(a)

1. (1) The Health Services Permit Agency (under the direction of the Health Services Permit Commission or appropriate court) will issue, deny, or withdraw permits of approval.
2. (2) Using the commission’s rules and procedures, the agency may exempt appropriate projects from review.
3. (3) Each recommendation of the agency must be based on the completed application and its relationship to adopted standards and criteria.
4. (4) Each review decision of the commission must be consistent with adopted standards, criteria, and the record of the review.

(b) Projects requiring permit of approval review include but are not limited to:

1. (1)

   1. (A) Nursing home construction.
   2. (B) All proposals for conversion of services or alteration or renovation or construction having an associated capital expenditure of one million dollars ($1,000,000) or more;

2. (2)

   1. (A) Additional beds.
   2. (B) Unless exempted by the act or by the commission, all health facilities seeking to add new long-term care (LTC) beds or otherwise expand LTC bed capacity shall apply for a permit of approval;

3. (3)

   1. (A) Home health services.
   2. (B) Unless exempted by the act or by the commission, all health facilities seeking to add home health services or expands existing home health service areas shall apply for a permit of approval.
   3. (C) This includes changes in license designation;

4. (4)

   1. (A) Hospice.
   2. (B) Unless exempted by statute or by the commission, all hospices or hospice programs shall apply for a permit of approval; and

5. (5)

   1. (A) Cost overrun.
   2. (B) Any increase in cost in an approved project or cost of renovation or construction or alteration of a health facility:

(i) Is deemed a cost overrun; and

1. (ii) Must be documented and filed with the agency.

   1. (C) During the course of review, the reasonableness of the proposed capital expenditure will be evaluated.

   2. (D) A reasonable contingency cost in anticipation of a possible increase in cost due to inflation or other unforeseen factors will be allowed as part of the proposed capital expenditure.

      1. (c) Projects requiring approval by the commission:

2. (1)

   1. (A) Movement of existing long-term care beds.
   2. (B) Any movement of long-term care beds from one (1) site to another site within the service area must be approved by the commission.
   3. (C) The applicant should submit the request in writing to the agency.
   4. (D) Any proposed movement of beds is subject to the time limitations in 20 CAR § 255-106(a) and the reporting requirements of 20 CAR § 255-106(b).
   5. (E) Failure to comply with these requirements will result in the withdrawal of permission to move the beds;

3. (2)

   1. (A) Movement of site location of permit approval.
   2. (B) Any movement of a site location for a project approved by the commission for an existing permit of approval is subject to review.

   3. (C) The applicant shall submit a request to the agency in writing, detailing:

      1. (i) All information required in the original application regarding a site;
      2. (ii) The reasons for relocating the site from the original application approved;
      3. (iii) Any additional costs associated with the relocation; and
      4. (iv) The time remaining for completion under various rules of the commission regarding implementation of a permit of approval.
   4. (D) The commission, at its next regularly scheduled meeting, must approve the relocation before site location change is made.
   5. (E) The relocation shall not extend the deadline for implementation of a permit of approval; and

4. (3)

   1. (A) Transfer of permit of approval legal title or right of ownership.

   2. (B) A permit of approval may only be transferred:

      1. (i) If the entity presently holding the permit, legal title, or right of ownership has tangible assets of at least two thousand five hundred dollars ($2,500) that will be transferred with the permit, legal title, or right of ownership; and
      2. (ii) With the approval of the commission.
   3. (C) The applicant must provide proof of tangible assets.
   4. (D) Any person requesting approval to receive a permit of approval via transfer from an existing permit holder must submit an application for a permit of approval to the agency in accordance with 20 CAR § 255-105, Procedures for review.

   5. (E) A permit of approval may not be transferred to a county other than the county where the current permit of approval is located unless authorized in the applicable methodology.

      1. (d) Projects exempt from permit of approval process:

5. (1)

   1. (A) Capital expenditures less than adopted thresholds.

   2. (B) Projects proposed for the construction, expansion, or alteration by or on the behalf of a nursing home, which:

      1. (i) Have an associated capital expenditure of less than one million dollars ($1,000,000); and
      2. (ii) Do not add long-term care beds or home health services;
6. (2) Hospitals licensed in Arkansas are not subject to review except when a hospital seeks to add long-term care beds or convert acute beds to long-term beds or add or expand home health services;

7. (3)

   1. (A) Conversion of services or new services.
   2. (B) A conversion of services offered in an existing health facility or alteration or renovation of an existing health facility having an associated capital expenditure of less than one million dollars ($1,000,000) for nursing homes and not resulting in additional bed capacity;

8. (4)

   1. (A) Acquisition of a health facility.
   2. (B) The obligation of a capital expenditure to acquire an existing healthcare facility shall not require a permit of approval.
   3. (C) Such an exemption applies to an acquisition by purchase, lease, donation, or transfer of ownership;

9. (5)

   1. (A) Religious facilities.
   2. (B) Any facility which is conducted by and for those who rely exclusively upon treatment by prayer alone for healing in accordance with the tenets or practices of any recognized religious denomination;
10. (6) Outpatient surgery centers;
11. (7) Imaging centers; and
12. (8) Free-standing radiation therapy centers.

(e) Expedited reviews.

1. (1)

   1. (A) An expedited review is an exception to the normal procedures for permit of approval review.
   2. (B) If a proposal meets the criteria for expedited review (see below) then that application may be submitted at any time without regard to the published batching cycles.
   3. (C) The agency may take action on the proposal thirty (30) days after notice of expedited review has been given to the public.

2. (2) The expedited review process will be utilized if the capital expenditure is required to:

   1. (A) Eliminate or prevent imminent safety hazards as defined by federal, state, or local fire, building, or life safety codes;
   2. (B) Comply with state licensure standards;
   3. (C) Comply with accreditation or certification standards which must be met to receive reimbursement under Title XVIII of the Social Security Act of 1935, 42 U.S.C. § 1395 et seq., or payments under a state plan for medical assistance approved under Title XIX of the Social Security Act of 1935, 42 U.S.C. § 1396 et seq.;
   4. (D) Eliminate emergency circumstances that pose an imminent threat to public health; or
   5. (E) Increase the cost of an approved project in order to replace remodeling with new construction.
3. (3) Those portions of a proposed project, which do not comply with subdivision (e)(2) of this section, above, are subject to the full review using established criteria, if that portion would otherwise have been subject to review.
4. (4) Under no circumstances will additional beds, additional services, or expanded service areas be approved by the agency under the expedited review process.