WIXLIB

HB948(vi) One ( 1) representative of the ambulatory surgicaltreatment center industry.(2) The governor shall consult with interested groups, including, but notlimited to, the organizations listed in subdivision (b)(1) to determine qualifiedpersons to fill positions with the agency.(3) In making appointments to the health services and developmentagency, the governor and the speakers shall strive to ensure that racialminorities, females, persons sixty (60) years of age and older, and the three (3)grand divisions are represented.(4) The consumer members must be persons who are knowledgeable ofhealth needs and services and who are further knowledgeable by training orexperience in healthcare facility design or construction, financing of healthcareservices or construction, reimbursement of healthcare services, or generalhealthcare economics. The consumer members shall not be a direct provider ofhealthcare goods or services.(c)(1) A member of the agency shall not serve beyond the expiration of themember's term, whether or not a successor has been appointed by the governoror the speakers of the senate and the house of representatives.(2) Except for the comptroller of the treasury, the commissioner ofcommerce and insurance, and the director of TennCare, or their respectivedesignees, agency members are appointed for three-year terms, and a membershall not serve more than two (2) consecutive three-year terms.(3) If a member is absent from three (3) consecutive, regularly scheduledpublic meetings of the agency, then the individual's membership is automaticallyterminated, and the position is considered as vacant.(d)(1) Each member of the agency shall receive fifty dollars ( 50.00) perdiem when actually engaged in the discharge of the member's official duties, andin addition, shall be reimbursed for all travel and other necessary expenses.However, agency members who are state employees shall not receive per diem,but must be reimbursed for all travel and other necessary expenses.(2) Expenditures must be claimed and paid in accordance with thecomprehensive travel regulations as promulgated by the department of financeand administration, and approved by the attorney general and reporter.(e)( 1) At the first meeting in each fiscal year, the agency shall elect officers.The chair of the agency must be a consumer member to serve a term of two (2)years. A member of the agency may serve as vice chair, which is a term of one(1) year. A member shall not serve two (2) consecutive terms as vice chair.(2) Meetings of the agency must be held as frequently as its duties mayrequire.(3) Six (6) members constitute a quorum, but a vacancy on the agencydoes not impair its power to act.(4) An action of the agency is not effective unless the action is concurredin by a majority of agency members present and voting.(5) In the event of a tie vote, the action is considered disapproved.5

HB948(6) The agency shall record by name the votes taken on all actions of theagency.(7)(A) All agency members shall annually review and sign astatement acknowledging the statute, rules, and policies concerningconflicts of interest.(B)(i) A member, upon determining that a matter scheduledfor consideration by the agency results in a conflict with a directinterest, shall immediately notify the executive director and isrecused from any deliberation of the matter, from making anyrecommendation, from testifying concerning the matter, or fromvoting on the matter. The member shall join the public during theproceedings.(ii) A member with an indirect interest shall publiclyacknowledge such interest.(iii) All members shall make every reasonable effort toavoid even the appearance of a conflict of interest. If a member isuncertain whether the relationship justifies recusal, then themember shall follow the determination by the legal counsel for theagency.(iv) A determination by the agency or a court that amember of the agency with a direct interest failed to provide noticeand be recused from deliberations of the matter, from making anyrecommendation, from testifying concerning the matter, or fromvoting on the matter, results in the member's automatictermination from the agency and the position is considered vacant.The member is not eligible for appointment to any agency, board,or commission of this state for a period of two (2) years.(v) The executive director, upon determining that a conflictexists for the executive director or a member of the staff, shallnotify the chair of the agency and take such action as the chairprescribes and pursuant to this part.68-11-1605. Powers and duties of agency.In addition to the powers granted elsewhere in this part, the agency has the dutyand responsibility to:(1) Develop criteria and standards to guide the agency when issuingcertificates of need that are:(A) Based, in whole or in part, upon input the agency receivedduring development of the criteria and standards from the division ofTennCare, or its successor; the departments of health, mental health andsubstance abuse services, and intellectual and developmental disabilities;the health and welfare committee of the senate; and the health committeeof the house of representatives;(B) Evaluated and updated not less than once every five (5) years;and(C) Developed by rule in accordance with theAdministrative Procedures Act, compiled in title 4, chapter 5;6Uniform

H8948(2) Receive and consider applications for certificates of need, to reviewrecommendations on certificates of need, and to grant or deny certificates ofneed on the basis of the merits of the applications within the context of the local,regional, and state health needs, including, but not limited to, the criteria andstandards developed in accordance with this part;(3) Conduct studies related to health care, including a needs assessmentthat must be updated at least annually;(4) Promulgate rules and policies deemed necessary by the agency forthe fulfillment of its duties and responsibilities under this part, including aprocedure for the issuance of a certificate of need upon an emergencyapplication if an unforeseen event necessitates the issuance of a certificate ofneed to protect the public health, safety, and welfare, and if the public health,safety, and welfare would be unavoidably jeopardized by compliance with theprocedures established under this part;(5) Contract when necessary for the development of criteria andstandards to guide the agency when issuing certificates of need and for theimplementation of the certificate of need program described in this part;(6) Weigh and consider access to quality health care and the healthcareneeds of consumers, particularly those in underserved communities; those whoare uninsured or underinsured; women and racial and ethnic minorities;TennCare or medicaid recipients; and low-income groups whenever the agencyperforms its duties or responsibilities assigned by law; and(7) Issue exemptions from the voiding of a certificate of need and anactivity authorized by the certificate of need pursuant to § 68-11-1609(i), if theactions the certificate of need authorizes are not performed for a continuousperiod of one (1) year after the date the certificate of need is implemented.68-11-1606. Executive director of agency Delegation of authority- Review.Appointment -Salary -Duties -(a) The agency shall appoint an executive director qualified by education andexperience. The executive director must demonstrate knowledge and experience in theareas of public administration and health policy development.(b) The agency shall fix the salary of the executive director, who serves at thepleasure of the agency. The executive director is the chief administrative officer of theagency and the appointing authority, exercising general supervision over all personsemployed by the agency.(c) The executive director has the following duties:(1) Administering the development of criteria and standards to guide theagency when issuing certificates of need;(2) Administering the certificate of need program;(3) Conducting studies related to health care;(4) Representing the agency before the general assembly;(5) Overseeing the issuance of responses to requests for determinationregarding the applicability of this part;(6) Issuing exemptions from the requirement that a certificate of need beobtained for the relocation of existing or certified facilities providing healthcareservices and healthcare institutions under§ 68-11-1607(a)(4);(7) Keeping a written record of proceedings and transactions of theagency, which must be open to public inspection during regular office hours;7

HB948(8) Preparing the agenda, including consent and emergency calendars,and notice to the general public of all meetings and public hearings of theagency;(9) Employing personnel, within the agency's budget, to assist in carryingout this part;( 10) Carrying out policies and rules that are promulgated by the agencyand supervising the expenditure of funds;(11) Submitting an annual report, no later than January 15 of each year,to the chairs of the health and welfare committee of the senate and the healthcommittee of the house of representatives that includes, but is not limited to, acomparison of the actual payer mix and uncompensated care provided bycertificate of need holders with the projections the holders submitted in theholder's certificate of need application; and(12) Submitting to the chairs of the health and welfare committee of thesenate and health committee of the house of representatives no later thanJanuary 1, 2023, a plan:(A) Developed by the executive director;(B) To consolidate into a health facilities commission the powersand duties of the agency with those of the board for licensing health carefacilities established under part 2 of this chapter; and(C) For which agencies of this state shall provide assistance to theexecutive director following a request by the executive director.(d) In addition to the duties provided in subsection (c), the agency has theauthority to delegate, and it is the intent of the general assembly that the agencyexercise the authority to delegate the following responsibilities and duties to theexecutive director:(1) Granting deferral of applications for certificates of need in accordancewith § 68-11-1609; and(2) Granting approval or denial of modifications, changes of conditions orownership, and extensions of certificates of need in accordance with this part.(e) A delegation of authority pursuant to subsection (d) continues until specificallyrevoked by the agency as a result of a determination that revocation is necessary toensure the proper and orderly operation of the agency.(f) The executive director shall, within two (2) business days, notify the agency ofan action taken pursuant to a delegation of authority under subsection (d).(g)( 1) The agency shall review an action by the executive director, if:(A) The executive director receives a written request for agencyreview; or(B) An agency member requests agency review.(2)(A) If a request for agency review pursuant to subdivision (g)( 1) isreceived within fifteen ( 15) days of the date the executive directorprovides notice of the action pursuant to subsection (f), then the actiondoes not become final until the agency has rendered its final decision.8

HB948(B) If a request for agency review is not received pursuant tosubdivision (g)(1 ), then the executive director's action becomes final as ifthe action was taken by the agency.(h)(1) An agency review of an action taken by the executive director must beconducted at the next regularly scheduled agency meeting that is scheduled for adate no less than two (2) weeks after the date the request for review is receivedpursuant to subsection (g).(2) Agency review of an action by the executive director is de novo.(3) The agency shall use the then-current edition of Robert's Rules ofOrder as the rules of parliamentary procedure applicable to an agency review ofan action taken by the executive director.68-11-1607. Certificate of need - Applications equipment - Critical access hospital designation.Exemptions -Registration of(a) A person shall not perform the following actions in this state, except afterapplying for and receiving a certificate of need for the action:( 1) The construction, development, or other establishment of any type ofhealthcare institution as described in this part;(2) In the case of a healthcare institution, a change in the bedcomplement, regardless of cost, that:(A) Increases by one (1) or more the number of nursing homebeds;(B) Redistributes beds from any category to acute, rehabilitation,or long-term care, if at the time of redistribution the healthcare institutiondoes not have beds licensed for the category to which the beds will beredistributed; or(C) Relocates beds to another facility or site;(3) Initiation of the following healthcare services:(A) Burn unit;(B) Neonatal intensive care unit;(C) Open heart surgery;(D) Organ transplantation;(E) Cardiac catheterization;(F) Linear accelerator;(G) Home health;(H) Hospice; or(I) Opiate addiction treatment provided through a nonresidentialsubstitution-based treatment center for opiate addiction;(4)(A) Except as provided in subdivision (a)(4)(B), a change in thelocation of existing or certified facilities providing healthcare services andhealthcare institutions. However, the executive director may issue an9

HB948exemption for the relocation of existing healthcare institutions andapproved services if the executive director determines that:(i)(a) At least seventy-five percent (75%) of patientsto be served are reasonably expected to reside in thesame zip codes as the existing patient population; and(b) The relocation will not reduce access toconsumers, particularly those in underserved communities;those who are uninsured or underinsured; women andracial and ethnic minorities; TennCare or medicaidrecipients; and low-income groups;(ii) The executive director must notify the agency of anexemption granted pursuant to subdivision (a)(4)(A)(i) within two(2) business days of the date the executive director grants theexemption;(iii) An exemption granted by the executive directorpursuant to subdivision (a)(4)(A)(i) is subject to agency review inthe same manner as described in§ 68-11-1606(9) and (h);(B) The relocation of the principal office of a home health agencyor hospice within its licensed service area does not require a certificate ofneed;(5) Except as otherwise provided in subdivision (m)(2) and subsection (u),the following actions in a county with a population of one hundred seventy-fivethousand (175,000) or less, according to the 2010 federal census or anysubsequent federal census:(A) Initiation of magnetic resonance imaging services; or(B) Increasing the number of magnetic resonance imagingmachines, except for replacing or decommissioning an existing machine;(6) Establishing a satellite emergency department facility or a satelliteinpatient facility by a hospital at a location other than the hospital's main campus;and(7) Except as otherwise provided in subsection (u), the initiation ofpositron emission tomography in a county with a population of one hundredseventy-five thousand (175,000) or less, according to the 2010 federal census orany subsequent federal census.(b) An agency of this state, or of a county or municipal government, shall notapprove a grant of funds for, or issue a license to, a healthcare institution for a portion oractivity of the healthcare institution that is established, modified, relocated, changed, orresumed, or that constitutes a covered healthcare service, in violation of this part. If anagency of this state, or of a county or municipal government, approves a grant of fundsfor, or issues a license to, a person or institution for which a certificate of need wasrequired but was not granted, then the license is void and the person or institution shallrefund the funds to the state within ninety (90) days. The health services anddevelopment agency has the authority to impose civil penalties and petition a circuit orchancery court having jurisdiction to enjoin a person who is in violation of this part.(c)(1) For each application, a letter of intent must be filed between the firstday of the month and the fifteenth day of the month prior to the application'ssubmission. At the time of filing, the applicant shall cause the letter of intent to be10

HB948published in a newspaper of general circulation in the proposed service area ofthe project. The published letter of intent must contain a statement that any:(A) Healthcare institution wishing to oppose the application mustfile written notice with the agency no later than fifteen (15) days beforethe agency meeting at which the application is originally scheduled; and(B) Other person wishing to oppose the application may file awritten objection with the agency at or prior to the consideration of theapplication by the agency, or may appear in person to express opposition.(2) Persons desiring to file a certificate of need application seeking asimultaneous review regarding a similar project for which a letter of intent hasbeen filed shall file with the agency a letter of intent between the sixteenth day ofthe month and the last day of the month of publication of the first filed letter ofintent. A copy of a letter of intent filed after the first letter of intent must be mailedor delivered to the first filed applicant and must be published in a newspaper ofgeneral circulation in the proposed service area of the first filed applicant. Thehealth services and development agency shall consider and decide theapplications simultaneously. However, the agency may refuse to consider theapplications simultaneously if it finds that the applications do not meet therequirements of "simultaneous review" under the rules of the agency.(3) Applications for a certificate of need, including simultaneous reviewapplications, must be filed by the first business day of the month following thedate of publication of the letter of intent.(4) If there are two (2) or more applications to be reviewed simultaneouslyin accordance with this part and the rules of the agency, and one (1) or more ofthose applications is not deemed complete by the deadline to be considered atthe next agency meeting, then the other applications that are deemed completeby the deadline must be considered at the next agency meeting. The applicationor applications that are not deemed complete by the deadline to be considered atthe next agency meeting will not be considered with the applications deemedcomplete by the deadline to be considered at the next agency meeting.(5) Review cycles begin on the fifteenth day of each month. Reviewcycles are thirty (30) days. The first meeting at which an application can beconsidered by the agency is the meeting following the application's review cycle.If an application is not deemed complete within sixty (60) days after initial writtennotification is given to the applicant by agency staff that the application isdeemed incomplete, then the application is void. If the applicant decides toresubmit the application, then the applicant shall comply with all procedures asset out by this part and pay a new filing fee when submitting the application. Priorto deeming an application complete, the executive director shall ensureindependent review and verification of information submitted to the agency inapplications, presentations, or otherwise. The purpose of the independent reviewand verification is to ensure that the information is accurate, complete,comprehensive, timely, and relevant to the decision to be made by the agency.The independent review and verification must be applied to, but not necessarilybe limited to, applicant-provided information as to th

(16) "Nursing home" has the same meaning as defined in § 68-11-201; (17) "Nursing home bed" means: (A) A licensed bed within a nursing home, regardless of whether the bed is certified for medicare or medicaid services; and (B) A bed at a healthcare institution used as a swing bed under 42 C.F.R. § 485.645;