H. B. 4426
(By Delegate Andes)
[Introduced February 10, 2010
; referred to the
Committee on Health and Human Resources then the Judiciary.]
A BILL to repeal §16-2D-1, §16-2D-2, §16-2D-3, §16-2D-4, §16-2D-4a,
§16-2D-4b, §16-2D-5, §16-2D-5a, §16-2D-6, §16-2D-7, §16-2D-7a,
§16-2D-8, §16-2D-9, §16-2D-10, §16-2D-11, §16-2D-12, §16-2D-
13, §16-2D-14 and §16-2D-15 of the Code of West Virginia,
1931, as amended; to repeal §16-29A-20; to repeal §16-42-6 of
said code to repeal §49-7-30 of said code; to amend and
reenact §9-5-19 of said code; to amend and reenact §16-1-4 of
said code; to amend and reenact §16-29B-1, §16-29B-8, §16-29B-
11 and §16-29B-19a of said code; to amend and reenact §16-29I-
6 of said code; and to amend and reenact §33-15B-5 of said
code; all relating to elimination of the requirement that
health facilities receive a certificate of need before
opening.
Be it enacted by the Legislature of West Virginia:
That §16-2D-1, §16-2D-2, §16-2D-3, §16-2D-4, §16-2D-4a, §16-
2D-4b, §16-2D-5, §16-2D-5a, §16-2D-6, §16-2D-7, §16-2D-7a, §16-2D-8, §16-2D-9, §16-2D-10, §16-2D-11, §16-2D-12, §16-2D-13, §16-2D-14
and §16-2D-15 of the Code of West Virginia, 1931, as amended, be
repealed; that §16-29A-20 of said code be repealed; that §16-42-6
of said code be repealed; that §49-7-30 of said code be repealed;
that §9-5-19 of said code be amended and reenacted; that §16-1-4 of
said code be amended and reenacted; that §16-29B-1, §16-29B-8, §16-
29B-11 and §16-29B-19a of said code be amended and reenacted; that
§16-29I-6 of said code be amended and reenacted; and that §33-15B-5
of said code be amended and reenacted, all to read as follows:
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-19. Summary review for certain behavioral health facilities
and services.
(a) A certificate of need as provided in article two-d,
chapter sixteen of this code is not required by an entity proposing
additional behavioral health care services, but only to the extent
necessary to gain federal approval of the Medicaid MR/DD waiver
program, if a summary review is performed in accordance with the
provisions of this section.
(b) Prior to initiating any summary review, the secretary
shall direct the revision of the State Mental Health Plan as
required by the provisions of 42 U.S.C. 300x and section four,
article one-a, chapter twenty-seven of this code. In developing
those revisions, the secretary is to appoint an advisory committee
composed of representatives of the associations representing
providers, child care providers, physicians and advocates. The secretary shall appoint the appropriate department employees
representing regulatory agencies, reimbursement agencies and
oversight agencies of the behavioral health system.
(c) If the Secretary of the Department of Health and Human
Resources determines that specific services are needed but
unavailable, he or she shall provide notice of the department's
intent to develop those services. Notice may be provided through
publication in the State Register, publication in newspapers or a
modified request for proposal as developed by the secretary.
(d) The secretary may initiate a summary review of additional
behavioral health care services, but only to the extent necessary
to gain federal approval of the Medicaid MR/DD waiver program, by
recommending exemption from the provisions of article two-d,
chapter sixteen of this code to the Health Care Authority. The
recommendation is to include the following findings:
(1) That the proposed service is consistent with the State
health plan and the State Mental Health Plan;
(2) That the proposed service is consistent with the
department's programmatic and fiscal plan for behavioral health
services;
(3) That the proposed service contributes to providing
services that prevent admission to restrictive environments or
enables an individual to remain in a nonrestrictive environment;
(4) That the proposed service contributes to reducing the
number of individuals admitted to inpatient or residential treatment programs or services;
(5) If applicable, that the proposed service will be
community-based, locally accessible, provided in an appropriate
setting consistent with the unique needs and potential of each
client and his or her family and located in an area that is
unserved or underserved or does not allow consumers a choice of
providers; and
(6) That the secretary is determining that sufficient funds
are available for the proposed service without decreasing access to
or provision of existing services. The secretary may, from time to
time, transfer funds pursuant to the general provisions of the
budget bill.
(e) The secretary's findings required by this section shall be
filed with the secretary's recommendation and appropriate
documentation. If the secretary's findings are supported by the
accompanying documentation, the proposal does not require a
certificate of need.
(f) Any entity that does not qualify for summary review is
subject to a certificate of need review.
(g) (f) Any provider of the proposed services denied
authorization to provide those services pursuant to the summary
review has the right to appeal that decision to the state agency in
accordance with the provisions of section ten, article two-d,
chapter sixteen of this code.
ARTICLE 1. STATE PUBLIC HEALTH SYSTEM.
§16-1-4. Proposal of rules by the secretary.
The secretary may propose rules in accordance with the
provisions of article three, chapter twenty-nine-a of this code
that are necessary and proper to effectuate the purposes of this
chapter. The secretary may appoint or designate advisory councils
of professionals in the areas of hospitals, nursing homes, barbers
and beauticians, postmortem examinations, mental health and mental
retardation centers and any other areas necessary to advise the
secretary on rules.
The rules may include, but are not limited to, the regulation
of:
(a) Land usage endangering the public health:
Provided, That
no rules may be promulgated or enforced restricting the subdivision
or development of any parcel of land within which the individual
tracts, lots or parcels exceed two acres each in total surface area
and which individual tracts, lots or parcels have an average
frontage of not less than one hundred fifty feet even though the
total surface area of the tract, lot or parcel equals or exceeds
two acres in total surface area, and which tracts are sold, leased
or utilized only as single-family dwelling units. Notwithstanding
the provisions of this subsection, nothing in this section may be
construed to abate the authority of the department to: (1)
Restrict the subdivision or development of a tract for any more
intense or higher density occupancy than a single-family dwelling
unit; (2) propose or enforce rules applicable to single-family dwelling units for single-family dwelling unit sanitary sewerage
disposal systems; or (3) restrict any subdivision or development
which might endanger the public health, the sanitary condition of
streams or sources of water supply;
(b) The sanitary condition of all institutions and schools,
whether public or private, public conveyances, dairies,
slaughterhouses, workshops, factories, labor camps, all other
places open to the general public and inviting public patronage or
public assembly, or tendering to the public any item for human
consumption and places where trades or industries are conducted;
(c) Occupational and industrial health hazards, the sanitary
conditions of streams, sources of water supply, sewerage facilities
and plumbing systems and the qualifications of personnel connected
with any of those facilities, without regard to whether the
supplies or systems are publicly or privately owned; and the design
of all water systems, plumbing systems, sewerage systems, sewage
treatment plants, excreta disposal methods and swimming pools in
this state, whether publicly or privately owned;
(d) Safe drinking water, including:
(1) The maximum contaminant levels to which all public water
systems must conform in order to prevent adverse effects on the
health of individuals and, if appropriate, treatment techniques
that reduce the contaminant or contaminants to a level which will
not adversely affect the health of the consumer. The rule shall
contain provisions to protect and prevent contamination of wellheads and well fields used by public water supplies so that
contaminants do not reach a level that would adversely affect the
health of the consumer;
(2) The minimum requirements for: Sampling and testing;
system operation; public notification by a public water system on
being granted a variance or exemption or upon failure to comply
with specific requirements of this section and rules promulgated
under this section; record keeping; laboratory certification; as
well as procedures and conditions for granting variances and
exemptions to public water systems from state public water systems
rules; and
(3) The requirements covering the production and distribution
of bottled drinking water and may establish requirements governing
the taste, odor, appearance and other consumer acceptability
parameters of drinking water;
(e) Food and drug standards, including cleanliness,
proscription of additives, proscription of sale and other
requirements in accordance with article seven of this chapter as
are necessary to protect the health of the citizens of this state;
(f) The training and examination requirements for emergency
medical service attendants and emergency medical care technician-
paramedics; the designation of the health care facilities, health
care services and the industries and occupations in the state that
must have emergency medical service attendants and emergency
medical care technician-paramedics employed and the availability, communications and equipment requirements with respect to emergency
medical service attendants and to emergency medical care
technician-paramedics:
Provided, That any regulation of emergency
medical service attendants and emergency medical care technician-
paramedics may not exceed the provisions of article four-c of this
chapter;
(g) The health and sanitary conditions of establishments
commonly referred to as bed and breakfast inns. For purposes of
this article, "bed and breakfast inn" means an establishment
providing sleeping accommodations and, at a minimum, a breakfast
for a fee:
Provided, That the secretary may not require an owner
of a bed and breakfast providing sleeping accommodations of six or
fewer rooms to install a restaurant-style or commercial food
service facility:
Provided, however, That the secretary may not
require an owner of a bed and breakfast providing sleeping
accommodations of more than six rooms to install a restaurant-type
or commercial food service facility if the entire bed and breakfast
inn or those rooms numbering above six are used on an aggregate of
two weeks or less per year;
(h) Fees for services provided by the Bureau for Public Health
including, but not limited to, laboratory service fees,
environmental health service fees, health facility fees and permit
fees;
(i) The collection of data on health status, the health system
and the costs of health care;
(j) Opioid treatment programs duly licensed and operating
under the requirements of chapter twenty-seven of this code.
The
Health Care Authority shall develop new certificate of need
standards, pursuant to the provisions of article two-d of this
chapter, that are specific for opioid treatment program facilities.
No applications for a certificate of need for opioid treatment
programs shall be approved by the Health Care Authority as of the
effective date of the 2007 amendments to this subsection. The
secretary shall promulgate revised emergency rules to govern
licensed programs:
Provided, That there is a moratorium on the
licensure of new opioid treatment programs that do not have a
certificate of need as of the effective date of the 2007 amendments
to this subsection, which shall continue until the Legislature
determines that there is a necessity for additional opioid
treatment facilities in West Virginia. The secretary shall file
revised emergency rules with the Secretary of State to regulate
opioid programs in compliance with subsections (1) through (9),
inclusive, of this section:
Provided, however, That any opioid
treatment program facility that has received a certificate of need
pursuant to article two-d of this chapter by the Health Care
Authority shall be permitted to proceed to license and operate the
facility. All existing opioid treatment programs shall be in
compliance within one hundred eighty days of the effective date of
the revised emergency rules as required herein. The revised
emergency rules shall provide at a minimum:
(1) That the initial assessment prior to admission for entry
into the opioid treatment program shall include an initial drug
test to determine whether an individual is either opioid addicted
or presently receiving methadone for an opioid addiction from
another opioid treatment program. The patient may be admitted to
the program if there is a positive test for either opioids or
methadone or there are objective symptoms of withdrawal, or both,
and all other criteria set forth in the rule for admission into an
opioid treatment program are met:
Provided, That admission to the
program may be allowed to the following groups with a high risk of
relapse without the necessity of a positive test or the presence of
objective symptoms: Pregnant women with a history of opioid abuse,
prisoners or parolees recently released from correctional
facilities, former clinic patients who have successfully completed
treatment but who believe themselves to be at risk of imminent
relapse and HIV patients with a history of intravenous drug use.
(2) That within seven days of the admission of a patient, the
opioid treatment program shall complete an initial assessment and
an initial plan of care. Subsequently, the opioid treatment
program shall develop a treatment plan of care by the thirtieth day
after admission and attach to the patient's chart no later than
five days after such plan is developed. The treatment plan is to
reflect that detoxification is an option for treatment and
supported by the program.
(3) That each opioid treatment program shall report and provide statistics to the Department of Health and Human Resources
at least semiannually which includes the total number of patients;
the number of patients who have been continually receiving
methadone treatment in excess of two years, including the total
number of months of treatment for each such patient; the state
residency of each patient; the number of patients discharged from
the program, including the total months in the treatment program
prior to discharge and whether the discharge was for:
(A) Termination or disqualification;
(B) Completion of a program of detoxification;
(C) Voluntary withdrawal prior to completion of all
requirements of detoxification as determined by the opioid
treatment program; or
(D) An unexplained reason.
(4) That random drug testing of patients be conducted during
the course of treatment. For purposes of these rules, random drug
testing shall mean that each patient of an opioid treatment program
facility has a statistically equal chance of being selected for
testing at random and at unscheduled times. Any refusal to
participate in a random drug test shall be considered a positive
test:
Provided, That nothing contained in this section or the
legislative rules promulgated in conformity herewith will preclude
any opioid treatment program from administering such additional
drug tests as determined necessary by the opioid treatment program.
(5) That all random drug tests conducted by an opioid treatment program shall, at a minimum, test for the following:
(A) Opiates, including oxycodone at common levels of dosing;
(B) Methadone and any other medication used by the program as
an intervention;
(C) Benzodiazepine including diazepam, lorazepan, clonazepam
and alprazolam;
(D) Cocaine;
(E) Methamphetamine or amphetamine; and
(F) Other drugs determined by community standards, regional
variation or clinical indication.
A positive test is a test that results in the presence of any
drug or substance listed in this schedule and any other drug or
substance prohibited by the opioid treatment program;
(6) That a positive drug test result after the first six
months in an opioid treatment program shall result in the
following:
(A) Upon the first positive drug test result, the opioid
treatment program shall:
(1) Provide mandatory and documented weekly counseling to the
patient, which shall include weekly meetings with a counselor who
is licensed, certified or enrolled in the process of obtaining
licensure or certification in compliance with the rules and on
staff at the opioid treatment program;
(2) Immediately revoke the take- home methadone privilege for
a minimum of thirty days; and
(B) Upon a second positive drug test result within six months
of a previous positive drug test result, the opioid treatment
program shall:
(1) Provide mandatory and documented weekly counseling, which
shall include weekly meetings with a counselor who is licensed,
certified or enrolled in the process of obtaining licensure or
certification in compliance with the rules and on staff at the
opioid treatment program;
(2) Immediately revoke the take-home methadone privilege for
a minimum of sixty days; and
(3) Provide mandatory documented treatment team meetings with
the patient.
(C) Upon a third positive drug test result within a period of
six months the opioid treatment program shall:
(1) Provide mandatory and documented weekly counseling, which
shall include weekly meetings with a counselor who is licensed,
certified or enrolled in the process of obtaining licensure or
certification in compliance with the rules and on staff at the
opioid treatment program;
(2) Immediately revoke the take-home methadone privilege for
a minimum of one hundred twenty days; and
(3) Provide mandatory and documented treatment team meetings
with the patient which will include, at a minimum: The need for
continuing treatment; a discussion of other treatment alternatives;
and the execution of a contract with the patient advising the patient of discharge for continued positive drug tests.
(D) Upon a fourth positive drug test within a six-month
period, the patient shall be immediately discharged from the opioid
treatment program or, at the option of the patient, shall
immediately be provided the opportunity to participate in a twenty-
one day detoxification plan, followed by immediate discharge from
the opioid treatment program.
(7) That the opioid treatment program must report and provide
statistics to the Department of Health and Human Resources
demonstrating compliance with the random drug test rules including
confirmation that:
(A) The random drug tests were truly random in regard to both
the patients tested and to the times random drug tests were
administered by lottery or some other objective standard so as not
to prejudice or protect any particular patient.
(B) The total number and the number of positive results; and
(C) The number of expulsions from the program.
(8) That all opioid treatment facilities be open for business
seven days per week:
Provided, That the opioid treatment center
may be closed for eight holidays and two training days per year.
(9) That the Office of Health Facility Licensure and
Certification develop policies and procedures in conjunction with
the Board of Pharmacy that will allow access to the Prescription
Drug Registry maintained by the Board of Pharmacy before
administration of methadone or other treatment in an opioid treatment program, after any positive drug test, and at each
ninety-day treatment review to ensure the patient is not seeking
prescription medication from multiple sources.
(k) The secretary shall propose a rule for legislative
approval in accordance with the provisions of article three,
chapter twenty-nine-a or this code for the distribution of state
aid to local health departments and basic public health services
funds.
(1) The rule shall include the following provisions:
(A) Base allocation amount for each county;
(B) Establishment and administration of an emergency fund of
no more than two percent of the total annual funds of which unused
amounts are to be distributed back to local boards of health at the
end of each fiscal year;
(C) A calculation of funds utilized for state support of local
health departments;
(D) Distribution of remaining funds on a per capita weighted
population approach which factors coefficients for poverty, health
status, population density and health department interventions for
each county and a coefficient which encourages counties to merge in
the provision of public health services;
(E) A hold-harmless provision to provide that each local
health department receives no less in state support for a period
of three years beginning in the 2009 budget year.
(2) The Legislature finds that an emergency exists and, therefore, the secretary shall file an emergency rule to implement
the provisions of this section pursuant to the provisions of
section fifteen, article three, chapter twenty-nine-a of this code.
The emergency rule is subject to the prior approval of the
Legislative Oversight Commission on Health and Human Resources
Accountability prior to filing with the Secretary of State.
(l) Other health-related matters which the department is
authorized to supervise and for which the rule-making authority has
not been otherwise assigned.
ARTICLE 29B. HEALTH CARE AUTHORITY.
§16-29B-1. Legislative findings; purpose.
The Legislature hereby finds and declares that the health and
welfare of the citizens of this state is being threatened by
unreasonable increases in the cost of health care services, a
fragmented system of health care, lack of integration and
coordination of health care services, unequal access to primary and
preventative care, lack of a comprehensive and coordinated health
information system to gather and disseminate data to promote the
availability of cost-effective, high-quality services and to permit
effective health planning and analysis of utilization, clinical
outcomes and cost and risk factors. In order to alleviate these
threats: (1) Information on health care costs must be gathered;
(2) a system of cost control must be developed; and (3) an entity
of state government must be given authority to ensure the
containment of health care costs, to gather and disseminate health care information; to analyze and report on changes in the health
care delivery system as a result of evolving market forces,
including the implementation of managed care; and to assure that
the state health plan,
certificate of need program, rate regulation
program and information systems serve to promote cost containment,
access to care, quality of services and prevention. Therefore, the
purpose of this article is to protect the health and well-being of
the citizens of this state by guarding against unreasonable loss of
economic resources as well as to ensure the continuation of
appropriate access to cost-effective, high-quality health care
services.
§16-29B-8. Powers generally; budget expenses of the board.
(a) In addition to the powers granted to the board elsewhere
in this article, the board may:
(1) Adopt, amend and repeal necessary, appropriate and lawful
policy guidelines and rules in accordance with article three,
chapter twenty-nine-a of this code:
Provided, That subsequent
amendments and modifications to any rule promulgated pursuant to
this article and not exempt from the provisions of article three,
chapter twenty-nine-a of this code may be implemented by emergency
rule;
(2) Hold public hearings, conduct investigations and require
the filing of information relating to matters affecting the costs
of health care services subject to the provisions of this article
and may subpoena witnesses, papers, records, documents and all other data in connection therewith. The board may administer oaths
or affirmations in any hearing or investigation;
(3) Apply for, receive and accept gifts, payments and other
funds and advances from the United States, the state or any other
governmental body, agency or agencies or from any other private or
public corporation or person (with the exception of hospitals
subject to the provisions of this article, or associations
representing them, doing business in the State of West Virginia,
except in accordance with subsection (c) of this section), and
enter into agreements with respect thereto, including the
undertaking of studies, plans, demonstrations or projects. Any
such gifts or payments that may be received or any such agreements
that may be entered into shall be used or formulated only so as to
pursue legitimate, lawful purposes of the board, and shall in no
respect inure to the private benefit of a board member, staff
member, donor or contracting party;
(4) Lease, rent, acquire, purchase, own, hold, construct,
equip, maintain, operate, sell, encumber and assign rights or
dispose of any property, real or personal, consistent with the
objectives of the board as set forth in this article:
Provided,
That such acquisition or purchase of real property or construction
of facilities shall be consistent with planning by the state
building commissioner and subject to the approval of the
Legislature;
(5) Contract and be contracted with and execute all instruments necessary or convenient in carrying out the board's
functions and duties; and
(6) Exercise, subject to limitations or restrictions herein
imposed, all other powers which are reasonably necessary or
essential to effect the express objectives and purposes of this
article.
(b) The board shall annually prepare a budget for the next
fiscal year for submission to the Governor and the Legislature
which shall include all sums necessary to support the activities of
the board and its staff.
(c) Each hospital subject to the provisions of this article
shall be assessed by the board on a pro rata basis using the gross
revenues of each hospital as reported under the authority of
section eighteen of this article as the measure of the hospital's
obligation. The amount of such fee shall be determined by the
board except that in no case shall the hospital's obligation exceed
one tenth of one percent of its gross revenue. Such fees shall be
paid on or before July 1, in each year and shall be paid into the
State Treasury and kept as a special revolving fund designated
Health Care Cost Review Fund", with the moneys in such fund being
expendable after appropriation by the Legislature for purposes
consistent with this article. Any balance remaining in said fund
at the end of any fiscal year shall not revert to the treasury, but
shall remain in said fund and such moneys shall be expendable after
appropriation by the Legislature in ensuing fiscal years.
(d) Each hospital's assessment shall be treated as an
allowable expense by the board.
(e) The board is empowered to withhold rate approvals
certificates of need and rural health system loans and grants if
any such fees remain unpaid, unless exempted under subsection (g),
section four, article two-d of this chapter.
§16-29B-11. Related programs.
In addition to carrying out its duties under this article, the
board shall carry out its information disclosure functions set
forth in article five-f of this chapter and its functions set forth
in article two-d of this chapter, including health planning,
issuing grants and loans to financially vulnerable health care
entities located in underserved areas, and the review and approval
or disapproval of capital expenditures for health care facilities
or services.
In making decisions in the certificate of need review
process, the board shall be guided by the state health plan
approved by the Governor.
§16-29B-19a. Additional legislative directives; studies, findings
and recommendations.
(a) The Legislature finds and declares that changing market
forces require periodic changes in the regulatory structure for
health care providers and hereby directs the board to study the
following:
(1) The certificate of need program, including the effect of
any changes on managed care and access for uninsured and rural consumers; determining which services or capital expenditures
should be exempt and why; and the status of similar programs in
other states;
(2) (1) The hospital rate-setting methodology, including the
need for hospital rate-setting and the development of alternatives
to the cost-based reimbursement methodology;
(3) (2) Managed care markets, including the need for
regulatory programs in managed care markets; and
(4) (3) Barriers or obstacles, if any, presented by the
certificate of need program or standards in the state health plan
to health care providers' need to reduce excess capacity,
restructure services and integrate the delivery of services.
(b) The board may form task forces to assist it in addressing
these issues and it shall prepare a report on its findings and
recommendations, which is to be filed with the Governor, the
President of the Senate and the Speaker of the House of Delegates
on or before October 1,
one thousand nine hundred ninety-eight,1998
identifying each problem and recommendation with specificity and the
effect of each recommendation on cost, access and quality of care.
The task forces, if formed, shall be composed of representatives of
consumers, businesses, providers, payors and state agencies.
(c) The board shall report quarterly to the Legislative
Oversight Commission on health and human resources accountability
regarding the appointment, direction and progress of the studies.
ARTICLE 29I. WEST VIRGINIA HEALTH CARE AUTHORITY REVOLVING LOAN AND GRANT FUND.
§16-29I-6. Review of hospital restructuring plans.
(a) The board shall review and may approve or reject hospital
restructuring plans submitted to it from time to time. Upon
approval of any submitted plan, the board may in its sole discretion
provide from the fund a loan, low-interest loan, or no-interest
loan, in a form and on those terms and conditions as the board
considers appropriate to assist in the implementation of the
hospital restructuring plan. Prior to approving any plan, the board
shall make a factual determination that the implementation of the
hospital restructuring plan will rationalize and restructure the
delivery of health care services provided by the hospital or
combination of hospitals submitting the plan, and shall further
determine that the implementation of the plan will provide a cost
savings for hospital services delivered by the hospital or
combination of hospitals for both public and private health care
payors.
(b) The board may approve hospital restructuring plans and
loans from the revolving fund contingent upon any conditions
considered necessary by the board to assure the repayment of any
loan, which may include, but need not be limited to, the successful
implementation of the cost containment objectives of any hospital
restructuring plan.
(c) The board may withhold future rate approvals
certificates
of need and rural health system loans and grants if any of the terms or conditions of the loan provided by the board are not subsequently
satisfied or met by the hospital or combination of hospitals
receiving the loan from the fund.
ARTICLE 15B. UNIFORM HEALTH CARE ADMINISTRATION ACT.
§33-15B-5. Penalties for violation.
Any person, partnership, corporation, limited liability
company, professional corporation, health care provider or other
entity violating any provision of this article shall be guilty of
a misdemeanor and, upon conviction shall be punished by a fine of
not more than $1,000. Each day of continuing violation after
conviction shall be considered a separate offense.
The West
Virginia Health Care Authority is empowered to withhold rate
approval or a certificate of need for any health care provider
violating any provision of this article.
NOTE: The purpose of this bill is to end the requirement that
health facilities acquire a certificate of need to open.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added