1. A. The Commission may exempt from the requirement of CON review and approval the following actions:

   1. (1) Merger or consolidation of two or more hospitals or other health care facilities, if the facilities or an organization that operates the facilities give the Commission 45 days written notice of their intent to merge or consolidate;

   2. (2) Relocation of an existing health care facility owned or controlled by a merged asset system, if:

      1. (a) The relocation is to a site outside:

         1. (i) The primary service area of the hospital to be relocated but within the primary service area of the merged asset system; or
         2. (ii) The service area of the non-hospital health care facility to be relocated but within the primary service area of the merged asset system; and

      2. (b) The relocation of the existing health care facility does not:

         1. (i) Change the type or scope of health care services offered; and
         2. (ii) In the case of a hospital, require a capital expenditure for its construction that exceeds the hospital capital threshold, adjusted for inflation, except as provided by Regulation .03J of this chapter;
   3. (3) A change in the bed capacity of an existing health care facility pursuant to the consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a health care facility to a non-health-related use, except as provided in Regulation .03F of this chapter;

   4. (4) A change in the type or scope of the health care services offered by a health care facility, if, at least 45 days before increasing or decreasing the volume of one or more health care services, the Commission finds that the proposed change is pursuant to the:

      1. (a) Consolidation or merger of two or more health care facilities;
      2. (b) Conversion of all or part of a health care facility to a non-health-related use; or
      3. (c) Conversion of a hospital to a limited service hospital;
   5. (5) A capital expenditure that exceeds the review threshold for capital expenditure made as part of a consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a health care facility to a non-health-related use; or
   6. (6) The establishment of a freestanding medical facility through the conversion of an acute general hospital, as provided in §F of this regulation and in COMAR 10.24.19.04C.

2. B. Unless otherwise provided in this chapter for a specific type of health care facility, complete notice of intent to seek exemption from CON review shall be filed with the Commission at least 45 days before the intended action, and shall include:

   1. (1) The name and location of each affected health care facility;

   2. (2) A general description of the proposed project including, in the case of mergers and consolidations, any proposed:

      1. (a) Conversion, expansion, relocation, or reduction of one or more health care services;
      2. (b) Renovation of existing facilities;
      3. (c) New construction;
      4. (d) Relocation or reconfiguration of existing medical services; or
      5. (e) Change in bed capacity at each affected facility;
   3. (3) The scheduled date of the project's completion;
   4. (4) Identification of each outstanding public obligation;

   5. (5) Information demonstrating that the project:

      1. (a) Is not inconsistent with the State Health Plan;
      2. (b) Will result in the delivery of more efficient and effective delivery of health care services; and
      3. (c) Is in the public interest; and
   6. (6) Any other information, analyses, or other requirements established in State Health Plan regulation for requests seeking exemption from CON review.

3. C. Notice by the Commission to the Public, Elected Officials, and Other State Agencies.

   1. (1) Within 5 days after it receives a complete Notice of Intent from a health care facility seeking exemption from CON review, the Commission shall publish notice of its receipt:

      1. (a) In at least one newspaper of general circulation in the affected area;
      2. (b) In the next available issue of the Maryland Register; and
      3. (c) On the Commission’s website.
   2. (2) The Commission shall mail the same notice to elected public officials in whose district or jurisdiction the exemption from CON review is proposed.
   3. (3) The Commission shall solicit comment from the affected public, in evaluating whether the action or project proposed for exemption from CON review is in the public interest.

4. D. Public Informational Hearing.

   1. (1) An acute general hospital shall hold a public informational hearing in the jurisdiction where it is located within 30 days after it has filed with the Commission notice of its intent to:

      1. (a) Close;
      2. (b) Partially close, if the hospital is located in a jurisdiction with fewer than three acute general hospitals; or
      3. (c) Convert to a limited service hospital or freestanding medical facility.

   2. (2) Before holding the public informational hearing, the hospital shall consult with the Commission, to ensure that:

      1. (a) Within 5 days of notifying the Commission of its intent to close, partially close, or convert, the hospital has provided public notice of the proposed closure or conversion and of the time and location of the required public informational hearing and how the public can electronically obtain additional information, including publication in at least one newspaper of general circulation in the affected area; and
      2. (b) The public hearing will address the information required by §D(3) of this regulation.

   3. (3) Requirements for a Public Informational Hearing.

      1. (a) The acute general hospital proposing to close, partially close, or convert to a limited service hospital or freestanding medical facility shall hold a public informational hearing at the hospital or if that is not feasible at a public meeting area near the hospital.
      2. (b) The hospital shall post a notice of the public informational hearing in public areas of its facility and on the landing page of its website.
      3. (c) The hospital shall identify to the public the names of the senior management and Board of Directors attending the hearing;

      4. (d) The hospital shall present at least the following information at the public informational hearing:

         1. (i) The reasons for the closure, partial closure, or conversion;
         2. (ii) The plan for transitioning acute care services previously provided by the hospital to residents of the hospital service area;
         3. (iii) The plan for addressing the health care needs of the residents of the hospital service area;
         4. (iv) The plan for retraining and placing displaced employees;
         5. (v) The plan for the hospital’s physical plant and site; and
         6. (vi) The proposed timeline for the closure, partial closure, or conversion to a freestanding medical facility.
      5. (e) The public informational hearing shall be recorded.

      6. (f) Within 10 business days after the public informational hearing, the hospital shall make available on its website a recording of the public informational hearing and provide a written summary of the hearing, which shall also be provided to:

         1. (i) The Governor;
         2. (ii) The Secretary;
         3. (iii) The governing body of the jurisdiction in which the hospital is located;
         4. (iv) The local health department and the local board of health or similar body for the jurisdiction in which the hospital is located;
         5. (v) The Commission; and
         6. (vi) Subject to State Government Article, §2-1257, Annotated Code of Maryland, the Senate Finance Committee, the House Health and Government Operations Committee, and the members of the General Assembly who represent the district in which the hospital is located.

5. E. Commission Action.

   1. (1) Unless otherwise provided in this chapter for a specific type of health care facility, the Commission shall issue an exemption from CON review to the health care facility or the merged asset system seeking this determination within 45 days after it receives the notice of intent required by §B of this regulation, if:

      1. (a) The facility or system has provided the information required by the notice of intent, and has held a public informational hearing if required by §D of this regulation; and

      2. (b) The Commission, in its sole discretion, finds that the action proposed:

         1. (i) Is not inconsistent with the State Health Plan or an institution-specific plan developed by the Commission under Health-General Article, §19-119, Annotated Code of Maryland;
         2. (ii) Will result in more efficient and effective delivery of health care services; and
         3. (iii) Is in the public interest.
   2. (2) For any project that the Commission may exempt from CON review under §A of this regulation, for which a final Commission decision has not been issued within 45 days after it receives a complete notice of intent as required by §B of this regulation, Commission staff shall provide a status report at the next Commission meeting and any subsequent Commission meeting stating the reasons for the delay and the expected time frame for issuing its final decision.
   3. (3) CON review is not required and the exemption request shall be deemed approved for any project which the Commission may exempt from CON review under §A of this regulation if final action by the Commission does not occur within 90 days after the facility or system has provided complete notice of intent as required by §B of this regulation and has held a public hearing if required by §D of this regulation.
   4. (4) Upon request, Commission staff shall provide written confirmation that an exemption request has been deemed approved in accordance with §E(3) of this regulation.

6. F. Freestanding Medical Facility.

   1. (1) In accordance with COMAR 10.24.19.04C and this regulation, the Commission may exempt from CON review the establishment of a freestanding medical facility as a result of a conversion from a licensed acute general hospital.
   2. (2) At least 60 days before the conversion, written notice of intent to convert the licensed general hospital to a freestanding medical facility shall be filed with the Commission in accordance with COMAR 10.24.19.04C.

   3. (3) Provided that all the requirements of this regulation and COMAR 10.24.19.04C are met, the Commission shall grant the exemption if it finds, in its sole discretion, that the conversion:

      1. (a) Is consistent with the State Health Plan;
      2. (b) Will result in the delivery of more efficient and effective health care services;
      3. (c) Will maintain adequate and appropriate delivery of emergency care within the statewide emergency medical services system as determined by the State Emergency Medical Services Board; and
      4. (d) Is in the public interest.
   4. (4) The Commission may approve, approve with conditions, or deny the requested exemption.
   5. (5) Failure to maintain compliance with conditions on an exemption or with the time frame for completion of the conversion may result in withdrawal of the exemption issued by the Commission in accordance with Regulation .12 of this chapter. An exemption holder may request approval of a reasonable modification to the conversion timeline in accordance with Regulation .12A(4) of this chapter.

Authority: Health-General Article, §§19-109(a)(1) and (8), 19-116(b), 19-118(d), 19-120, 19-120.1, and 19-126, et seq. Annotated Code of Maryland

Effective date: July 6, 1972

Regulations .01 — .16 amended effective February 4, 1976 (3:3 Md. R. 151)

Regulations .17 and .18 adopted effective February 4, 1976 (3:3 Md. R. 151)

Chapter revised effective March 24, 1978 (5:6 Md. R. 466)

Regulations .01B; .02A, B; .05E; .06B, D — G, K; .07A, B, E; .08A, C; .09A; .11A, D; .15A, B; and .17A, B, D amended as an emergency provision effective July 1, 1978 (5:17 Md. R. 1321); adopted permanently effective December 15, 1978 (5:25 Md. R. 1855)

Regulations .01B; .02A; .06B, F, L; .09D; .11D; .19 amended effective January 25, 1980 (7:2 Md. R. 115)

Regulation .06B amended as an emergency provision effective February 4, 1981 (8:4 Md. R. 334); emergency status expired June 20, 1981 (Emergency provisions are temporary and not printed in COMAR)

Regulation .06M adopted as an emergency provision effective July 1, 1978 (5:17 Md. R. 1321); adopted permanently effective December 15, 1978 (5:25 Md. R. 1855)

Regulations .09E, .11E — G, and .16-1 adopted effective January 25, 1980 (7:2 Md. R. 115)

Regulation .16F repealed effective January 25, 1980 (7:2 Md. R. 115)

Chapter revised as an emergency provision effective March 18, 1983 (10:6 Md. R. 536); emergency status extended at 10:17 Md. R. 1520, 10:22 Md. R. 1964, and 11:5 Md. R. 460 (Emergency provisions are temporary and not printed in COMAR)

Chapter revised effective April 23, 1984 (11:8 Md. R. 714)

Regulation .01 amended and recodified as .01-1, and Preface codified as new Regulation .01 effective November 17, 1986 (13:23 Md. R. 2480)

Regulations .01B, .03D, .07H, and .20B amended as an emergency provision and .03F and .21 adopted as an emergency provision effective August 1, 1985 (12:17 Md. R. 1694); emergency status extended at 12:26 Md. R. 2540; emergency status reapproved effective April 4, 1987 (13:9 Md. R. 1021); emergency status extended at 13:14 Md. R. 1629 and 13:20 Md. R. 2206 (Emergency provisions are temporary and not printed in COMAR)

Regulations .01B, .02A, and .03B amended as an emergency provision and .03F adopted as an emergency provision effective February 28, 1986 (13:6 Md. R. 669) (Emergency provisions are temporary and not printed in COMAR)

Regulations .01B, .06C, E, .07A — D, F, P, .11, and .23 amended as an emergency provision and .06F adopted as an emergency provision effective March 15, 1986 (13:8 Md. R. 890) (Emergency provisions are temporary and not printed in COMAR)

Regulations .01-1, .03, .06, .07, and .11 amended as an emergency provision effective July 16, 1987 (14:16 Md. R. 1767); emergency status extended at 14:18 Md. R. 1962 (Emergency provisions are temporary and not printed in COMAR)

Regulations .01-1, .03, .06, .07, .11 and .23 amended as an emergency provision effective September 23, 1987 (14:21 Md. R. 2217); adopted permanently effective February 8, 1988 (15:3 Md. R. 304)

Regulations .01-1, .03, .06, .07, .09, .11, .15 — .18, and .20 amended as an emergency provision effective March 9, 1989 (16:7 Md. R. 802); emergency status extended at 16:20 Md. R. 2178 and 17:3 Md. R. 295 (Emergency provisions are temporary and not printed in COMAR)

Regulation .01-1 amended effective February 13, 1995 (22:3 Md. R. 154)

Regulation .01-1B amended effective April 6, 1987 (14:7 Md. R. 831); October 30, 1989 (16:21 Md. R. 2262); March 19, 1990 (17:5 Md. R. 638)

Regulation .02A — C amended effective November 17, 1986 (13:23 Md. R. 2480); March 19, 1990 (17:5 Md. R. 638)

Regulation .02D amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .03 amended effective November 17, 1986 (13:23 Md. R. 2480); March 19, 1990 (17:5 Md. R. 638)

Regulation .03G — I amended effective February 13, 1995 (22:3 Md. R. 154)

Regulation .03H adopted effective April 6, 1987 (14:7 Md. R. 831)

Regulation .03K adopted effective June 13, 1988 (15:12 Md. R. 1447)

Regulation .03L adopted effective October 30, 1989 (16:21 Md. R. 2262)

Regulation .06 amended effective November 17, 1986 (13:23 Md. R. 2480)

Regulation .06C amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .07 amended effective November 17, 1986 (13:23 Md. R. 2480); April 6, 1987 (14:7 Md. R. 831); March 19, 1990 (17:5 Md. R. 638); June 6, 1994 (21:11 Md. R. 951)

Regulation .08C amended effective November 17, 1986 (13:23 Md. R. 2480); August 3, 1992 (19:15 Md. R. 1390)

Regulation .09A amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .11 amended effective November 17, 1986 (13:23 Md. R. 2480)

Regulation .11C amended effective February 13, 1995 (22:3 Md. R. 154)

Regulation .11E amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .15 amended effective March 19, 1990 (17:5 Md. R. 638); October 10, 1994 (21:20 Md. R. 1732)

Regulation .16E amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .17A amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .18 amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .20A amended effective March 19, 1990 (17:5 Md. R. 638)

Regulation .20B amended effective November 17, 1986 (13:23 Md. R. 2480)

Regulation .21 amended effective November 17, 1986 (13:23 Md. R. 2480)

Regulation .23 amended effective November 17, 1986 (13:23 Md. R. 2480)

Regulation .23B amended effective April 6, 1987 (14:7 Md. R. 831)

Regulation .23E, F amended effective February 13, 1995 (22:3 Md. R. 154)

Annotation: COMAR 10.24.01.06 cited in Doctors' Hospital v. Health Resources Planning Commission, 65 Md. App. 656 (1986)

Annotation: COMAR 10.24.01.07 cited in Sinai Hospital v. Health Resources Planning Commission, 306 Md. 472 (1986)

Annotation: COMAR 10.24.01.07 cited in Perini Services Inc. v. Health Resources Planning Commission, 67 Md. App. 189 (1986)

Regulations .01 — .23 repealed and new Regulations .01 — .22 adopted effective November 6, 1995 (22:22 Md. R. 1658)

Regulation .01B amended as an emergency provision effective November 9, 1995 (22:24 Md. R. 1874); amended permanently effective March 11, 1996 (23:5 Md. R. 379)

Regulation .01B amended effective August 21, 2000 (27:16 Md. R. 1523); February 5, 2001 (28:2 Md. R. 100); November 24, 2003 (30:23 Md. R. 1652); April 11, 2005 (32:7 Md. R. 680); October 23, 2006 (33:21 Md. R. 1675); April 9, 2007 (34:7 Md. R. 699)

Regulation .01B amended as an emergency provision effective January 23, 2009 (36:4 Md. R. 345); amended permanently effective April 20, 2009 (36:8 Md. R. 595)

Regulation .02 repealed and new Regulation .02 adopted effective August 21, 2000 (27:16 Md. R. 1523)

Regulation .02 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .02A amended effective February 5, 2001 (28:2 Md. R. 100)

Regulation .03 repealed and new Regulation .03 adopted effective August 21, 2000 (27:16 Md. R. 1523)

Regulation .03 amended effective August 21, 2000 (27:16 Md. R. 1523); April 11, 2005 (32:7 Md. R. 680)

Regulation .03A amended effective November 24, 2003 (30:23 Md. R. 1652)

Regulation .03B, J amended effective October 23, 2006 (33:21 Md. R. 1675)

Regulation .03I amended effective April 10, 2006 (33:7 Md. R. 672)

Regulation .03K amended effective April 9, 2007 (34:7 Md. R. 699)

Regulation .04 repealed and new Regulation .04 adopted effective August 21, 2000 (27:16 Md. R. 1523)

Regulation .04 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .05 repealed and new Regulation .05 adopted effective April 6, 1998 (25:7 Md. R. 527)

Regulation .05 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .07 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .08 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .08C, E amended effective April 10, 2006 (33:7 Md. R. 672)

Regulation .08D, F amended effective April 9, 2007 (34:7 Md. R. 699)

Regulation .08E, G amended as an emergency provision effective November 9, 1995 (22:24 Md. R. 1874); amended permanently effective March 11, 1996 (23:5 Md. R. 379)

Regulation .09 amended effective April 11, 2005 (32:7 Md. R. 680); April 9, 2007 (34:7 Md. R. 699)

Regulation .09A amended as an emergency provision effective November 9, 1995 (22:24 Md. R. 1874); amended permanently effective March 11, 1996 (23:5 Md. R. 379)

Regulation .09A amended effective April 10, 2006 (33:7 Md. R. 672)

Regulation .09C amended effective November 24, 2003 (30:23 Md. R. 1652)

Regulation .09D amended effective April 10, 2006 (33:7 Md. R. 672)

Regulation .10 amended as an emergency provision effective November 9, 1995 (22:24 Md. R. 1874); amended permanently effective March 11, 1996 (23:5 Md. R. 379)

Regulation .10 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .11 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .12 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .12C amended effective November 24, 2003 (30:23 Md. R. 1652); April 9, 2007 (34:7 Md. R. 699)

Regulation .13 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .13B amended effective May 5, 1997 (24:9 Md. R. 657)

Regulation .14 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .15 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .16 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .17 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .18 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .19 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .20 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulation .20E amended effective April 9, 2007 (34:7 Md. R. 699)

Regulation .22 amended effective April 11, 2005 (32:7 Md. R. 680)

Regulations .01—.22 under Certificate of Need for Health Care Facilities repealed and new Regulations .01—.22 under Procedural Regulations for Health Care Facilities and Services adopted effective December 1, 2023 (50:22 Md. R. 975)

Regulation .01B amended effective February 17, 2025 (52:3 Md. R. 159)

Regulation .03 mended effective February 17, 2025 (52:3 Md. R. 159)

Regulation .12 amended effective July 22, 2024 (51:14 Md. R. 678)

Regulation .12E amended effective February 17, 2025 (52:3 Md. R. 159)

Regulation .21 adopted effective February 17, 2025 (52:3 Md. R. 159)

Regulation .21 recodified to be Regulation .22 effective February 17, 2025 (52:3 Md. R. 159)

Regulation .22 recodified to be Regulation .23 effective February 17, 2025 (52:3 Md. R. 159)