Filing of Request. A holder that desires to change a project that has received CON or other Commission approval shall submit a request for the proposed change and supporting documentation to the Commission, copying each local health department within the health planning region of the project and, in the case of a change in the location or address of a project involving construction of a new health care facility, to all health care facilities of that type located in the health planning region. Commission Approval Required Before Project Changes. Any of the following proposed changes that would place the project at variance with its CON or other approval issued under this chapter, including any condition placed on the approval, shall be reviewed by the Commission: A significant change in physical plant design; A capital cost increase that exceeds the approved capital cost inflated by an amount determined by applying the Hospital Capital Market Baskets published by IHS Markit in Health Care Cost Review or other guidance approved by the Commission and posted on the Commission website from the application submission date to the date of the filing of a request for a project change; A change in the financing mechanisms of the project; or A change in the location of the project. Impermissible Changes. The following proposed changes to an approved project require a new CON or other appropriate review and may not be considered by the Commission: Changes in the fundamental nature of a facility or the services to be provided in the facility from those that were approved by the Commission; Increases in the facility’s total bed capacity or operating room inventory; or Changes in the medical service provided or approved. Commission Action. Requested changes subject to review under §B of this regulation shall be reviewed by the Commission. Within 5 days after the Commission’s receipt of a written request to change the address or location of an approved project, Commission staff shall arrange to publish notice of receipt of the change request in the Maryland Register and one newspaper of general circulation in the appropriate health planning region, shall post the notice on its website, and shall provide written notice of receipt of the change request to: Each member of the General Assembly in whose district the relocation is planned; Each member of the governing body for the jurisdiction in which the relocation is planned; and The county executive, mayor, or chief executive officer, if any, in whose county or city the relocation is planned. The Commission shall provide a written notification within 45 days of the Commission’s receipt of a complete change request that: The proposed change is approved in whole or part and incorporated into a modified CON or other modified approval for the project with conditions as appropriate; or The proposed change is denied, with explanation.