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SENATE PROPOSAL OF AMENDMENT 2007-2008

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H.777

An act relating to the certificate of need program

     The Senate proposes to the House to amend the bill by striking out all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  18 V.S.A. § 9432(4) is amended to read:

(4)  “Capital expenditure” means an expenditure for the plant or equipment which is not properly chargeable as an expense of operation and maintenance and includes acquisition by purchase, donation, leasehold expenditure, or operating lease which is treated as capital expense in accordance to the accounting standards established for lease expenditures by the Financial Accounting Standards Board, calculated over the length of the lease for plant or equipment, and includes assets having an expected life of at least three years.  A capital expenditure includes the cost of studies, surveys, designs, plans, working drawings, specifications and other activities essential to the acquisition, improvement, expansion, or replacement of the plant and equipment.

Sec. 2.  18 V.S.A. § 9439(b) is amended to read:

(b)  When a letter of intent to compete has been filed, the review process is suspended and the time within which a decision must be made as provided in subdivision 9440(c)(2) 9440(d)(4) of this title is stayed until the competing application has been ruled complete or for a period of 55 days from the date of notification under subdivision 9440(b)(4) 9440(c)(8) as to the original application, whichever is shorter.

Sec. 3.  18 V.S.A. § 9440(c)(6) is amended to read:

(6)  If an applicant fails to respond to an information request under subdivision (4) of this subsection within six months or, in the case of review cycle applications under section 9439 of this title, within such time limits as the commissioner shall establish by rule, the application will be deemed inactive unless the applicant has, within said six months, filed an adequate, as determined by the commissioner, amended letter of intent requests in writing that the application be reactivated and the commissioner grants the request.  If an applicant fails to respond to an information request within 12 months or, in the case of review cycle applications under section 9439 of this title, within such time limits as the commissioner shall establish by rule, the application will become invalid unless the applicant requests, and the commissioner grants, an extension.

Sec. 4.  18 V.S.A. § 9440(c)(9) is amended to read:

(9)  The health care ombudsman’s office established under section 4089j subchapter 1A of chapter 107 of Title 8 or, in the case of nursing homes, the long-term care ombudsman’s office established under section 7502 of Title 33, is authorized but not required to participate in any administrative or judicial review of an application under this subchapter and shall be considered an interested party in such proceedings upon filing a notice of intervention with the commissioner.

Sec. 5.  18 V.S.A. § 9440(d)(4) and (7) are amended to read:

(4)  A review shall be completed and the commissioner shall make a final decision within 120 days after the date of notification under subdivision (b)(4)(c)(4) of this section.  Whenever it is not practicable to complete a review within 120 days, the commissioner may extend the review period up to an additional 30 days.  Any review period may be extended with the written consent of the applicant and all other applicants in the case of a review cycle process.

(7)  Notice of the final decision shall be sent to the applicant, competing applicants, and interested parties.  This notice The final decision shall make include written findings and conclusions stating the basis of the decision.

Sec. 5a.  18 V.S.A. § 9440(e) is amended to read:

(e)  The commissioner shall adopt rules governing procedures for the expeditious processing of applications for replacement, repair, rebuilding, or reequipping of any part of a health care facility or health maintenance organization destroyed or damaged as the result of fire, storm, flood, act of God, or civil disturbance, or any other circumstances beyond the control of the applicant, and of applications where the health care facility is affected by bankruptcy proceedings, where the commissioner finds that the circumstances require action in less time than normally required for review. If the nature of the emergency requires it, an application under this subsection may be reviewed by the commissioner only, without notice and opportunity for public hearing or intervention by any party.

Sec. 5b.  18 V.S.A. § 9440(g) is added to read:

(g)  If the commissioner has reason to believe that the applicant has violated a provision of this subchapter, a rule adopted pursuant to this subchapter, or the terms or conditions of a prior certificate of need, the commissioner may take into consideration such violation in determining whether to approve, deny, or approve the application subject to conditions.  The applicant shall be provided an opportunity to contest whether such violation occurred, unless such an opportunity has already been provided.  The commissioner may impose as a condition of approval of the application that a violation be corrected or remediated before the certificate may take effect.

Sec. 5c.  18 V.S.A. § 9445(d) is added to read:

(d)  The commissioner shall adopt by rule criteria for assessing the circumstances in which a violation of a provision of this subchapter, a rule adopted pursuant to this subchapter, or the terms or conditions of a certificate of need require that a penalty under this section shall be imposed, and criteria for assessing the circumstances in which a penalty under this section may be imposed.

Sec. 5d.  18 V.S.A. § 9440(c)(5) is amended to read:

(5)  An applicant seeking expedited review of a certificate of need application may simultaneously file a letter of intent and an application with the commissioner.  Upon making a determination that the proposed project may be uncontested and does not substantially alter services, as defined by rule, or upon making a determination that the application relates to a health care facility affected by bankruptcy proceedings, the commissioner shall issue public notice of the application and the request for expedited review and identify a date by which a competing application or petition for interested party status must be filed.  If a competing application is not filed and no person opposing the application is granted interested party status, the commissioner may formally declare the application uncontested and may issue a certificate of need without further process, or with such abbreviated process as the commissioner deems appropriate.  If a competing application is filed or a person opposing the application is granted interested party status, the applicant shall follow the certificate of need standards and procedures in this section, except that in the case of a health care facility affected by bankruptcy proceedings, the commissioner after notice and an opportunity to be heard may issue a certificate of need with such abbreviated process as the commissioner deems appropriate, notwithstanding the contested nature of the application.


Sec. 5e.  18 V.S.A. § 9440(e) is amended to read:

(e)  The commissioner shall adopt rules governing procedures for the expeditious processing of applications for replacement, repair, rebuilding, or reequipping of any part of a health care facility or health maintenance organization destroyed or damaged as the result of fire, storm, flood, act of God, or civil disturbance, or any other circumstances beyond the control of the applicant, and of applications where the health care facility is affected by bankruptcy proceedings, where the commissioner finds that the circumstances require action in less time than normally required for review. If the nature of the emergency requires it, an application under this subsection may be reviewed by the commissioner only, without notice and opportunity for public hearing or intervention by any party.

Sec. 6.  18 V.S.A. § 9444 is amended to read:

§ 9444.  REVOCATION OF CERTIFICATES; MATERIAL CHANGE

The commissioner may revoke a certificate of need for substantial noncompliance with the scope of the project as designated in the application, or for failure to comply with the conditions set forth in the certificate of need granted by the commissioner.  In the event that after a project has been approved, its proponent wishes to materially change the scope or cost of the approved project, all such changes are subject to review under this subchapter. If a change itself would be considered a new health care project as defined in subsection 9434(a) section 9434 of this title, it shall be considered as material.  If the change itself would not be considered a new health care project as defined in subsection 9434(a) section 9434 of this title, the commissioner may decide not to review the change and shall notify the applicant and all parties of such decision.  Where the commissioner decides not to review a change, such change will be deemed to have been granted a certificate of need.

Sec. 7.  18 V.S.A. § 9445 is amended to read:

§ 9445.  ENFORCEMENT

(a)  Any person who offers or develops any new health care project within the meaning of this subchapter without first obtaining a certificate of need as required herein, or who otherwise violates any of the provisions of this subchapter, shall may be subject to the following administrative sanctions by the commissioner, after notice and an opportunity to be heard:

(1)  The state shall not issue a commissioner may order that no license or certificate permitted to be issued by the department or any other state agency may be issued to any health care facility to operate, offer, or develop any new health care project in violation of this subchapter and without a certificate of need or certificate of exemption issued pursuant thereto for a specified period of time, or that remedial conditions be attached to the issuance of such licenses or certificates.

(2)  The state shall not furnish from any reimbursement program commissioner may order that payments or reimbursements to the entity for claims made under any health insurance policy, subscriber contract, or health benefit plan offered or administered by any public or private health insurer, including the Medicaid program and any other health benefit program administered by the state, nor shall any entity chartered under the laws of this state or any person doing business in the state provide reimbursement for any new health care project offered or developed in contravention of the requirements of this subchapter be denied, reduced, or limited, and in the case of a hospital that the hospital’s annual budget approved under subchapter 7 of this chapter be adjusted, modified or reduced.

(3)(b)  In addition to all other sanctions, if any person offers or develops any new health care project without first having been issued a certificate of need or certificate of exemption therefore, or violates any other provision of this subchapter or any lawful rule or regulation promulgated thereunder, the commissioner and health care providers or consumers located in the state shall have standing to maintain a civil action in the superior court of the county wherein such alleged violation has occurred, or wherein such person may be found, to enjoin, restrain, or prevent such violation.  Upon written request by the commissioner, it shall be the duty of the attorney general of the state to furnish appropriate legal services and to prosecute an action for injunctive relief to an appropriate conclusion, which shall not be reimbursed under subdivision (2) of this subsection.

(b)(c)  After notice and an opportunity for hearing, the commissioner may impose on a person who knowingly violates a provision of this subchapter, or a rule or order adopted pursuant to this subchapter or section 15 of Title 8, a civil administrative penalty of no more than $40,000.00, or in the case of a continuing violation, a civil administrative penalty of no more than $100,000.00 or one-tenth of one percent of the gross annual revenues of the health care facility, whichever is greater, which shall not be reimbursed under subdivision (a)(2) of this section, and the commissioner may order the entity to cease and desist from further violations, and to take such other actions necessary to remediate a violation.  A person aggrieved by a decision of the commissioner under this subdivision may appeal the commissioner’s decision to the supreme court.

Sec. 8.  18 V.S.A. § 9437 is amended to read:

§ 9437.  CRITERIA

A certificate of need shall be granted if the applicant demonstrates and the commissioner finds that:

(1) the application is consistent with the health resource allocation plan;

(2) the cost of the project is reasonable, because:

(A) the applicant's financial condition will sustain any financial burden likely to result from completion of the project;

(B) the project will not result in an undue increase in the costs of medical care.  In making a finding under this subdivision the commissioner shall consider and weigh relevant factors including:

(i)  the financial implications of the project on hospitals and other clinical settings, including the impact on their services, expenditures, and charges; 

(ii)  whether the impact on  services, expenditures and charges is outweighed by the benefit of the project to the public; and

Sec. 9.  EMERGENCY RULES; EFFECTIVE DATE; PROSPECTIVE REPEAL

(a)  The commissioner may adopt emergency rules to carry out the purposes of Sec. 5a of this act.

(b)  This act shall take effect on July 1, 2008, except that Sec. 5a of this act shall take effect on passage, and Sec. 5e of this act shall take effect on July 1, 2009.

(c)  Subsection (a) of this section shall be repealed on June 30, 2009.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us