUSE BILL 810
144	144
145	145
146	146	(e) “Health care practitioner” means any individual who is licensed, certified, or 1
147	147	otherwise authorized under the Health Occupations Article to provide health care 2
148	148	services. 3
149	149
150	150	(f) “Health service area” means an area of this State that the Governor 4
151	151	designates as appropriate for planning and developing of health services. 5
152	152
153	153	(g) “Local health planning agency” means the health department of a 6
154	154	jurisdiction or a body designated by the local health department to perform health 7
155	155	planning functions. 8
156	156
157	157	(h) “State health plan” means the State health plan for facilities and services. 9
158	158
159	159	19–120. 10
160	160
161	161	(a) (1) In this section the following words have the meanings indicated. 11
162	162
163	163	(2) “Consolidation” and “merger” include increases and decreases in bed 12
164	164	capacity or services among the components of an organization that: 13
165	165
166	166	(i) Operates more than one health care facility; or 14
167	167
168	168	(ii) Operates one or more health care facilities and holds an 15
169	169	outstanding certificate of need to construct a health care facility. 16
170	170
171	171	(3) (i) “Health care service” means any clinically related patient 17
172	172	service. 18
173	173
174	174	(ii) “Health care service” includes a medical service. 19
175	175
176	176	(4) “Hospital capital threshold” means the lesser of: 20
177	177
178	178	(i) 25% of the hospital’s gross regulated charges for the 21
179	179	immediately preceding year; or 22
180	180
181	181	(ii) $50,000,000. 23
182	182
183	183	(5) “Limited service hospital” means a health care facility that: 24
184	184
185	185	(i) Is licensed as a hospital on or after January 1, 1999; 25
186	186
187	187	(ii) Changes the type or scope of health care services offered by 26
188	188	eliminating the facility’s capability to admit or retain patients for overnight 27
189	189	hospitalization; 28
190	190
191	191	(iii) Retains an emergency or urgent care center; and 29
192	192	HOUSE BILL 810 5
193	193
194	194
195	195	(iv) Complies with the regulations adopted by the Secretary under § 1
196	196	19–307.1 of this title. 2
197	197
198	198	(6) “Medical service” means: 3
199	199
200	200	(i) Any of the following categories of health care services: 4
201	201
202	202	1. Medicine, surgery, gynecology, addictions; 5
203	203
204	204	2. Obstetrics; 6
205	205
206	206	3. Pediatrics; 7
207	207
208	208	4. Psychiatry; 8
209	209
210	210	5. Rehabilitation; 9
211	211
212	212	6. Chronic care; 10
213	213
214	214	7. Comprehensive care; 11
215	215
216	216	8. Extended care; 12
217	217
218	218	9. Intermediate care; or 13
219	219
220	220	10. Residential treatment; or 14
221	221
222	222	(ii) Any subcategory of the rehabilitation, psychiatry, 15
223	223	comprehensive care, or intermediate care categories of health care services for which need 16
224	224	is projected in the State health plan. 17
225	225
226	226	(b) The Commission may set an application fee for a certificate of need for 18
227	227	health care facilities not assessed a user fee under this subtitle. 19
228	228
229	229	(c) The Commission shall adopt rules and regulations for applying for and 20
230	230	issuing certificates of need. 21
231	231
232	232	(d) The Commission may adopt, after October 1, 1983, new thresholds or 22
233	233	methods for determining the circumstances or minimum cost requirements under which a 23
234	234	certificate of need application must be filed. 24
235	235
236	236	(e) (1) A person shall have a certificate of need issued by the Commission 25
237	237	before the person develops, operates, or participates in any of the health care projects for 26
238	238	which a certificate of need is required under this section. 27
239	239
240	240	(2) A certificate of need issued before January 13, 1987, may not be 28
241	241	rendered wholly or partially invalid solely because certain conditions have been imposed, 29 6 HOUSE BILL 810
242	242
243	243
244	244	if an appeal concerning the certificate of need, challenging the power of the Commission 1
245	245	to impose certain conditions on a certificate of need, has not been noted by an aggrieved 2
246	246	party before January 13, 1987. 3
247	247
248	248	(f) Except as provided in subsection (g)(2)(iii) of this section, a certificate of need 4
249	249	is required before a new health care facility is built, developed, or established. 5
250	250
251	251	(g) (1) A certificate of need is required before an existing or previously 6
252	252	approved, but unbuilt, health care facility is moved to another site. 7
253	253
254	254	(2) This subsection does not apply if: 8
255	255
256	256	(i) The Commission adopts limits for relocations and the proposed 9
257	257	relocation does not exceed those limits; 10
258	258
259	259	(ii) The relocation is the result of a partial or complete replacement 11
260	260	of an existing hospital or related institution, as defined in § 19–301 of this title, and the 12
261	261	relocation is to another part of the site or immediately adjacent to the site of the existing 13
262	262	hospital or related institution; 14
263	263
264	264	(iii) Subject to the provisions of subsections (i) and (j) of this section, 15
265	265	the relocation is of an existing health care facility owned or controlled by a merged asset 16
266	266	system and is to: 17
267	267
268	268	1. A site within the primary service area of the health care 18
269	269	facility to be relocated if: 19
270	270
271	271	A. The proposed relocation is not across county boundaries; 20
272	272	and 21
273	273
274	274	B. At least 45 days prior to the proposed relocation, notice is 22
275	275	filed with the Commission; 23
276	276
277	277	2. A site outside the primary service area of the health care 24
278	278	facility to be relocated but within the primary service area of the merged asset system if: 25
279	279
280	280	A. At least 45 days prior to the proposed relocation, notice is 26
281	281	filed with the Commission; and 27
282	282
283	283	B. The Commission in its sole discretion, and in accordance 28
284	284	with the criteria adopted by regulation, finds that the relocation is in the public interest, 29
285	285	is not inconsistent with the State health plan, and will result in the more efficient and 30
286	286	effective delivery of health care services; or 31
287	287
288	288	3. For a limited service hospital, a site within the 32
289	289	immediate area as defined in regulation by the Commission; or 33
290	290	HOUSE BILL 810 7
291	291
292	292
293	293	(iv) The relocation involves moving a portion of a complement of 1
294	294	comprehensive care beds previously approved by the Commission after January 1, 1995, 2
295	295	for use in a proposed new related institution, as defined in § 19–301 of this title, but 3
296	296	unbuilt on October 1, 1998, if: 4
297	297
298	298	1. The comprehensive care beds that were originally 5
299	299	approved by the Commission in a prior certificate of need review were approved for use in 6
300	300	a proposed new related institution to be located in a municipal corporation within Carroll 7
301	301	County in which a related institution is not located; 8
302	302
303	303	2. The comprehensive care beds being relocated will be used 9
304	304	to establish an additional new related institution that is located in another municipal 10
305	305	corporation within Carroll County in which a related institution is not located; 11
306	306
307	307	3. The comprehensive care beds not being relocated are 12
308	308	intended to be used to establish a related institution on the original site; and 13
309	309
310	310	4. Both the previously approved comprehensive care beds 14
311	311	for use on the original site and the relocated comprehensive care beds for use on the new 15
312	312	site will be used as components of single buildings on each site that also offer independent 16
313	313	or assisted living residential units. 17
314	314
315	315	(3) Notwithstanding any other provision of this subtitle, a certificate of 18
316	316	need is not required for a relocation described under paragraph (2)(iv) of this subsection. 19
317	317
318	318	(h) (1) A certificate of need is required before the bed capacity of a health 20
319	319	care facility is changed. 21
320	320
321	321	(2) This subsection does not apply to any increase or decrease in bed 22
322	322	capacity if: 23
323	323
324	324	(i) For a health care facility that is not a hospital, during a 2–year 24
325	325	period the increase or decrease would not exceed the lesser of 10 percent of the total bed 25
326	326	capacity or 10 beds; 26
327	327
328	328	(ii) 1. The increase or decrease would change the bed capacity 27
329	329	for an existing medical service; and 28
330	330
331	331	2. A. The change would not increase total bed capacity; 29
332	332
333	333	B. The change is maintained for at least a 1–year period; 30
334	334	and 31
335	335
336	336	C. At least 45 days prior to the change, the hospital provides 32
337	337	written notice to the Commission describing the change and providing an updated 33
338	338	inventory of the hospital’s licensed bed complement; 34
339	339	8 HOUSE BILL 810
340	340
341	341
342	342	(iii) 1. At least 45 days before increasing or decreasing bed 1
343	343	capacity, written notice of intent to change bed capacity is filed with the Commission; 2
344	344
345	345	2. The Commission in its sole discretion finds that the 3
346	346	proposed change: 4
347	347
348	348	A. Is pursuant to the consolidation or merger of two or more 5
349	349	health care facilities, or conversion of a health care facility or part of a facility to a 6
350	350	nonhealth–related use; 7
351	351
352	352	B. Is not inconsistent with the State health plan or the 8
353	353	institution–specific plan developed by the Commission; 9
354	354
355	355	C. Will result in the delivery of more efficient and effective 10
356	356	health care services; and 11
357	357
358	358	D. Is in the public interest; and 12
359	359
360	360	3. Within 45 days of receiving notice, the Commission 13
361	361	notifies the health care facility of its finding; 14
362	362
363	363	(iv) The increase or decrease in bed capacity is the result of the 15
364	364	annual licensed bed recalculation provided under § 19–307.2 of this title; or 16
365	365
366	366	(v) 1. The increase or decrease in bed capacity will occur in[: 17
367	367
368	368	A. An] AN intermediate care facility that offers residential 18
369	369	or intensive substance–related disorder treatment services and has a current license 19
370	370	issued by the Secretary[; or 20
371	371
372	372	B. An existing general hospice program that has a current 21
373	373	license issued by the Secretary]; and 22
374	374
375	375	2. At least 45 days before increasing or decreasing bed 23
376	376	capacity, written notice of the intent to change bed capacity is filed with the Commission. 24
377	377
378	378	(i) (1) Except as provided in paragraph (2) of this subsection, for a hospital 25
379	379	located in a county with three or more hospitals, a certificate of need is not required 26
380	380	before the bed capacity is increased or decreased if the change: 27
381	381
382	382	(i) Occurs on or after July 1, 2000; 28
383	383
384	384	(ii) Is between hospitals in a merged asset system located within 29
385	385	the same health service area; 30
386	386
387	387	(iii) Does not involve comprehensive or extended care beds; and 31
388	388	HOUSE BILL 810 9
389	389
390	390
391	391	(iv) Does not occur earlier than 45 days after a notice of intent to 1
392	392	reallocate bed capacity is filed with the Commission. 2
393	393
394	394	(2) A hospital may not create a new health care service through the 3
395	395	relocation of beds from one county to another county pursuant to this subsection. 4
396	396
397	397	(j) (1) A certificate of need is required before the type or scope of any health 5
398	398	care service is changed if the health care service: 6
399	399
400	400	(i) Is offered: 7
401	401
402	402	1. By a health care facility; 8
403	403
404	404	2. In space that is leased from a health care facility; or 9
405	405
406	406	3. In space that is on land leased from a health care facility; 10
407	407	or 11
408	408
409	409	(ii) Results in a change in operating room capacity in a hospital, a 12
410	410	freestanding medical facility, or an ambulatory surgical facility. 13
411	411
412	412	(2) This subsection does not apply if: 14
413	413
414	414	(i) The Commission adopts limits for changes in health care 15
415	415	services and the proposed change would not exceed those limits; 16
416	416
417	417	(ii) The proposed change and the annual operating revenue that 17
418	418	would result from the addition is entirely associated with the use of medical equipment; 18
419	419
420	420	(iii) The proposed change would establish, increase, or decrease a 19
421	421	health care service and the change would not result in the: 20
422	422
423	423	1. Establishment of a new medical service or elimination of 21
424	424	an existing medical service; 22
425	425
426	426	2. Establishment of a cardiac surgery, organ transplant 23
427	427	surgery, or burn or neonatal intensive health care service; 24
428	428
429	429	3. Except as provided in § 19–120.1 of this subtitle, 25
430	430	establishment of percutaneous coronary intervention services; 26
431	431
432	432	4. Establishment of a home health program [, hospice 27
433	433	program,] or freestanding ambulatory surgical center or facility; or 28
434	434
435	435	5. Expansion of a comprehensive care, extended care, 29
436	436	intermediate care, residential treatment, psychiatry, or rehabilitation medical service, 30 10 HOUSE BILL 810
437	437
438	438
439	439	except for an expansion related to an increase in total bed capacity in accordance with 1
440	440	subsection (h)(2)(i) of this section; or 2
441	441
442	442	(iv) 1. At least 45 days before increasing or decreasing the 3
443	443	volume of one or more health care services, written notice of intent to change the volume 4
444	444	of health care services is filed with the Commission; 5
445	445
446	446	2. The Commission in its sole discretion finds that the 6
447	447	proposed change: 7
448	448
449	449	A. Is pursuant to: 8
450	450
451	451	I. The consolidation or merger of two or more health care 9
452	452	facilities; 10
453	453
454	454	II. The conversion of a health care facility or part of a 11
455	455	facility to a nonhealth–related use; 12
456	456
457	457	III. The conversion of a hospital to a limited service hospital; 13
458	458	or 14
459	459
460	460	IV. The conversion of a licensed general hospital to a 15
461	461	freestanding medical facility in accordance with subsection [(o)(3)] (N)(3) of this section; 16
462	462
463	463	B. Is not inconsistent with the State health plan or the 17
464	464	institution–specific plan developed and adopted by the Commission; 18
465	465
466	466	C. Will result in the delivery of more efficient and effective 19
467	467	health care services; and 20
468	468
469	469	D. Is in the public interest; and 21
470	470
471	471	3. Within 45 days of receiving notice under item 1 of this 22
472	472	item, the Commission notifies the health care facility of its finding. 23
473	473
474	474	(3) Notwithstanding the provisions of paragraph (2) of this subsection, a 24
475	475	certificate of need is required: 25
476	476
477	477	(i) Before an additional home health agency, branch office, or home 26
478	478	health care service is established by an existing health care agency or facility; 27
479	479
480	480	(ii) Before an existing home health agency or health care facility 28
481	481	establishes a home health agency or home health care service at a location in the service 29
482	482	area not included under a previous certificate of need or license; 30
483	483
484	484	(iii) Before a transfer of ownership of any branch office of a home 31
485	485	health agency or home health care service of an existing health care facility that 32 HOUSE BILL 810 11
486	486
487	487
488	488	separates the ownership of the branch office from the home health agency or home health 1
489	489	care service of an existing health care facility which established the branch office; or 2
490	490
491	491	(iv) Before the expansion of a home health service or program by a 3
492	492	health care facility that: 4
493	493
494	494	1. Established the home health service or program without 5
495	495	a certificate of need between January 1, 1984 and July 1, 1984; and 6
496	496
497	497	2. During a 1–year period, the annual operating revenue of 7
498	498	the home health service or program would be greater than $333,000 after an annual 8
499	499	adjustment for inflation, based on an appropriate index specified by the Commission. 9
500	500
501	501	(k) (1) A certificate of need is required before any of the following capital 10
502	502	expenditures are made by or on behalf of a hospital: 11
503	503
504	504	(i) Any expenditure that, under generally accepted accounting 12
505	505	principles, is not properly chargeable as an operating or maintenance expense, if: 13
506	506
507	507	1. The expenditure is made as part of an acquisition, 14
508	508	improvement, or expansion, and, after adjustment for inflation as provided in the 15
509	509	regulations of the Commission, the total expenditure, including the cost of each study, 16
510	510	survey, design, plan, working drawing, specification, and other essential activity, is more 17
511	511	than the hospital capital threshold; 18
512	512
513	513	2. The expenditure is made as part of a replacement of any 19
514	514	plant and equipment of the hospital and is more than the hospital capital threshold after 20
515	515	adjustment for inflation as provided in the regulations of the Commission; 21
516	516
517	517	3. The expenditure results in a substantial change in the 22
518	518	bed capacity of the hospital; or 23
519	519
520	520	4. The expenditure results in the establishment of a new 24
521	521	medical service in a hospital that would require a certificate of need under subsection (i) 25
522	522	of this section; or 26
523	523
524	524	(ii) Any expenditure that is made to lease or, by comparable 27
525	525	arrangement, obtain any plant or equipment for the hospital, if: 28
526	526
527	527	1. The expenditure is made as part of an ac quisition, 29
528	528	improvement, or expansion, and the total expenditure, including the cost of each study, 30
529	529	survey, design, plan, working drawing, specification, and other essential activity, is more 31
530	530	than the hospital capital threshold; 32
531	531
532	532	2. The expenditure is made as part of a replacement of any 33
533	533	plant and equipment and is more than the hospital capital threshold after adjustment for 34
534	534	inflation as provided in the regulations of the Commission; 35 12 HOUSE BILL 810
535	535
536	536
537	537
538	538	3. The expenditure results in a substantial change in the 1
539	539	bed capacity of the hospital; or 2
540	540
541	541	4. The expenditure results in the establishment of a new 3
542	542	medical service in a hospital that would require a certificate of need under subsection (i) 4
543	543	of this section. 5
544	544
545	545	(2) A certificate of need is required before any of the following capital 6
546	546	expenditures are made by or on behalf of a health care facility other than a hospital: 7
547	547
548	548	(i) Any expenditure that, under generally accepted accounting 8
549	549	principles, is not properly chargeable as an operating or maintenance expense, if: 9
550	550
551	551	1. The expenditure results in a substantial change in the 10
552	552	bed capacity of the health care facility other than a hospital; or 11
553	553
554	554	2. The expenditure results in the establishment of a new 12
555	555	medical service in a health care facility other than a hospital that would require a 13
556	556	certificate of need under subsection (i) of this section; or 14
557	557
558	558	(ii) Any expenditure that is made to lease or, by comparable 15
559	559	arrangement, obtain any plant or equipment for the health care facility other than a 16
560	560	hospital, if: 17
561	561
562	562	1. The expenditure results in a substantial change in the 18
563	563	bed capacity of the health care facility other than a hospital; or 19
564	564
565	565	2. The expenditure results in the establishment of a new 20
566	566	medical service in a health care facility other than a hospital that would require a 21
567	567	certificate of need under subsection (i) of this section. 22
568	568
569	569	(3) A certificate of need is required before any equipment or plant is 23
570	570	donated to a health care facility, if a certificate of need would be required under 24
571	571	paragraph (1) or (2) of this subsection for an expenditure by the health care facility to 25
572	572	acquire the equipment or plant directly. 26
573	573
574	574	(4) A certificate of need is required before any equipment or plant is 27
575	575	transferred to a health care facility at less than fair market value if a certificate of need 28
576	576	would be required under paragraph (1) or (2) of this subsection for the transfer at fair 29
577	577	market value. 30
578	578
579	579	(5) A certificate of need is required before a person acquires a health care 31
580	580	facility if a certificate of need would be required under paragraph (1) or (2) of this 32
581	581	subsection for the acquisition by or on behalf of the health care facility. 33
582	582
583	583	(6) This subsection does not apply to: 34 HOUSE BILL 810 13
584	584
585	585
586	586
587	587	(i) Site acquisition; 1
588	588
589	589	(ii) Acquisition of a health care facility if, at least 30 days before 2
590	590	making the contractual arrangement to acquire the facility, written notice of the intent to 3
591	591	make the arrangement is filed with the Commission and the Commission does not find, 4
592	592	within 30 days after the Commission receives notice, that the health services or bed 5
593	593	capacity of the facility will be changed[, provided that, for a merger with or acquisition of 6
594	594	an existing general hospice, the purchaser of the general hospice may only acquire the 7
595	595	authority to provide home–based hospice services in jurisdictions in which the seller of 8
596	596	the general hospice is licensed to provide home–based hospice services]; 9
597	597
598	598	(iii) Acquisition of business or office equipment that is not directly 10
599	599	related to patient care; 11
600	600
601	601	(iv) Capital expenditures to the extent that they are directly related 12
602	602	to the acquisition and installation of major medical equipment; 13
603	603
604	604	(v) A capital expenditure made as part of a consolidation or merger 14
605	605	of two or more health care facilities, or conversion of a health care facility or part of a 15
606	606	facility to a nonhealth–related use if: 16
607	607
608	608	1. At least 45 days before an expenditure is made, written 17
609	609	notice of intent is filed with the Commission; 18
610	610
611	611	2. Within 45 days of receiving notice, the Commission in its 19
612	612	sole discretion finds that the proposed consolidation, merger, or conversion: 20
613	613
614	614	A. Is not inconsistent with the State health plan or the 21
615	615	institution–specific plan developed by the Commission as appropriate; 22
616	616
617	617	B. Will result in the delivery of more efficient and effective 23
618	618	health care services; and 24
619	619
620	620	C. Is in the public interest; and 25
621	621
622	622	3. Within 45 days of receiving notice, the Commission 26
623	623	notifies the health care facility of its finding; 27
624	624
625	625	(vi) A capital expenditure by a nursing home for equipment, 28
626	626	construction, or renovation that: 29
627	627
628	628	1. Is not directly related to patient care; and 30
629	629
630	630	2. Is not directly related to any change in patient charges or 31
631	631	other rates; 32
632	632	14 HOUSE BILL 810
633	633
634	634
635	635	(vii) A capital expenditure by a hospital, as defined in § 19–301 of 1
636	636	this title, for equipment, construction, or renovation that: 2
637	637
638	638	1. Is not directly related to patient care; and 3
639	639
640	640	2. Does not increase patient charges or hospital rates; 4
641	641
642	642	(viii) A capital expenditure by a hospital, as defined in § 19–301 of 5
643	643	this title, for a project in excess of the hospital capital threshold and is for construction or 6
644	644	renovation that: 7
645	645
646	646	1. May be related to patient care; 8
647	647
648	648	2. Does not require, over the entire period or schedule of 9
649	649	debt service associated with the project, a total cumulative increase in patient charges or 10
650	650	hospital rates of more than $1,500,000 for the capital costs associated with the project as 11
651	651	determined by the Commission, after consultation with the Health Services Cost Review 12
652	652	Commission; 13
653	653
654	654	3. At least 45 days before the proposed expenditure is made, 14
655	655	the hospital notifies the Commission; 15
656	656
657	657	4. A. Within 45 days of receipt of the relevant financial 16
658	658	information, the Commission makes the financial determination required under item 2 of 17
659	659	this item; or 18
660	660
661	661	B. The Commission has not made the financial 19
662	662	determination required under item 2 of this item within 60 days of the receipt of the 20
663	663	relevant financial information; and 21
664	664
665	665	5. The relevant financial information to be submitted by the 22
666	666	hospital is defined in regulations adopted by the Commission, after consultation with the 23
667	667	Health Services Cost Review Commission; 24
668	668
669	669	(ix) A plant donated to a hospital, as defined in § 19–301 of this 25
670	670	title, that does not require a cumulative increase in patient charges or hospital rates of 26
671	671	more than $1,500,000 for capital costs associated with the donated plant as determined 27
672	672	by the Commission, after consultation with the Health Services Cost Review Commission, 28
673	673	if: 29
674	674
675	675	1. At least 45 days before the proposed donation is made, 30
676	676	the hospital notifies the Commission; 31
677	677
678	678	2. A. Within 45 days of receipt of the relevant financial 32
679	679	information, the Commission makes the financial determination required under this item 33
680	680	(ix) of this paragraph; or 34
681	681	HOUSE BILL 810 15
682	682
683	683
684	684	B. The Commission has not made the financial 1
685	685	determination required under this item (ix) of this paragraph within 60 days of the 2
686	686	receipt of the relevant financial information; and 3
687	687
688	688	3. The relevant financial information to be submitted by the 4
689	689	hospital is defined in regulations adopted by the Commission after consultation with the 5
690	690	Health Services Cost Review Commission; or 6
691	691
692	692	(x) A capital expenditure made as part of a conversion of a licensed 7
693	693	general hospital to a freestanding medical facility in accordance with subsection [(o)(3)] 8
694	694	(N)(3) of this section. 9
695	695
696	696	(7) Paragraph (6)(vi), (vii), (viii), (ix), and (x) of this subsection may not be 10
697	697	construed to permit a facility to offer a new health care service for which a certificate of 11
698	698	need is otherwise required. 12
699	699
700	700	(l) (1) A certificate of need is not required to close any health care facility or 13
701	701	part of a health care facility if at least 90 days before the closing or if at least 45 days 14
702	702	before the partial closing of the health care facility, including a State hospital, a person 15
703	703	proposing to close all or part of the health care facility files notice of the proposed closing 16
704	704	or partial closing with the Commission. 17
705	705
706	706	(2) A hospital shall hold a public informational hearing in the county 18
707	707	where the hospital is located if the hospital: 19
708	708
709	709	(i) Files a notice of the proposed closing of the hospital with the 20
710	710	Commission; 21
711	711
712	712	(ii) Requests an exemption from the Commission under subsection 22
713	713	[(o)(3)] (N)(3) of this section to convert to a freestanding medical facility; or 23
714	714
715	715	(iii) Is located in a county with fewer than three hospitals and files 24
716	716	a notice of the partial closing of the hospital with the Commission. 25
717	717
718	718	(3) The Commission may require a health care facility other than a 26
719	719	hospital described in paragraph (2) of this subsection that files notice of its proposed 27
720	720	closing or partial closing to hold a public informational hearing in the county where the 28
721	721	health care facility is located. 29
722	722
723	723	(4) A public informational hearing required under paragraph (2) or (3) of 30
724	724	this subsection shall be held by the health care facility, in consultation with the 31
725	725	Commission, within 30 days after: 32
726	726
727	727	(i) The health care facility files with the Commission a notice of its 33
728	728	proposed closing or partial closing; or 34
729	729	16 HOUSE BILL 810
730	730
731	731
732	732	(ii) The hospital files with the Commission a notice of intent to 1
733	733	convert to a freestanding medical facility. 2
734	734
735	735	(5) (i) The Commission shall establish by regulation requirements for 3
736	736	a public informational hearing required under paragraph (2) or (3) of this subsection. 4
737	737
738	738	(ii) For a hospital proposing to close, partially close, or convert to a 5
739	739	freestanding medical facility, the regulations shall require the hospital to address: 6
740	740
741	741	1. The reasons for the closure, partial closure, or 7
742	742	conversion; 8
743	743
744	744	2. The plan for transitioning acute care services previously 9
745	745	provided by the hospital to residents of the hospital service area; 10
746	746
747	747	3. The plan for addressing the health care needs of the 11
748	748	residents of the hospital service area; 12
749	749
750	750	4. The plan for retraining and placing displaced employees; 13
751	751
752	752	5. The plan for the hospital’s physical plant and site; and 14
753	753
754	754	6. The proposed timeline for the closure, partial closure, or 15
755	755	conversion to a freestanding medical facility. 16
756	756
757	757	(6) Within 10 working days after a public informational hearing held by a 17
758	758	hospital under this subsection, the hospital shall provide a written summary of the 18
759	759	hearing to: 19
760	760
761	761	(i) The Governor; 20
762	762
763	763	(ii) The Secretary; 21
764	764
765	765	(iii) The governing body of the county in which the hospital is 22
766	766	located; 23
767	767
768	768	(iv) The local health department and the local board of health or 24
769	769	similar body for the county in which the hospital is located; 25
770	770
771	771	(v) The Commission; and 26
772	772
773	773	(vi) Subject to § 2–1257 of the State Government Article, the Senate 27
774	774	Finance Committee, the House Health and Government Operations Committee, and the 28
775	775	members of the General Assembly who represent the district in which the hospital is 29
776	776	located. 30
777	777	HOUSE BILL 810 17
778	778
779	779
780	780	(m) (1) Notwithstanding any other provision of this section, the Commission 1
781	781	shall consider the special needs and circumstances of a county where a medical service, as 2
782	782	defined in this section, does not exist; and 3
783	783
784	784	(2) The Commission shall consider and may approve under this 4
785	785	subsection a certificate of need application to establish, build, operate, or participate in a 5
786	786	health care project to provide a new medical service in a county if the Commission, in its 6
787	787	sole discretion, finds that: 7
788	788
789	789	(i) The proposed medical service does not exist in the county that 8
790	790	the project would be located; 9
791	791
792	792	(ii) The proposed medical service is necessary to meet the health 10
793	793	care needs of the residents of that county; 11
794	794
795	795	(iii) The proposed medical service would have a positive impact on 12
796	796	the existing health care system; 13
797	797
798	798	(iv) The proposed medical service would result in the delivery of 14
799	799	more efficient and effective health care services to the residents of that county; and 15
800	800
801	801	(v) The application meets any other standards or regulations 16
802	802	established by the Commission to approve applications under this subsection. 17
803	803
804	804	(n) [The Commission may not issue a certificate of need or a determination with 18
805	805	respect to an acquisition that authorizes a general hospice to provide home–based hospice 19
806	806	services on a statewide basis. 20
807	807
808	808	(o)] (1) Except as provided in paragraphs (2) and (3) of this subsection, a 21
809	809	person shall have a certificate of need issued by the Commission before a person 22
810	810	establishes or operates a freestanding medical facility. 23
811	811
812	812	(2) A certificate of need is not required for the establishment or operation 24
813	813	of a freestanding medical facility pilot project established under § 19–3A–07 of this title. 25
814	814
815	815	(3) (i) A certificate of need is not required to establish or operate a 26
816	816	freestanding medical facility if: 27
817	817
818	818	1. The freestanding medical facility is established as the 28
819	819	result of the conversion of a licensed general hospital; 29
820	820
821	821	2. Through the conversion, the licensed general hospital 30
822	822	will eliminate the capability of the hospital to admit or retain patients for overnight 31
823	823	hospitalization, except for observation stays; 32
824	824	18 HOUSE BILL 810
825	825
826	826
827	827	3. Except as provided in subparagraph (ii) of this 1
828	828	paragraph, the freestanding medical facility will remain on the site of, or on a site 2
829	829	adjacent to, the licensed general hospital; 3
830	830
831	831	4. At least 60 days before the conversion, written notice of 4
832	832	intent to convert the licensed general hospital to a freestanding medical facility is filed 5
833	833	with the Commission; 6
834	834
835	835	5. The Commission in its sole discretion finds that the 7
836	836	conversion: 8
837	837
838	838	A. Is consistent with the State health plan; 9
839	839
840	840	B. Will result in the delivery of more efficient and effective 10
841	841	health care services; 11
842	842
843	843	C. Will maintain adequate and appropriate delivery of 12
844	844	emergency care within the statewide emergency medical services system as determined 13
845	845	by the State Emergency Medical Services Board; and 14
846	846
847	847	D. Is in the public interest; and 15
848	848
849	849	6. Within 60 days after receiving notice under item 4 of this 16
850	850	subparagraph, the Commission notifies the licensed general hospital of the Commission’s 17
851	851	findings. 18
852	852
853	853	(ii) The Commission may approve a site for a freestanding medical 19
854	854	facility that is not on the site of, or on a site adjacent to, the licensed general hospital if: 20
855	855
856	856	1. The licensed general hospital is: 21
857	857
858	858	A. The only hospital in the county; or 22
859	859
860	860	B. One of two hospitals in the county that are part of the 23
861	861	same merged asset system, and are the only two hospitals in the county; and 24
862	862
863	863	2. The site is within a 5–mile radius and in the primary 25
864	864	service area of the licensed general hospital. 26
865	865
866	866	(iii) Notwithstanding subparagraph (i) of this paragraph, a licensed 27
867	867	general hospital located in Kent County may not convert to a freestanding medical facility 28
868	868	in accordance with subparagraph (i) of this paragraph before July 1, 2020. 29
869	869
870	870	19–906. 30
871	871
872	872	(a) To qualify for a license, an applicant and the hospice care program and its 31
873	873	medical director shall meet the requirements of this section. 32 HOUSE BILL 810 19
874	874
875	875
876	876
877	877	(b) An applicant who is an individual, and any individual who is applying on 1
878	878	behalf of a corporation, association, or government agency shall be: 2
879	879
880	880	(1) At least 18 years old; and 3
881	881
882	882	(2) Of reputable and responsible character. 4
883	883
884	884	(c) [(1) Except for a limited licensee, the applicant shall have a certificate of 5
885	885	need, as required under Subtitle 1 of this title, for the hospice care program to be 6
886	886	operated. 7
887	887
888	888	(2) The Secretary, in consultation with the Maryland Health Care 8
889	889	Commission, shall specify those jurisdictions in which a general hospice is authorized to 9
890	890	provide home–based hospice services. 10
891	891
892	892	(3) A general hospice may not be licensed to provide home–based hospice 11
893	893	services in a jurisdiction unless the general hospice or an entity acquired by the general 12
894	894	hospice provided home–based hospice services to a patient in the jurisdiction during the 13
895	895	12–month period ending December 31, 2001. 14
896	896
897	897	(4) Notwithstanding paragraph (3) of this subsection: 15
898	898
899	899	(i) A general hospice may provide home–based hospice services to 16
900	900	a specific patient outside of the jurisdictions in which the hospice is licensed if the 17
901	901	Maryland Health Care Commission approves the service provision; and 18
902	902
903	903	(ii) A general hospice that is a hospital–based hospice or that had 19
904	904	an affiliation agreement before April 5, 2003 with a health care facility or health care 20
905	905	system may serve patients immediately upon discharge from the hospital, health care 21
906	906	facility, or health care system, regardless of the jurisdiction in which the patient resides. 22
907	907
908	908	(5) Upon the notification by the Maryland Health Care Commission of the 23
909	909	issuance of a certificate of need to a general hospice, the Secretary shall append to the 24
910	910	general hospice license any additional jurisdictions in which the general hospice may 25
911	911	provide home–based hospice services. 26
912	912
913	913	(6)] The hospice care program to be operated and its medical director shall 27
914	914	meet the requirements that the Secretary adopts under this subtitle. 28
915	915
916	916	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 29
917	917	October 1, 2023. 30