1Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
2act relating to health care; prescribing the powers and
3duties of the Department of Health; establishing and
4providing the powers and duties of the State Health
5Coordinating Council, health systems agencies and Health Care
6Policy Board in the Department of Health, and State Health
7Facility Hearing Board in the Department of Justice;
8providing for certification of need of health care providers
9and prescribing penalties," making extensive reenactments,
10revisions and additions by: in preliminary provisions,
11further providing for definitions; in administrative
12provisions, further providing for the Department of Health;
13in health systems, further providing for the Health Policy
14Board and its functions and for Statewide planning;
15establishing the Certificate of Need Review Board; in
16administration, further providing for regulations and for
17orders; in certificate of need, further providing for
18requirement and review, for operation, for procedure, for
19public meetings, for good cause, for information, for review
20criteria, for monitoring and expiration, for emergencies, for
21notice of termination, for review of activities and for
22sanctions; in health care facility licensing, further
23providing for issuance; and in miscellaneous provisions,
24further providing for existing facilities and institutions,
25for fees and for expiration.

26The General Assembly of the Commonwealth of Pennsylvania
27hereby enacts as follows:

28Section 1. Section 103 of the act of July 19, 1979 (P.L.130, 
29No.48), known as the Health Care Facilities Act, amended
30December 18, 1992 (P.L.1602, No.179) and October 16, 1998 

1(P.L.777, No.95), is reenacted and amended to read:

2Section 103. Definitions.

3The following words and phrases when used in this act shall
4have, unless the context clearly indicates otherwise, the
5meanings given to them in this section:

6"Act." The comprehensive Health Care Facilities Act.

7"Board." The Health Policy Board established under section
8401.1.

9"Certificate of need." A notice of approval issued by the
10department under the provisions of this act, including those
11notices of approval issued as an amendment to an existing
12certificate of need.

13"Clinically related health service." Certain diagnostic,
14treatment or rehabilitative services as determined in section
15701.

16"Community-based health services planning committee." A
17committee established [in accordance with procedures approved by
18the Department of Health which includes representatives of local
19or regional groups of consumers, business, labor, health care
20providers, payors or other affected interests] under section 
21702(h.1).

22"Conflict of interest." [For the purpose of section 501,
23the] The interest of any person, whether financial, by
24association with, or as a contributor of money or time to, any
25nonprofit corporation or other corporation, partnership,
26association, or other organization, and whenever a person is a
27director, officer or employee of such organization, but shall
28not exist whenever the organization in which such person is
29interested is being considered as part of a class or group for
30whom regulations are being considered, if the material facts as

1to the relationship or interest are disclosed or are known to
2the board.

3"Consumer." A natural person who is not involved in the
4provision of health services or health insurance. For the
5purpose of this act, any person who holds a fiduciary position
6in any health care facility, health maintenance organization or
7third party payor shall not be considered a consumer.

8"Department." The Department of Health of the Commonwealth.

9"Develop." When used in connection with health services or
10facilities, means to undertake those activities which on their
11completion will result in the offer of a new health service or
12the incurring of a financial obligation in relation to the
13offering of such a service.

14"Health care facility." [For purposes of Chapter 7, any] A
15health care facility providing clinically related health
16services, including, but not limited to, a general or special
17hospital, including psychiatric hospitals, rehabilitation
18hospitals, ambulatory surgical facilities, diagnostic imaging 
19centers, MRI facilities, long-term care nursing facilities,
20cancer treatment centers using radiation therapy on an
21ambulatory basis and inpatient drug and alcohol treatment
22facilities, both profit and nonprofit and including those
23operated by an agency or State or local government. The term
24shall also include a hospice. The term shall not include an
25office used primarily for the private or group practice by
26health care practitioners where no reviewable clinically related
27health service is offered, a facility providing treatment solely
28on the basis of prayer or spiritual means in accordance with the
29tenets of any church or religious denomination or a facility
30conducted by a religious organization for the purpose of

1providing health care services exclusively to clergy or other
2persons in a religious profession who are members of the
3religious denominations conducting the facility.

4"Health care practitioner." An individual who is authorized
5to practice some component of the healing arts by a license,
6permit, certificate or registration issued by a Commonwealth
7licensing agency or board.

8"Health care provider" or "provider." An individual, a trust
9or estate, a partnership, a corporation (including associations,
10joint stock companies and insurance companies), the
11Commonwealth, or a political subdivision or instrumentality
12(including a municipal corporation or authority) thereof, that
13operates a health care facility.

14"Health planning area." A geographic area within the
15Commonwealth designated by the Department of Health for purposes
16of health planning.

17"Hearing board." The State Health Facility Hearing Board
18created in the Office of General Counsel under the provisions of
19this act.

20"Interested person" or "person expressing an interest." [For
21the purposes of Chapter 7, a] A member of the public who is to
22be served by the proposed new health service in the area to be
23served by the applicant, a health care facility or health
24maintenance organization or any health care provider providing
25similar services in the area to be served by the applicant or
26who has received a certificate of need to provide services in
27the area to be served by the applicant or who has formally filed
28with the department a letter of intent to provide similar
29services in the area in which the proposed service is to be
30offered or developed and any third party payor of health

1services provided in that area who provides written notice to
2the department that the person is interested in a specific
3certificate of need application before the department.

4"Offer." Make provision for providing in a regular manner
5and on an organized basis clinically related health services.

6"Patient." A natural person receiving health care in or from
7a health care provider.

8"Person." A natural person, corporation (including
9associations, joint stock companies and insurance companies),
10partnership, trust, estate, association, the Commonwealth, and
11any local governmental unit, authority and agency thereof.

12"Policy board." The Health Policy Board [created in the
13Department of Health under the provisions of this act]
14established under section 401.1(a).

15"Public meeting." A meeting open to the public where any
16person has an opportunity to comment on a certificate of need
17application or proposed State health [services] improvement plan
18amendment.

19"Review board." The Certificate of Need Review Board
20established under section 501(a).

21"Secretary." The Secretary of [the Department of] Health of
22the Commonwealth of Pennsylvania.

23"State health [services] improvement plan." A document
24developed by the Department of Health, after consultation with
25the policy board and approved by the Governor, that is
26consistent with section 401.3, that meets the current and
27projected needs of the Commonwealth's citizens. The State health
28[services] improvement plan shall contain, in part, the
29standards and criteria against which certificate of need
30applications are reviewed and upon which decisions are based.

1"Third party payor." A person who makes payments on behalf
2of patients under compulsion of law or contract who does not
3supply care or services as a health care provider or who is
4engaged in issuing any policy or contract of individual or group
5health insurance or hospital or medical service benefits. The
6term shall not include the Federal, State, or any local
7government unit, authority, or agency thereof or a health
8maintenance organization.

9Section 2. Sections 201, 401.1, 401.2 and 401.3 of the act,
10amended or added December 18, 1992 (P.L.1602, No.179), are
11reenacted and amended to read:

12Section 201. Powers and duties of the department.

13The Department of Health shall have the power and its duties
14shall be:

15(1) To exercise exclusive jurisdiction over health care
16providers in accordance with the provisions of this act.

17[(2) To issue determinations of reviewability or
18nonreviewability of certificate of need proposals.

19(3) To issue certificates of need and amended
20certificates of need in accordance with the provisions of
21this act.

22(4) To withdraw expired certificates of need.]

23(5) To require, pursuant to regulation, submission of
24periodic reports by providers of health services and other
25persons subject to review respecting the development of
26proposals subject to review.

27(6) Upon consultation with the policy board, to
28research, prepare and, after approval by the Governor,
29publish, no later than 18 months after the effective date of
30this act and annually thereafter, a revised State health

1[services] improvement plan for the Commonwealth as defined
2under this act. Until the State health [services] improvement
3plan as defined in section 401.3 is adopted, the department
4shall apply the State health plan in existence on the
5effective date of this act, along with any subsequent updates
6to that plan.

7(7) [To] In consultation with the policy board, to
8collect and disseminate such other information as may be
9appropriate to determine the appropriate level of facilities
10and services for the effective implementation of
11certification of need under this act. Where such information
12is collected by any other agency of State government,
13duplication shall be avoided by coordination of data
14collection activities, if such coordination does not 
15otherwise unduly burden those State agencies.

16(8) To furnish such staff support and expertise to the
17policy board and the review board as may be needed to
18[perform its] fulfill their responsibilities.

19[(9) To receive, log and review all applications for
20certificates of need or amendments thereof and approve or
21disapprove the same.]

22(10) To minimize the administrative burden on health
23care providers by eliminating unnecessary duplication of
24financial and operational reports and to the extent possible
25and without undue burden coordinating reviews and inspections
26performed by Federal, State, local and private agencies.

27(11) To adopt and promulgate regulations necessary to
28carry out the purposes and provisions of this act relating to
29certificate of need.

30(12) To enforce the rules and regulations promulgated by

1the department as provided in this act.

2(13) To provide technical assistance to individuals and
3public and private entities in filling out the necessary
4forms for the development of projects and programs.

5[(14) To establish and publish in the Pennsylvania
6Bulletin a fee schedule for certificate of need applications
7and letters of intent in accordance with section 902.1.]

8(15) To coordinate any data collection activities
9necessary for administration of this act so as not to
10duplicate unnecessarily the data collection activities of
11other Federal and State agencies.

12(16) [To] In consultation with the policy board, to
13modify the list of reviewable clinically related health
14services established under section 701.

15Section 401.1. Health Policy Board.

16(a) An advisory board is hereby established in the
17department known as the Health Policy Board. The membership of
18the board shall consist of:

19(1) The Secretary of Health or his designee who shall
20act as chairman.

21(2) One representative of hospitals.

22(3) One physician.

23(4) One representative of a long-term care facility.

24(5) Two health care providers not already designated,
25one of whom shall be a provider of home health services.

26(6) One representative of Blue Cross or Blue Shield.

27(7) One representative of health maintenance
28organizations.

29(8) One representative of commercial insurance carriers.

30(9) One representative of business.

1(10) One representative of organized labor.

2(11) Three consumers.

3(12) One representative of county or municipal
4government.

5(b) All members shall be appointed to the policy board by
6the Governor and confirmed by a majority vote of the Senate. The
7Governor shall make all appointments to the policy board within
890 days of the effective date of this act, and the operations of
9the policy board shall begin immediately upon confirmation of
10the full board. The secretary shall convene the first meeting
11within 30 days after the confirmation of the full board.

12(1) Appointments shall be made in a manner that provides
13representation of the various geographical regions of this
14Commonwealth, including those medically underserved areas in
15rural and inner-city locations. At least two of the
16appointments shall be individuals knowledgeable of rural
17health care needs.

18(2) Of the 15 members first appointed, five shall be
19appointed for a term of one year, five for a term of two
20years and five for a term of three years. Thereafter,
21appointments shall be made for a term of three years.

22(3) No appointed member shall serve more than two full
23consecutive terms of three years.

24(4) No policy board member, other than the secretary,
25may act or attend through a designee or a proxy.

26(c) A simple majority of those members with current
27appointments of the policy board shall constitute a quorum for
28the transaction of any business. The act by the majority of the
29members present at any meeting in which there is a quorum shall
30be deemed to be an act of the board.

1(d) All meetings of the policy board shall be advertised and
2conducted pursuant to [the act of July 3, 1986 (P.L.388, No.84),
3known as the "Sunshine Act."] 65 Pa.C.S. Ch. 7 (relating to open 
4meetings). The board shall meet at least four times a year and
5may provide for special meetings as may be necessary.

6(e) The members of the policy board shall not receive any
7compensation for serving as members of the board but shall be
8reimbursed at established Commonwealth rates for necessary
9expenses incurred in the performance of their duties.

10Section 401.2. Powers and duties of policy board.

11The policy board shall exercise all powers necessary and
12appropriate to carry out its duties, including the following:

13(1) Advise and assist the department in development and
14revision of the State health [services] improvement plan.

15(2) Annually review a work plan developed by the
16department which identifies those provisions of the State
17health [services] improvement plan which must be revised,
18reconsidered or developed within the succeeding calendar
19year.

20(3) Annually review the list of clinically related
21health services subject to review developed by the department
22pursuant to the provisions of section 701.

23Section 401.3. State health [services] improvement plan.

24The State health [services] improvement plan shall consist of
25at a minimum:

26(1) An identification of the clinically related health
27services necessary to serve the health needs of the
28population of this Commonwealth, including those medically
29underserved areas in rural and inner-city locations.

30(2) An analysis of the availability, accessibility and

1affordability of the clinically related health services
2necessary to meet the health needs of the population of this
3Commonwealth.

4(3) Qualitative and quantitative standards and criteria
5for the review of certificate of need applications by the
6department under this act.

7(4) An exceptions process which permits exceptions to be
8granted to the standards and criteria in order to reflect
9local experience or ensure access or to respond to
10circumstances which pose a threat to public health and
11safety.

12Section 3. The act is amended by adding a chapter to read:

13CHAPTER 5

14REVIEW BOARD

15Section 501. Establishment and operation.

16(a) Members.--The Certificate of Need Review Board is
17established within the department. The membership of the review
18board shall consist of:

19(1) The secretary.

20(2) Three consumers.

21(3) One health care administrator.

22(4) One physician.

23(5) One nurse.

24(6) One representative of health insurance providers.

25(7) Three health economics experts.

26(b) Appointments.--Members under subsection (a)(2) through
27(7) shall be appointed by the Governor and must be confirmed by
28a majority vote of the Senate. The Governor shall make all
29appointments to the policy board within 60 days of the effective
30date of this section.

1(c) Terms.--Terms shall be as follows:

2(1) The secretary shall serve ex officio.

3(2) Except as set forth in paragraph (1), the following
4apply:

5(i) Of the members initially appointed:

6(A) four shall serve one-year terms;

7(B) four shall serve two-year terms; and

8(C) three shall serve three-year terms.

9(ii) Except as set forth in subparagraph (iii), a
10member appointed subsequent to initial appointment shall
11serve a three-year term.

12(iii) A member appointed to fill a vacancy shall
13serve the unexpired term.

14(iv) A member may not serve more than two full
15consecutive terms of three years.

16(d) Procedure.--The following apply to procedure:

17(1) The secretary shall serve as chair. The secretary
18shall convene the first meeting within 30 days after the
19confirmation of the full review board.

20(2) A simple majority of those members with current
21appointments of the review board shall constitute a quorum.
22The act by the majority of the members present at a meeting
23in which there is a quorum shall be deemed to be an act of
24the review board.

25(3) The secretary may act through a designee.

26(4) Except as set forth in paragraph (3), a member may
27not act or attend through a designee or a proxy.

28(5) The review board shall meet as necessary for the
29conduct of its business and the timely processing of
30certificate of need applications and fulfillment of the

1responsibilities and duties of this act.

2(6) Meetings of the review board are subject to 65
3Pa.C.S. Ch. 7 (relating to open meetings). The review board
4shall be deemed a Commonwealth agency for purposes of the act
5of February 14, 2008 (P.L.6, No.3), known as the Right-to-
6Know Law.

7(e) Compensation.--The members of the review board may not
8receive any compensation for serving as members of the board.
9Except for the secretary, members shall be reimbursed at
10established Commonwealth rates for necessary expenses incurred
11in the performance of their functions.

12Section 502. Powers and duties.

13The review board has the following powers and duties:

14(1) In consultation with department staff, to develop
15and approve guidelines for filing certificate of need letters
16of intent and certificate of need applications.

17(2) To issue determinations of reviewability or
18nonreviewability of certificate of need proposals.

19(3) To issue and amend certificates of need in
20accordance with the provisions of this act using the
21qualitative and quantitative standards and criteria developed
22by the policy board.

23(4) To withdraw expired certificates of need.

24(5) To develop a certificate of need exception process
25that permits an exception to be granted to the standards and
26criteria in order to reflect local experience, to ensure
27access or to respond to circumstances that pose a threat to 
28public health and safety. The exceptions process shall begin 
29only after the review board issues a denial of a certificate 
30of need application. An exception must be publicly disclosed. 

1This paragraph creates no right or entitlement to an 
2exception.

3(6) To receive, log, review and approve or disapprove
4applications for certificates of need and for amendments to
5certificates of need.

6(7) To establish and publish in the Pennsylvania
7Bulletin a fee schedule for certificate of need applications
8and letters of intent in accordance with section 902.1.

9(8) To establish and publish in the Pennsylvania
10Bulletin a detailed schedule of the review process, including
11at least one public meeting in the region from which the
12application was filed, for each certificate of need
13application submitted to the review board.

14(9) To work in collaboration with the community-based
15health services planning committees to review certificate of
16need applications.

17(10) To ensure that the intent of section 202 is upheld.

18(11) To take action necessary and appropriate to carry
19out the powers and duties under this section.

20Section 4. Section 602 of the act is reenacted and amended
21to read:

22Section 602. Regulations.

23The department [is] and the review board are hereby
24authorized and empowered pursuant to the provisions of this act
25to adopt rules and regulations establishing procedures required
26by this act for administration of certificate of need.

27Section 5. Sections 603, 701 and 702 of the act, amended 
28December 18, 1992 (P.L.1602, No.179), are reenacted and amended 
29to read:

30Section 603. Enforcement of orders relating to certificate of

1need.

2(a) The following apply:

3(1) No certificate of need shall be granted to any
4person for a health care facility or reviewable clinically
5related health service unless such facility or clinically
6related health service is found by the [department] review 
7board to be needed.

8(2) No person shall offer or develop a health care
9facility or reviewable clinically related health service
10without obtaining a certificate of need as required by this
11act.

12(3) No binding arrangement or commitment for financing
13the offering or development of a health care facility or
14reviewable clinically related health service shall be made by
15any person unless a certificate of need for such clinically
16related health service or facility has been granted in
17accordance with this act.

18(b) Orders for which the time of appeal has expired shall be
19enforced by the [department] review board in summary proceedings
20or, when necessary, with the aid of the court.

21(c) No [collateral attack on any order, including] questions
22relating to jurisdiction shall be permitted in the enforcement
23proceeding, but such relief may be sought when such relief has
24not been barred by the failure to take a timely appeal.

25(d) Any person operating a reviewable clinically related
26health service or health care facility within this Commonwealth
27for which no certificate of need has been obtained, after
28service of a cease and desist order of the department, [or after
29expiration of the time for appeal of any final order on appeal,
30upon conviction thereof,] shall be [sentenced to pay] subject to

1a fine of not less than [$100] $1,000 or more than [$1,000]
2$10,000 and costs of [prosecution] enforcement. Each day of
3operating a clinically related health service or health care
4facility after issuance of a cease and desist order shall
5constitute a separate offense.

6(e) Any person who violates this act by failing to obtain a
7certificate of need, by deviating from the provisions of the
8certificate, by beginning construction, by providing services,
9or by acquiring equipment after the expiration of a certificate
10of need shall be subject to a penalty of not less than [$100]
11$1,000 per day and not more than [$1,000] $10,000 per day. Each
12day of each such violation shall be considered a separate
13offense.

14(f) The department may seek injunctive relief to prevent
15continuing violations of this act. In seeking such relief, the
16department need not prove damages or irreparable harm.

17(g) No license to operate a health care facility or
18reviewable clinically related health service by any person in
19this Commonwealth shall be granted and any license issued shall
20be void and of no effect as to any facility, organization,
21service or part thereof for which a certificate of need is
22required by this act and not granted.

23Section 701. Certificate of need required; clinically related
24health services subject to review.

25(a) Any person, including, but not limited to, a health care
26facility, health maintenance organization or health care
27provider who offers, develops, constructs, renovates, expands or
28otherwise establishes or undertakes to establish within the
29State a clinically related health service that is included in
30the department's list of reviewable services developed under

1subsections (d) and (e) or a health care facility as defined in
2section 103 must obtain a certificate of need from the
3[department] review board if one or more of the following
4factors applies:

5(1) [The proposal requires a capital expenditure in
6excess of $2,000,000 under] Under generally accepted
7accounting principles, consistently applied[.], the proposal 
8requires a capital expenditure in excess of:

9(i) for a new high-cost technology or high-cost
10replacement technology in any health care facility,
11$500,000;

12(ii) for equipment or other facility improvements in
13an ambulatory surgical facility, or in an office where
14reviewable clinically related health care services are
15offered, whether a free-standing facility or office
16within a hospital, $1,000,000; or

17(iii) for any other hospital-based improvement,
18$2,000,000.

19(2) The proposal involves the establishment of a health
20care facility or a reviewable clinically related health
21service.

22(3) The proposal increases the number of licensed beds
23by more than ten beds or 10%, whichever is less, every two
24years.

25(i) If the additional beds are acute care beds and
26are not beds in a distinct-part psychiatric,
27rehabilitation or long-term care unit, all licensed beds
28of the acute-care facility shall be counted in
29determining whether the increased number of beds exceeds
3010%.

1(ii) If the additional beds are beds in a distinct-
2part psychiatric, rehabilitation or long-term care unit
3of an acute care facility, only the beds within that unit
4shall be counted in determining whether the increased
5number of beds exceeds 10%.

6(iii) If the additional beds are in a freestanding
7psychiatric, rehabilitation or long-term care facility,
8all licensed beds of the freestanding facility shall be
9counted in determining whether the increased number of
10beds exceeds 10%.

11(4) The proposal substantially expands an existing
12clinically related health service as determined by the
13department in the State health [services] improvement plan.

14(b) For the purposes of this act, an expenditure for the
15purpose of acquiring an existing health care facility [or
16replacement of equipment where there is no change in service]
17shall not be considered to be a capital expenditure subject to
18review. Expenditures for nonclinical activities or services,
19such as parking garages, computer systems or refinancing of
20debt, and research projects involving premarket approval of new
21equipment shall not be subject to review.

22(c) The capital expenditure threshold identified in
23subsection (a)(1) may be modified periodically by the department
24to reflect any increase in the construction cost or other
25factors influencing health care-related capital expenditures.
26The department shall publish a modification of the expenditure
27threshold through the regulatory review process.

28(d) A list of reviewable clinically related health services
29shall be published by the department and the policy board within
3030 days of the effective date of this act and may be modified by

1regulation on an annual basis. Exclusive of new high-cost
2technology, the initial list published by the department and the 
3policy board as required under this subsection shall be no more
4extensive than those services reviewable on the effective date
5of this act. Criteria for inclusion of reviewable services shall
6include, but not be limited to:

7(1) the quality of the service to be offered is likely
8to be compromised through insufficient volumes or
9utilization;

10(2) the service is dependent upon the availability of
11scarce natural resources such as human organs;

12(3) the operating costs associated with the service are
13reimbursed by major third party payors on a cost
14reimbursement basis; or

15(4) the service involves the use of new technology.

16(e) Any changes to the list required under subsection (d)
17and proposed by regulation shall be developed by the department
18after consultation with the policy board.

19(f) A facility providing treatment solely on the basis of
20prayer or spiritual means in accordance with the tenets of any
21church or religious denomination or a facility conducted by a
22religious organization for the purpose of providing health care
23services exclusively to clergy or other persons in a religious
24profession who are members of the religious denomination
25conducting the facility shall not be considered to constitute a
26health service subject to review under this act.

27(g) As used in this section, "new high-cost technology" 
28means new technological equipment with an aggregate purchase 
29cost of greater than $500,000. The department and the policy 
30review board shall consult with national medical and surgical 

1speciality organizations recognized by the American Board of 
2Medical Specialities (ABMS) and other nationally recognized 
3scientific resources in the determination of what constitutes 
4new technological equipment.

5Section 702. Certificates of need; notice of intent;
6application; issuance.

7(a) Projects requiring a certificate of need shall, at the
8earliest possible time in their planning, be submitted to the
9department and the review board in a letter of intent in such
10detail advising of the scope and nature of the project as
11required by regulations. Within 30 days after receipt of the
12letter of intent, the [department] review board shall inform the
13applicant providing the letter of intent whether the proposed
14project is subject to a certificate of need review or if
15additional information is required to make that determination.
16If the [department] review board determines that the project is
17subject to a certificate of need review, the project shall be
18subject to the remaining provisions of this act.

19(b) A person desiring to obtain or amend a certificate of
20need shall apply in writing to the department and the review 
21board, supplying such information as is required by the
22department and the review board, including, but not limited to, 
23a cost impact analysis as further defined by the department in 
24regulations implementing this act, and certifying that all data,
25information and statements are factual to the best of their
26knowledge, information and belief. The [department] review board
27shall have 60 days after receipt of the application within which
28to assess the application and in which to request specific
29further information. If further information is requested, the
30[department] review board shall complete its preliminary

1assessment of the application within 45 days of receipt of the
2same. No information shall be required that is not specified in
3the rules and regulations promulgated by the department and the 
4review board.

5(c) Timely notice of the beginning of review of the
6application by the [department] review board shall be published
7after preliminary assessment of the application is completed by
8the [department] review board. The "date of notification" of the
9beginning of review shall be the date such notice is sent, or
10the date such notice is published in the Pennsylvania Bulletin
11or in a newspaper of general circulation, whichever is latest.

12(c.1) The review board shall conduct at least one public
13meeting within 45 days from the date of notification in the
14region where the certificate of need application is filed.

15(d) The [department] review board shall approve or
16disapprove the application within [90] 120 days from the date of
17notification of the beginning of the review unless the period
18for review is extended by the applicant in writing.

19(e) The following apply:

20(1) Certificates of need shall be granted or refused by 
21the review board. They shall not be conditioned upon the
22applicant changing other aspects of its facilities or
23services or requiring the applicant to meet other specified
24requirements, and no such condition shall be imposed by the
25department in granting or refusing approval of certificates
26of need.

27(2) A certificate of need shall state the maximum amount
28of expenditures which may be obligated under it and
29applicants proceeding with an approved project may not exceed
30this level of expenditure except as allowed under the

1conditions and procedures established by the department
2through regulation.

3(f) The following apply:

4(1) The [department] review board shall make written
5findings which state the basis for any final decision made by
6the [department] review board. Such findings shall be served
7upon the applicant and provided to all persons expressing an
8interest in the proceedings and shall be made available to
9others upon written request.

10(2) All decisions of the [department] review board shall
11be based solely on the record. No ex parte contact regarding
12the application between any employee of the department or the 
13review board who exercises responsibilities respecting the
14application and the applicant, any person acting on behalf of
15the applicant or any person opposed to the issuance of the
16certificate of need shall occur after the commencement of a
17hearing on the application and before a decision is made by
18the department.

19(g) Modification of the application at any stage of the
20proceeding shall not extend the time limits provided by this act
21unless the [department] review board expressly finds that the
22modification represents a substantial change in the character of
23the application.

24(h) The responsibility of performing certificate of need
25review may not be delegated by the department and the review 
26board. The department and the review board shall consider
27recommendations of [one or more] the community-based health
28services planning [committees] committee whose localities are
29affected by specific applications in reviewing the applications.

30(h.1) The following shall apply to a community-based health

1planning committee:

2(1) A community-based health planning committee shall be
3formed within 15 days from the date of notification of the
4beginning of the review.

5(2) The secretary shall appoint and form the community-
6based health planning committee and the committee shall
7contain at least 12 members including:

8(i) The State Senator and State Representative
9representing the location for which the certificate of
10need is being applied.

11(ii) At least three consumers of health care
12services representing local, regional and underserved
13populations.

14(iii) A representative of the county health
15department.

16(iv) A representative of business.

17(v) A representative of labor.

18(vi) A physician.

19(vii) A nurse.

20(viii) A representative of a third party payor.

21(ix) Other local citizens that the secretary
22believes can provide additional guidance and
23recommendations related to the certificate of need
24application.

25(3) The community-based health planning committee shall
26consult the review board during the review of the certificate
27of need application and may nominate one of its members to
28provide testimony at the hearing required under subsection
29(c.1).

30(4) If simultaneous and comparative reviews are 

1proceeding in a similar region as permitted under subsection 
2(i), the same community-based health planning committee may 
3be used.

4(i) The department and the review board may provide that
5categories of projects shall receive simultaneous and
6comparative review.

7Section 6. Section 703 of the act, amended July 12, 1980 
8(P.L.655, No.136), is reenacted and amended to read:

9Section 703. Notice and hearings before [health systems
10agencies] the review board.

11(a) Notice of completed applications for certificates of 
12need or amendment thereto and of the beginning of review shall 
13be published by the [health systems agency] review board in the 
14appropriate news media and by the department in the Pennsylvania 
15Bulletin in accordance with 45 Pa.C.S. [Chap. 7B] Ch. 7 Subch. B 
16(relating to publication of documents), and the [health systems 
17agency] review board shall notify all affected persons with 
18notice of the schedule for review, the date [by which a] that 
19the public hearing must be demanded, and of the manner notice 
20will be given of a hearing, if one is to be held. Notice to 
21affected persons (other than members of the public who are to be 
22served by the proposed new institutional health service) shall 
23be by mail (which may be part of a newsletter). Members of the 
24public [may] shall be notified through newspapers of general 
25circulation. Directly affected persons may file objections 
26within 15 days of such publication with the [local health 
27systems agency] review board setting forth specifically the 
28reasons such objections were filed. Persons filing the 
29objections shall be parties to the proceeding, unless and until 
30such objections are withdrawn.

1(b) [Affected persons may request a public hearing or the
2health systems agency may require a public hearing during the
3course of such review.] Fourteen days written notice of the
4hearing shall be given to affected persons in the same manner as
5a notice of a completed application is provided in subsection
6(a). In the hearing, any person shall have the right to be
7represented by counsel and to present oral or written arguments
8and relevant evidence. Any person directly affected may conduct
9reasonable questioning of persons who make relevant factual
10allegations. A record of the hearing shall be maintained.

11Section 7. Section 704 of the act, amended December 18, 1992 
12(P.L.1602, No.179), is reenacted and amended to read:

13Section 704. Notice of public meetings.

14(a) Notification of the beginning of review of a certificate 
15of need application shall be published by the [department] 
16review board in the appropriate news media and in the 
17Pennsylvania Bulletin in accordance with 45 Pa.C.S. Ch. 7 Subch. 
18B (relating to publication of documents). The notice shall 
19identify the schedule for review[,] and the date by which a 
20public meeting [must be requested and the manner in which notice 
21will be given of a meeting, if one is] will be held.

22(b) [Interested persons may request a public meeting within
2315 days of publication, and the department shall hold such a
24meeting or the department may require a public meeting during
25the course of such review.] The [department] review board shall
26publish written notice of the meeting in the appropriate news
27media and the Pennsylvania Bulletin at least 14 days prior to
28the public meeting date. In the meeting, the applicant and any
29interested person providing prior notice to the [department]
30review board shall have the right to present oral or written

1comments and relevant evidence on the application in the manner
2prescribed by the [department] review board. The [department]
3review board shall prepare a transcript of the oral testimony
4presented at the meeting. Meetings shall be held in accordance
5with the guidelines and procedures established by the
6[department] review board and published in the Pennsylvania Code
7as a statement of policy. The [department] review board may
8require the applicant to provide copies of the application to
9any interested person making a request for such application, at
10the expense of the interested person.

11(c) The applicant may, for good cause shown, request in
12writing a public hearing for the purpose of reconsideration of a
13decision of the [department] review board within ten days of
14service of the decision of the [department] review board. The
15[department] review board shall treat the request in accordance
16with the provisions of 1 Pa. Code § 35.241 (relating to
17application for rehearing or reconsideration). The [department]
18review board shall set forth the cause for the hearing and the
19issues to be considered at such hearing. If such hearing is
20granted, it shall be held no sooner than six days and no later
21than 30 days after the notice to grant such a hearing and shall
22be limited to the issues submitted for reconsideration. A
23transcript shall be made of the hearing and a copy of the
24transcript shall be provided at cost to the applicant. The
25[department] review board shall affirm or reverse its decision
26and submit the same to the person requesting the hearing within
2730 days of the conclusion of such hearing. Any change in the
28decision shall be supported by the reasons for the change.

29(d) Where hearings under subsection (b) are held on more
30than two days, consecutive days of hearings and intervening

1weekends and holidays shall be excluded in calculating the time
2permitted for the [department] review board to conduct its
3review, and, if briefs are to be filed, ten days subsequent to
4the adjournment of the hearing shall also be excluded.

5Section 8. Section 705 of the act, amended December 18, 1992
6(P.L.1602, No.179), is reenacted to read;

7Section 705. Good cause.

8Good cause shall be deemed to have been shown if:

9(1) there is significant, relevant information not
10previously considered;

11(2) there is significant change in factors or
12circumstances relied on in making the decision;

13(3) there has been material failure to comply with the
14procedural requirements of this act; or

15(4) good cause is otherwise found to exist.

16Section 9. Sections 706, 707 and 708.1 of the act, amended 
17or added December 18, 1992 (P.L.1602, No.179), are reenacted and 
18amended to read:

19Section 706. Information during review.

20During the course of review the [department] review board
21shall upon request of any person set forth the status, any
22findings made in the proceeding and other appropriate
23information requested. The [department] review board may require
24such request in writing.

25Section 707. Criteria for review of applications for
26certificates of need or amendments.

27(a) An application for certificate of need shall be
28considered for approval when the [department] review board
29determines that the application substantially meets the
30requirements listed below:

1(1) There is need by the population served or to be
2served by the proposed service or facility.

3(2) The proposed service or facility will provide care
4consistent with quality standards established by the State
5health [services] improvement plan.

6(3) The proposed service or facility will meet the
7standards identified in the State health [services]
8improvement plan for access to care by medically underserved
9groups, including individuals eligible for medical assistance
10and persons without health insurance.

11(4) The applicant has submitted a data-based cost
12analysis that includes an analysis demonstrating that:

13(i) There is not a more appropriate, less costly or
14more effective alternative method of providing the
15proposed services.

16(ii) The service or facility is financially and
17economically feasible, considering anticipated volume of
18care and the availability of reasonable financing based
19on information from the applicant and other sources
20during the review process.

21(iii) The proposed service or facility will not have
22an inappropriate, adverse impact on the overall level of
23health care expenditures in the area.

24(iv) The proposed service or facility does not
25adversely impact the maintenance and development of rural
26and inner-city health services generally and, in
27particular, those services provided by health care
28providers which are based in rural and inner-city
29locations and which have an established history of
30providing services to medically underserved populations.

1(b) The [department] review board shall issue a certificate
2of need if the project substantially meets the criteria of
3subsection [(a)(1), (2) and (3)] (a) and the project is
4consistent with the State health [services] improvement plan
5unless the [department] review board can demonstrate:

6(1) There is a more appropriate, less costly or more
7effective alternative method of providing the proposed
8services.

9(2) The service or facility is not financially and
10economically feasible, considering anticipated volume of care
11and the availability of reasonable financing based on
12information received from the applicant and other sources
13during the review process.

14(3) The proposed service or facility will have an
15inappropriate, adverse impact on the overall level of health
16care expenditures in the area.

17(4) The proposed service or facility adversely impacts
18the maintenance and development of rural and inner-city
19health services generally and, in particular, those services
20provided by health care providers which are based in rural
21and inner-city locations and which have an established
22history of providing services to medically underserved
23populations.

24(c) Notwithstanding the provisions of subsections (a) and
25(b), applications for projects described in subsection (d) shall
26be approved unless the [department] review board finds that the
27facility or service with respect to such expenditure as proposed
28is not needed or that the project is not consistent with the
29State health [services] improvement plan. An application made
30under this subsection shall be approved only to the extent that

1the [department] review board determines it is required to
2overcome the conditions described in subsection (d).

3(d) Subject to the provisions of subsection (c), subsections
4(a) and (b) shall not apply to capital expenditures required to:

5(1) eliminate or prevent imminent safety hazards as a
6result of violations of safety codes or regulations;

7(2) comply with State licensure standards; or

8(3) comply with accreditation standards, compliance with
9which is required to receive reimbursement or payments under
10Title XVIII or XIX of the Federal Social Security Act.

11Section 708.1. Monitoring certificate of need; expiration of a
12certificate of need.

13A certificate of need or an amendment to it shall expire two
14years from the date issued unless substantially implemented, as
15defined by regulation. The [department] review board may grant
16extensions for a specified time upon request of the applicant
17and upon a showing that the applicant has or is making a good
18faith effort to substantially implement the project. An expired
19certificate of need shall be invalid, and no person may proceed
20to undertake any activity pursuant to it for which a certificate
21of need or amendment is required. The applicant shall report to
22the department and the review board, on forms prescribed by the
23department and the review board, the status of the project until
24such time as the project is licensed or operational, if no
25license is required.

26Section 10. Section 709 of the act, amended December 18, 
271992 (P.L.1602, No.179), is reenacted to read:

28Section 709. Emergencies.

29Notwithstanding any other provision of this act, in the event
30of an emergency the department may suspend the foregoing

1application process and permit such steps to be taken as may be
2required to meet the emergency including the replacement of
3equipment or facilities.

4Section 11. Section 710 of the act is reenacted and amended
5to read:

6Section 710. Notice of termination of services.

7For informational purposes only, at least 30 days prior to
8termination or substantial reduction of a service or a permanent
9decrease in the bed complement, the provider shall notify the
10[health systems agency and the] department of its intended
11action.

12Section 12. Section 711 of the act, amended December 18, 
131992 (P.L.1602, No.179), is reenacted and amended to read:

14Section 711. Review of activities.

15(a) The department and the review board shall prepare and
16publish not less frequently than annually reports of reviews
17conducted under this act, including a statement on the status of
18each such review and of reviews completed by it and statements
19of the decisions made in the course of such reviews since the
20last report. The department and the review board shall also make
21available to the general public for examination at reasonable
22times of the business day all applications reviewed by it. Such
23reports and applications shall be considered public records.

24(b) The department's and the review board's report which
25shall be submitted to the members of the Health and Welfare
26Committees of the Senate and House of Representatives shall
27contain the following information:

28(1) The volume of applications submitted, by project
29type, their dollar value, and the numbers and costs
30associated with those approved and those not approved.

1(2) The assessment of the extent of competition in
2specific service sectors that guided decisions.

3(3) A detailed description of projects involving
4nontraditional or innovative service delivery methods or
5organizational arrangements and the decisions made on each of
6these projects.

7(4) The average time for review, by level of review.

8(5) The fees collected for reviews and the cost of the
9program.

10Section 13. Section 712 of the act, added July 12, 1980 
11(P.L.655, No.136) and repealed in part December 20, 1982 
12(P.L.1409, No.326), is reenacted and amended to read:

13Section 712. Actions against violations of law and rules and
14regulations[; bonds].

15(a) Whenever any person, regardless of whether such person
16is a licensee, has willfully violated any of the provisions of
17this act or the rules and regulations adopted thereunder, the
18department may maintain any action in the name of the
19Commonwealth for an injunction or other process restraining or
20prohibiting such person from engaging in such activity.

21Section 14. Section 808 of the act, amended December 18, 
221992 (P.L.1602, No.179), July 7, 2006 (P.L.334, No.69) and

23December 22, 2011 (P.L.563, No.122), is reenacted to read:

24Section 808. Issuance of license.

25(a) Standards.--The department shall issue a license to a
26health care provider when it is satisfied that the following
27standards have been met:

28(1) that the health care provider is a responsible
29person;

30(2) that the place to be used as a health care facility

1is adequately constructed, equipped, maintained and operated
2to safely and efficiently render the services offered;

3(3) that the health care facility provides safe and
4efficient services which are adequate for the care, treatment
5and comfort of the patients or residents of such facility;

6(4) that there is substantial compliance with the rules
7and regulations adopted by the department pursuant to this
8act;

9(5) that a certificate of need has been issued if one is
10necessary; and

11(6) that, in the case of abortion facilities, such
12facility is in compliance with the requirements of 18 Pa.C.S.
13Ch. 32 (relating to abortion) and such regulations
14promulgated thereunder.

15(b) Separate and limited licenses.--Separate licenses shall
16not be required for different services within a single health
17care facility except that home health care, home care, hospice
18or long-term nursing care will require separate licenses. A
19limited license, excluding from its terms a particular service
20or portion of a health care facility, may be issued under the
21provisions of this act.

22(c) Addition of services.--When the certificate of need for
23a facility is amended as to services which can be offered, the
24department shall issue an appropriate license for those services
25upon demonstration of compliance with licensure requirements.

26Section 15. Section 901 of the act, amended July 12, 1980 
27(P.L.655, No.136), is reenacted and amended to read:

28Section 901. Existing facilities and institutions.

29(a) The following apply:

30(1) No certificate of need shall be required for any

1buildings, real property and equipment owned, leased or being
2operated, or under contract for construction, purchase, or
3lease and for all services being rendered by licensed or
4approved providers [on April 1, 1980.] prior to the effective 
5date of this paragraph.

6(2) Nor shall a certificate of need be required for any
7new institutional health services for which an approval has
8been granted under section 1122 of the Social Security Act or
9for which an application is found pursuant to such section to
10be in conformity with the standards, criteria or plans to
11which such section refers, or as to which the Federal
12Secretary of Health and Human Services makes a finding that
13reimbursement shall be granted[: Provided, however, That such
14approval is in force on August 1, 1980 or such application
15shall have been filed prior to August 1, 1980 or the
16acceptance of applications for reviews under this act,
17whichever shall last occur].

18(b) Existing facilities and institutions shall be required
19to obtain a certificate of need for projects outlined in section
20701.

21Section 16. Section 902.1 of the act, added December 18, 
221992 (P.L.1602, No.179), is reenacted and amended to read:

23Section 902.1. Fees for review of certificate of need
24applications.

25(a) The [department] review board shall charge a fee of
26[$150] $500 for each letter of intent filed. The letter of
27intent fee shall be deducted from the total application fee
28required under subsection (b) if an application is submitted on
29the project proposed in the letter of intent.

30(b) For each application the [department] review board shall

1charge a fee, payable on submission of an application. The fee
2shall not be less than $500 plus up to [$3] $10 per $1,000 of
3proposed capital expenditure and shall not be more than
4[$20,000] $50,000.

5(c) The [department] review board shall publish a fee
6schedule in the Pennsylvania Bulletin which shall explain the
7procedure for filing fees.

8(d) All fees payable under this section are due upon the
9date of filing a letter of intent or application. If a person
10fails to file the appropriate fee, all time frames required of
11the [department] review board under this act, with respect to
12review of a letter of intent or application, are suspended until
13the applicable fee is paid in full.

14(e) Each community-based health services planning committee
15may apply for up to $10,000 in funding from the department for
16administrative functions associated with reviewing certificate
17of need proposals. This funding is to be allocated from the
18Patient Safety Authority appropriation.

19Section 17. Section 904.1 of the act, added December 18, 
201992 (P.L.1602, No.179), is repealed:

21[Section 904.1. Sunset.

22The authority, obligations and duties arising under Chapter 7
23and all other provisions of this act pertaining to certificates
24of need shall terminate four years after the effective date of
25this section. Twelve months prior to this expiration, the
26Legislative Budget and Finance Committee shall commence a review
27of the impact of the certificate of need program on quality,
28access and cost of health care services, including the costs of
29appeals, reviewable under this act.]

30Section 18. This act shall take effect immediately.