Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 220 - VIRGINIA MEDICAL CARE FACILITIES CERTIFICATE OF PUBLIC NEED RULES AND REGULATIONS › Part I - Definitions › Section 12VAC5-220-10 - Definitions

Current through Register Vol. 40, No. 24, July 15, 2024
The following words and terms when used in this chapter
					 shall have the following meanings unless the context clearly indicates
					 otherwise:
"Acquisition" means an expenditure of $600,000 or more that
					 changes the ownership of a medical care facility. It shall also include the
					 donation or lease of a medical care facility. An acquisition of a medical care
					 facility shall not include a capital expenditure involving the purchase of
					 stock. See
					 12VAC5-220-120.
"Amendment" means any modification to an application that
					 is made following the public hearing and prior to the issuance of a certificate
					 and includes those factors that constitute a significant change as defined in
					 this chapter. An amendment shall not include a modification to an application
					 that serves to reduce the scope of a project.
"Applicant" means the owner of an existing medical care
					 facility or the sponsor of a proposed medical care facility project submitting
					 an application for a certificate of public need.
"Application" means a prescribed format for the
					 presentation of data and information deemed necessary by the board to determine
					 a public need for a medical care facility project.
"Board" means the State Board of Health.
"Capital expenditure" means any expenditure by or in behalf
					 of a medical care facility that, under generally accepted accounting
					 principles, is not properly chargeable as an expense of operation and
					 maintenance. Such expenditure shall also include a series of related
					 expenditures during a 12-month period or a financial obligation or a series of
					 related financial obligations made during a 12-month period by or in behalf of
					 a medical care facility. Capital expenditures need not be made by a medical
					 care facility so long as they are made in behalf of a medical care facility by
					 any person.
"Certificate of public need" means a document that legally
					 authorizes a medical care facility project as defined herein and that is issued
					 by the commissioner to the owner of such project.
"Clinical health service" means a single diagnostic,
					 therapeutic, rehabilitative, preventive, or palliative procedure as defined in
					 § 32.1-102.1 of the Code of Virginia.
"Commissioner" means the State Health Commissioner who has
					 authority to make a determination respecting the issuance or revocation of a
					 certificate.
"Competing applications" means applications for the same or
					 similar services and facilities that are proposed for the same planning
					 district or medical service area and that are in the same review cycle. See
					 12VAC5-220-220.
"Completion" means conclusion of construction activities
					 necessary for substantial performance of the contract.
"Construction" means the building of a new medical facility
					 or the expansion, remodeling, or alteration of an existing medical care
					 facility.
"Construction, initiation of" means that a project shall be
					 considered under construction for the purpose of certificate extension
					 determinations upon the presentation of evidence by the owner of (i) a signed
					 construction contract; (ii) the completion of short term financing and a
					 commitment for long term (permanent) financing when applicable; (iii) the
					 completion of predevelopment site work; and (iv) the completion of building
					 foundations.
"Date of issuance" means the date of the commissioner's
					 decision awarding a certificate of public need.
"Department" means the Virginia Department of
					 Health.
"Designated medically underserved areas" means (i) areas
					 designated as medically underserved areas pursuant to § 32.1-122.5 of the
					 Code of Virginia; (ii) federally designated Medically Underserved Areas (MUA);
					 or (iii) federally designated Health Professional Shortage Areas (HPSA).
"Ex parte" means any meeting that takes place between (i)
					 any person acting in behalf of the applicant or holder of a certificate of
					 public need or any person opposed to the issuance or in favor of the revocation
					 of a certificate of public need and (ii) any person who has authority in the
					 department to make a decision respecting the issuance or revocation of a
					 certificate of public need for which the department has not provided 10 days
					 written notification to opposing parties of the time and place of such meeting.
					 An ex parte contact shall not include a meeting between the persons identified
					 in clause (i) and staff of the department.
"Gamma knife surgery" means stereotactic radiosurgery,
					 where stereotactic radiosurgery is the noninvasive therapeutic procedure
					 performed by directing radiant energy beams from any source at a treatment
					 target in the head to produce tissue destruction.
"Health planning region" means a contiguous geographical
					 area of the Commonwealth as defined in § 32.1-102.1 of the Code of
					 Virginia.
"Informal fact-finding conference" means a conference held
					 pursuant to § 2.2-4019 of the Code of Virginia.
"Inpatient beds" means accommodations within a medical care
					 facility with continuous support services (such as food, laundry, housekeeping)
					 and staff to provide health or health-related services to patients who
					 generally remain in the medical care facility in excess of 24 hours. Such
					 accommodations are known by varying nomenclatures including nursing beds,
					 intensive care beds, minimal or self care beds, isolation beds, hospice beds,
					 observation beds equipped and staffed for overnight use, and obstetric,
					 medical, surgical, psychiatric, substance abuse, medical rehabilitation, and
					 pediatric beds, including pediatric bassinets and incubators. Bassinets and
					 incubators in a maternity department and beds located in labor or birthing
					 rooms, recovery rooms, emergency rooms, preparation or anesthesia inductor
					 rooms, diagnostic or treatment procedures rooms, or on-call staff rooms are
					 excluded from this definition.
"Medical care facility" means any institution, place,
					 building, or agency as defined in § 32.1-3 of the Code of Virginia.
"Medical service area" means the geographic territory from
					 which at least 75% of patients come or are expected to come to existing or
					 proposed medical care facilities, the delineation of which is based on such
					 factors as population characteristics, natural geographic boundaries, and
					 transportation and trade patterns, and all parts of which are reasonably
					 accessible to existing or proposed medical care facilities.
"Modernization" means the alteration, repair, remodeling,
					 replacement, or renovation of an existing medical care facility or any part
					 thereto, including that which is incident to the initial and subsequent
					 installation of equipment in a medical care facility. See definition of
					 "construction."
"Operating expenditure" means any expenditure by or in
					 behalf of a medical care facility that, under generally accepted accounting
					 principles, is properly chargeable as an expense of operation and maintenance
					 and is not a capital expenditure.
"Operator" means any person having designated
					 responsibility and legal authority from the owner to administer and manage a
					 medical care facility. See definition of "owner."
"Other plans" means any plan that is formally adopted by an
					 official state agency or regional health planning agency and that provides for
					 the orderly planning and development of medical care facilities and services
					 and that is not otherwise defined in this chapter.
"Owner" means any person who has legal responsibility and
					 authority to construct, renovate, or equip or otherwise control a medical care
					 facility as defined herein.
"Person" means an individual, corporation, partnership,
					 association, or any other legal entity, whether governmental or private. Such
					 person may also include the following:
1. The applicant for a certificate of public need;
2. The regional health planning agency for the health
					 planning region in which the proposed project is to be located;
3. Any resident of the geographic area served or to be
					 served by the applicant;
4. Any person who regularly uses health care facilities
					 within the geographic area served or to be served by the applicant;
5. Any facility or health maintenance organization (HMO)
					 established under § 38.2-4300 et seq. of the Code of Virginia that is
					 located in the health planning region in which the project is proposed and that
					 provides services similar to the services of the medical care facility project
					 under review;
6. Third party payors who provide health care insurance or
					 prepaid coverage to 5.0% or more patients in the health planning region in
					 which the project is proposed to be located; and
7. Any agency that reviews or establishes rates for health
					 care facilities.
"Physician's office" means a place, owned, or operated by a
					 licensed physician or group of physicians practicing in any legal form
					 whatsoever that is designed and equipped solely for the provision of
					 fundamental medical care whether diagnostic, therapeutic, rehabilitative,
					 preventive, or palliative to ambulatory patients and that does not participate
					 in cost-based or facility reimbursement from third party health insurance
					 programs or prepaid medical service plans excluding pharmaceuticals and other
					 supplies administered in the office.
"Planning district" means a contiguous area within the
					 boundaries established by the Department of Housing and Community Development
					 as set forth in § 15.2-4202 of the Code of Virginia, except that for
					 purposes of this chapter, Planning District 23 shall be divided into two
					 planning districts: Planning District 20, consisting of the counties of Isle of
					 Wight and Southampton and the Cities of Chesapeake, Franklin, Norfolk,
					 Portsmouth, Suffolk, and Virginia Beach; and Planning District 21, consisting
					 of the Counties of James City and York and the Cities of Hampton, Newport News,
					 Poquoson, and Williamsburg.
"Predevelopment site work" means any preliminary activity
					 directed towards preparation of the site prior to the completion of the
					 building foundations. This includes soil testing, clearing, grading, extension
					 of utilities, and power lines to the site.
"Primary medical care services" means first-contact,
					 whole-person medical and health services delivered by broadly trained,
					 generalist physicians, nurses, and other professionals, intended to include,
					 without limitation, obstetrics/gynecology, family practice, internal medicine,
					 and pediatrics.
"Progress" means actions that are required in a given
					 period of time to complete a project for which a certificate of public need has
					 been issued. See
					 12VAC5-220-450,
					 Demonstration of progress.
"Project" means any plan or proposal as defined in §
					 32.1-102.1 of the Code of Virginia that is subject to Certificate of Public
					 Need approval.
"Public hearing" means a proceeding conducted by a regional
					 health planning agency at which an applicant for a certificate of public need
					 and members of the public may present oral or written testimony in support or
					 opposition to the application that is the subject of the proceeding and for
					 which a verbatim record is made. See subsection A of
					 12VAC5-220-230.
"Regional health plan" means the regional plan adopted by
					 the regional health planning agency board.
"Regional health planning agency" means the regional agency
					 as defined in § 32.1-102.1 of the Code of Virginia.
"Rural" means territory, population, and housing units that
					 are classified as "rural" by the Bureau of the Census of the U.S. Department of
					 Commerce, Economics and Statistics Administration.
"Schedule for completion" means the timetable that
					 identifies the major activities required to complete a project as identified by
					 the applicant and set forth on the certificate of public need. The timetable is
					 used by the commissioner to evaluate the applicant's progress in completing an
					 approved project.
"Significant change" means any alteration, modification, or
					 adjustment to a reviewable project for which a certificate of public need has
					 been issued or requested following the public hearing that:
1. Changes the site;
2. Increases the capital expenditure amount authorized by
					 the commissioner on the certificate of public need issued for the project by
					 10% or more;
3. Changes the service proposed to be offered; or
4. Extends the schedule for completion of the project
					 beyond three years (36 months) from the date of certificate issuance or beyond
					 the time period approved by the commissioner at the date of certificate
					 issuance, whichever is greater. See
					 12VAC5-220-440 and
					 12VAC5-220-450.
"Standard review process" means the process utilized in the
					 review of all certificate of public need requests with the exception of:
1. Certain bed relocations as specified in
					 12VAC5-220-280;
					 or
2. Certain projects that involve an increase in the number
					 of beds in which nursing facility or extended care services are provided as
					 specified in
					 12VAC5-220-325.
"State Medical Facilities Plan" means the planning document
					 as contained in Article 1.1 (§ 32.1-102.1 et seq.) of Chapter 4 of Title
					 32.1 of the Code of Virginia, used to make medical care facilities and services
					 needs decisions.
Statutory Authority: §§ 32.1-12 and 32.1-102.2
						of the Code of Virginia.