Tennessee 2025-2026 Regular Session

Tennessee Senate Bill SB0853 Compare Versions

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

Old	New	Differences
1	1
2	2	HOUSE BILL 970
3	3	By Hawk
4	4
5	5	SENATE BILL 853
6	6	By Taylor
7	7
8	8
9	9	SB0853
10	10	001424
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13	13	AN ACT to amend Tennessee Code Annotated, Title 4;
14	14	Title 34; Title 42; Title 56; Title 63; Title 68; Title 71
15	15	and Chapter 985 of the Public Acts of 2024,
16	16	relative to certificates of need.
17	17
18	18	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
19	19	SECTION 1. Chapter 985 of the Public Acts of 2024, is amended by deleting
20	20	subdivisions (2)-(5) from Section 22, and by deleting Sections 1-10 and 12-17.
21	21	SECTION 2. Tennessee Code Annotated, Section 68-11-1601, is amended by deleting
22	22	the section and substituting:
23	23	This part is known and may be cited as the "Tennessee Healthcare Quality and
24	24	Access Act of 2025."
25	25	SECTION 3. Tennessee Code Annotated, Section 68-11-1602(10), is amended by
26	26	deleting the subdivision and substituting:
27	27	(10) "Healthcare institution" means an agency, institution, facility, or place,
28	28	whether publicly or privately owned or operated, that provides health services and that is
29	29	a nursing home;
30	30	SECTION 4. Tennessee Code Annotated, Section 68-11-1602(18)(B), is amended by
31	31	deleting the language "healthcare institution" and substituting "facility".
32	32	SECTION 5. Tennessee Code Annotated, Section 68-11-1607, is amended by deleting
33	33	the section and substituting:
34	34	(a) A person shall not perform the following actions in this state, except after
35	35	applying for and receiving a certificate of need for the action:
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40	40	(1) The construction, development, or other establishment of a type of
41	41	healthcare institution as described in this part;
42	42	(2) In the case of a healthcare institution, a change in the bed
43	43	complement, regardless of cost, that:
44	44	(A) Increases by one (1) or more the number of nursing home
45	45	beds;
46	46	(B) Redistributes beds from any category to acute, rehabilitation,
47	47	or long-term care, if at the time of redistribution, the healthcare institution
48	48	does not have beds licensed for the category to which the beds will be
49	49	redistributed; or
50	50	(C) Relocates beds to another facility or site;
51	51	(3)
52	52	(A) Except as provided in subdivision (a)(3)(D), a change in the
53	53	location of existing or certified facilities providing healthcare services and
54	54	healthcare institutions. However, the executive director may issue an
55	55	exemption for the relocation of existing healthcare institutions and
56	56	approved services if the executive director determines that:
57	57	(i) At least ninety-five percent (95%) of patients to be
58	58	served are reasonably expected to reside in the same zip codes
59	59	as the existing patient population;
60	60	(ii) The relocation will not reduce access to consumers,
61	61	particularly those in underserved communities; those who are
62	62	uninsured or underinsured; women and racial and ethnic
63	63	minorities; TennCare or medicaid recipients; and low-income
64	64	groups; and
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69	69	(iii) The payor mix will not include an increase in
70	70	commercial insurance;
71	71	(B) The executive director must notify the commission of an
72	72	exemption granted pursuant to subdivision (a)(3)(A) at the next regularly
73	73	scheduled commission meeting; and
74	74	(C) An exemption granted or denied by the executive director
75	75	pursuant to subdivision (a)(3)(A) is subject to commission review in the
76	76	same manner as described in § 68-11-277(g) and (h).
77	77	(b) An agency of this state, or of a county or municipal government, shall not
78	78	approve a grant of funds for, or issue a license to, a healthcare institution for a portion or
79	79	activity of the healthcare institution that is established, modified, relocated, changed, or
80	80	resumed, or that constitutes a covered healthcare service, in violation of this part. If an
81	81	agency of this state, or of a county or municipal government, approves a grant of funds
82	82	for, or issues a license to, a person or institution for which a certificate of need was
83	83	required but was not granted, then the license is void, and the person or institution shall
84	84	refund the funds to the state within ninety (90) days. The health facilities commission
85	85	has the authority to impose civil penalties and petition a circuit or chancery court having
86	86	jurisdiction to enjoin a person who is in violation of this part.
87	87	(c)
88	88	(1) For each application, a letter of intent must be filed between the first
89	89	day of the month and the fifteenth day of the month prior to the application's
90	90	submission. At the time of filing, the applicant shall cause the letter of intent to
91	91	be published in a newspaper of general circulation in the proposed service area
92	92	of the project. The published letter of intent must contain a statement that any:
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97	97	(A) Healthcare institution wishing to oppose the application must
98	98	file written notice with the commission no later than fifteen (15) days
99	99	before the commission meeting at which the application is originally
100	100	scheduled; and
101	101	(B) Other person wishing to oppose the application may file a
102	102	written objection with the commission at or prior to the consideration of
103	103	the application by the commission, or may appear in person to express
104	104	opposition.
105	105	(2) Persons desiring to file a certificate of need application seeking a
106	106	simultaneous review regarding a similar project for which a letter of intent has
107	107	been filed shall file with the commission a letter of intent between the sixteenth
108	108	day of the month and the last day of the month of publication of the first filed
109	109	letter of intent. A copy of a letter of intent filed after the first letter of intent must
110	110	be mailed or delivered to the first filed applicant and must be published in a
111	111	newspaper of general circulation in the proposed service area of the first filed
112	112	applicant. The health facilities commission shall consider and decide the
113	113	applications simultaneously. However, the commission may refuse to consider
114	114	the applications simultaneously if it finds that the applications do not meet the
115	115	requirements of "simultaneous review" under the rules of the commission.
116	116	(3) Applications for a certificate of need, including simultaneous review
117	117	applications, must be filed by the first business day of the month following the
118	118	date of publication of the letter of intent.
119	119	(4) If there are two (2) or more applications to be reviewed
120	120	simultaneously in accordance with this part and the rules of the commission, and
121	121	one (1) or more of those applications are not deemed complete by the deadline
122	122
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126	126	to be considered at the next commission meeting, then the other applications that
127	127	are deemed complete by the deadline must be considered at the next
128	128	commission meeting. The application or applications that are not deemed
129	129	complete by the deadline to be considered at the next commission meeting will
130	130	not be considered with the applications deemed complete by the deadline to be
131	131	considered at the next commission meeting.
132	132	(5) Review cycles begin on the fifteenth day of each month. Review
133	133	cycles are thirty (30) days. The first meeting at which an application can be
134	134	considered by the commission is the meeting following the application's review
135	135	cycle. If an application is not deemed complete within sixty (60) days after initial
136	136	written notification is given to the applicant by commission staff that the
137	137	application is deemed incomplete, then the application is void. If the applicant
138	138	decides to resubmit the application, then the applicant shall comply with all
139	139	procedures as set out by this part and pay a new filing fee when submitting the
140	140	application. Prior to deeming an application complete, the executive director
141	141	shall ensure independent review and verification of information submitted to the
142	142	commission in applications, presentations, or otherwise. The purpose of the
143	143	independent review and verification is to ensure that the information is accurate,
144	144	complete, comprehensive, timely, and relevant to the decision to be made by the
145	145	commission. The independent review and verification must be applied, but not
146	146	necessarily be limited, to applicant-provided information as to the number of
147	147	available beds within a region, occupancy rates, the number of individuals on
148	148	waiting lists, the demographics of a region, the number of procedures, and other
149	149	critical information submitted or requested concerning an application, and staff
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154	154	examinations of data sources, data input, data processing, and data output, and
155	155	verification of critical information.
156	156	(6) An application filed with the commission must be accompanied by a
157	157	nonrefundable examination fee fixed by the rules of the commission. The
158	158	examination fee may be applied to a second application for the same project if
159	159	the letter of intent for the first application is voided for non-compliance with law or
160	160	rule by the executive director, the commission, or a court. The second
161	161	application must be filed with the commission within ninety (90) days of the
162	162	voiding of the first letter of intent for the examination fee to be applied.
163	163	(7) Information provided in the application or information submitted to the
164	164	commission in support of an application must be true and correct. Substantive
165	165	amendments to the application, as defined by rule of the commission, are not
166	166	allowed.
167	167	(8) An applicant shall designate a representative as the contact person
168	168	for the applicant and shall notify the commission, in writing, of the contact
169	169	person's name, address, and telephone number. The applicant shall immediately
170	170	notify the commission in writing of a change in the identity or contact information
171	171	of the contact person. In addition to other methods of service permitted by law,
172	172	the commission may serve by registered or certified mail a notice or other legal
173	173	document upon the contact person at the person's last address of record in the
174	174	files of the commission. Notwithstanding a law to the contrary, service in the
175	175	manner specified in this subdivision (c)(8) constitutes actual service upon the
176	176	applicant.
177	177	(9)
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182	182	(A) If an application involves a healthcare facility in which a
183	183	county or municipality is the lessor of the facility or real property on which
184	184	it sits, then, within ten (10) days of filing the application, the applicant
185	185	shall notify the chief executive officer of the county or municipality of the
186	186	filing, by certified mail, return receipt requested.
187	187	(B) An application subject to the notification requirements of this
188	188	subdivision (c)(9) is not complete if the applicant has not provided proof of
189	189	compliance with this subdivision (c)(9) to the commission.
190	190	(d) Communications with the members of the commission are not permitted
191	191	once the letter of intent initiating the application process is filed with the commission.
192	192	Communication between commission members and commission staff is not prohibited.
193	193	Communication received by a commission member from a person unrelated to the
194	194	applicant or party opposing the application must be reported to the executive director,
195	195	and a written summary of the communication must be made part of the certificate of
196	196	need file.
197	197	(e) For purposes of this part, commission action is the same as administrative
198	198	action, as defined in § 3-6-301.
199	199	(f)
200	200	(1) Notwithstanding this section to the contrary, Tennessee state
201	201	veterans' homes under title 58, chapter 7, are not required to obtain a certificate
202	202	of need pursuant to this section.
203	203	(2) Notwithstanding this section to the contrary, the beds located in a
204	204	Tennessee state veterans' home pursuant to title 58, chapter 7, must not be
205	205	considered by the health facilities commission when granting a certificate of need
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210	210	to a healthcare institution due to a change in the number of licensed beds,
211	211	redistribution of beds, or relocation of beds pursuant to this section.
212	212	(g) After a person holding a certificate of need has completed the actions for
213	213	which the certificate of need was granted, the time to complete activities authorized by
214	214	the certificate of need expires.
215	215	(h)
216	216	(1) Notwithstanding subdivision (a)(2)(A) or (a)(3), a nursing home may
217	217	increase its total number of licensed beds by the lesser of ten (10) beds or ten
218	218	percent (10%) of its licensed capacity no more frequently than one (1) time every
219	219	three (3) years without obtaining a certificate of need. The nursing home shall
220	220	provide written notice of the increase in beds to the commission on forms
221	221	provided by the commission prior to the request for licensing by the board for
222	222	licensing healthcare facilities.
223	223	(2) For new nursing homes, the ten-bed or ten-percent increase cannot
224	224	be requested until one (1) year after the date all of the new beds were initially
225	225	licensed.
226	226	(3) When determining projected county nursing home bed need for
227	227	certificate of need applications, all notices filed with the commission pursuant to
228	228	subdivision (h)(1) must be considered with the total of licensed nursing home
229	229	beds, plus the number of beds from approved certificates of need, but yet
230	230	unlicensed.
231	231	(i)
232	232	(1) This part does not require a certificate of need for actions in a county
233	233	that:
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238	238	(A) Is designated as an economically distressed eligible county by
239	239	the department of economic and community development pursuant to §
240	240	67-6-104, as updated annually; and
241	241	(B) Has no hospital that is actively licensed under this title located
242	242	within the county.
243	243	(2) A person that establishes a healthcare institution shall submit proof of
244	244	accreditation by an appropriate external peer-review organization for the service
245	245	or facility to the commission within two (2) years of the date of licensure of the
246	246	healthcare institution.
247	247	(j) No later than July 1, 2023, the commission shall implement and make
248	248	available for use by applicants an electronic certificate of need application system.
249	249	SECTION 6. Tennessee Code Annotated, Section 68-11-1609(c), is amended by
250	250	deleting the first sentence and substituting:
251	251	Activity authorized by a certificate of need must be completed within a period not
252	252	to exceed three (3) years for nursing home projects from the date of its issuance, and
253	253	after such time the certificate of need authorization expires.
254	254	SECTION 7. Tennessee Code Annotated, Section 68-11-1609(h), is amended by
255	255	deleting the language "The commission shall maintain" and substituting "Except as provided in
256	256	subdivision (h)(2), the commission shall maintain", designating the existing language as
257	257	subdivision (h)(1), and adding the following as subdivision (h)(2):
258	258	(2) On and after June 30, 2025, the commission shall only maintain continuing
259	259	oversight over a certificate of need issued to or approved for a healthcare institution as
260	260	that term is defined on June 30, 2025.
261	261	SECTION 8. Tennessee Code Annotated, Section 68-11-1609(i)(1)(B), is amended by
262	262	deleting the subdivision.
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267	267	SECTION 9. Tennessee Code Annotated, Section 68-11-1626, is amended by deleting
268	268	the section and substituting:
269	269	(a) The commission may renew a license for a hospital upon application by the
270	270	party seeking to establish the hospital and finding that the hospital will operate in a
271	271	manner that is substantially similar to the manner authorized under the previous
272	272	hospital's license at the time of the previous hospital's closure, if:
273	273	(1) The hospital was previously licensed under this title or another
274	274	hospital was previously licensed under this title at the proposed location;
275	275	(2) The hospital is located in a county:
276	276	(A) Designated by the commission of economic and community
277	277	development as a tier 2, tier 3, or tier 4 enhancement county pursuant to
278	278	§ 67-4-2109; or
279	279	(B) With a population less than forty-nine thousand (49,000),
280	280	according to the 2010 federal census or a subsequent census;
281	281	(3) The last date of operations at the hospital, the hospital site service
282	282	area, or proposed hospital site service area was no more than fifteen (15) years
283	283	prior to the date on which the party seeking to establish the hospital submits
284	284	information to the commission pursuant to subsection (b); and
285	285	(4) The party seeking to establish the hospital applies for a certificate of
286	286	need from the agency within twelve (12) months of the date on which the party
287	287	submits information to the commission pursuant to this section.
288	288	(b) The commission shall review and make a determination on an application
289	289	submitted pursuant to subsection (a) and notify the applicant in writing of the
290	290	determination within sixty (60) days of the date the applicant submits a completed
291	291	application to the commission. If the commission's determination is to deny the
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296	296	application, then the commission must also provide to the applicant a written explanation
297	297	detailing the reasons for the denial.
298	298	SECTION 10. Tennessee Code Annotated, Title 68, Chapter 11, Part 16, is amended
299	299	by adding the following as a new section:
300	300	This part does not apply to an entity that, on or after June 30, 2025, is not a
301	301	healthcare institution as defined in this part.
302	302	SECTION 11. Tennessee Code Annotated, Section 34-6-201(4), is amended by
303	303	deleting the subdivision and substituting:
304	304	(4) "Health care institution" means a facility as defined in § 68-11-201;
305	305	SECTION 12. Tennessee Code Annotated, Section 42-8-101(1), is amended by
306	306	deleting the language "health care institution as defined in § 68-11-1602" and substituting
307	307	"facility as defined in § 68-11-201".
308	308	SECTION 13. Tennessee Code Annotated, Section 63-6-204(l)(1)(A)(iii), is amended by
309	309	deleting the subdivision.
310	310	SECTION 14. Tennessee Code Annotated, Section 63-6-601(2), is amended by
311	311	deleting the subdivision and substituting:
312	312	(2) "Health care facility" means and includes any real property or equipment of a
313	313	facility as that term is defined in § 68-11-201; and
314	314	SECTION 15. Tennessee Code Annotated, Section 68-11-201(40)(A), is amended by
315	315	deleting the language "and for which a certificate of need is required by this chapter".
316	316	SECTION 16. Tennessee Code Annotated, Section 68-11-202(e)(1)(A), is amended by
317	317	deleting the language "pursuant to its certificate of need authority or".
318	318	SECTION 17. Tennessee Code Annotated, Section 68-11-202(e)(1)(B), is amended by
319	319	deleting the language "its certificate of need or".
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323	323
324	324	SECTION 18. Tennessee Code Annotated, Section 68-11-205(g)(1)(A)(iii), is amended
325	325	by deleting the subdivision.
326	326	SECTION 19. Tennessee Code Annotated, Section 68-11-206(c), is amended by
327	327	deleting the subsection.
328	328	SECTION 20. Tennessee Code Annotated, Section 68-11-277(c)(7), is amended by
329	329	deleting the language "§ 68-11-1607(a)(4)" and substituting "§ 68-11-1607(a)(3)".
330	330	SECTION 21. Tennessee Code Annotated, Section 68-11-1802(a)(8), is amended by
331	331	deleting the subdivision and substituting:
332	332	(8) "Health care institution" means a facility as defined in § 68-11-201;
333	333	SECTION 22. Section 1 of this act takes effect upon becoming a law, the public welfare
334	334	requiring it. The remainder of this act takes effect June 30, 2025, the public welfare requiring it.