                                 CODE OF VIRGINIA

REGULATIONS (§ 32.1-102.2)

A. The Board shall promulgate regulations that are consistent with this article
and:

   1. Shall establish concise procedures for the prompt review of applications
   for certificates consistent with the provisions of this article which may
   include a structured batching process which incorporates, but is not limited
   to, authorization for the Commissioner to request proposals for certain
   projects. In any structured batching process established by the Board,
   applications, combined or separate, for 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, and proton beam therapy shall be considered in the radiation therapy
   batch. A single application may be filed for a combination of (i) 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, and proton beam
   therapy and (ii) any or all of the computed tomographic (CT) scanning,
   magnetic resonance imaging (MRI), and positron emission tomographic (PET)
   scanning;

   2. May classify projects and may eliminate one or more or all of the
   procedures prescribed in &#xA7; 32.1-102.6 for different classifications;

   3. May provide for exempting from the requirement of a certificate projects
   determined by the Commissioner, upon application for exemption, to be subject
   to the economic forces of a competitive market or to have no discernible
   impact on the cost or quality of health services;

   4. May establish a schedule of fees for applications for certificates or
   registration of a project to be applied to expenses for the administration and
   operation of the Certificate of Public Need Program;

   5. Shall establish an expedited application and review process for any
   certificate for projects reviewable pursuant to (i) subdivision B 1 of &#xA7;
   32.1-102.1:3 for the establishment of a new medical care facility described in
   subdivision A 2 of &#xA7; 32.1-102.1:3 by an existing medical care facility
   described in subdivision A 1 or 2 of &#xA7; 32.1-102.1:3 that has an existing
   certificate to provide psychiatric services pursuant to subdivision B 6 of
   &#xA7; 32.1-102.1:3, provided such new medical care facility is located in the
   same planning district as the existing medical care facility; (ii) subdivision
   B 2 of &#xA7; 32.1-102.1:3 for the addition of psychiatric beds at an existing
   medical care facility described in subdivision A 1 or 2 of &#xA7; 32.1-102.1:3
   that has an existing certificate to provide psychiatric services pursuant to
   subdivision B 5 of &#xA7; 32.1-102.1:3, not to exceed 10 beds or 10 percent of
   all beds at the medical care facility, whichever is greater, and provided that
   the applicant has not been awarded a certificate for the addition of
   psychiatric beds pursuant to this provision in the previous two-year period;
   (iii) subdivision B 3 of &#xA7; 32.1-102.1:3 for the relocation of psychiatric
   beds to an existing medical care facility described in subdivision A 1 or 2 of
   &#xA7; 32.1-102.1:3 that has had an existing certificate to introduce a
   psychiatric service for at least the previous 12 months pursuant to
   subdivision B 5 of &#xA7; 32.1-102.1:3 and that is within the same planning
   district; (iv) and subdivision B 8 of &#xA7; 32.1-102.1:3. Regulations
   establishing the expedited application and review procedure shall include
   provisions for (a) notice and opportunity for public comment on the
   application for a certificate, (b) a review cycle that is complete within 90
   days, (c) the filing of an expedited application in four batch cycles
   specifically for expedited applications, (d) the ability of a member of the
   public to request a public hearing for the expedited application, and (e)
   criteria pursuant to which an application that would normally undergo the
   review process would instead undergo the full certificate of public need
   review process set forth in &#xA7; 32.1-102.6;

   6. Shall establish an exemption from the requirement for a certificate for a
   project involving a temporary increase in the total number of beds in an
   existing hospital or nursing home, including a temporary increase in the total
   number of beds resulting from the addition of beds at a temporary structure or
   satellite location operated by the hospital or nursing home, provided that the
   ability remains to safely staff services across the existing hospital or
   nursing home, (i) for a period of no more than the duration of the
   Commissioner&#8217;s determination plus 30 days when the Commissioner has
   determined that a natural or man-made disaster has caused the evacuation of a
   hospital or nursing home and that a public health emergency exists due to a
   shortage of hospital or nursing home beds or (ii) for a period of no more than
   the duration of the emergency order entered pursuant to &#xA7; 32.1-13 or
   32.1-20 plus 30 days when the Board, pursuant to &#xA7; 32.1-13, or the
   Commissioner, pursuant to &#xA7; 32.1-20, has entered an emergency order for
   the purpose of suppressing a nuisance dangerous to public health or a
   communicable, contagious, or infectious disease or other danger to the public
   life and health; and

   7. Shall require every medical care facility subject to the requirements of
   this article, other than a nursing home, that is not a medical care facility
   for which a certificate with conditions imposed pursuant to subsection B of
   &#xA7; 32.1-102.4 has been issued and that provides charity care, as defined
   in &#xA7; 32.1-102.1, to annually report the amount of charity care provided.

B. The Board shall promulgate regulations providing for time limitations for
schedules for completion and limitations on the exceeding of the maximum capital
expenditure amount for all reviewable projects. The Commissioner shall not
approve any such extension or excess unless it complies with the Board&#8217;s
regulations. However, the Commissioner may approve a significant change in cost
for an approved project that exceeds the authorized capital expenditure by more
than 20 percent, provided the applicant has demonstrated that the cost increases
are reasonable and necessary under all the circumstances and do not result from
any material expansion of the project as approved.

C. The Board shall also promulgate regulations authorizing the Commissioner to
condition approval of a certificate on the agreement of the applicant to provide
a level of charity care to indigent persons or accept patients requiring
specialized care. Such regulations shall include a methodology and formulas for
uniform application of, active measuring and monitoring of compliance with, and
approval of alternative plans for satisfaction of such conditions. In addition,
the Board&#8217;s licensure regulations shall direct the Commissioner to
condition the issuing or renewing of any license for any applicant whose
certificate was approved upon such condition on whether such applicant has
complied with any agreement to provide a level of charity care to indigent
persons or accept patients requiring specialized care. 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. &#xA7; 1395 et seq.

D. The Board shall also promulgate regulations to require the registration of a
project; for introduction into an existing medical care facility of any new
lithotripsy, stereotactic radiosurgery, stereotactic 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,
obstetrical, or nuclear imaging services that the facility has never provided or
has not provided in the previous 12 months; and for the addition by an existing
medical care facility of any medical equipment for lithotripsy, stereotactic
radiosurgery, stereotactic 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 nuclear imaging services.
Replacement of existing equipment for lithotripsy, stereotactic radiosurgery,
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 nuclear
imaging services shall not require registration. Such regulations shall include
provisions for (i) establishing the agreement of the applicant to provide a
level of care in services or funds that matches the average percentage of
indigent care provided in the appropriate health planning region and to
participate in Medicaid at a reduced rate to indigents, (ii) obtaining
accreditation from a nationally recognized accrediting organization approved by
the Board for the purpose of quality assurance, and (iii) reporting utilization
and other data required by the Board to monitor and evaluate effects on health
planning and availability of health care services in the Commonwealth.

HISTORY: 1982, c. 388; 1991, c. 561; 1993, c. 704; 1996, c. 1050; 1999, cc. 899,
922, 926; 2003, cc. 61, 72; 2007, c. 502; 2009, c. 175; 2017, c. 791; 2019, cc.
136, 343, 839; 2020, c. 1271; 2022, cc. 712, 772; 2025, c. 325.