{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-102.4.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-102.4.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-102.4.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-102.4.html"}],"law_id":84648,"edition_id":1,"section_id":84648,"structure_id":14008,"section_number":"32.1-102.4","catch_line":"Conditions of certificates; monitoring; revocation of certificates; civil penalties","history":"1982, c. 388; 1991, c. 561; 1992, c. 682; 1993, cc. 668, 704; 1998, c. 794; 2009, cc. 175, 711, 796, 877; 2013, c. 460; 2017, cc. 768, 791; 2019, c. 839; 2020, c. 1271; 2025, c. 325.","full_text":"A\n\nThe Commissioner may, in accordance with regulations of the Board, condition issuance of a certificate on compliance with a schedule for the completion of the proposed project and a maximum capital expenditure amount for the proposed project. The approved schedule and maximum capital expenditure for a proposed project shall be issued together with the certificate. The approved schedule may not be extended and the maximum capital expenditure may not be exceeded without the approval of the Commissioner in accordance with the regulations of the Board. The Commissioner shall not approve an extension for a schedule for completion of any project or the exceeding of the maximum capital expenditure of any project unless such extension or excess complies with the limitations provided in the regulations promulgated by the Board pursuant to § 32.1-102.2.\n\t\t\tThe Commissioner shall monitor each project to determine its progress and compliance with the approved schedule and with the maximum capital expenditure, and may revoke the certificate for (i) lack of substantial and continuing progress toward completion of the project in accordance with the schedule or (ii) expenditures in excess of the approved maximum capital expenditure for the project.\n\t\t\tAny person willfully violating conditions imposed pursuant to this subsection shall be subject to a civil penalty of up to $100 per violation per day until the date of completion of the project which shall be collected by the Commissioner and paid into the Literary Fund.\n\t\t\tFor the purposes of this subsection, “completion” means conclusion of construction activities necessary for the substantial performance of the contract.B\n\nThe Commissioner shall, pursuant to the regulations of the Board, condition the approval of a certificate upon the agreement of the applicant to provide care to individuals who are eligible for benefits under Title XVIII of the Social Security Act (42 U.S.C. § 1395 et seq.), Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), and 10 U.S.C. § 1071 et seq. In addition, the Commissioner shall condition the approval of a certificate upon the agreement of the applicant to (i) provide a specified level of charity care to indigent persons or accept patients requiring specialized care, (ii) facilitate the development and operation of primary and specialty medical care services in designated medically underserved areas of the applicant’s service area, or (iii) all of the above. Except in the case of nursing homes, the value of charity care provided to individuals pursuant to this subsection shall be based on the provider reimbursement methodology utilized by the Centers for Medicare and Medicaid Services for reimbursement under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.\n\t\t\tEvery certificate holder shall develop a financial assistance policy that includes specific eligibility criteria and procedures for applying for charity care, which shall be provided to a patient at the time of admission or discharge or at the time services are provided, included with any billing statements sent to uninsured patients, posted conspicuously in public areas of the medical care facility for which the certificate was issued and posted on a website maintained by the certificate holder.\n\t\t\tThe certificate holder shall annually provide documentation to the Department demonstrating that the certificate holder has satisfied the conditions of the certificate, including documentation of the amount of charity care provided to patients. If the certificate holder is unable or fails to satisfy the conditions of a certificate, the Department may approve alternative methods to satisfy the conditions pursuant to a plan of compliance, which shall identify a timeframe within which the certificate holder will satisfy the conditions of the certificate, and identify how the certificate holder will satisfy the conditions of the certificate, which may include (a) making direct payments to an organization authorized under a memorandum of understanding with the Department to receive contributions satisfying conditions of a certificate, (b) making direct payments to a private nonprofit foundation that funds basic insurance coverage for indigents authorized under a memorandum of understanding with the Department to receive contributions satisfying conditions of a certificate, or (c) other documented efforts or initiatives to provide primary or specialized care to underserved populations. In cases in which the certificate holder holds more than one certificate with conditions pursuant to this subsection, and the certificate holder is unable to satisfy the conditions of one certificate, such plan of compliance may provide for satisfaction of the conditions on that certificate by providing care at a reduced rate to indigent individuals in excess of the amount required by another certificate issued to the same holder, in an amount approved by the Department provided such care is offered at the same facility. Nothing in the preceding sentence shall prohibit the satisfaction of conditions of more than one certificate among various affiliated facilities or certificates subject to a system-wide or all-inclusive charity care condition established by the Commissioner. In determining whether the certificate holder has met the conditions of the certificate pursuant to a plan of compliance, only such actions undertaken after issuance of the conditioned certificate shall be counted towards satisfaction of conditions.\n\t\t\tAny person refusing, failing, or neglecting to honor such agreement shall be subject to a civil penalty of up to $100 per violation per day until the date of compliance which shall be collected by the Commissioner and paid into the Literary Fund. For the purpose of determining the amount of a civil penalty imposed pursuant to this subsection, the date on which the person began providing services in accordance with the original certificate shall be the date from which the period of noncompliance shall be calculated.C\n\nThe Commissioner may, pursuant to the regulations of the Board, condition the approval of a certificate for any project to (i) establish a medical care facility pursuant to subdivision A 2 of § 32.1-102.1:3; (ii) introduce a psychiatric service pursuant to subdivision B 5 of § 32.1-102.1:3; or (iii) add psychiatric beds to an existing medical care facility described in subdivision A 1 or 2 of § 32.1-102.1:3 upon the agreement of the applicant to provide care to individuals who are the subject of an involuntary temporary detention under § 37.2-809.D\n\nThe Commissioner shall (i) review every certificate of public need upon which conditions were imposed pursuant to subsection B at least once every three years to determine whether such conditions continue to be appropriate or should be revised and (ii) notify each certificate holder of his conclusions regarding (a) the appropriateness of conditions imposed on the certificate and whether such conditions should be revised and (b) the process by which the certificate holder may request amendments to conditions imposed on a certificate in accordance with subsection E.E\n\nPursuant to regulations of the Board, the Commissioner may accept requests for and approve amendments to conditions of existing certificates related to the provision of care at reduced rates or to patients requiring specialized care or related to the development and operation of primary medical care services in designated medically underserved areas of the certificate holder’s service area.F\n\nIn determining whether conditions imposed on a certificate of public need pursuant to subsection B are appropriate for the purposes of subsection D or should be amended in response to a request submitted pursuant to subsection E, the Commissioner shall consider any changes in the circumstances of the certificate holder resulting from changes in the financing or delivery of health care services, including changes to the Commonwealth’s program of medical assistance services, and any other specific circumstances of the certificate holder.","order_by":null,"text":{"0":{"id":303408,"text":"The Commissioner may, in accordance with regulations of the Board, condition issuance of a certificate on compliance with a schedule for the completion of the proposed project and a maximum capital expenditure amount for the proposed project. The approved schedule and maximum capital expenditure for a proposed project shall be issued together with the certificate. The approved schedule may not be extended and the maximum capital expenditure may not be exceeded without the approval of the Commissioner in accordance with the regulations of the Board. The Commissioner shall not approve an extension for a schedule for completion of any project or the exceeding of the maximum capital expenditure of any project unless such extension or excess complies with the limitations provided in the regulations promulgated by the Board pursuant to § 32.1-102.2.\n\t\t\tThe Commissioner shall monitor each project to determine its progress and compliance with the approved schedule and with the maximum capital expenditure, and may revoke the certificate for (i) lack of substantial and continuing progress toward completion of the project in accordance with the schedule or (ii) expenditures in excess of the approved maximum capital expenditure for the project.\n\t\t\tAny person willfully violating conditions imposed pursuant to this subsection shall be subject to a civil penalty of up to $100 per violation per day until the date of completion of the project which shall be collected by the Commissioner and paid into the Literary Fund.\n\t\t\tFor the purposes of this subsection, “completion” means conclusion of construction activities necessary for the substantial performance of the contract.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":303409,"text":"The Commissioner shall, pursuant to the regulations of the Board, condition the approval of a certificate upon the agreement of the applicant to provide care to individuals who are eligible for benefits under Title XVIII of the Social Security Act (42 U.S.C. § 1395 et seq.), Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), and 10 U.S.C. § 1071 et seq. In addition, the Commissioner shall condition the approval of a certificate upon the agreement of the applicant to (i) provide a specified level of charity care to indigent persons or accept patients requiring specialized care, (ii) facilitate the development and operation of primary and specialty medical care services in designated medically underserved areas of the applicant’s service area, or (iii) all of the above. Except in the case of nursing homes, the value of charity care provided to individuals pursuant to this subsection shall be based on the provider reimbursement methodology utilized by the Centers for Medicare and Medicaid Services for reimbursement under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.\n\t\t\tEvery certificate holder shall develop a financial assistance policy that includes specific eligibility criteria and procedures for applying for charity care, which shall be provided to a patient at the time of admission or discharge or at the time services are provided, included with any billing statements sent to uninsured patients, posted conspicuously in public areas of the medical care facility for which the certificate was issued and posted on a website maintained by the certificate holder.\n\t\t\tThe certificate holder shall annually provide documentation to the Department demonstrating that the certificate holder has satisfied the conditions of the certificate, including documentation of the amount of charity care provided to patients. If the certificate holder is unable or fails to satisfy the conditions of a certificate, the Department may approve alternative methods to satisfy the conditions pursuant to a plan of compliance, which shall identify a timeframe within which the certificate holder will satisfy the conditions of the certificate, and identify how the certificate holder will satisfy the conditions of the certificate, which may include (a) making direct payments to an organization authorized under a memorandum of understanding with the Department to receive contributions satisfying conditions of a certificate, (b) making direct payments to a private nonprofit foundation that funds basic insurance coverage for indigents authorized under a memorandum of understanding with the Department to receive contributions satisfying conditions of a certificate, or (c) other documented efforts or initiatives to provide primary or specialized care to underserved populations. In cases in which the certificate holder holds more than one certificate with conditions pursuant to this subsection, and the certificate holder is unable to satisfy the conditions of one certificate, such plan of compliance may provide for satisfaction of the conditions on that certificate by providing care at a reduced rate to indigent individuals in excess of the amount required by another certificate issued to the same holder, in an amount approved by the Department provided such care is offered at the same facility. Nothing in the preceding sentence shall prohibit the satisfaction of conditions of more than one certificate among various affiliated facilities or certificates subject to a system-wide or all-inclusive charity care condition established by the Commissioner. In determining whether the certificate holder has met the conditions of the certificate pursuant to a plan of compliance, only such actions undertaken after issuance of the conditioned certificate shall be counted towards satisfaction of conditions.\n\t\t\tAny person refusing, failing, or neglecting to honor such agreement shall be subject to a civil penalty of up to $100 per violation per day until the date of compliance which shall be collected by the Commissioner and paid into the Literary Fund. For the purpose of determining the amount of a civil penalty imposed pursuant to this subsection, the date on which the person began providing services in accordance with the original certificate shall be the date from which the period of noncompliance shall be calculated.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":303410,"text":"The Commissioner may, pursuant to the regulations of the Board, condition the approval of a certificate for any project to (i) establish a medical care facility pursuant to subdivision A 2 of § 32.1-102.1:3; (ii) introduce a psychiatric service pursuant to subdivision B 5 of § 32.1-102.1:3; or (iii) add psychiatric beds to an existing medical care facility described in subdivision A 1 or 2 of § 32.1-102.1:3 upon the agreement of the applicant to provide care to individuals who are the subject of an involuntary temporary detention under § 37.2-809.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":303411,"text":"The Commissioner shall (i) review every certificate of public need upon which conditions were imposed pursuant to subsection B at least once every three years to determine whether such conditions continue to be appropriate or should be revised and (ii) notify each certificate holder of his conclusions regarding (a) the appropriateness of conditions imposed on the certificate and whether such conditions should be revised and (b) the process by which the certificate holder may request amendments to conditions imposed on a certificate in accordance with subsection E.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":303412,"text":"Pursuant to regulations of the Board, the Commissioner may accept requests for and approve amendments to conditions of existing certificates related to the provision of care at reduced rates or to patients requiring specialized care or related to the development and operation of primary medical care services in designated medically underserved areas of the certificate holder’s service area.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":303413,"text":"In determining whether conditions imposed on a certificate of public need pursuant to subsection B are appropriate for the purposes of subsection D or should be amended in response to a request submitted pursuant to subsection E, the Commissioner shall consider any changes in the circumstances of the certificate holder resulting from changes in the financing or delivery of health care services, including changes to the Commonwealth’s program of medical assistance services, and any other specific circumstances of the certificate holder.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E"}},"ancestry":[{"id":14008,"edition_id":1,"name":"Medical Care Facilities Certificate of Public Need","identifier":"1.1","label":"article","depth":3,"order_by":1,"parent_id":13670,"metadata":{},"date_created":"2026-06-26 03:46:36","date_modified":"2026-06-26 03:46:36","permalink":{"id":202397,"object_type":"structure","relational_id":14008,"identifier":"1.1","token":"32.1\/4\/1.1","url":"\/32.1\/4\/1.1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13670,"edition_id":1,"name":"Health Care Planning","identifier":"4","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:45:31","date_modified":"2026-06-26 03:45:31","permalink":{"id":202389,"object_type":"structure","relational_id":13670,"identifier":"4","token":"32.1\/4","url":"\/32.1\/4\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":77111,"structure_id":14008,"section_number":"32.1-102.1","catch_line":"Definitions","url":"\/32.1-102.1\/","token":"32.1\/4\/1.1\/32.1-102.1","metadata":false},{"id":75479,"structure_id":14008,"section_number":"32.1-102.10","catch_line":"Commencing project without certificate or registration grounds for refusing to issue license","url":"\/32.1-102.10\/","token":"32.1\/4\/1.1\/32.1-102.10","metadata":false},{"id":55098,"structure_id":14008,"section_number":"32.1-102.11","catch_line":"Application of article","url":"\/32.1-102.11\/","token":"32.1\/4\/1.1\/32.1-102.11","metadata":false},{"id":63051,"structure_id":14008,"section_number":"32.1-102.12","catch_line":"Repealed","url":"\/32.1-102.12\/","token":"32.1\/4\/1.1\/32.1-102.12","metadata":false},{"id":77991,"structure_id":14008,"section_number":"32.1-102.13","catch_line":"Repealed","url":"\/32.1-102.13\/","token":"32.1\/4\/1.1\/32.1-102.13","metadata":false},{"id":86983,"structure_id":14008,"section_number":"32.1-102.1:1","catch_line":"Equipment registration required","url":"\/32.1-102.1_1\/","token":"32.1\/4\/1.1\/32.1-102.1_1","metadata":false},{"id":69151,"structure_id":14008,"section_number":"32.1-102.1:2","catch_line":"Certificate of public need required; registration of certain equipment and capital projects required","url":"\/32.1-102.1_2\/","token":"32.1\/4\/1.1\/32.1-102.1_2","metadata":false},{"id":63394,"structure_id":14008,"section_number":"32.1-102.1:3","catch_line":"(Effective July 1, 2028) Medical care facilities and projects for which a certificate is required","url":"\/32.1-102.1_3\/","token":"32.1\/4\/1.1\/32.1-102.1_3","metadata":false},{"id":85729,"structure_id":14008,"section_number":"32.1-102.2","catch_line":"Regulations","url":"\/32.1-102.2\/","token":"32.1\/4\/1.1\/32.1-102.2","metadata":false},{"id":63638,"structure_id":14008,"section_number":"32.1-102.2:1","catch_line":"State Health Services Plan; Task Force","url":"\/32.1-102.2_1\/","token":"32.1\/4\/1.1\/32.1-102.2_1","metadata":false},{"id":59668,"structure_id":14008,"section_number":"32.1-102.3","catch_line":"Demonstration of public need required; criteria for determining need","url":"\/32.1-102.3\/","token":"32.1\/4\/1.1\/32.1-102.3","metadata":false},{"id":73618,"structure_id":14008,"section_number":"32.1-102.3:1","catch_line":"Application for certificate not required of certain nursing facilities or nursing homes","url":"\/32.1-102.3_1\/","token":"32.1\/4\/1.1\/32.1-102.3_1","metadata":false},{"id":74212,"structure_id":14008,"section_number":"32.1-102.3:1.1","catch_line":"Continuing care retirement communities accessing medical assistance","url":"\/32.1-102.3_1.1\/","token":"32.1\/4\/1.1\/32.1-102.3_1.1","metadata":false},{"id":81863,"structure_id":14008,"section_number":"32.1-102.3:2","catch_line":"Certificates of public need; applications to be filed in response to Requests for Applications (RFAs)","url":"\/32.1-102.3_2\/","token":"32.1\/4\/1.1\/32.1-102.3_2","metadata":false},{"id":72268,"structure_id":14008,"section_number":"32.1-102.3:2.1","catch_line":"Repealed","url":"\/32.1-102.3_2.1\/","token":"32.1\/4\/1.1\/32.1-102.3_2.1","metadata":false},{"id":70992,"structure_id":14008,"section_number":"32.1-102.3:2.2","catch_line":"Expired","url":"\/32.1-102.3_2.2\/","token":"32.1\/4\/1.1\/32.1-102.3_2.2","metadata":false},{"id":81767,"structure_id":14008,"section_number":"32.1-102.3:3","catch_line":"Repealed","url":"\/32.1-102.3_3\/","token":"32.1\/4\/1.1\/32.1-102.3_3","metadata":false},{"id":85570,"structure_id":14008,"section_number":"32.1-102.3:5","catch_line":"Repealed","url":"\/32.1-102.3_5\/","token":"32.1\/4\/1.1\/32.1-102.3_5","metadata":false},{"id":58921,"structure_id":14008,"section_number":"32.1-102.3:7","catch_line":"Application for transfer of nursing facility beds","url":"\/32.1-102.3_7\/","token":"32.1\/4\/1.1\/32.1-102.3_7","metadata":false},{"id":87198,"structure_id":14008,"section_number":"32.1-102.3:8","catch_line":"Application for an open admission period for a continuing care retirement community","url":"\/32.1-102.3_8\/","token":"32.1\/4\/1.1\/32.1-102.3_8","metadata":false},{"id":84648,"structure_id":14008,"section_number":"32.1-102.4","catch_line":"Conditions of certificates; monitoring; revocation of certificates; civil penalties","url":"\/32.1-102.4\/","token":"32.1\/4\/1.1\/32.1-102.4","metadata":false},{"id":70069,"structure_id":14008,"section_number":"32.1-102.5","catch_line":"Certificate not transferable","url":"\/32.1-102.5\/","token":"32.1\/4\/1.1\/32.1-102.5","metadata":false},{"id":59090,"structure_id":14008,"section_number":"32.1-102.6","catch_line":"Administrative procedures","url":"\/32.1-102.6\/","token":"32.1\/4\/1.1\/32.1-102.6","metadata":false},{"id":73958,"structure_id":14008,"section_number":"32.1-102.6:1","catch_line":"Revocation of a certificate","url":"\/32.1-102.6_1\/","token":"32.1\/4\/1.1\/32.1-102.6_1","metadata":false},{"id":62746,"structure_id":14008,"section_number":"32.1-102.7","catch_line":"Repealed","url":"\/32.1-102.7\/","token":"32.1\/4\/1.1\/32.1-102.7","metadata":false},{"id":64703,"structure_id":14008,"section_number":"32.1-102.8","catch_line":"Enjoining project undertaken without certificate or registration","url":"\/32.1-102.8\/","token":"32.1\/4\/1.1\/32.1-102.8","metadata":false},{"id":64968,"structure_id":14008,"section_number":"32.1-102.9","catch_line":"Designation of judge","url":"\/32.1-102.9\/","token":"32.1\/4\/1.1\/32.1-102.9","metadata":false}],"previous_section":{"id":87198,"structure_id":14008,"section_number":"32.1-102.3:8","catch_line":"Application for an open admission period for a continuing care retirement community","url":"\/32.1-102.3_8\/","token":"32.1\/4\/1.1\/32.1-102.3_8","metadata":false},"next_section":{"id":70069,"structure_id":14008,"section_number":"32.1-102.5","catch_line":"Certificate not transferable","url":"\/32.1-102.5\/","token":"32.1\/4\/1.1\/32.1-102.5","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-102.4\/","history_text":"

This law was first created in 1982. The record of its establishment is cataloged in chapter 388 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1982 \u201cActs\u201d aren\u2019t available online. It has been modified 10 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1991, chapter 561; in 1992, chapter 682; in 1993, chapters 668 and 704; in 1998, chapter 794<\/a>; in 2009, chapters 175<\/a>, 711<\/a>, 796<\/a>, and 877<\/a>; in 2013, chapter 460<\/a>; in 2017, chapters 768<\/a> and 791<\/a>; in 2019, chapter 839<\/a>; in 2020, chapter 1271<\/a>; in 2025, chapter 325<\/a>.<\/p>","references":[{"id":85729,"section_number":"32.1-102.2","catch_line":"Regulations","order_by":null,"url":"\/32.1-102.2\/"},{"id":73958,"section_number":"32.1-102.6:1","catch_line":"Revocation of a certificate","order_by":null,"url":"\/32.1-102.6_1\/"},{"id":84829,"section_number":"32.1-276.5","catch_line":"Providers to submit data; civil penalty","order_by":null,"url":"\/32.1-276.5\/"}],"refers_to":[{"id":63394,"section_number":"32.1-102.1:3","catch_line":"(Effective July 1, 2028) Medical care facilities and projects for which a certificate is required","order_by":null,"url":"\/32.1-102.1_3\/"},{"id":85729,"section_number":"32.1-102.2","catch_line":"Regulations","order_by":null,"url":"\/32.1-102.2\/"}],"permalink":{"id":202479,"object_type":"law","relational_id":84648,"identifier":"32.1-102.4","token":"32.1\/4\/1.1\/32.1-102.4","url":"\/32.1-102.4\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-102.4\/","token":"32.1\/4\/1.1\/32.1-102.4","dublin_core":{"Title":"Conditions of certificates; monitoring; revocation of certificates; civil penalties","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-102.4","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> The Commissioner<\/span> may, in accordance with regulations of the Board<\/span>, condition issuance of a certificate<\/span> on compliance with a schedule for the completion<\/span> of the proposed project<\/span> and a maximum capital expenditure amount for the proposed project<\/span>. The approved schedule and maximum capital expenditure for a proposed project<\/span> shall be issued together with the certificate<\/span>. The approved schedule may not be extended and the maximum capital expenditure may not be exceeded without the approval of the Commissioner<\/span> in accordance with the regulations of the Board<\/span>. The Commissioner<\/span> shall not approve an extension for a schedule for completion<\/span> of any project<\/span> or the exceeding of the maximum capital expenditure of any project<\/span> unless such extension or excess complies with the limitations provided in the regulations promulgated by the Board<\/span> pursuant to § 32.1-102.2<\/a>.\n\t\t\tThe Commissioner<\/span> shall monitor each project<\/span> to determine its progress and compliance with the approved schedule and with the maximum capital expenditure, and may revoke the certificate<\/span> for (i) lack of substantial and continuing progress toward completion<\/span> of the project<\/span> in accordance with the schedule or (ii) expenditures in excess of the approved maximum capital expenditure for the project<\/span>.\n\t\t\tAny person<\/span> willfully violating conditions imposed pursuant to this subsection shall be subject to a civil penalty<\/span> of up to $100 per violation per day until the date of completion<\/span> of the project<\/span> which shall be collected by the Commissioner<\/span> and paid into the Literary Fund.\n\t\t\tFor the purposes of this subsection, “completion<\/span>” means conclusion of construction activities necessary for the substantial performance of the contract<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Commissioner<\/span> shall, pursuant to the regulations of the Board<\/span>, condition the approval of a certificate<\/span> upon the agreement of the applicant to provide care to individuals who are eligible for benefits under Title XVIII of the Social Security Act (42 U.S.C. § 1395 et seq.), Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), and 10 U.S.C. § 1071 et seq. In addition, the Commissioner<\/span> shall condition the approval of a certificate<\/span> upon the agreement of the applicant to (i) provide a specified level of charity care<\/span> to indigent<\/span> persons<\/span> or accept patients requiring specialized care, (ii) facilitate the development and operation of primary and specialty medical care services in designated medically underserved areas of the applicant’s service area, or (iii) all of the above. Except in the case of nursing homes, the value of charity care<\/span> provided to individuals pursuant to this subsection shall be based on the provider reimbursement methodology utilized by the Centers for Medicare and Medicaid Services for reimbursement under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq.\n\t\t\tEvery certificate<\/span> holder shall develop a financial assistance policy that includes specific eligibility criteria and procedures for applying for charity care<\/span>, which shall be provided to a patient at the time of admission or discharge or at the time services are provided, included with any billing statements sent to uninsured patients, posted conspicuously in public areas of the medical care facility<\/span> for which the certificate<\/span> was issued and posted on a website maintained by the certificate<\/span> holder.\n\t\t\tThe certificate<\/span> holder shall annually provide documentation to the Department<\/span> demonstrating that the certificate<\/span> holder has satisfied the conditions of the certificate<\/span>, including documentation of the amount of charity care<\/span> provided to patients. If the certificate<\/span> holder is unable or fails to satisfy the conditions of a certificate<\/span>, the Department<\/span> may approve alternative methods to satisfy the conditions pursuant to a plan of compliance, which shall identify a timeframe within which the certificate<\/span> holder will satisfy the conditions of the certificate<\/span>, and identify how the certificate<\/span> holder will satisfy the conditions of the certificate<\/span>, which may include (a) making direct payments to an organization authorized under a memorandum<\/span> of understanding with the Department<\/span> to receive contributions satisfying conditions of a certificate<\/span>, (b) making direct payments to a private nonprofit foundation that funds basic insurance coverage for indigents<\/span> authorized under a memorandum<\/span> of understanding with the Department<\/span> to receive contributions satisfying conditions of a certificate<\/span>, or (c) other documented efforts or initiatives to provide primary or specialized care to underserved populations. In cases in which the certificate<\/span> holder holds more than one certificate<\/span> with conditions pursuant to this subsection, and the certificate<\/span> holder is unable to satisfy the conditions of one certificate<\/span>, such plan of compliance may provide for satisfaction of the conditions on that certificate<\/span> by providing care at a reduced rate to indigent<\/span> individuals in excess of the amount required by another certificate<\/span> issued to the same holder, in an amount approved by the Department<\/span> provided such care is offered at the same facility. Nothing in the preceding sentence shall prohibit the satisfaction of conditions of more than one certificate<\/span> among various affiliated facilities or certificates<\/span> subject to a system-wide or all-inclusive charity care<\/span> condition established by the Commissioner<\/span>. In determining whether the certificate<\/span> holder has met the conditions of the certificate<\/span> pursuant to a plan of compliance, only such actions undertaken after issuance of the conditioned certificate<\/span> shall be counted towards satisfaction of conditions.\n\t\t\tAny person<\/span> refusing, failing, or neglecting to honor such agreement shall be subject to a civil penalty<\/span> of up to $100 per violation per day until the date of compliance which shall be collected by the Commissioner<\/span> and paid into the Literary Fund. For the purpose of determining the amount of a civil penalty<\/span> imposed pursuant to this subsection, the date on which the person<\/span> began providing services in accordance with the original certificate<\/span> shall be the date from which the period of noncompliance shall be calculated. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> The Commissioner<\/span> may, pursuant to the regulations of the Board<\/span>, condition the approval of a certificate<\/span> for any project<\/span> to (i) establish a medical care facility<\/span> pursuant to subdivision A 2 of § 32.1-102.1:3<\/a>; (ii) introduce a psychiatric service pursuant to subdivision B 5 of § 32.1-102.1:3<\/a>; or (iii) add psychiatric beds to an existing medical care facility<\/span> described in subdivision A 1 or 2 of § 32.1-102.1:3<\/a> upon the agreement of the applicant to provide care to individuals who are the subject of an involuntary temporary detention under § 37.2-809<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> The Commissioner<\/span> shall (i) review every certificate<\/span> of public need upon which conditions were imposed pursuant to subsection B at least once every three years to determine whether such conditions continue to be appropriate or should be revised and (ii) notify each certificate<\/span> holder of his conclusions regarding (a) the appropriateness of conditions imposed on the certificate<\/span> and whether such conditions should be revised and (b) the process by which the certificate<\/span> holder may request amendments to conditions imposed on a certificate<\/span> in accordance with subsection E. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Pursuant to regulations of the Board<\/span>, the Commissioner<\/span> may accept requests for and approve amendments to conditions of existing certificates<\/span> related to the provision of care at reduced rates or to patients requiring specialized care or related to the development and operation of primary medical care services in designated medically underserved areas of the certificate<\/span> holder’s service area. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> In determining whether conditions imposed on a certificate<\/span> of public need pursuant to subsection B are appropriate for the purposes of subsection D or should be amended in response to a request submitted pursuant to subsection E, the Commissioner<\/span> shall consider any changes in the circumstances of the certificate<\/span> holder resulting from changes in the financing or delivery of health care services, including changes to the Commonwealth’s program of medical assistance services, and any other specific circumstances of the certificate<\/span> holder. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nCONDITIONS OF CERTIFICATES; MONITORING; REVOCATION OF CERTIFICATES; CIVIL\nPENALTIES (\u00a7 32.1-102.4)\n\nA. The Commissioner may, in accordance with regulations of the Board, condition\nissuance of a certificate on compliance with a schedule for the completion of\nthe proposed project and a maximum capital expenditure amount for the proposed\nproject. The approved schedule and maximum capital expenditure for a proposed\nproject shall be issued together with the certificate. The approved schedule may\nnot be extended and the maximum capital expenditure may not be exceeded without\nthe approval of the Commissioner in accordance with the regulations of the\nBoard. The Commissioner shall not approve an extension for a schedule for\ncompletion of any project or the exceeding of the maximum capital expenditure of\nany project unless such extension or excess complies with the limitations\nprovided in the regulations promulgated by the Board pursuant to §\n32.1-102.2.\n\t\t\tThe Commissioner shall monitor each project to determine its progress and\ncompliance with the approved schedule and with the maximum capital expenditure,\nand may revoke the certificate for (i) lack of substantial and continuing\nprogress toward completion of the project in accordance with the schedule or\n(ii) expenditures in excess of the approved maximum capital expenditure for the\nproject.\n\t\t\tAny person willfully violating conditions imposed pursuant to this subsection\nshall be subject to a civil penalty of up to $100 per violation per day until\nthe date of completion of the project which shall be collected by the\nCommissioner and paid into the Literary Fund.\n\t\t\tFor the purposes of this subsection, “completion” means\nconclusion of construction activities necessary for the substantial performance\nof the contract.\n\nB. The Commissioner shall, pursuant to the regulations of the Board, condition\nthe approval of a certificate upon the agreement of the applicant to provide\ncare to individuals who are eligible for benefits under Title XVIII of the\nSocial Security Act (42 U.S.C. § 1395 et seq.), Title XIX of the Social\nSecurity Act (42 U.S.C. § 1396 et seq.), and 10 U.S.C. § 1071 et seq.\nIn addition, the Commissioner shall condition the approval of a certificate upon\nthe agreement of the applicant to (i) provide a specified level of charity care\nto indigent persons or accept patients requiring specialized care, (ii)\nfacilitate the development and operation of primary and specialty medical care\nservices in designated medically underserved areas of the applicant’s\nservice area, or (iii) all of the above. Except in the case of nursing homes,\nthe value of charity care provided to individuals pursuant to this subsection\nshall be based on the provider reimbursement methodology utilized by the Centers\nfor Medicare and Medicaid Services for reimbursement under Title XVIII of the\nSocial Security Act, 42 U.S.C. § 1395 et seq.\n\t\t\tEvery certificate holder shall develop a financial assistance policy that\nincludes specific eligibility criteria and procedures for applying for charity\ncare, which shall be provided to a patient at the time of admission or discharge\nor at the time services are provided, included with any billing statements sent\nto uninsured patients, posted conspicuously in public areas of the medical care\nfacility for which the certificate was issued and posted on a website maintained\nby the certificate holder.\n\t\t\tThe certificate holder shall annually provide documentation to the Department\ndemonstrating that the certificate holder has satisfied the conditions of the\ncertificate, including documentation of the amount of charity care provided to\npatients. If the certificate holder is unable or fails to satisfy the conditions\nof a certificate, the Department may approve alternative methods to satisfy the\nconditions pursuant to a plan of compliance, which shall identify a timeframe\nwithin which the certificate holder will satisfy the conditions of the\ncertificate, and identify how the certificate holder will satisfy the conditions\nof the certificate, which may include (a) making direct payments to an\norganization authorized under a memorandum of understanding with the Department\nto receive contributions satisfying conditions of a certificate, (b) making\ndirect payments to a private nonprofit foundation that funds basic insurance\ncoverage for indigents authorized under a memorandum of understanding with the\nDepartment to receive contributions satisfying conditions of a certificate, or\n(c) other documented efforts or initiatives to provide primary or specialized\ncare to underserved populations. In cases in which the certificate holder holds\nmore than one certificate with conditions pursuant to this subsection, and the\ncertificate holder is unable to satisfy the conditions of one certificate, such\nplan of compliance may provide for satisfaction of the conditions on that\ncertificate by providing care at a reduced rate to indigent individuals in\nexcess of the amount required by another certificate issued to the same holder,\nin an amount approved by the Department provided such care is offered at the\nsame facility. Nothing in the preceding sentence shall prohibit the satisfaction\nof conditions of more than one certificate among various affiliated facilities\nor certificates subject to a system-wide or all-inclusive charity care condition\nestablished by the Commissioner. In determining whether the certificate holder\nhas met the conditions of the certificate pursuant to a plan of compliance, only\nsuch actions undertaken after issuance of the conditioned certificate shall be\ncounted towards satisfaction of conditions.\n\t\t\tAny person refusing, failing, or neglecting to honor such agreement shall be\nsubject to a civil penalty of up to $100 per violation per day until the date of\ncompliance which shall be collected by the Commissioner and paid into the\nLiterary Fund. For the purpose of determining the amount of a civil penalty\nimposed pursuant to this subsection, the date on which the person began\nproviding services in accordance with the original certificate shall be the date\nfrom which the period of noncompliance shall be calculated.\n\nC. The Commissioner may, pursuant to the regulations of the Board, condition the\napproval of a certificate for any project to (i) establish a medical care\nfacility pursuant to subdivision A 2 of § 32.1-102.1:3; (ii) introduce a\npsychiatric service pursuant to subdivision B 5 of § 32.1-102.1:3; or (iii)\nadd psychiatric beds to an existing medical care facility described in\nsubdivision A 1 or 2 of § 32.1-102.1:3 upon the agreement of the applicant\nto provide care to individuals who are the subject of an involuntary temporary\ndetention under § 37.2-809.\n\nD. The Commissioner shall (i) review every certificate of public need upon which\nconditions were imposed pursuant to subsection B at least once every three years\nto determine whether such conditions continue to be appropriate or should be\nrevised and (ii) notify each certificate holder of his conclusions regarding (a)\nthe appropriateness of conditions imposed on the certificate and whether such\nconditions should be revised and (b) the process by which the certificate holder\nmay request amendments to conditions imposed on a certificate in accordance with\nsubsection E.\n\nE. Pursuant to regulations of the Board, the Commissioner may accept requests\nfor and approve amendments to conditions of existing certificates related to the\nprovision of care at reduced rates or to patients requiring specialized care or\nrelated to the development and operation of primary medical care services in\ndesignated medically underserved areas of the certificate holder’s service\narea.\n\nF. In determining whether conditions imposed on a certificate of public need\npursuant to subsection B are appropriate for the purposes of subsection D or\nshould be amended in response to a request submitted pursuant to subsection E,\nthe Commissioner shall consider any changes in the circumstances of the\ncertificate holder resulting from changes in the financing or delivery of health\ncare services, including changes to the Commonwealth’s program of medical\nassistance services, and any other specific circumstances of the certificate\nholder.\n\nHISTORY: 1982, c. 388; 1991, c. 561; 1992, c. 682; 1993, cc. 668, 704; 1998, c.\n794; 2009, cc. 175, 711, 796, 877; 2013, c. 460; 2017, cc. 768, 791; 2019, c.\n839; 2020, c. 1271; 2025, c. 325.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}