Sec. 10.24.01.04. Exemption from Certificate of Need Review

A. Subject to the procedural requirements of this regulation, the Commission may exempt from the requirement of Certificate of Need review and approval the following actions proposed by a health care facility or merged asset system comprised of two or more health care facilities:

(1) Merger or consolidation of two or more hospitals or other health care facilities, if the facilities or an organization that operates the facilities give the Commission 45 days written notice of their intent to merge or consolidate;

(2) Relocation of an existing health care facility owned or controlled by a merged asset system, if:

(a) The relocation is to a site outside the primary service area of the health care facility to be relocated but within the primary service area of the merged asset system; and

(b) The relocation of the existing health care facility does not:

(i) Change the type or scope of health care services offered; and

(ii) Does not require a capital expenditure for its construction that exceeds the capital review threshold, adjusted for inflation, except as provided by Regulation .03I of this chapter;

(3) A change in the bed capacity of an existing health care facility pursuant to the consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a facility to a nonhealth-related use, except as provided in Regulation .03I of this chapter;

(4) A change in the type or scope of the health care services offered by a health care facility, if, at least 45 days before increasing or decreasing the volume of one or more health care services, the Commission in its sole discretion finds that the proposed change is pursuant to the:

(a) Consolidation or merger or two or more health care facilities;

(b) Conversion of all or part of a health care facility to a non-health-related use; or

(c) Conversion of a hospital to a limited service hospital;

(5) A capital expenditure that exceeds the review threshold for capital expenditure made as part of a consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a facility to a non-health-related use; or

(6) The closure of an acute general hospital or part of a hospital, in a jurisdiction with fewer than three acute general hospitals.

B. A complete notice of intent to seek exemption from Certificate of Need review shall be filed with the Commission at least 45 days before the intended action, and shall include:

(1) The name or names of each affected health care facility;

(2) The location of each health care facility;

(3) A general description of the proposed project including, in the case of mergers and consolidations, any proposed:

(a) Conversion, expansion, relocation, or reduction of one or more health care services;

(b) Renovation of existing facilities;

(c) New construction;

(d) Relocation or reconfiguration of existing medical services; or

(e) Change in bed capacity at each affected facility;

(4) The scheduled date of the project's completion;

(5) Identification of any outstanding public body obligation; and

(6) Information demonstrating that the project:

(a) Is consistent with the State Health Plan;

(b) Will result in more efficient and effective delivery of health care services; and

(c) Is in the public interest.

C. Notice by the Commission to the Public, Elected Officials, and Other State Agencies.

(1) Within 5 days after it receives a complete Notice of Intent from a health care facility seeking exemption from Certificate of Need review, the Commission shall publish notice of its receipt in:

(a) At least one newspaper of daily circulation in the affected area; and

(b) The next available issue of the Maryland Register.

(2) The Commission shall mail the same notice to elected public officials in whose district or jurisdiction the exemption from Certificate of Need review is proposed.

(3) The Commission shall solicit comment and relevant information from the affected public, in evaluating whether the action or project proposed for exemption from Certificate of Need review is in the public interest.

(4) If a hospital that intends to close or to convert to a limited service hospital has outstanding public body obligations issued on its behalf, written notification of intended closure or conversion shall be given to the Maryland Health and Higher Educational Facilities Authority and the Health Services Cost Review Commission by the:

(a) Commission, within 5 days after receiving a written notification by the hospital of intended closure or conversion, that it has received the hospital's notification and begun its review of the information provided pursuant to §B of this regulation;

(b) Hospital, within 10 days of filing with the Commission its written notification of intended closure or conversion, along with a written statement of any public body obligations issued on behalf of the hospital that provides the information required by Article 43C, §16A(g), Annotated Code of Maryland; and

(c) Commission, not later than 150 days before the scheduled date of the hospital's closure, that it has made the finding required by §E of this regulation.

D. Public Informational Hearing.

(1) Within 30 days of filing a notice of intent to seek exemption from Certificate of Need review, a public informational hearing shall be held in the jurisdiction where an acute general hospital or a State hospital is located that intends to:

(a) Close or partially close, if the hospital is located in a jurisdiction with fewer than three acute general hospitals; or

(b) Convert to a limited service hospital.

(2) Before holding the public informational hearing, the hospital shall consult with the Commission, to ensure that:

(a) Within 5 days of notifying the Commission of its intent to close, the hospital has provided public notice of the proposed closure and of the time and location of the required public informational hearing, including publication in at least one newspaper of daily circulation in the affected area; and

(b) Information will be presented at the public hearing regarding continued access to acute care or other services in the affected area, and plans of the hospital, or the merged asset system that owns or controls the hospital, for retraining and placement of displaced employees and reuse of the physical plant.

E. The Commission shall issue a determination of exemption from Certificate of Need review to the health care facility or the merged asset system seeking this determination within 45 days after it receives the notice of intent required by §B of this regulation, if:

(1) The facility or system has provided the information required by the notice of intent, and has held a public informational hearing if required by §D of this regulation; and

(2) The Commission, in its sole discretion, finds that the action proposed:

(a) Is in the public interest;

(b) Is not inconsistent with the State Health Plan or an institution-specific plan developed by the Commission under Health-General Article, §19-122, Annotated Code of Maryland; and

(c) Will result in more efficient and effective delivery of health care services.