                                 CODE OF VIRGINIA

(EFFECTIVE JULY 1, 2028) MEDICAL CARE FACILITIES AND PROJECTS FOR WHICH A
CERTIFICATE IS REQUIRED (§ 32.1-102.1:3)

A. The following medical care facilities shall be subject to the provisions of
this article:

   1. Any facility licensed as a hospital, as defined in &#xA7; 32.1-123;

   2. Any hospital licensed as a provider by the Department of Behavioral Health
   and Developmental Services in accordance with Article 2 (&#xA7; 37.2-403 et
   seq.) of Chapter 4 of Title 37.2;

   3. Any facility licensed as a nursing home, as defined in &#xA7; 32.1-123;

   4. Any intermediate care facility established primarily for the medical,
   psychiatric, or psychological treatment and rehabilitation of individuals with
   substance abuse licensed by the Department of Behavioral Health and
   Developmental Services in accordance with Article 2 (&#xA7; 37.2-403 et seq.)
   of Chapter 4 of Title 37.2;

   5. Any intermediate care facility for individuals with developmental
   disabilities other than an intermediate care facility established for
   individuals with intellectual disability (ICF/IID) that has not more than 12
   beds and is in an area identified as in need of residential services for
   individuals with intellectual disability in any plan of the Department of
   Behavioral Health and Developmental Services; and

   6. Any specialized center or clinic or that portion of a physician&#8217;s
   office developed for the provision of outpatient or ambulatory surgery,
   cardiac catheterization, computed tomographic (CT) scanning, magnetic
   resonance imaging (MRI), positron emission tomographic (PET) scanning,
   radiation therapy, stereotactic radiotherapy other than radiotherapy performed
   using a linear accelerator or other medical equipment that uses concentrated
   doses of high-energy X-rays to perform external beam radiation therapy, or
   proton beam therapy.

B. The following actions undertaken by or on behalf of a medical care facility
described in subsection A shall constitute a project for which a certificate of
public need is required pursuant to subsection A of § 32.1-102.1:2:

   1. Establishment of a medical care facility described in subsection A;

   2. An increase in the total number of beds or operating rooms in an existing
   medical care facility described in subsection A;

   3. Relocation of beds from an existing medical care facility described in
   subsection A to another existing medical care facility described in subsection
   A;

   4. Addition of any new nursing home service at an existing medical care
   facility described in subsection A;

   5. Introduction into an existing medical care facility described in subsection
   A of any cardiac catheterization, computed tomographic (CT) scanning, magnetic
   resonance imaging (MRI), medical rehabilitation, neonatal special care, open
   heart surgery, positron emission tomographic (PET) scanning, psychiatric,
   organ or tissue transplant service, radiation therapy, stereotactic
   radiotherapy other than radiotherapy performed using a linear accelerator or
   other medical equipment that uses concentrated doses of high-energy X-rays to
   perform external beam radiation therapy, proton beam therapy, or substance
   abuse treatment when such medical care facility has not provided such service
   in the previous 12 months;

   6. Conversion of beds in an existing medical care facility described in
   subsection A to medical rehabilitation beds or psychiatric beds;

   7. The addition by an existing medical care facility described in subsection A
   of any new medical equipment for the provision of cardiac catheterization,
   computed tomographic (CT) scanning, magnetic resonance imaging (MRI), open
   heart surgery, positron emission tomographic (PET) scanning, radiation
   therapy, stereotactic radiotherapy other than radiotherapy performed using a
   linear accelerator or other medical equipment that uses concentrated doses of
   high-energy X-rays to perform external beam radiation therapy, or proton beam
   therapy, other than new medical equipment for the provision of such service
   added to replace existing medical equipment for the provision of such service;

   8. Any capital expenditure of $15 million or more, not defined as reviewable
   in subdivisions 1 through 7, by or on behalf of a medical care facility
   described in subsection A other than a general hospital. The amounts specified
   in this subdivision shall be revised annually to reflect inflation using
   appropriate measures incorporating construction costs and medical inflation.
   Nothing in this subdivision shall be construed to modify or eliminate the
   reviewability of any project described in subdivisions 1 through 7 when
   undertaken by or on behalf of a general hospital; and

   9. Conversion in an existing medical care facility described in subsection A
   of psychiatric inpatient beds to nonpsychiatric inpatient beds.

C. Notwithstanding the provisions of subsection A, any nursing home affiliated
with a facility that, on January 1, 1982, and thereafter, (i) is operated as a
nonprofit institution, (ii) is licensed jointly by the Department as a nursing
home and by the Department of Social Services as an assisted living facility,
and (iii) restricts admissions such that (a) admissions to the facility are only
allowed pursuant to the terms of a &#8220;life care contract&#8221; guaranteeing
that the full complement of services offered by the facility is available to the
resident as and when needed, (b) admissions to the assisted living facility unit
of the facility are restricted to individuals defined as ambulatory by the
Department of Social Services, and (c) admissions to the nursing home unit of
the facility are restricted to those individuals who are residents of the
assisted living facility unit of the facility shall not be subject to the
requirements of this article.

D. Notwithstanding the provisions of subsection B, a certificate of public need
shall not be required for the following actions undertaken by or on behalf of a
medical care facility described in subsection A:

   1. Relocation of up to 10 beds or 10 percent of the beds, whichever is less,
   (i) from one existing medical care facility described in subsection A to
   another existing medical care facility described in subsection A at the same
   site in any two-year period or (ii) in any three-year period, from one
   existing medical care facility described in subsection A licensed as a nursing
   home to any other existing medical care facility described in subsection A
   licensed as a nursing home that is owned or controlled by the same person and
   located either within the same planning district or within another planning
   district out of which, during or prior to that three-year period, at least 10
   times that number of beds have been authorized by statute to be relocated from
   one or more medical care facilities described in subsection A located in that
   other planning district, and at least half of those beds have not been
   replaced; or

   2. Use of up to 10 percent of beds as nursing home beds by a medical care
   facility described in subsection A licensed as a hospital, as provided in
   &#xA7; 32.1-132

E. The Department shall regularly review the types of medical care facilities
subject to the provisions of this article and projects for which a certificate
is required and provide to the Governor and the General Assembly, at least once
every five years, a recommendation related to the continued appropriateness of
requiring such types of medical care facilities to be subject to the provisions
of this article and such types of projects to be subject to the requirement of a
certificate. In developing such recommendations, the Department shall consider,
for each type of medical care facility and project, the following criteria:

   1. The current and projected future availability of the specific type of
   medical care facility or project;

   2. The current and projected future demand for the specific type of medical
   care facility or project;

   3. The current and projected future rate of utilization of the specific type
   of medical care facility or project;

   4. The current and projected future capacity of existing medical care
   facilities or projects of that specific type;

   5. The anticipated impact of changes in population and demographics,
   reimbursement structures and rates, and technology on demand for and
   availability, utilization, and capacity of existing medical care facilities or
   projects of that specific type;

   6. Existing quality, utilization, and other controls applicable to the
   specific type of medical care facility or project; and

   7. Any risk to the health or well-being of the public resulting from inclusion
   of the specific type of medical care facility or project on such list.

HISTORY: 2020, c. 1271; 2025, cc. 114, 135, 325.