Amends TCA Title 4; Title 33; Title 68 and Title 71.

POLICY STATEMENT Present law provides that the public policy of Tennessee is that the establishment and modification of healthcare institutions, facilities, and services must be accomplished in a manner that promotes access to necessary, high quality, and cost-effective services for the health care of the people of this state. To this end, the present law applies equitably to all healthcare entities, regardless of ownership or type, except those owned and operated by the United States government. This bill removes this policy statement. ISSUED EXEMPTIONS One of the duties of the executive director of the health facilities commission ("commission") is to issue exemptions from the requirement that a certificate of need be obtained for the relocation of existing or certified facilities providing healthcare services and healthcare institutions. This bill revises this duty by requiring the director to issue exemptions only for a relocation of existing approved services, rather than for the relocation of existing or certified facilities providing healthcare services and healthcare institutions. CERTIFICATE OF NEED Present law prohibits a person from performing the following actions in this state without a certificate of need: (1) The construction, development, or other establishment of a type of healthcare institution; (2) In the case of a healthcare institution, a change in the bed complement, regardless of cost, that increases by one or more the number of nursing home beds; redistributes beds from any category to acute, rehabilitation, or long-term care, if at the time of redistribution, the healthcare institution does not have beds licensed for the category to which the beds will be redistributed; or relocates beds to another facility or site; (3) Initiation of the certain healthcare services, such as a burn unit; neonatal intensive care unit; open heart surgery; organ transplantation; cardiac catheterization; linear accelerator; home health; hospice; or opiate addiction treatment provided through a nonresidential substitution-based treatment center for opiate addiction; (4) A change in the location of existing or certified facilities providing healthcare services and healthcare institutions. However, the executive director may issue an exemption for the relocation of existing healthcare institutions and approved services if certain conditions provided in law are met; (5) The initiation of magnetic resonance imaging services; increasing the number of magnetic resonance imaging machines, except for replacing or decommissioning an existing machine within a county with a population of 175,000 or less; the establishment of a satellite emergency department facility or a satellite inpatient facility by a hospital at a location other than the hospital’s main campus; and the initiation of a positron emission tomography; (6) The establishment of a satellite emergency department facility or a satellite inpatient facility by a hospital at a location other than the hospital's main campus; and (7) Except in certain circumstances, the initiation of positron emission tomography in Williamson, Rutherford, Hamilton, Knox, Davidson, and Shelby counties. This bill rewrites the above provisions to, instead, prohibit a person from performing the following actions in this state without a certificate of need: (1) Initiation of a burn unit or organ transplantation; and (2) A change in the location of existing approved services. However, the executive director may issue an exemption for the relocation of existing approved services if the executive director determines that certain conditions provided in current law are met. NONRESIDENTIAL SUBSTITUTION BASED TREATMENT CENTER FOR OPIATE ADDICTION Present law provides that, within 10 days of the filing of an application for a nonresidential substitution-based treatment center for opiate addiction with the commission, the applicant must send a notice to the county mayor of the county in which the facility is proposed to be located; the state representative and senator representing the house district and the senate district in which the facility is proposed to be located; and the mayor of the municipality, if the facility is proposed to be located within the corporate boundaries of a municipality, by certified mail, return receipt requested, informing those officials that an application for a nonresidential substitution-based treatment center for opiate addiction has been filed with the commission by the applicant. If an application involves a healthcare facility in which a county or municipality is the lessor of the facility or real property on which it sits, then, within 10 days of filing the application, the applicant must notify the chief executive officer of the county or municipality of the filing, by certified mail, return receipt requested. An application subject to the notification requirements of this subdivision is not complete if the applicant has not provided proof of compliance with this subdivision to the commission. This bill removes these provisions. Present law also provides that a certificate of need is not required for a hospital to operate a nonresidential substitution-based treatment center for opiate addiction if the treatment center is located on the same campus as the operating hospital and the hospital is licensed by the department of health or the department of mental health and substance abuse and intellectual and developmental disabilities. This bill removes these provisions. TENNESSEE STATE VETERANS' HOMES Present law provides that Tennessee state veterans' homes are not required to obtain a certificate of need and that the beds located in such a home are not considered by the commission when granting a certificate of need to a healthcare institution due to a change in the number of licensed beds, redistribution of beds, or relocation of beds. This bill removes these provisions. EQUIPMENT REGISTRATION Present law requires the owners of computerized axial tomographers, magnetic resonance imagers, linear accelerators, and positron emission tomography to register the equipment with the commission. The registration must be in a manner and on forms prescribed by the commission and must include ownership, location, and the expected useful life of the equipment. Registration must occur within 90 days of acquisition of the equipment. All such equipment must be filed on an annual inventory survey developed by the commission. The survey must include, but not be limited to, the identification of the equipment and utilization data according to source of payment. The survey must be filed no later than 30 days following the end of each state fiscal year. The commission may impose a penalty not to exceed $50 for each day the survey is late. This bill removes these provisions. CRITICAL ACCESS HOSPITAL Present law provides that an entity, or its successor, that was formerly licensed as a hospital, and that has received from the executive director a written determination that it will be eligible for designation as a critical access hospital under the medicare rural hospital flexibility program, is not required to obtain a certificate of need to establish a hospital qualifying for that designation, if it meets the requirements of this provision. In order to qualify for the exemption in this provision, the entity proposing to establish a critical access hospital shall publish notice of its intent to do so in a newspaper of general circulation in the county where the hospital will be located and in contiguous counties. The notice must be published at least twice within a 15-day period. The written determination from the executive director and proof of publication must be filed with the commission within 10 days after the last date of publication. If no healthcare institution within the same county or contiguous counties files a written objection to the proposal with the commission within 30 days of the last publication date, then the exemption in this provision applies. However, this exemption applies only to the establishment of a hospital that qualifies as a critical access hospital under the medicare rural flexibility program and not to another activity or service. If a written objection by a healthcare institution within the same county or contiguous counties is filed with the commission within 30 days from the last date of publication, then the exemption in this provision does not apply. This bill removes these provisions. NURSING HOMES Present law provides that a nursing home may increase its total number of licensed beds by the lesser of 10 beds or 10 percent of its licensed capacity no more frequently than one time every three years without obtaining a certificate of need. The nursing home shall provide written notice of the increase in beds to the commission on forms provided by the commission prior to the request for licensing by the board for licensing healthcare facilities. For new nursing homes, the 10-bed or 10-percent increase cannot be requested until one year after the date all of the new beds were initially licensed. When determining projected county nursing home bed need for certificate of need applications, all notices filed with the commission must be considered with the total of licensed nursing home beds, plus the number of beds from approved certificates of need, but yet unlicensed. This bill removes these provisions. HOME CARE ORGANIZATIONS Present law provides that a certificate of need is not required for a home care organization that is authorized to provide only professional support services. However, present law also provides that a home care organization may generally only initiate hospice services after applying for and receiving a certificate of need for providing hospice services. This bill removes these provisions. Present law also provides that a certificate of need is not required to establish a home care organization or residential hospice limited to providing hospice services to patients under the care of a healthcare research institution. A license issued by the commission must be limited to the provision of services only to the patients of the healthcare research institution, or the patients of a hospital or clinic that has its principal place of business located in this state and that is affiliated with the healthcare research institution. A home care organization or residential hospice that provides hospice services without a certificate of need must, within 12 months of the date the home care organization is granted a license by the commission, be accredited by The Joint Commission, the Community Health Accreditation Partner (CHAP), DNV GL Healthcare, or the Accreditation Commission for Health Care (ACHC), in order to continue to qualify for the exception. This bill removes these provisions. MAGNETIC RESONANCE IMAGING SERVICES / POSITRON EMISSION TOMOGRAPHY Present law provides that a person who provides magnetic resonance imaging services must file with the commission an annual report no later than 30 days following the end of each state fiscal year that details the mix of payers by percentage of cases for the prior calendar year for its patients, including private pay, private insurance, uncompensated care, charity care, medicare, and medicaid. However, in Williamson, Rutherford, Hamilton, Knox, Davidson, and Shelby counties, a person who initiates magnetic resonance imaging services must notify the commission in writing that imaging services are being initiated and must indicate whether magnetic resonance imaging services will be provided to a patient who is 14 or younger on more than five occasions per year. This bill removes these provisions. Present law also provides that a certificate of need is not required to establish or operate, in Williamson, Rutherford, Hamilton, Knox, Davidson, and Shelby counties, initiation of magnetic resonance imaging services, or increasing the number of magnetic resonance imaging machines used, as long as magnetic resonance imaging services are not provided to a patient who is 14 or younger on more than five occasions per year; or initiation of positron emission tomography. However, a provider of positron emission tomography established without a certificate of need must become accredited by the American College of Radiology and provide to the commission proof of the accreditation within two years of the date of licensure. A provider of positron emission tomography established without a certificate of need and that fails to comply with the accreditation is subject to licensure sanction. This bill removes these provisions. OUTPATIENT DIAGNOSTIC CENTERS Present law provides that, within two years after the date of receiving a certificate of need, an outpatient diagnostic center must become accredited by the American College of Radiology in the modalities provided by that facility as a condition of receiving the certificate of need. An outpatient diagnostic center that fails to comply with the accreditation requirement is subject to licensure sanction. This bill removes these provisions. ACCREDITATION Present law provides that a certificate of need is not required for actions in a county that is designated as an economically distressed eligible county by the department of economic and community development; and has no hospital that is actively licensed under this title located within the county. Present law requires a person that provides positron emission tomography services or magnetic resonance imaging services pursuant to the above exemption to be accredited by The Joint Commission or the American College of Radiology in the modalities provided by that person and submit proof of the accreditation to the commission within two years of the initiation of service. Present law requires a person that provides positron emission tomography services or magnetic resonance imaging services pursuant to the above exemption and that fails to comply with the accreditation requirement to be subject to licensure sanction. A person that provides a service other than those described in these provisions, or establishes a healthcare institution, must submit proof of accreditation by an appropriate external peer-review organization for the service or facility to the commission within two years of the date of initiation of service or licensure of the healthcare institution. This bill retains the exemption but removes the accreditation requirements. HOME HEALTH AGENCY Present law provides that a certificate of need is not required to establish a home health agency limited to providing home health services under the federal Energy Employees Occupational Illness Compensation Program Act of 2000, or a subsequent amendment, revision, or modification to that Act. A license issued by the commission for services under that Act is limited to the provision of only those services. A home health agency providing home health services without a certificate of need must be accredited by The Joint Commission, the Community Health Accreditation Partner, or the Accreditation Commission for Health Care and submit proof of such accreditation to the commission within two years of the initiation of service. A home health agency that provides home health services without a certificate of need and that fails to comply with the accreditation requirement is subject to licensure sanction. This bill removes these provisions. Present law also provides that a certificate of need is not required to establish a home health agency limited to providing home health services to patients less than 18. A license issued by the commission for the provision of home health services to such patients must be limited to the provision of only those services. The commission may permit a home health agency providing home health services to such patients to continue providing home health services to the patient until the patient reaches 21 if the patient received home health services from the home health agency prior to the date the patient reached 18; and the home health services are provided under the TennCare program. A home health agency that provides home health services without a certificate of need must, within two years of the initiation of service, be accredited by and submit proof to the commission of the accreditation from an accrediting organization with deeming authority from the federal centers for medicare and medicaid services; the Joint Commission; the Community Health Accreditation Partner; or the Accreditation Commission for Health Care. A home health agency that provides home health services without a certificate of need and that fails to comply with the accreditation requirement is subject to licensure sanction. This bill removes these provisions. MENTAL HEALTH HOSPITALS Present law provides that a certificate of need is not required in order for an existing hospital licensed by the department of mental health and substance abuse services to become licensed by the commission as a satellite of an affiliated general acute care hospital. This bill removes this provision. DECISION ON APPLICATION Present law requires the commission, upon consideration of an application and review of the evaluation and other relevant information, to, among other things, approve part or all of the application and grant a certificate of need, upon lawful conditions that the commission deems appropriate and enforceable on the grounds that those parts of the proposal appear to meet applicable criteria. However, a condition that is placed on a certificate of need, and that appears on the face of the certificate of need when issued, must also be made a condition of any corresponding license issued by the commission or department of mental health and substance abuse services. This bill removes the requirement that a condition placed on the certificate of need also be placed on any corresponding license issued by the department. Present law generally provides that activity authorized by a certificate of need must be completed within a period not to exceed three years for hospital and nursing home projects, and two years for all other projects, from the date of its issuance and after such time the certificate of need authorization expires. This bill rewrites this provision to provide, instead, that activity authorized by a certificate of need must be completed within a period not to exceed two years from the date of its issuance and after such time the certificate of need authorization expires. Present law provides that a license or occupancy approval must not be issued by the commission or the department of mental health and substance abuse services for an activity for which a certificate of need has become void. This bill removes this prohibition on a license or occupancy approval issued by the department. OPPOSITION TO APPLICATION Present law provides that a healthcare institution wishing to oppose a certificate of need application must be located within a 35-mile radius of the location of the action proposed, and must have served patients within that radius within the 365 days immediately preceding the date of filing the certificate of need application. A healthcare institution wishing to oppose an application for the establishment of a home care organization, the modification of a certificate of need issued to a home care organization, or the addition of counties to the licensed service area of an existing home care organization must have served patients in at least one of the counties in the application's proposed service area within the 730 days immediately preceding the filing date of the certificate of need application, rather than demonstrate proximity within a 35-mile radius of the location. This bill removes the provisions that allow a healthcare institution to oppose such application. OVERSIGHT BY COMMISSION Present law requires the commission to maintain continuing oversight over a certificate of need that it approves on or after July 1, 2016. Oversight by the commission includes requiring annual reports for the first three years of the implementation of the certificate of need concerning appropriate quality measures as determined by the commission. This bill lowers that time period from three years to two years. NONPERFORMANCE OF AUTHORIZED SERVICES Present law provides that a certificate of need and activity the certificate authorizes become void if the actions the certificate authorizes have not been performed for a continuous period of two years after the date the certificate of need is implemented. The commission and the department of mental health and substance abuse services must not issue or renew a license for an activity for which certificate of need authorization has become void. With respect to a home care organization, this provision applies to whether the home care organization provides home health services anywhere within its service area, and not on the basis of each county for which the home care organization is licensed. This bill removes the department of mental health and substance abuse services from this provision and removes the provision relative to a home care organization. INFORMATION FROM DEPARTMENTS TO THE COMMISSION Present law authorizes the commissioners of health, mental health and substance abuse services, and intellectual and developmental disabilities to submit written reports or statements and to send representatives to testify before the commission to inform the commission with respect to applications. This bill only authorizes the commissioner of health to submit such reports or statements and to send representatives. Present law requires the commissioner of mental health and substance abuse services to provide the commission with aggregate data about nonresidential substitution-based treatment centers for opiate addiction licensed in this state within seven business days from the commissioner's receipt of a request. The information must include aggregate data about patient origin by state, county, or zip code, as requested, at licensee treatment centers in this state. The information must not include patient identifiers that would lead to a patient's identity, such as name or street address. Information received pursuant to this section must be available for public disclosure by the commission, as long as it does not contain patient identifiers. This bill removes these provisions. GROUNDS FOR REVOCATION OF CERTIFICATE OF NEED In addition to other grounds for revocation provided by other statutes, rule of law,