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vidual who is not a physician owner or in-
vestor. 
‘‘(E) PATIENT SAFETY.— 
‘‘(i) Insofar as the hospital admits a 
patient and does not have any physician 
available on the premises to provide services 
during all hours in which the hospital is 
providing services to such patient, before 
admitting the patient— 
‘‘(I) the hospital discloses such 
fact to a patient; and 
‘‘(II) following such disclosure, the 
hospital receives from the patient a 
signed acknowledgment that the pa-
tient understands such fact. 
‘‘(ii) The hospital has the capacity 
to— 
‘‘(I) provide assessment and ini-
tial treatment for patients; and 
‘‘(II) refer and transfer patients 
to hospitals with the capability to treat 
the needs of the patient involved. 
‘‘(F) LIMITATION ON APPLICATION TO CER-
TAIN CONVERTED FACILITIES.—The hospital was 
not converted from an ambulatory surgical cen-
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ter to a hospital on or after the date of enact-
ment of this subsection. 
‘‘(2) 
PUBLICATION
OF
INFORMATION
RE-
PORTED.—The Secretary shall publish, and update on 
an annual basis, the information submitted by hos-
pitals under paragraph (1)(C)(i) on the public Inter-
net website of the Centers for Medicare & Medicaid 
Services. 
‘‘(3) EXCEPTION TO PROHIBITION ON EXPANSION 
OF FACILITY CAPACITY.— 
‘‘(A) PROCESS.— 
‘‘(i) ESTABLISHMENT.—The Secretary 
shall establish and implement a process 
under which an applicable hospital (as de-
fined in subparagraph (E)) may apply for 
an exception from the requirement under 
paragraph (1)(B). 
‘‘(ii) OPPORTUNITY
FOR
COMMUNITY 
INPUT.—The process under clause (i) shall 
provide individuals and entities in the com-
munity in which the applicable hospital ap-
plying for an exception is located with the 
opportunity to provide input with respect to 
the application. 
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‘‘(iii) TIMING FOR IMPLEMENTATION.— 
The Secretary shall implement the process 
under clause (i) on August 1, 2011. 
‘‘(iv) REGULATIONS.—Not later than 
July 1, 2011, the Secretary shall promul-
gate regulations to carry out the process 
under clause (i). 
‘‘(B) FREQUENCY.—The process described 
in subparagraph (A) shall permit an applicable 
hospital to apply for an exception up to once 
every 2 years. 
‘‘(C) PERMITTED INCREASE.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii) and subparagraph (D), an applicable 
hospital granted an exception under the 
process described in subparagraph (A) may 
increase the number of operating rooms, 
procedure rooms, and beds for which the ap-
plicable hospital is licensed above the base-
line number of operating rooms, procedure 
rooms, and beds of the applicable hospital 
(or, if the applicable hospital has been 
granted a previous exception under this 
paragraph, above the number of operating 
rooms, procedure rooms, and beds for which 
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the hospital is licensed after the application 
of the most recent increase under such an 
exception). 
‘‘(ii) 100 PERCENT INCREASE LIMITA-
TION.—The Secretary shall not permit an 
increase in the number of operating rooms, 
procedure rooms, and beds for which an ap-
plicable hospital is licensed under clause (i) 
to the extent such increase would result in 
the number of operating rooms, procedure 
rooms, and beds for which the applicable 
hospital is licensed exceeding 200 percent of 
the baseline number of operating rooms, 
procedure rooms, and beds of the applicable 
hospital. 
‘‘(iii) BASELINE
NUMBER
OF
OPER-
ATING
ROOMS, PROCEDURE
ROOMS, AND 
BEDS.—In this paragraph, the term ‘base-
line number of operating rooms, procedure 
rooms, and beds’ means the number of oper-
ating rooms, procedure rooms, and beds for 
which the applicable hospital is licensed as 
of the date of enactment of this subsection. 
‘‘(D) INCREASE LIMITED TO FACILITIES ON 
THE MAIN CAMPUS OF THE HOSPITAL.—Any in-
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crease in the number of operating rooms, proce-
dure rooms, and beds for which an applicable 
hospital is licensed pursuant to this paragraph 
may only occur in facilities on the main campus 
of the applicable hospital. 
‘‘(E) APPLICABLE HOSPITAL.—In this para-
graph, the term ‘applicable hospital’ means a 
hospital— 
‘‘(i) that is located in a county in 
which the percentage increase in the popu-
lation during the most recent 5-year period 
(as of the date of the application under sub-
paragraph (A)) is at least 150 percent of 
the percentage increase in the population 
growth of the State in which the hospital is 
located during that period, as estimated by 
Bureau of the Census; 
‘‘(ii) whose annual percent of total in-
patient admissions that represent inpatient 
admissions under the program under title 
XIX is equal to or greater than the average 
percent with respect to such admissions for 
all hospitals located in the county in which 
the hospital is located; 
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‘‘(iii) 
that 
does 
not 
discriminate 
against beneficiaries of Federal health care 
programs and does not permit physicians 
practicing at the hospital to discriminate 
against such beneficiaries; 
‘‘(iv) that is located in a State in 
which the average bed capacity in the State 
is less than the national average bed capac-
ity; and 
‘‘(v) that has an average bed occu-
pancy rate that is greater than the average 
bed occupancy rate in the State in which 
the hospital is located. 
‘‘(F) PROCEDURE
ROOMS.—In this sub-
section, the term ‘procedure rooms’ includes 
rooms in which catheterizations, angiographies, 
angiograms, and endoscopies are performed, ex-
cept such term shall not include emergency 
rooms or departments (exclusive of rooms in 
which 
catheterizations, 
angiographies, 
angiograms, and endoscopies are performed). 
‘‘(G) PUBLICATION OF FINAL DECISIONS.— 
Not later than 60 days after receiving a complete 
application under this paragraph, the Secretary 
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