                                 CODE OF VIRGINIA

CONDITIONS OF CERTIFICATES; MONITORING; REVOCATION OF CERTIFICATES; CIVIL
PENALTIES (§ 32.1-102.4)

A. 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 &#xA7;
32.1-102.2.
			The 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.
			Any 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.
			For the purposes of this subsection, &#8220;completion&#8221; means
conclusion of construction activities necessary for the substantial performance
of the contract.

B. 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. &#xA7; 1395 et seq.), Title XIX of the Social
Security Act (42 U.S.C. &#xA7; 1396 et seq.), and 10 U.S.C. &#xA7; 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&#8217;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. &#xA7; 1395 et seq.
			Every 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.
			The 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.
			Any 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. 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 &#xA7; 32.1-102.1:3; (ii) introduce a
psychiatric service pursuant to subdivision B 5 of &#xA7; 32.1-102.1:3; or (iii)
add psychiatric beds to an existing medical care facility described in
subdivision A 1 or 2 of &#xA7; 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 &#xA7; 37.2-809.

D. 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.

E. 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&#8217;s service
area.

F. 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&#8217;s program of medical
assistance services, and any other specific circumstances of the certificate
holder.

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.