                                 CODE OF VIRGINIA

CERTIFICATES OF PUBLIC NEED; APPLICATIONS TO BE FILED IN RESPONSE TO REQUESTS
FOR APPLICATIONS (RFAS) (§ 32.1-102.3:2)

A. Except for applications for continuing care retirement community nursing home
bed projects filed by continuing care providers registered with the State
Corporation Commission pursuant to Chapter 49 (&#xA7; 38.2-4900 et seq.) of
Title 38.2 which comply with the requirements established in this section, the
Commissioner shall approve, authorize or accept applications for the issuance of
any certificate of public need pursuant to this article only in response to
Requests for Applications (RFAs) for any project which would result in an
increase in the number of beds in a planning district in which nursing facility
or extended care services are provided, except as provided in &#xA7;
32.1-102.3:7.

B. The Board shall adopt regulations establishing standards for the approval and
issuance of Requests for Applications by the Commissioner. The standards shall
include, but shall not be limited to, a requirement that determinations of need
take into account any limitations on access to existing nursing home beds in the
planning districts. The RFAs, which shall be published at least annually, shall
be jointly developed by the Department and the Department of Medical Assistance
Services. RFAs shall be based on analyses of the need, or lack thereof, for
increases in the nursing home bed supply in each of the Commonwealth&#8217;s
planning districts in accordance with standards adopted by the Board by
regulation. The Commissioner shall only accept for review applications in
response to such RFAs which conform with the geographic and bed need
determinations of the specific RFA.

C. Sixty days prior to the Commissioner&#8217;s approval and issuance of any
RFA, the Board shall publish the proposed RFA in the Virginia Register for
public comment together with an explanation of (i) the regulatory basis for the
planning district bed needs set forth in the RFA and (ii) the rationale for the
RFA&#8217;s planning district designations. Any person objecting to the contents
of the proposed RFA may notify, within 14 days of the publication, the Board and
the Commissioner of his objection and the objection&#8217;s regulatory basis.
The Commissioner shall prepare, and deliver by registered mail, a written
response to each such objection within two weeks of the date of receiving the
objection. The objector may file a rebuttal to the Commissioner&#8217;s response
in writing within five days of receiving the Commissioner&#8217;s response. If
objections are received, the Board may, after considering the provisions of the
RFA, any objections, the Commissioner&#8217;s responses, and if filed, any
written rebuttals of the Commissioner&#8217;s responses, hold a public hearing
to receive comments on the specific RFA. Prior to making a decision on the RFA,
the Commissioner shall consider any recommendations made by the Board.

D. Except for a continuing care retirement community applying for a certificate
of public need pursuant to provisions of subsections A, B, and C, applications
for continuing care retirement community nursing home bed projects shall be
accepted by the Commissioner only if the following criteria are met: (i) the
facility is registered with the State Corporation Commission as a continuing
care provider pursuant to Chapter 49 (&#xA7; 38.2-4900 et seq.) of Title 38.2,
(ii) the number of new nursing home beds requested in the initial application
does not exceed the lesser of 20 percent of the continuing care retirement
community&#8217;s total number of beds that are not nursing home beds or 60
beds, (iii) the number of new nursing home beds requested in any subsequent
application does not cause the continuing care retirement community&#8217;s
total number of nursing home beds to exceed 20 percent of its total number of
beds that are not nursing home beds, and (iv) the continuing care retirement
community has established a qualified resident assistance policy.

E. The Commissioner may approve an initial certificate of public need for
nursing home beds in a continuing care retirement community not to exceed the
lesser of 60 beds or 20 percent of the total number of beds that are not nursing
home beds which authorizes an initial one-time, three-year open admission period
during which the continuing care retirement community may accept direct
admissions into its nursing home beds. The Commissioner may approve a
certificate of public need for nursing home beds in a continuing care retirement
community in addition to those nursing home beds requested for the initial
one-time, three-year open admission period if (i) the number of new nursing home
beds requested in any subsequent application does not cause the continuing care
retirement community&#8217;s total number of nursing home beds to exceed 20
percent of its total number of beds that are not nursing beds, (ii) the number
of licensed nursing home beds within the continuing care retirement community
does not and will not exceed 20 percent of the number of occupied beds that are
not nursing beds, and (iii) no open-admission period is allowed for these
nursing home beds. Upon the expiration of any initial one-time, three-year open
admission period, a continuing care retirement community which has obtained a
certificate of public need for a nursing facility project pursuant to subsection
D may admit into its nursing home beds (a) a standard contract holder who has
been a bona fide resident of the non-nursing home portion of the continuing care
retirement community for at least 30 days, (b) a person who is a standard
contract holder who has lived in the non-nursing home portion of the continuing
care retirement community for less than 30 days but who requires nursing home
care due to change in health status since admission to the continuing care
retirement community, (c) a person who is a family member of a standard contract
holder residing in a non-nursing home portion of the continuing care retirement
community, (d) a person who is an employee or a member of the board of trustees
or board of directors of the continuing care retirement community, (e) a person
who is a family member of an employee or a member of the board of trustees or
board of directors of the continuing care retirement community, or (f) a person
who is an accredited practitioner of the religious organization or denomination
with which the continuing care retirement community is affiliated.

F. Any continuing care retirement community applicant for a certificate of
public need to increase the number of nursing home beds shall authorize the
State Corporation Commission to disclose such information to the Commissioner as
may be in the State Corporation Commission&#8217;s possession concerning such
continuing care retirement community in order to allow the Commissioner to
enforce the provisions of this section. The State Corporation Commission shall
provide the Commissioner with the requested information when so authorized.

G. For the purposes of this section:
			&#8220;Family member&#8221; means spouse, mother, father, son, daughter,
brother, sister, aunt, uncle, or cousin by blood, marriage, or adoption.
			&#8220;One-time, three-year open admission period&#8221; means the three
years after the initial licensure of nursing home beds during which the
continuing care retirement community may take admissions directly into its
nursing home beds without the signing of a standard contract. The facility or a
related facility on the same campus shall not be granted any open admissions
period for any subsequent application or authorization for nursing home beds.
			&#8220;Qualified resident assistance policy&#8221; means a procedure,
consistently followed by a facility, pursuant to which the facility endeavors to
avoid requiring a resident to leave the facility because of inability to pay
regular charges and which complies with the requirements of the Internal Revenue
Service for maintenance of status as a tax exempt charitable organization under
&#xA7; 501(c)(3) of the Internal Revenue Code. This policy shall be (i)
generally made known to residents through the resident contract and (ii)
supported by reasonable and consistent efforts to promote the availability of
funds, either through a special fund, separate foundation or access to other
available funds, to assist residents who are unable to pay regular charges in
whole or in part.
			This policy may (a) take into account the sound financial management of the
facility, including existing reserves, and the reasonable requirements of
lenders and (b) include requirements that residents seeking such assistance
provide all requested financial information and abide by reasonable conditions,
including seeking to qualify for other assistance and restrictions on the
transfer of assets to third parties.
			A qualified resident assistance policy shall not constitute the business of
insurance as defined in Chapter 1 (&#xA7; 38.2-100 et seq.) of Title 38.2.
			&#8220;Standard contract&#8221; means a contract requiring the same entrance
fee, terms, and conditions as contracts executed with residents of the
non-nursing home portion of the facility, if the entrance fee is no less than
the amount defined in &#xA7; 38.2-4900.

H. This section shall not be construed to prohibit or prevent a continuing care
retirement community from discharging a resident (i) for breach of nonfinancial
contract provisions, (ii) if medically appropriate care can no longer be
provided to the resident, or (iii) if the resident is a danger to himself or
others while in the facility.

I. The provisions of subsections D, E, and H shall not affect any certificate of
public need issued prior to July 1, 1998; however, any certificate of public
need application for additional nursing home beds shall be subject to the
provisions of this act.

HISTORY: 1989, c. 517; 1990, cc. 191, 478, 753, 845; 1991, c. 561; 1992, cc.
612, 682; 1993, cc. 347, 474, 540, 564, 704, 762, 957, 993; 1994, cc. 57, 680,
711, 726, 797; 1995, cc. 505, 632, 641, 695, 753; 1996, cc. 531, 849, 901; 1998,
c. 794; 2009, c. 175; 2012, c. 492; 2013, cc. 433, 515.