BILLASPASSEDBYTHEHOUSE H.96
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H.96
IntroducedbyRepresentativesCordesofBristol,ArsenaultofWilliston,
BerbecoofWinooski,BlackofEssex,ChapinofEast
Montpelier,CinaofBurlington,GoldmanofRockingham,
HarrisonofChittenden,LoganofBurlington,Marcotteof
Coventry,McFaunofBarreTown,OlsonofStarksboro,Pageof
NewportCity,andPriestleyofBradford
ReferredtoCommitteeon
Date:
Subject:Health;healthcarefacilities;GreenMountainCareBoard;certificates
ofneed
Statementofpurposeofbillasintroduced:Thisbillproposestoincreasethe
monetarythresholdsthattriggeracertificateofneedrequirementandto
exempthealthcareservicesandhealthcarefacilityprojectsthataretheresult
ofacontractawardedbytheStateofVermont.
Anactrelatingtoincreasingthemonetarythresholdsforcertificatesofneed
ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
Sec.1.18V.S.A.§ 9434isamendedtoread:
§9434.CERTIFICATEOFNEED;GENERALRULES
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(a)Ahealthcarefacilityotherthanahospitalshallnotdeveloporhave
developedonitsbehalfanewhealthcareprojectwithoutissuanceofa
certificateofneedbytheBoard.Forpurposesofthissubsection,a“new
healthcareproject”includesthefollowing:
(1)Theconstruction,development,purchase,renovation,orother
establishmentofahealthcarefacility,oranycapitalexpenditurebyoron
behalfofahealthcarefacility,forwhichthecapitalcostexceeds
$1,500,000.00$10,000,000.00.
(2)Achangefromonelicensingperiodtothenextinthenumberof
licensedbedsofahealthcarefacilitythroughadditionorconversion,or
throughrelocationfromonephysicalfacilityorsitetoanother.
(3)Theofferingofanyhomehealthservice,orthetransferor
conveyanceofmorethana50percentownershipinterestinahealthcare
facilityotherthanahospitalornursinghome.
(4)Thepurchase,lease,orothercomparablearrangementofasingle
pieceofdiagnosticandtherapeuticequipmentforwhichthecost,orinthecase
ofadonationthevalue,isinexcessof$1,000,000.00$10,000,000.00.For
purposesofthissubdivision,thepurchaseorleaseofoneormorearticlesof
diagnosticortherapeuticequipmentthatarenecessarilyinterdependentinthe
performanceoftheirordinaryfunctionsorthatwouldconstituteanyhealth
carefacilityincludedundersubdivision9432(8)(B)ofthistitle,asdetermined
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bytheBoard,shallbeconsideredtogetherincalculatingtheamountofan
expenditure.TheBoard’sdeterminationoffunctionalinterdependenceof
itemsofequipmentunderthissubdivisionshallhavetheeffectofafinal
decisionandissubjecttoappealundersection9381ofthistitle.
(5)Theofferingofahealthcareserviceortechnologyhavinganannual
operatingexpensethatexceeds$500,000.00$10,000,000.00foreitherofthe
nexttwobudgetedfiscalyears,iftheserviceortechnologywasnotofferedor
employed,eitheronafixedoramobilebasis,bythehealthcarefacilitywithin
thepreviousthreefiscalyears.
(6)Theconstruction,development,purchase,lease,orother
establishmentorexpansionofanambulatorysurgicalcenterforwhichthecost
exceeds$10,000,000.00.
(b)Ahospitalshallnotdeveloporhavedevelopedonitsbehalfanew
healthcareprojectwithoutissuanceofacertificateofneedbytheBoard.For
purposesofthissubsection,a“newhealthcareproject”includesthefollowing:
(1)Theconstruction,development,purchase,renovation,orother
establishmentofahealthcarefacility,oranycapitalexpenditurebyoron
behalfofahospital,forwhichthecapitalcostexceeds$3,000,000.00
$10,000,000.00.
(2)Thepurchase,lease,orothercomparablearrangementofasingle
pieceofdiagnosticandtherapeuticequipmentforwhichthecost,orinthecase
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ofadonationthevalue,isinexcessof$1,500,000.00$10,000,000.00.For
purposesofthissubdivision,thepurchaseorleaseofoneormorearticlesof
diagnosticortherapeuticequipmentthatarenecessarilyinterdependentinthe
performanceoftheirordinaryfunctionsorthatwouldconstituteanyhealth
carefacilityincludedundersubdivision9432(8)(B)ofthistitle,asdetermined
bytheBoard,shallbeconsideredtogetherincalculatingtheamountofan
expenditure.TheBoard’sdeterminationoffunctionalinterdependenceof
itemsofequipmentunderthissubdivisionshallhavetheeffectofafinal
decisionandissubjecttoappealundersection9381ofthistitle.
(3)Theofferingofahealthcareserviceortechnologyhavinganannual
operatingexpensethatexceeds$1,000,000.00$10,000,000.00foreitherofthe
nexttwobudgetedfiscalyears,iftheserviceortechnologywasnotofferedor
employed,eitheronafixedoramobilebasis,bythehospitalwithinthe
previousthreefiscalyears.
(4)Achangefromonelicensingperiodtothenextinthenumberof
licensedbedsofahealthcarefacilitythroughadditionorconversion,or
throughrelocationfromonephysicalfacilityorsitetoanother.
(5)Theofferingofanyhomehealthservice.
(c)Inthecaseofaprojectthatrequiresacertificateofneedunderthis
section,expendituresforwhichareanticipatedtobeinexcessof
$30,000,000.00$50,000,000.00,theapplicantfirstshallsecureaconceptual
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developmentphasecertificateofneed,inaccordancewiththestandardsand
proceduresestablishedinthissubchapter,thatpermitstheapplicanttomake
expendituresforarchitecturalservices,engineeringdesignservices,orany
otherplanningservices,asdefinedbytheBoard,neededinconnectionwith
theproject.Uponcompletionoftheconceptualdevelopmentphaseofthe
project,andbeforeofferingorfurtherdevelopingtheproject,theapplicant
shallsecureafinalcertificateofneedinaccordancewiththestandardsand
proceduresestablishedinthissubchapter.Applicantsshallnotbesubjectto
sanctionsforfailuretocomplywiththeprovisionsofthissubsectionifsuch
failureissolelytheresultofgoodfaithrelianceonverifiedprojectcost
estimatesissuedbyqualifiedpersons,whichcostestimateswouldhaveleda
reasonablepersontoconcludetheprojectwasnotanticipatedtobeinexcessof
$30,000,000.00$50,000,000.00andthereforenotsubjecttothissubsection.
Theprovisionsofthissubsectionnotwithstanding,expendituresmaybemade
inpreparationforobtainingaconceptualdevelopmentphasecertificateof
need,whichexpendituresshallnotexceed$1,500,000.00fornon-hospitalsor
$3,000,000.00forhospitals$10,000,000.00.
(d)IftheBoarddeterminesthatapersonrequiredtoobtainacertificateof
needunderthissubchapterhasseparatedasingleprojectintocomponentsin
ordertoavoidcostthresholdsorotherrequirementsunderthissubchapter,the
personshallberequiredtosubmitanapplicationforacertificateofneedfor
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theentireproject,andtheBoardmayproceedundersection9445ofthistitle.
TheBoard’sdeterminationunderthissubsectionshallhavetheeffectofafinal
decisionandissubjecttoappealundersection9381ofthistitle.
(e)TheBoardmayperiodicallyadjustthemonetaryjurisdictional
thresholdscontainedinthissection.Indoingso,theBoardshallreflectthe
samecategoriesofhealthcarefacilities,services,andprogramsrecognizedin
thissection.AnyadjustmentbytheBoardshallnotexceedanamount
calculatedusingthecumulativeConsumerPriceIndexrateofinflation.
Sec.2.18V.S.A.§ 9435isamendedtoread:
§9435.EXCLUSIONS
***
(i)Excludedfromthissubchapteraretheofferingofahealthcareservice,
ortheconstruction,development,purchase,renovation,orotherestablishment
ofahealthcarefacility,astheresultofacontractawardedbytheStateof
Vermont.
Sec.3.EFFECTIVEDATE
ThisactshalltakeeffectonJuly1,2025.
Sec.1.18V.S.A.§ 9434isamendedtoread:
§9434.CERTIFICATEOFNEED;GENERALRULES
(a)Ahealthcarefacilityotherthanahospitalshallnotdeveloporhave
developedonitsbehalfanewhealthcareprojectwithoutissuanceofa
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certificateofneedbytheBoard.Forpurposesofthissubsection,a“new
healthcareproject”includesmeansanyofthefollowing:
(1)Theconstruction,development,purchase,renovation,orother
establishmentofahealthcarefacility,oranycapitalexpenditurebyoron
behalfofahealthcarefacility,forwhichthecapitalcostexceeds
$1,500,000.00$10,000,000.00.
(2)Achangefromonelicensingperiodtothenextinthenumberof
licensedbedsofahealthcarefacilitythroughadditionorconversion,or
throughrelocationfromonephysicalfacilityorsitetoanother.
(3)Theofferingofanyhomehealthservice,orthetransferor
conveyanceofmorethana50percentownershipinterestinahealthcare
facilityotherthanahospitalornursinghome.
(4)Thepurchase,lease,orothercomparablearrangementofasingle
pieceofdiagnosticandtherapeuticequipmentforwhichthecost,orinthe
caseofadonationthevalue,isinexcessof$1,000,000.00$5,000,000.00.For
purposesofthissubdivision,thepurchaseorleaseofoneormorearticlesof
diagnosticortherapeuticequipmentthatarenecessarilyinterdependentinthe
performanceoftheirordinaryfunctionsorthatwouldconstituteanyhealth
carefacilityincludedundersubdivision9432(8)(B)ofthistitle,asdetermined
bytheBoard,shallbeconsideredtogetherincalculatingtheamountofan
expenditure.TheBoard’sdeterminationoffunctionalinterdependenceofitems BILLASPASSEDBYTHEHOUSE H.96
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ofequipmentunderthissubdivisionshallhavetheeffectofafinaldecisionand
issubjecttoappealundersection9381ofthistitle.
(5)Theofferingofahealthcareserviceortechnologyhavinganannual
operatingexpensethatexceeds$500,000.00$3,000,000.00foreitherofthe
nexttwobudgetedfiscalyears,iftheserviceortechnologywasnotofferedor
employed,eitheronafixedoramobilebasis,bythehealthcarefacilitywithin
thepreviousthreefiscalyears.
(6)Theconstruction,development,purchase,lease,orother
establishmentorexpansionofanambulatorysurgicalcenterforwhichthecost
exceeds$10,000,000.00.
(b)Ahospitalshallnotdeveloporhavedevelopedonitsbehalfanew
healthcareprojectwithoutissuanceofacertificateofneedbytheBoard.For
purposesofthissubsection,a“newhealthcareproject”includesmeansanyof
thefollowing:
(1)Theconstruction,development,purchase,renovation,orother
establishmentofahealthcarefacility,oranycapitalexpenditurebyoron
behalfofahospital,forwhichthecapitalcostexceeds$3,000,000.00
$10,000,000.00.
(2)Thepurchase,lease,orothercomparablearrangementofasingle
pieceofdiagnosticandtherapeuticequipmentforwhichthecost,orinthe
caseofadonationthevalue,isinexcessof$1,500,000.00$5,000,000.00.For BILLASPASSEDBYTHEHOUSE H.96
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purposesofthissubdivision,thepurchaseorleaseofoneormorearticlesof
diagnosticortherapeuticequipmentthatarenecessarilyinterdependentinthe
performanceoftheirordinaryfunctionsorthatwouldconstituteanyhealth
carefacilityincludedundersubdivision9432(8)(B)ofthistitle,asdetermined
bytheBoard,shallbeconsideredtogetherincalculatingtheamountofan
expenditure.TheBoard’sdeterminationoffunctionalinterdependenceofitems
ofequipmentunderthissubdivisionshallhavetheeffectofafinaldecisionand
issubjecttoappealundersection9381ofthistitle.
(3)Theofferingofahealthcareserviceortechnologyhavinganannual
operatingexpensethatexceeds$1,000,000.00$3,000,000.00foreitherofthe
nexttwobudgetedfiscalyears,iftheserviceortechnologywasnotofferedor
employed,eitheronafixedoramobilebasis,bythehospitalwithinthe
previousthreefiscalyears.
(4)Achangefromonelicensingperiodtothenextinthenumberof
licensedbedsofahealthcarefacilitythroughadditionorconversion,or
throughrelocationfromonephysicalfacilityorsitetoanother.
(5)Theofferingofanyhomehealthservice.
(c)Inthecaseofaprojectthatrequiresacertificateofneedunderthis
section,expendituresforwhichareanticipatedtobeinexcessof
$30,000,000.00$50,000,000.00,theapplicantfirstshallsecureaconceptual
developmentphasecertificateofneed,inaccordancewiththestandardsand BILLASPASSEDBYTHEHOUSE H.96
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proceduresestablishedinthissubchapter,thatpermitstheapplicanttomake
expendituresforarchitecturalservices,engineeringdesignservices,orany
otherplanningservices,asdefinedbytheBoard,neededinconnectionwith
theproject.Uponcompletionoftheconceptualdevelopmentphaseofthe
project,andbeforeofferingorfurtherdevelopingtheproject,theapplicant
shallsecureafinalcertificateofneedinaccordancewiththestandardsand
proceduresestablishedinthissubchapter.Applicantsshallnotbesubjectto
sanctionsforfailuretocomplywiththeprovisionsofthissubsectionifsuch
failureissolelytheresultofgoodfaithrelianceonverifiedprojectcost
estimatesissuedbyqualifiedpersons,whichcostestimateswouldhaveleda
reasonablepersontoconcludetheprojectwasnotanticipatedtobeinexcess
of$30,000,000.00$50,000,000.00andthereforenotsubjecttothissubsection.
Theprovisionsofthissubsectionnotwithstanding,expendituresmaybemade
inpreparationforobtainingaconceptualdevelopmentphasecertificateof
need,whichexpendituresshallnotexceed$1,500,000.00fornon-hospitalsor
$3,000,000.00forhospitals$10,000,000.00.
(d)IftheBoarddeterminesthatapersonrequiredtoobtainacertificateof
needunderthissubchapterhasseparatedasingleprojectintocomponentsin
ordertoavoidcostthresholdsorotherrequirementsunderthissubchapter,the
personshallberequiredtosubmitanapplicationforacertificateofneedfor
theentireproject,andtheBoardmayproceedundersection9445ofthistitle. BILLASPASSEDBYTHEHOUSE H.96
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TheBoard’sdeterminationunderthissubsectionshallhavetheeffectofafinal
decisionandissubjecttoappealundersection9381ofthistitle.
(e)TheBoardmayperiodicallyadjustthemonetaryjurisdictional
thresholdscontainedinthissection.Indoingso,theBoardshallreflectthe
samecategoriesofhealthcarefacilities,services,andprogramsrecognizedin
thissection.AnyadjustmentbytheBoardshallnotexceedanamount
calculatedusingthecumulativeConsumerPriceIndexrateofinflation.
Sec.2.18V.S.A.§ 9435isamendedtoread:
§9435.EXCLUSIONS
***
(f)(1)Excludedfromthissubchapterareroutinereplacementsof:
(A)medicalequipmentthatisfullydepreciated;and
(B)nonmedicalequipmentandfixtures,includingfurnaces,boilers,
refrigerationunits,kitchenequipment,heatingandcoolingunits,andsimilar
items,regardlessoftheirremainingusefullife.
(2)TheseThereplacementsdescribedinsubdivision(1)ofthis
subsectionandpurchasedbyahospitalshallbeincludedinthehospital’s
budgetandmaybereviewedinthebudgetprocesssetforthinsubchapter7of
thischapter.
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(i)Excludedfromthissubchapterareemergencyandnonemergency
groundambulanceservices,affiliatedagencies,andequipmentandsupplies
usedbyemergencymedicalpersonnel,asthosetermsaredefinedin24V.S.A.
§ 2651.
Sec.3.EFFECTIVEDATE
ThisactshalltakeeffectonJuly1,2025andshallapplytoallnewhealth
careprojectsinitiatedonorafterthatdate.Forapplicationsforacertificate
ofneedthatarealreadyinprocessonJuly1,2025forwhichoneormore
personshavebeengrantedinterestedpartystatus,thejurisdictionalthresholds
andexclusionsinplaceatthetimetheapplicationwasfiledshallcontinueto
applyuntilafinaldecisionismadeontheapplication.Forapplicationsfora
certificateofneedthatarealreadyinprocessonJuly1,2025forwhichno
personhasbeengrantedinterestedpartystatus,theapplicantmaywithdraw
theapplicationinaccordancewithBoardrules.