Amendment #8 to H4643

Certain Projects Qualifying for Exemption from Determination of Need

Mr. Pignatelli of Lenox moves to amend the amendment by inserting after section 113 the following section:

"SECTION XXXX. Section 25C1/2 of said chapter 111, is hereby amended by deleting the clause “of projects related to inpatient services” from the title and replacing it with the clause “of certain projects,” as follows:

“Exemption from determination of need of certain projects”

and by adding a new subsection following section (c) as follows:

“(d) Notwithstanding the provisions of section twenty-five C, no determination of need shall be required for the following:

(i) For critical access hospitals: any substantial capital expenditure for construction related to the provision of inpatient or outpatient services, or for any substantial change in such inpatient or outpatient services;

(ii) For critical access hospitals, and for federally designated rural hospitals and federally designated sole community hospitals, provided any such hospital does not have Baseline Imaging Capability defined as one magnetic resonance imaging unit and two computed tomography scanners: the acquisition of such number of the aforementioned imaging units so as to enable any such hospital to have Baseline Imaging Capability;

(iii) For federally designated rural hospital and federally designated sole community hospitals: a Replacement project of a Health Care Facility or service or component thereof if the project will result in Replacement of facilities that are at least thirty (30) years old at the time construction commences. For the purposes of this subsection, the following definitions shall apply:

a. Replacement. Construction that consists solely of a project(s) that would Sustain, Restore or Modernize a Health Care Facility or service for its designated purpose at least to its original functionality, without Addition, or Expansion.

b. Sustain. Maintenance and repair activities necessary to keep a Health Care Facility or service in good working order including regularly scheduled adjustments and inspections, preventive maintenance tasks, and emergency response and service calls for minor repairs, and major repairs or replacement

of facility components that are expected to occur periodically throughout the life cycle of said Health Care Facility or service. This work includes, but is not limited to, regular roof replacement, refinishing of wall surfaces, repairing and replacement of heating and cooling systems, replacing tile and carpeting, and similar types of work. It does not include environmental compliance costs, facility leases, or other tasks associated with facilities operations, such as custodial services, grounds services, waste disposal, and the provision of central utilities.

c. Restore. To return a Health Care Facility or service to such a condition that it may be used for its designated purpose or to restore the Health Care Facility or service's original functionality. This may include coming into compliance with all applicable federal, state, and local licensure, safety, and building requirements including nationally recognized Health Care facility construction guidelines and accreditation standards, such as those issued by the Facility Guidelines Institute, the American Institute of Architects, or the Joint Commission.

d. Modernize. Alteration or replacement of all, or part, of a Health Care Facility or service to accommodate new or increased functionality, or to replace components of a Health Care Facility or service beyond that necessary to Sustain or Restore said facility or service, without Addition or Expansion.

e. Addition: Except as otherwise exempt under Section 25C 1/2 of chapter 111, (1) the initial provision of a DoN-required service or procedure, or acquisition of medical equipment defined as DoN-required equipment under department regulations; or (2) the initial provision of any service that may be provided by a Health Care Facility.

f. Expansion: Except as otherwise exempt under Section 25C 1/2 of chapter 111, (1) any increase or upgrade by a Health Care Facility to the existing functionality of a DoN-required service or DoN-required equipment under department regulations; and (2) any increase or upgrade to the total number of beds, services, or stations.

For the avoidance of doubt, the addition of emergency department bays or examination rooms shall not be considered an addition or an expansion. Hospitals with projects exempt pursuant to subsection (d)(iii) shall maintain documentation of the age of any facility replaced.

(iv) For critical access hospitals, and for federally designated rural hospitals and federally designated sole community hospitals with respect to any project not otherwise exempt from the determination of need requirement, project application requirements and department review shall be modified as follows:

a. Applications shall be reviewed and processed by the department upon receipt and in an expedited matter to the maximum extent possible.

b. The department may delegate the review of this category of applications.

c. Applications shall not be subject to the requirements contained under factor 1 and factor 6 of the department’s regulations and guidelines in effect as of the

effective date of this legislation and with respect to any successor provisions thereto.

d. Applicants may complete the required financial feasibility analysis contained under factor 4 of the department’s regulations and guidelines in effect as of the effective date of this legislation internally with the use applicant staff.

e. No independent cost-analysis shall be undertaken pursuant to Section 25C(h) in connection with this category of applications.

f. Post approval reporting obligations for applicants shall be waived or limited and shortened to the maximum extent possible.

g. Requests for waivers of DoN requirements shall be liberally considered.

Subsection (d) shall not be construed so as to limit the ability of critical access hospitals and of federally designated rural hospitals and federally designated sole community hospitals to replace their already approved DoN-required equipment in the ordinary course as permitted by the department. All hospitals with projects exempt under subsection (d) shall obtain any required plan approvals from the department.”.

Additional co-sponsor(s) added to Amendment #8, as changed to H4643

Certain Projects Qualifying for Exemption from Determination of Need