Title 19. Health Care Facilities — Subtitle 1. Health Care Planning and Systems Regulation

Develop health care cost containment strategies to help provide access to appropriate quality health care services for all Marylanders, after consulting with the Health Services Cost Review Commission;

Promote the development of a health regulatory system that provides, for all Marylanders, financial and geographic access to quality health care services at a reasonable cost by:

Facilitate the public disclosure of medical claims data for the development of public policy;

Establish and develop a medical care database on health care services rendered by health care practitioners;

Encourage the development of clinical resource management systems to permit the comparison of costs between various treatment settings and the availability of information to consumers, providers, and purchasers of health care services;

In accordance with Title 15, Subtitle 12 of the Insurance Article, develop a uniform set of effective benefits to be included in the Comprehensive Standard Health Benefit Plan;

Analyze the medical care database and provide, in aggregate form, an annual report on the variations in costs associated with health care practitioners;

Ensure utilization of the medical care database as a primary means to compile data and information and annually report on trends and variances regarding fees for service, cost of care, regional and national comparisons, and indications of malpractice situations;

Establish standards for the operation and licensing of medical care electronic claims clearinghouses in Maryland;

Reduce the costs of claims submission and the administration of claims for health care practitioners and payors;

Determine the cost of mandated health insurance services in the State in accordance with Title 15, Subtitle 15 of the Insurance Article;

Promote the availability of information to consumers on charges by practitioners and reimbursements from payors;

Oversee and administer the Maryland Trauma Physician Services Fund in conjunction with the Health Services Cost Review Commission; and

Establish policies and standards to protect the confidentiality of patient and health care practitioner information related to legally protected health care as defined in § 4–301 of this article.

The Commission shall consist of 15 members appointed by the Governor with the advice and consent of the Senate.

Of the 15 members:

The term of a member is 4 years.

The terms of members are staggered as required by the terms provided for members of the Commission on October 1, 1999.

At the end of a term, a member continues to serve until a successor is appointed and qualifies.

A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.

The Governor may remove a member for neglect of duty, incompetence, or misconduct.

A member may not serve more than two consecutive terms.

Assure that:

To the extent practicable, assure geographic balance and promote racial, ethnic, and gender diversity in the Commission’s membership.

The executive director, the deputy directors, and the principal section chiefs shall be executive service or management service employees.

The Commission, in consultation with the Secretary, shall determine the appropriate job classification and, subject to the State budget, the compensation for the executive director, the deputy directors, and the principal section chiefs.

A majority of the full authorized membership of the Commission is a quorum.

The decision of the Commission shall be by a majority of the quorum present and voting.

Compensation in accordance with the State budget; and

Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.

The Commission may employ a staff in accordance with the State budget.

The Commission, in consultation with the Secretary, may set the compensation of a Commission employee in a position that:

The Secretary of Budget and Management, in consultation with the Secretary, shall determine the positions for which the Commission may set compensation under paragraph (2) of this subsection.

Shall adopt regulations specifying the Comprehensive Standard Health Benefit Plan to apply under Title 15, Subtitle 12 of the Insurance Article; and

On or before March 1, 2008, in consultation with the Department, shall propose regulations to:

Premiums for health benefit plans sold under Title 15, Subtitle 12 of the Insurance Article, categorized by age bands; and

Premiums for health benefit plans sold under Title 15, Subtitle 12 of the Insurance Article that include riders typically purchased by small employers in the State.

In this section the following words have the meanings indicated.

‘‘Health care service” has the meaning stated in § 15–10A–01 of the Insurance Article.

“Payor” means:

“Provider” has the meaning stated in § 19–7A–01 of this title.

“Step therapy or fail–first protocol” has the meaning stated in § 15–142 of the Insurance Article.

Standardizing and automating the process required by payors for preauthorizing health care services; and

Overriding a payor’s step therapy or fail–first protocol.

On or before October 1, 2012 (“Phase 1”), establishment of online access for providers to each payor’s:

On or before March 1, 2013 (“Phase 2”), establishment by each payor of an online process for:

On or before July 1, 2013 (“Phase 3”), establishment by each payor of an online preauthorization system to approve:

On or before July 1, 2015, establishment, by each payor that requires a step therapy or fail–first protocol, of a process for a provider to override the step therapy or fail–first protocol of the payor; and

On or before July 1, 2015, utilization by providers of:

Provide real–time notice to providers about preauthorization requests approved in real time; and

Provide notice to providers, within the time frames specified in subsection (c)(3)(ii) and (iii) of this section and in a manner that is able to be tracked by providers, about preauthorization requests not approved in real time.

The Commission shall establish by regulation a process through which a payor or provider may be waived from attaining the benchmarks described in subsections (b) and (c) of this section for extenuating circumstances.

For a provider, the extenuating circumstances may include:

For a payor, the extenuating circumstances may include:

On or before October 1, 2012, the Commission shall reconvene the multistakeholder workgroup whose collaboration resulted in the 2011 report “Recommendations for Implementing Electronic Prior Authorizations”.

The workgroup shall:

Adjust the Phase 2 or Phase 3 benchmark dates;

Require payors and providers to comply with the benchmarks; and

Establish penalties for noncompliance.

In this section the following words have the meanings indicated.

“Carrier” includes insurers, nonprofit health service plans, health maintenance organizations, third–party administrators, and pharmacy benefits managers.

“Health care provider” includes hospitals, physicians, nurse practitioners, pharmacists, and other persons entitled to reimbursement under § 15–701(a) of the Insurance Article.

“Workgroup” means the Health Care Provider–Carrier Workgroup.

Professional organizations or associations of health care providers who bill and receive reimbursement for health care services from carriers;

Carriers or organizations or trade associations representing carriers that reimburse health care providers for health care services provided under health benefit plans; and

Subject to subsection (e)(1)(iii) of this section, consumer organizations.

The Commission shall invite the following to appoint members to the Workgroup:

Membership in the Workgroup may change depending on the issues before the Workgroup.

The size of the Workgroup shall be at the discretion of the Commission but large enough to represent the appropriate range of stakeholders.

At least annually, Commission staff shall solicit issues for consideration by the Workgroup.

Issues shall be solicited from:

Research each issue before the issue is considered by the Workgroup;

Use the results of the research to inform Workgroup meetings;

Facilitate Workgroup meetings in a way that promotes resolution of disputes on issues and is satisfactory to the members of the Workgroup; and

On or before January 1, 2016, and each year thereafter, submit a report to the Commission and, in accordance with § 2–1257 of the State Government Article, the Senate Finance Committee and the House Health and Government Operations Committee regarding the issues considered by the Workgroup during the preceding year and the outcome of the Workgroup’s consideration of each issue.

Family medicine;

General pediatrics;

Primary care internal medicine;

Primary care obstetrics and gynecology;

Primary care nurse practitioner services; and

Primary care midwifery.

An analysis of primary care investment over the immediately preceding year, including data stratified by zip code and county, in relation to total health care spending over the previous year;

Ways to improve the quality of and access to primary care services, with special attention to increasing health care equity, reducing health care disparities, and avoiding increased costs to patients and the health care system; and

Any findings and recommendations of the Commission.

The Commission shall form a workgroup to develop the report required under subsection (b) of this section, including by interpreting the results of the required analysis and making the recommendations.

The workgroup required under this subsection shall include representatives of:

In this section the following words have the meanings indicated.

“Carrier” has the meaning stated in § 15–1301 of the Insurance Article.

“Health care provider” has the meaning stated in § 19–108.3 of this subtitle.

On or before July 1, 2026, a carrier shall establish and maintain an online process that:

A carrier may not:

On request of a health care provider, provide contact information for each third–party vendor or other entity that the carrier will use to meet the requirements of subsection (b) of this section; and

Post the contact information required to be provided under item (1) of this subsection on its website.

On or before July 1, 2026, each health care provider shall ensure that each e–prescribing system or electronic health record system owned or contracted for by the health care provider to maintain a health record of an insured or enrollee has the ability to access, at the point of prescribing:

The Commission shall establish by regulation a process through which a health care provider may request and receive a waiver of compliance from the requirements of this subsection.

On or before July 1, 2026, each carrier, or a pharmacy benefits manager on behalf of the carrier, shall:

Each carrier, or a pharmacy benefits manager on behalf of the carrier, shall make available the information required to be provided under paragraph (1) of this subsection to the health care provider at the point of prescribing in an accessible and understandable format, such as through the health care provider’s e–prescribing system or electronic health record system that the carrier, pharmacy benefits manager, or designated subcontractor has adopted that uses the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard from which the health care provider makes the request.

Evolving modalities of telehealth delivery; and

Changes in the costs of delivering telehealth services; and

Adopt rules and regulations to carry out the provisions of this subtitle;

Create committees from among its members;

Appoint advisory committees, which shall include consumers and may include representatives of interested public or private organizations, to make recommendations to the Commission on community–based services, long–term care, acute patient services, ambulatory surgical services, specialized health care services, residential treatment centers for emotionally disturbed children and adolescents, mental health and alcohol and drug abuse services, and any other topic or issue that the Commission considers necessary;

Apply for and accept any funds, property, or services from any person or government agency;

Subject to subsection (d) of this section, award any funds received from any person or government agency;

Make agreements with a grantor or payor or with a grantee or payee of funds, property, or services, including an agreement to make any study, plan, demonstration, or project;

Publish and give out any information that relates to the financial aspects of health care and is considered desirable in the public interest; and

Subject to the limitations of this subtitle, exercise any other power that is reasonably necessary to carry out the purposes of this subtitle, including adopting regulations that set reasonable deadlines for filing of information or reports required under this subtitle and impose reasonable penalties for failure to file information or reports as required.

Adopt rules and regulations that relate to its meetings, minutes, and transactions;

Keep minutes of each meeting;

Prepare annually a budget proposal that includes the estimated income of the Commission and proposed expenses for its administration and operation;

Beginning December 1, 2000, and each December 1 thereafter, submit to the Governor, the Secretary, and, subject to § 2–1257 of the State Government Article, the General Assembly an annual report on the operations and activities of the Commission during the preceding fiscal year, including:

Except for confidential or privileged medical or patient information, make:

In collaboration with the Office of Health Care Quality, develop a process to receive the following information and publish it on the Commission’s Maryland Quality Reporting website for each applicable facility:

The Commission may contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Commission.

Unless permission is granted specifically by the Commission, a third party hired by the Commission may not release, publish, or otherwise use any information to which the third party has access under its contract.

In awarding funds under subsection (a)(5) of this section, the Commission shall:

The Commission shall:

The power of the Secretary to transfer, by rule, regulation, or written directive, any staff, functions, or funds of units in the Department does not apply to any staff, function, or funds of the Commission.

The Secretary may assess an administrative charge, consistent with the indirect cost charge assessed to federal grants, to fund services provided to the Commission by the Executive Branch.

The power of the Secretary over the procurement procedure for units in the Department does not apply to the procurement procedure for the Commission.

Subject to the provisions of paragraph (1) of this subsection, any procurement for services to be performed or for supplies to be delivered to the Commission is subject to the purposes and requirements of the State Finance and Procurement Article.

In this section the following words have the meanings indicated.

“Fund” means the Maryland Health Care Commission Fund.

“Health benefit plan” has the meaning stated in § 15–1201 of the Insurance Article.

“Health care practitioner” means any individual who is licensed, certified, or otherwise authorized under the Health Occupations Article to provide health care services.

“Nursing home” means a related institution that is classified as a nursing home.

“Payor” means:

All hospitals;

All nursing homes;

All payors; and

All health care practitioners.

The total fees assessed by the Commission may not exceed $20,000,000.

The Commission shall pay all funds collected from the fees assessed in accordance with this section into the Fund.

The fees assessed may be expended only for purposes authorized by the provisions of this subtitle.

The amount in paragraph (1) of this subsection limits only the total fees the Commission may assess in a fiscal year.

Use a methodology that accounts for the portion of the Commission’s workload attributable to each industry assessed; and

Recalculate workload distribution every 4 years.

The fees assessed in accordance with this section on health care practitioners shall be:

The Commission may adopt regulations that waive the fee assessed under this section for a specific class of health care practitioners.

There is a Maryland Health Care Commission Fund.

The Fund is a special continuing, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.

The Treasurer shall separately hold, and the Comptroller shall account for, the Fund.

The Fund shall be invested and reinvested in the same manner as other State funds.

Any investment earnings shall be retained to the credit of the Fund.

The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2–1220 of the State Government Article.

This section may not be construed to prohibit the Fund from receiving funds from any other source.

The Fund shall be used only to provide funding for the Commission and for the purposes authorized under this subtitle.

On or before September 1 of each year, each payor, hospital, and nursing home assessed under this section shall make payment to the Commission.

The Commission shall make provisions for partial payments.

In this section the following words have the meanings indicated.

“Center” means a Patient Safety Center designated by the Commission.

“Fund” means the Maryland Patient Safety Center Fund.

On or before December 31, 2025, the Commission shall designate a Center for the State.

The Center designated under paragraph (1) of this subsection shall continue to act as the State–designated Center for the duration of the designation period, as determined by the Commission, if the Center continuously meets the standards and requirements established by the Commission.

Develop, coordinate, and implement patient safety initiatives across the State;

Be a model for patient safety innovation and implementation in the State;

Convene health care providers, patients, and families to:

Share information relating to best practices among providers and patients in the State.

There is a Patient Safety Center Fund.

The purpose of the Fund is to subsidize a portion of the costs of the Center so that the Center may perform the duties described under subsection (c) of this section.

The Commission shall administer the Fund.

The Fund consists of:

The Fund may be used only to subsidize a portion of the costs of the Center so that the Center may perform the duties described under subsection (c) of this section.

The Commission may provide an annual grant from the Fund to the Center in the amount appropriated under paragraph (1) of this subsection, plus any interest and other income distributed to the Fund.

Expenditures from the Fund may be made only in accordance with the State budget.

Money expended from the Fund for the Center is supplemental to, and is not intended to take the place of, funding that otherwise would be appropriated for the Center.

The Center’s statewide activities related to the development, coordination, and implementation of patient safety initiatives; and

How the Center’s statewide initiatives align with State–designated priorities.

A transfer of stock or assets that results in a change of the person that controls a health care facility; or

The transfer of more than 25% of stock or ownership interest in a health care facility.

Has three or more operating rooms;

Operates primarily for the purpose of providing surgical services to patients who do not require overnight hospitalization; and

Seeks reimbursement from payors as an ambulatory surgical facility.

“Health care facility” means:

“Health care facility” does not include:

Act as the State agency to represent the State under Title VI of the federal Public Health Service Act; and

Periodically participate in or perform analyses and studies that relate to:

The Secretary shall provide for a study of systems capacity in health services.

The study shall:

In addition to information that an applicant for a certificate of need must provide, the Commission may request, collect, and report any statistical or other information that:

If a health care facility fails to provide information as required in this subsection, the Commission may:

The Commission may send to the Department or a local health planning agency any statistical or other information the Commission is authorized to collect under paragraph (1) of this subsection.

On or before October 1 each year, the Commission shall adopt a State health plan.

The plan shall:

Assess each State health plan chapter;

Determine the chapter or chapters of the State health plan that should be reviewed and revised;

Establish, at a public meeting, the priority order and timeline of the State health plan chapter review and revision; and

Publish any changes in the State health plan that the Commission considers necessary, subject to the review and approval granted to the Governor under this subtitle.

The Commission shall develop standards and policies consistent with the State health plan that relate to the certificate of need program.

The standards:

In adopting standards regarding cost, efficiency, cost–effectiveness, or financial feasibility, the Commission shall take into account the relevant methodologies of the Health Services Cost Review Commission.

Accurate bed count data for licensed beds and staffed and operated beds;

Cost data associated with all hospital beds and associated services on a hospital-specific basis;

Migration patterns and current and future projected population data;

Accessibility and availability of beds;

Quality of care;

Current health care needs, as well as growth trends for such needs, for the area served by each hospital;

Hospitals in high growth areas; and

Utilization.

The Commission shall use the institution-specific plan in reviewing certificate of need applications for conversion, expansion, consolidation, or introduction of hospital services in conjunction with the State health plan.

If there is a conflict between the State health plan and any rule or regulation adopted by the Commission in accordance with Title 10, Subtitle 1 of the State Government Article to implement an institution-specific plan that is developed for identifying any excess capacity in beds and services, the provisions of whichever plan that is most recently adopted shall control.

Immediately upon adoption of the institution-specific plan the Commission shall begin the process of incorporating the institution-specific plan into the State health plan and shall complete the incorporation within 12 months.

A State health plan developed or adopted after the incorporation of the institution-specific plan into the State health plan shall include the criteria in subsection (b) of this section in addition to the criteria in § 19-118 of this subtitle.

In this section the following words have the meanings indicated.

“Consolidation” and “merger” include increases and decreases in bed capacity or services among the components of an organization that:

“Hospital capital threshold” means the lesser of:

“Limited service hospital” means a health care facility that:

“Medical service” means:

A person shall have a certificate of need issued by the Commission before the person develops, operates, or participates in any of the health care projects for which a certificate of need is required under this section.

A certificate of need issued before January 13, 1987, may not be rendered wholly or partially invalid solely because certain conditions have been imposed, if an appeal concerning the certificate of need, challenging the power of the Commission to impose certain conditions on a certificate of need, has not been noted by an aggrieved party before January 13, 1987.

A certificate of need is required before an existing or previously approved, but unbuilt, health care facility is moved to another site.

This subsection does not apply if:

Notwithstanding any other provision of this subtitle, a certificate of need is not required for a relocation described under paragraph (2)(iv) of this subsection.

A certificate of need is required before the bed capacity of a health care facility is changed.

This subsection does not apply to any increase or decrease in bed capacity if:

Except as provided in paragraph (2) of this subsection, for a hospital located in a county with three or more hospitals, a certificate of need is not required before the bed capacity is increased or decreased if the change:

A hospital may not create a new health care service through the relocation of beds from one county to another county pursuant to this subsection.

A certificate of need is required before the type or scope of any health care service is changed if the health care service:

This subsection does not apply if:

Notwithstanding the provisions of paragraph (2) of this subsection, a certificate of need is required:

A certificate of need is required before any of the following capital expenditures are made by or on behalf of a hospital:

A certificate of need is required before any of the following capital expenditures are made by or on behalf of a health care facility other than a hospital:

A certificate of need is required before any equipment or plant is donated to a health care facility, if a certificate of need would be required under paragraph (1) or (2) of this subsection for an expenditure by the health care facility to acquire the equipment or plant directly.

A certificate of need is required before any equipment or plant is transferred to a health care facility at less than fair market value if a certificate of need would be required under paragraph (1) or (2) of this subsection for the transfer at fair market value.

A certificate of need is required before a person acquires a health care facility if a certificate of need would be required under paragraph (1) or (2) of this subsection for the acquisition by or on behalf of the health care facility.

This subsection does not apply to:

Paragraph (6)(vi), (vii), (viii), (ix), and (x) of this subsection may not be construed to permit a facility to offer a new health care service for which a certificate of need is otherwise required.

A certificate of need is not required to close any health care facility or part of a health care facility if at least 90 days before the closing or if at least 45 days before the partial closing of the health care facility, including a State hospital, a person proposing to close all or part of the health care facility files notice of the proposed closing or partial closing with the Commission.

A hospital shall hold a public informational hearing in the county where the hospital is located if the hospital:

The Commission may require a health care facility other than a hospital described in paragraph (2) of this subsection that files notice of its proposed closing or partial closing to hold a public informational hearing in the county where the health care facility is located.

A public informational hearing required under paragraph (2) or (3) of this subsection shall be held by the health care facility, in consultation with the Commission, within 30 days after:

Within 10 working days after a public informational hearing held by a hospital under this subsection, the hospital shall provide a written summary of the hearing to:

Notwithstanding any other provision of this section, the Commission shall consider the special needs and circumstances of a county where a medical service, as defined in this section, does not exist; and

The Commission shall consider and may approve under this subsection a certificate of need application to establish, build, operate, or participate in a health care project to provide a new medical service in a county if the Commission, in its sole discretion, finds that:

Except as provided in paragraphs (2) and (3) of this subsection, a person shall have a certificate of need issued by the Commission before a person establishes or operates a freestanding medical facility.

A certificate of need is not required for the establishment or operation of a freestanding medical facility pilot project established under § 19–3A–07 of this title.

Written notice of the intent to establish or operate the intermediate care facility is filed with the Commission at least 45 days before establishment; and

The Commission in its sole discretion finds that the proposed intermediate care facility:

In this section the following words have the meanings indicated.

“Certificate of conformance” means an approval issued by the Commission that allows an acute general hospital to establish emergency PCI services or elective PCI services without a certificate of need.

“Certificate of ongoing performance” means an approval issued by the Commission that the cardiac surgery services, emergency PCI services, or elective PCI services provided by an acute general hospital meet standards evidencing continued quality.

“Elective PCI” (also known as “nonprimary PCI”) includes PCI provided to a patient who is not suffering from an acute coronary syndrome, but whose condition is appropriately treated with PCI based on regulations established by the Commission.

“Emergency PCI” (also known as “primary PCI”) includes PCI capable of relieving coronary vessel narrowing associated with STEMI or, as defined by the Commission in regulations, STEMI equivalent.

“PCI” means percutaneous coronary intervention.

“STEMI” (ST–segment–elevation myocardial infarction) means a type of heart attack or myocardial infarction that is caused by a prolonged period of blocked blood supply, which affects a large area of the heart muscle and causes changes on an electrocardiogram and in the blood levels of key chemical markers.

Beginning July 1, 2012, before an acute general hospital may establish emergency PCI services or elective PCI services, the hospital shall obtain a certificate of conformance from the Commission.

The Commission may not issue a certificate of conformance unless the Commission finds that the proposed emergency PCI services or proposed elective PCI services:

The acute general hospital was providing emergency PCI services on January 1, 2012; and

The Commission determines that the emergency PCI services are consistent with the State Health Plan for Facilities and Services.

On January 1, 2012, the acute general hospital was providing elective PCI services through the C–PORT E registry under authority of a research waiver issued by the Commission;

The Commission finds that the C–PORT E study produced results that should guide public policy; and

The Commission determines that the elective PCI services provided by the acute general hospital continue to be consistent with:

This subsection applies to an acute general hospital that provides cardiac surgery or PCI services under:

An acute general hospital shall obtain and maintain a certificate of ongoing performance to continue to provide:

The Commission shall adopt regulations through an update to the State Health Plan for Facilities and Services to implement this section.

The regulations shall:

In this section the following words have the meanings indicated.

“Executive Director” means the Executive Director of the Commission.

“Nursing home” has the meaning stated in § 19–1401 of this title.

“Request for acquisition” means a request for the Commission to approve the acquisition of a nursing home.

Involves at least a 5% transfer in ownership interest; and

Is not an acquisition that requires approval under subsection (c) of this section.

This subsection does not apply to an acquisition that involves only changes of ownership interests among existing owners of a nursing home.

At least 60 days before the closing date of the acquisition of a nursing home, a person shall:

The Executive Director shall review a completed request for acquisition within 45 days after receiving the completed request from the applicant.

The Executive Director, in consultation with the Secretary or the Secretary’s designee, may:

Is consistent with the State Health Plan; and

Subject to subsection (f) of this section, is in the public interest.

Solicit and accept comments from individuals who:

Consult with the Attorney General on whether the acquisition raises public interest concerns.

A decision of the Commission under subsection (g) or (h) of this section shall be a final decision for the purpose of judicial review.

A person that is a party to the acquisition may take a direct judicial appeal within 30 days after the Commission makes the final decision.

The Commission shall send each final decision to the Secretary, the Secretary of Aging, the Office of Health Care Quality, the Office of the Attorney General, and the State Long–Term Care Ombudsman.

On or before July 1 immediately following the acquisition of a nursing home and each year for 3 years thereafter, the person that acquired the nursing home shall submit a report to the Commission in accordance with regulations adopted by the Commission.

The Commission shall provide the report required under paragraph (1) of this subsection to the Secretary, the Secretary of Aging, the Office of Health Care Quality, the Office of the Attorney General, and the State Long–Term Care Ombudsman.

The Commission shall adopt regulations through an update to the State Health Plan for Facilities and Services to carry out the provisions of this section.

The regulations adopted under this subsection shall:

The criteria established by the Commission under paragraph (2)(iv) of this subsection shall require that the Commission take into consideration whether any nursing home currently or previously owned, within or outside the State, by the person submitting the request, for the period of 3 years immediately preceding the submission of the request:

A health maintenance organization or a health care facility that either controls, directly or indirectly, or is controlled by a health maintenance organization shall have a certificate of need before the health maintenance organization or health care facility builds, develops, operates, purchases, or participates in building, developing, operating, or establishing:

Notwithstanding paragraph (1)(ii) of this subsection, a health maintenance organization or a health care facility that either controls, directly or indirectly, or is controlled by a health maintenance organization is not required to obtain a certificate of need before purchasing an existing ambulatory surgical facility or center, as defined in § 19–114(b) of this subtitle.

Documents that the project is necessary to meet the needs of enrolled members and reasonably anticipated new members for the services proposed to be provided by the applicant; and

Is not inconsistent with those sections of the State health plan or those sections of the institution–specific plan that govern hospitals, as defined in § 19–301 of this title, and ambulatory surgical facilities or centers, as defined in § 19–114(b) of this subtitle, or health care projects for which a certificate of need is required under subsection (b)(1)(ii) of this section.

Through a health care facility;

In space leased from a health care facility; or

In space on land leased from a health care facility;

Each member of the General Assembly in whose district the action is planned;

Each member of the governing body for the county where the action is planned;

The county executive, mayor, or chief executive officer, if any, in whose county or city the action is planned; and

Any health care provider, third party payor, local planning agency, or any other person the Commission knows has an interest in the application.

All decisions of the Commission on an application for a certificate of need, except in emergency circumstances posing a threat to public health, shall be consistent with the State health plan and the standards for review established by the Commission.

The mere failure of the State health plan to address any particular project or health care service shall not alone be deemed to render the project inconsistent with the State health plan.

Unless the Commission finds that the facility or service for which the proposed expenditure is to be made is not needed or is not consistent with the State health plan, the Commission shall approve an application for a certificate of need required under § 19–120(k) of this subtitle to the extent that the expenditure is to be made to:

The Commission alone shall have final nondelegable authority to act upon an application for a certificate of need, except as provided in this subsection.

A majority of the full authorized membership of the Commission shall be a quorum to act on an application for a certificate of need.

After an application is filed, the staff of the Commission:

The Commission may delegate to a reviewer the responsibility for review of an application for a certificate of need, including:

The Commission shall designate a single Commissioner to act as a reviewer for the application and any competing applications.

The Commission shall delegate to its staff the responsibility for an initial review of an application, including, in the event that no written comments on an application are submitted by any interested party other than the staff of the Commission, the preparation of a recommended decision for consideration by the full Commission.

Any “interested party” may submit written comments on the application in accordance with procedural regulations adopted by the Commission.

The Commission shall define the term “interested party” to include, at a minimum:

The reviewer shall review the application, any written comments on the application, and any other materials permitted by this section or by the Commission’s regulations, and present a recommended decision on the application to the full Commission.

Any interested party who has submitted written comments under paragraph (7) of this subsection may submit written exceptions to the proposed decision and make oral argument to the Commission, in accordance with regulations adopted by the Commission, before the Commission takes final action on the application.

The Commission shall, after determining that the recommended decision is complete, vote to approve, approve with conditions, or deny the application on the basis of the recommended decision, the record before the staff or the reviewer, and exceptions and arguments, if any, before the Commission.

The decision of the Commission shall be by a majority of the quorum present and voting.

Have satisfactorily met all applicable standards;

The Commission finds at least comparable to all other applicants.

If any party or interested person requests an evidentiary hearing with respect to a certificate of need application for any health care facility other than an ambulatory surgical facility and the Commission, in accordance with criteria it has adopted by regulation, considers an evidentiary hearing appropriate due to the magnitude of the impact that the proposed project may have on the health care delivery system, the Commission or a committee of the Commission shall hold the hearing in accordance with the contested case procedures of the Administrative Procedure Act.

Except as provided in this section or in regulations adopted by the Commission to implement the provisions of this section, the review of an application for a certificate of need for an ambulatory surgical facility is not subject to the contested case procedures of Title 10, Subtitle 2 of the State Government Article.

An application for a certificate of need shall be acted upon by the Commission no later than 150 days after the application was docketed.

If an evidentiary hearing is not requested, the Commission’s decision on an application shall be made no later than 90 days after the application was docketed.

The applicant or any aggrieved party, as defined in § 19–128(a) of this subtitle, may petition the Commission within 15 days for a reconsideration.

The Commission shall decide whether or not it will reconsider its decision within 30 days of receipt of the petition for reconsideration.

The Commission shall issue its reconsideration decision within 30 days of its decision on the petition.

Except as provided in paragraph (2) of this subsection, if the Commission does not act on an application within the required period, the applicant may file with a court of competent jurisdiction within 60 days after expiration of the period a petition to require the Commission to act on the application.

In this section, “aggrieved party” means:

The grounds for appeal by the Secretary shall be that the decision is inconsistent with the State health plan or adopted standards.

A decision of the Commission shall be the final decision for purposes of judicial review.

A request for a reconsideration will stay the final decision of the Commission for purposes of judicial review until a decision is made on the reconsideration.

Review is necessary to secure uniformity of decision, as where the same statute has been construed differently by 2 or more judges; or

There are other special circumstances that render it desirable and in the public interest that the decision be reviewed.

Is not inconsistent with the State health plan or any institution-specific plan;

Will result in the delivery of more efficient and effective hospital services; and

Is in the public interest.

In this section the following words have the meanings indicated.

“Fund” means the Maryland Trauma Physician Services Fund.

“Maryland Trauma Specialty Referral Centers” means:

“Reasonable compensation equivalent” means the limitation on the cost established by the Centers for Medicare and Medicaid Services that a provider may claim for compensation of services.

“Rehabilitation hospital” means a facility classified as a special rehabilitation hospital as described in § 19–307 of this title that is affiliated with a trauma center by common ownership.

“Trauma health care practitioner” means a health care practitioner licensed under the Health Occupations Article who provides care in a trauma center or in a rehabilitation hospital to trauma patients on the State trauma registry as defined by the Maryland Institute for Emergency Medical Services Systems.

“Trauma physician” means a physician who provides care in a trauma center or in a rehabilitation hospital to trauma patients on the State trauma registry as defined by the Maryland Institute for Emergency Medical Services Systems.

“Uncompensated care” means care provided by a trauma physician or a trauma health care practitioner to a trauma patient on the State trauma registry who: