§ 9434. Certificate of need; general rules
(a) A health care facility shall not develop or have developed on its behalf a new health
care project without issuance of a certificate of need by the Board. For purposes
of this subsection, a “new health care project” means any of the following:
(1) The construction, development, purchase, renovation, or other establishment of a health
care facility, or any capital expenditure by or on behalf of a health care facility,
for which the capital cost exceeds $10,000,000.00.
(2) A change from one licensing period to the next in the number of licensed beds of a
health care facility through addition or conversion, or through relocation from one
physical facility or site to another.
(3) The offering of any home health service, or the transfer or conveyance of more than
a 50 percent ownership interest in a health care facility other than a hospital or
nursing home.
(4) The purchase, lease, or other comparable arrangement of a single piece of diagnostic
and therapeutic equipment for which the cost, or in the case of a donation the value,
is in excess of $5,000,000.00. For purposes of this subdivision, the purchase or lease
of one or more articles of diagnostic or therapeutic equipment that are necessarily
interdependent in the performance of their ordinary functions or that would constitute
any health care facility included under subdivision 9432(8)(B) of this title, as determined by the Board, shall be considered together in calculating the amount
of an expenditure. The Board’s determination of functional interdependence of items
of equipment under this subdivision shall have the effect of a final decision and
is subject to appeal under section 9381 of this title.
(5) The offering of a health care service or technology having an annual operating expense
that exceeds $3,000,000.00 for either of the next two budgeted fiscal years, if the
service or technology was not offered or employed, either on a fixed or a mobile basis,
by the health care facility within the previous three fiscal years.
(6) [Repealed.]
(b) [Repealed.]
(c) In the case of a project that requires a certificate of need under this section, expenditures
for which are anticipated to be in excess of $50,000,000.00, the applicant first shall
secure a conceptual development phase certificate of need, in accordance with the
standards and procedures established in this subchapter, that permits the applicant
to make expenditures for architectural services, engineering design services, or any
other planning services, as defined by the Board, needed in connection with the project.
Upon completion of the conceptual development phase of the project, and before offering
or further developing the project, the applicant shall secure a final certificate
of need in accordance with the standards and procedures established in this subchapter.
Applicants shall not be subject to sanctions for failure to comply with the provisions
of this subsection if such failure is solely the result of good faith reliance on
verified project cost estimates issued by qualified persons, which cost estimates
would have led a reasonable person to conclude the project was not anticipated to
be in excess of $50,000,000.00 and therefore not subject to this subsection. The provisions
of this subsection notwithstanding, expenditures may be made in preparation for obtaining
a conceptual development phase certificate of need, which expenditures shall not exceed
$10,000,000.00.
(d) If the Board determines that a person required to obtain a certificate of need under
this subchapter has separated a single project into components in order to avoid cost
thresholds or other requirements under this subchapter, the person shall be required
to submit an application for a certificate of need for the entire project, and the
Board may proceed under section 9445 of this title. The Board’s determination under this subsection shall have the effect of a final
decision and is subject to appeal under section 9381 of this title.
(e) The Board may periodically adjust the monetary jurisdictional thresholds contained
in this section. In doing so, the Board shall reflect the same categories of health
care facilities, services, and programs recognized in this section. Any adjustment
by the Board shall not exceed an amount calculated using the cumulative Consumer Price
Index rate of inflation. (Added 1979, No. 65, § 1; amended 1985, No. 234 (Adj. Sess.), § 2; 1987, No. 96, § 21(b); 1989, No. 180 (Adj. Sess.), § 2; 1991, No. 160 (Adj. Sess.), § 38, eff. May 11, 1992; 1993, No. 30, § 17, eff. May 21, 1993; 1995, No. 160 (Adj. Sess.), § 8; 1995, No. 178 (Adj. Sess.), §§ 132a, 306; 1995, No. 180 (Adj. Sess.), § 25; 1997, No. 159 (Adj. Sess.), § 8, eff. April 29, 1998; 2003, No. 53, §§ 10, 26; 2003, No. 105 (Adj. Sess.), § 14, eff. May 4, 2004; 2005, No. 57, § 4, eff. June 13, 2005; 2007, No. 27, § 7; 2009, No. 49, §§ 10, 10a; 2011, No. 171 (Adj. Sess.), § 16, eff. Jan. 1, 2013; 2017, No. 125 (Adj. Sess.), § 2; 2017, No. 167 (Adj. Sess.), § 6; 2019, No. 72, § E.329.1, eff. June 18, 2019; 2019, No. 72, § E.329.2, eff. July 1, 2020; 2025, No. 15, § 1, eff. May 13, 2025.)