Current through Register Vol. 49, No. 9, September, 2024
SECTION
I. INTRODUCTION
A. Organization
Section 1. The Arkansas Health Services
Permit Commission, hereinafter referred to as the Commission, and the Arkansas
Health Services Permit Agency, hereinafter referred to as the Agency, are
governed by Ark. Code Ann. §
20-8-101
et seq.
Section 2. The
administrative offices for the Commission are located at Freeway Medical Tower,
5800 West 10th Street, Suite 805, Little Rock, Arkansas.
B. Officers
Section
1. Number. Officers of the Commission shall be a Chair and a Vice
Chair.
Section 2. Terms of Office.
The terms of the Commission Chair and Vice Chair shall be for one year.
Officers may succeed themselves.
Section
3. Chair. The Chair shall have general supervision and management
of the affairs of the Commission subject to the control of the members. He or
she shall chair all meetings of the members; and perform all duties incident to
the office of the Chair and all such other duties as from time to time may be
assigned by the members.
Section 4.
Vice Chair. The Vice Chair shall in the absence or disability of the Chair,
perform the duties and exercise the powers of such office. The Vice Chair shall
perform such other duties and have such other powers as the Chair or the
members may from time to time prescribe.
C. Meetings
Section
1. Notice of Meetings. Formal notice of regular quarterly meetings
should be communicated to members at least 10 working days prior to the meeting
and additionally the news media and those who formally request notice from
staff. The agenda for the meeting should be approved by the Chair and provided
to the members, along with supporting materials, in sufficient time to permit
review prior to a regular quarterly meeting.
Section 2. Special Meetings. Special meetings
of the Commission may be required from time to time. Such meetings are subject
to call of the Chair, the Vice Chair, or three or more members. The call to a
special meeting should state the location and time, and the subject matter to
be covered at such meeting. The call to a special meeting should be provided to
members at least 24 hours prior to the meeting.
Section 3. Quorum and Manner of Action. A
quorum shall be not less than five of the duly appointed members of the
Commission. All actions of the Commission shall be decided by a simple majority
of the members present and voting but no action may be taken without four votes
for or against a motion with no proxy voting permitted.
Section 4. Robert's Rules of Order. Unless
otherwise covered by the Policies and Procedures of the Commission, the latest
edition of Robert's Rules of Order shall govern the conduct of any
meeting.
Section 5. Written
Minutes. The minutes of meetings shall be prepared and kept by Agency staff and
written copies mailed to members.
D. Committees of the Commission
Section 1. The Chairperson may establish and
create from time to time such committees as shall be necessary to carry out the
affairs and further the purposes of the Commission. The Commission may have
standing committees, ad hoc committees, or any other committees determined by
the Chairperson. The Chairperson shall appoint the membership to all
committees.
E. Conflict
of Interest
Section 1. Announcing a Conflict
of Interest. No member of the Commission shall use such membership for purposes
which are motivated by private gain, including gain for organizations or
institutions with which the individual is associated in any capacity. Annually
a disclosure statement shall be filed with the Agency listing all professional
interests in the health field; any financial interest in the health industry;
and any fiduciary interest held in a health institution, organization, or
agency. There shall be a conflict of interest when the member or his/her
organization or institution is the applicant or is a party to the adjudication
process. When a conflict arises for a member in the course of business of the
Commission, the individual member should declare the conflict.
Section 2. Voting Abstention. Any member who
declares a conflict of interest, or who is found to have a conflict should
neither participate in debate nor vote on the issue in
question.
SECTION
II. DEFINITIONS
A. "Affected
person" - includes, at a minimum, the applicant, appropriate state agencies,
any person residing within the proposed service area or any person who
regularly uses health care facilities within the proposed service area who has
notified the Agency in writing requesting notification of the review, health
care facilities located in the service area in which the project is proposed to
be located, and legal representatives of such persons.
B. "Agency" - the Health Services Permit
Agency
C. Assisted Living Facility
means any building or buildings, section or distinct part of a building,
boarding home, home for the aged, or other residential facility, whether
operated for profit or not, which undertakes through its ownership or
management to provide assisted living services for a period exceeding
twenty-four (24) hours to more than three (3) adult residents of the facility
who are not relatives of the owner or administrator. Assisted living facility
includes those facilities which provide assisted living services either
directly or through contractual arrangements or which facilitate contracting in
the name of residents.
D.
"Commission" - the Health Services Permit Commission
E. "Commissioner" - a duly appointed member
of the Health Services Permit Commission.
F. "Conversion of Services" - an alteration
of the category of services offered by a health facility.
G. "Director" - the director of the Health
Services Permit Agency.
H. "Health
Facility or Health Facilities" - "a long-term care facility" as defined by ACA
Section
20-10-101(8),
the Long Term Care Facilities and Services Act, or a "home health care services
agency" as defined by ACA Section
20-10-801,
the Home Services Act. The terms 'health facility" or "health facilities" does
not mean a "hospital", as defined by and licensed pursuant to ACA Section
20-9-201(3)
the Hospital and Health Facilities Licensure Act. Nothing in the Act or these
regulations shall be deemed to require a Permit of Approval for or otherwise
regulate the licensure of in any manner of a hospital except when a hospital
seeks to add long-term care beds or convert acute beds to long term care beds
or add or expand home health services. The term "health facility" does not
include offices of private physicians, outpatient surgery or imaging centers,
or establishments operated by the federal government or any agency thereof, or
free-standing radiation therapy centers, or 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.
I. "Home Health
Agency" - any person, partnership, association, corporation or other
organization whether public or private, proprietary or non-profit that provides
home health care services. (See "Home Health Services)
J. "Home Health Services" - the providing or
coordinating of acute, restorative, rehabilitative, maintenance, preventive or
health promotion services through professional nursing or by other therapeutic
services such as physical therapy, occupational therapy, speech therapy, home
health aide or personal services in a client's residence. In order to be
subject to Permit of Approval review such services must meet the definitions
contained in Act 956 of 1987.
K.
"Hospice" or "Hospice program" means an autonomous, centrally administered,
medically directed, coordinated program providing a continuum of home,
outpatient, and home-like inpatient care for the terminally ill patient and
family, and which employs an interdisciplinary team to assist in providing
palliative and supportive care to meet the special needs arising out of the
physical, emotional, spiritual, social, and economic stresses which are
experienced during the final stages of illness and during dying and
bereavement. The care shall be available twenty-four (24) hours a day, seven
(7) days a week, and provided on the basis of need, regardless of ability to
pay.
L. "Intermediate Care Facility
for the Mentally Retarded" (ICF-MR)
1. ICF-MR
16 beds or more - a facility with sixteen (16) or more beds that provides in a
protective residential setting, diagnosis, active treatment and rehabilitation
of persons with mental retardation or persons with related conditions. This
includes both public and privately operated ICF-MRs.
2. ICF-MR 15 beds or less - a facility with
from four (4) to fifteen (15) beds that provides in a protective residential
setting, diagnosis, active treatment and rehabilitation of persons with mental
retardation or persons with related conditions.
M. "Life Care Facility" - "Life care" means
continuing care as defined in Arkansas Code
23-93-103(2)
except that no additional charges are made for nursing care or personal care
beyond those charged all residents of the facility who are not receiving
nursing care or personal care services.
N. "Long term care" - means non-acute care
provided over a 24 hour period for 25 or more consecutive days.
O. "Long Term Care Facility" - means a
nursing home, residential care facility, post-acute head injury retraining and
residential care facility, or any other facility which provides long-term
medical or personal care. Permit of Approval review is not required of
hospitals as defined by and licensed pursuant to ACA
20-9-201(3)
except when a hospital seeks to add long term care beds or convert acute care
beds to long term care beds or add or expand home health services.
P. "Medical Care" - means the services that
are performed at the direction of a physician in behalf of patients by
physicians, nurses and other professional and technical personnel.
Q. "Nursing Home" - institution, or other
place for the reception, accommodation, board, care, or treatment of more than
three (3) unrelated individuals, who, because of physical or mental infirmity
are unable to sufficiently or properly care for themselves, and for which
reception, accommodation, board, care, and treatment, a charge is made. The
term "Nursing Home" shall not include the offices of private physicians and
surgeons, boarding homes, or hospitals, or institutions operated by the Federal
Government.
R. "Permit of Approval"
- a permit issued by the Commission, through the Agency, to an individual,
organization or health care facility approving a health care project subject to
review under Act 1800 of 2001, and the rules of the Commission.
S. "Person" - an individual, a trust or
estate, a partnership, corporation (including associations, joint stock
companies, and insurance companies), the State, or a political subdivision or
instrumentality (including a municipal corporation) of the State, or any legal
entity recognized by the State.
T.
"Personal Care" - means services which are defined as medically prescribed
tasks pertaining to a person's functional abilities which enable the person to
be treated on an outpatient basis rather than on an inpatient basis. Personal
care is in no way to be considered medical care.
U. "Physician" - a doctor of medicine or
osteopathy legally authorized by the State to practice medicine and
surgery.
V. "Population of a
county" - the population of a county will be based on the most recent Federal
census unless circumstances are such, that the Commission feels it should look
beyond the Census. A statewide planning agency should be utilized which will be
the Bureau of Census designee.
W.
"Post-Acute Head Injury Retraining and Residential Care Facilities" - a
building, or group of buildings if located contiguously and operated jointly,
used or maintained to provide, for pay, Retraining and Rehabilitation for three
(3) or more individuals who are disabled on account of Head Injury and who are
not in present need of in-patient diagnostic care in a hospital or related
institution. (Rules and Regulations for Post-Acute Head Injury Retraining and
Residential Care Facilities", OLTC, DHS)
X. "Psychiatric Residential Treatment
Facilities (PRTF) - 24-hour psychiatric residential treatment establishments
with permanent facilities (other than a psychiatric inpatient hospital) which
provides a structured, systematic therapeutic program of treatment, under the
supervision of a psychiatrist, for emotionally disturbed children and/or
adolescents, six to twenty-one years of age, grouped in an age appropriate
manner.
Y. "Residential Care
Facilities" - a building or structure which is used or maintained to provide
for pay on a 24-hour basis a place of residence and board for 3 or more
individuals whose functional capabilities have been impaired but do not require
hospital or nursing home care on a daily basis, but could require other
assistance in activities of daily living.
Z. Tangible assets - A tangible asset for the
purpose of transferring a permit, legal title and right of ownership is
property that may be felt or touched, and is necessarily corporeal, although it
may be either real or personal.
SECTION III. SCOPE OF REVIEW
The Agency (under the direction of the Commission or appropriate
Court) will issue, deny or withdraw Permits of Approval. Using the Commission's
rules and procedures, the Agency may exempt appropriate projects from review.
Each recommendation of the Agency must be based on the completed application
and its relationship to adopted standards and criteria. Each review decision of
the Commission must be consistent with adopted standards, criteria and the
record of the review.
A. PROJECTS
REQUIRING PERMIT OF APPROVAL REVIEW INCLUDE BUT ARE NOT LIMITED TO:
1. Nursing Home Construction
All proposals for conversion of services or alteration or
renovation or construction having an associated capital expenditure of $500,000
or more.
2. Additional Beds
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. Home Health Services
Unless exempted by the Act or by the Commission, all health
facilities seeking to add home health services or expand existing home health
service areas shall apply for a Permit of Approval. This includes changes in
license designation.
4.
Hospice
Unless exempted by statute or by the Commission, all hospices or
hospice programs shall apply for a Permit of Approval.
5. Cost Overrun
Any increase in cost in an approved project or cost of renovation
or construction or alteration of a health facility is deemed a cost overrun and
must be documented and filed with the agency. (During the course of review, the
reasonableness of the proposed capital expenditure will be evaluated. 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).
B. PROJECTS REQUIRING APPROVAL BY THE
COMMISSION:
1. Movement of Existing LTC beds -
(a) any movement of LTC beds from one site to
another site within the service area must be approved by the Commission. The
applicant should submit the request in writing to the Agency. Any proposed
movement of beds is subject to the time limitations in Section
VI.A and the reporting
requirements of Section
VI.B of the Commission's
Procedures. Failure to comply with these requirements will result in the
withdrawal of permission to move the beds.
(b) Movement of Site Location of Permit of
Approval Any movement of a site location for a project approved by the
Commission for an existing Permit of Approval is subject to review. The
applicant shall submit a request to the Agency in writing, detailing all
information required in the original application regarding a site, the reasons
for relocating the site from the original application approved, any additional
costs associated with the relocation, and the time remaining for completion
under various rules and regulations of the Commission regarding implementation
of a Permit of Approval. The Commission, at its next regularly-scheduled
meeting, must approve the relocation before site location change is made. The
relocation shall not extend the deadline for implementation of a Permit of
Approval.
(c) Transfer of Permit of
Approval, legal title, or right of ownership - A permit of approval may only be
transferred if the entitiy 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 then only with the approval of the Commission. The applicant
must provide proof of tangible assets. 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
Section V - Procedures for Review. 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.
C. PROJECTS EXEMPT FROM PERMIT OF APPROVAL
PROCESS:
1. Capital Expenditures less than
adopted thresholds
Projects proposed for the construction, expansion, or alteration
by or on the behalf of a nursing home which have an associated capital
expenditure of less than $500,000 and do not add LTC beds or home health
services.
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.
3.
Conversion of Services or New Services
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 $500,000 for nursing homes and not resulting
in additional bed capacity.
4. Acquisition of a Health Facility
The obligation of a capital expenditure to acquire an existing
health care facility shall not require a Permit of Approval. Such an exemption
applies to an acquisition by purchase, lease, donation or transfer of
ownership.
5. Religious
Facilities
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.
6. Outpatient Surgery Centers
7. Imaging Centers
8. Free Standing Radiation Therapy
Centers
D. EXPEDITED
REVIEWS
An expedited review is an exception to the normal procedures for
Permit of Approval review. If a proposal meets the criteria for expedited
review (See below) then that application may be submitted at anytime without
regard to the published batching cycles. The Agency may take action on the
proposal 30 days after notice of expedited review has been given to the
public.
1. The expedited review
process will be utilized if the capital expenditure is required:
(a) to eliminate or prevent imminent safety
hazards as defined by Federal, State, or local fire, building, or life safety
codes or regulations, or
(b) to
comply with State licensure standards, or
(c) to comply with accreditation or
certification standards which must be met to receive reimbursement under Title
XVIII of the Social Security Act or payments under a State plan for medical
assistance approved under Title XIX of that Act, or
(d) to eliminate emergency circumstances that
pose an imminent threat to public health, or
(e) to increase the cost of an approved
project in order to replace remodeling with new construction.
2. Those portions of a proposed
project which do not comply with D.1. above are subject to the full review
using established criteria, if that portion would otherwise have been subject
to review.
3. Under no
circumstances will additional beds, additional services, or expanded service
areas be approved by the Agency under the expedited review process.
SECTION
V. PROCEDURES FOR REVIEW
Although review procedures and criteria may vary according to the
purpose for which a particular review is being conducted, the normal procedures
are as follows:
A. Review Schedule
The Review Schedule below provides for the review of applications
to be considered in the same review cycle. Applications which satisfy the
requirements for expedited reviews may be submitted at anytime without regard
to the established Review Schedule.
PERMIT OF APPROVAL
Review Schedule
|
Application submitted by:*
|
Applications placed under review by:
|
Agency Decision by:
|
|
November 1
|
December 1
|
February 28
|
|
February 1
|
March 1
|
May 30
|
|
May 1
|
June 1
|
August 30
|
|
August 1
|
September 1
|
November 30
|
*Proposed applications should be submitted no later than 4:30
P.M. on this day. This will allow the Agency one month to determine if the
proposed application is complete. If the proposed application is determined
complete it will be considered received and will go under review. If the
application is not determined to be complete it will not go under review. The
review cycle will not start until the application is declared complete, and
official notification has been made placing the application under review.
Please note if deadlines fall on a weekend or holiday the deadline will be
extended to the next working day.
B. The Application/Review Process
The following are the steps of the application process. Each step
must be completed before a decision on the project can be rendered.
1. Application Form. The appropriate
application forms must be obtained from the Agency.
2. Pre-application conference/technical
assistance. If needed, a meeting will be scheduled at the request of the
applicant between the applicant and an Agency representative. The meeting is to
assist the applicant and to provide guidance in the preparation of the
application.
3. Submission of the
Application and Appropriate Review Fee. The applicant is responsible for the
timely submission to the Agency of an original and (2) copies of a completed
application and the review fee. The application must be signed in blue ink. The
review fee is $1,000 for all reviews. In the event that an application decision
results in a hearing before the Commission, the requesting party will be
charged the prevailing agency cost per page to cover the cost for the
additional copies required for the hearing.
4. Determination of completeness. The Agency
will determine the completeness of the application within 30 calendar days of
the scheduled submission date and, if appropriate, notify the applicant of any
additional information required for the review of the proposal. The Agency may
allow up to an additional fifteen days to obtain additional information.
Any proposed application that does not address substantially any
one of the criteria will have the proposal returned and will not be considered
for review for that cycle.
5. Information and Requirements. Applicants
subject to a review must submit to the Agency any information necessary for the
review. The information requirements may vary according to the type of review
and/or projects being reviewed. Please note that the Agency determination of
completeness merely indicates that the questions on the form have been
answered. This does not indicate that the application is approvable or that the
responses to the questions are adequate or appropriate. The only additional
information which may be submitted after the filing date is information
specifically requested in writing by the Agency. This request will be limited
to information necessary to complete the proposed application. An applicant may
correct a mistake in an application within the first 30 days after the
application is under review:
(a) if no other
application in the review cycle is considered as competitive; and
(b) if the change does not effect the scope
of the proposal, i.e., the change does not result in an increase in service
area, services to be offered or the number of beds requested.
6. Notification of the Beginning
of a Review.
(a) Timely written notification
will be sent to affected persons at the beginning of a review, and to any
person who has requested being on the Agency's mailing list. Notification will
include the proposed schedule for the review.
(b) The date of notification is the date on
which the notice is sent or the date on which the notice appears in a newspaper
of general circulation, whichever is later.
(c) Written notification to members of the
public and third party payers will be provided through a newspaper of general
circulation. Notification to all other affected persons will be by mail (which
may be a copy of the notice or a newspaper).
7. Review Period. Arkansas Code Ann. §
20-8-104
provides that the Agency must approve or deny the application within 90 days
from the date the application is deemed complete and submitted for review. An
application is submitted for review when the Agency has received a completed
application and has so notified the applicant and the public.
8. Availability of Reports; Methods for
Obtaining Public Access. All applications under review and all other written
materials essential to the review shall be accessible to the general public.
The Agency will provide, upon request, notification of the status of reviews,
findings, and other appropriate information. Depending on the amount of
material requested there may be a charge for copying.
9. Opponents Written Comments. Opponents to
applications have thirty (30) days from the Public Notice of the start of the
review cycle to submit written comments to the Agency. These comments will be
considered in, and will be attached to, the Agency's decision. An affected
person or any other interested party must submit written notice of opposition
to the Agency in order to receive notice of the Agency decision and preserve
the right to appeal the Agency decision to the Commission. Applicants will be
notified of these comments and will have until the fiftieth day of the review
cycle to respond in writing to opponent's comments.
10. Informal Hearing During Review. The
Director of the Agency may convene an informal hearing on any application under
review.
11. Agency Decision.
According to Arkansas Code Ann. §
20-8-104,
the Agency must approve or deny the application within 90 days from the date
the application is deemed complete and submitted for review. The criteria that
the proposed project met or failed to meet shall be set forth in written
findings to the applicant. Findings will be sent via certified mail to
opponents who have written a letter of opposition and also to unsuccessful
applicants.
12. Appeal for Hearing
Before the Commission.
(a) Opponents of
applications must submit a letter of opposition during the 30 day review period
in order to be eligible to request a hearing before the Commission. Any
applicant or opponent seeking an appeal of the Agency's decision on a Permit of
Approval shall file for a hearing within thirty (30) days of receipt of the
Agency's decision. An appeal shall be written and documented on the Agency's
Appeal Form for Permit of Approval Decisions. The grounds for the appeal must
be indicated on the form and no additional grounds may be raised before the
Commission. The form will be provided by the Agency.
(b) When there is an application pending
before the Agency or the Commission no additional applications will be placed
under review for the same service or facility in the same service area until an
appeal has been filed in circuit court or the time has expired for appeal to
Circuit Court on the pending application.
(c) Appeals to the Commission will be
conducted in accordance with the State Administrative Procedure Act.
(d) Appellant(s) will present their case
first. The Appellee(s) will follow. The appellant(s) shall be given an
opportunity to present rebuttal witnesses. Each side may cross-examine
witnesses. (The time for cross-examination will not be counted as part of the
suggested time frame). The following is the suggested time frame for appeals:
10 mins. for Opening Remarks for each side
40 mins. for presentation for each side
10 mins. for closing comments for each side (the appellant(s) may
reserve a portion of the time for rebuttal)
Each Commissioner will have a copy of the complete file. This is
a part of the record; therefore, it is not necessary to introduce the
application, findings, notices, etc. as exhibits in the administrative
hearing.
(e) The Commission
will conduct a hearing within ninety (90) days of the agency decision and shall
render its final decision within fifteen (15) days of the close of the hearing.
Failure of the Commission to take final action within these time periods shall
be considered a ratification of the Agency decision on the Permit of Approval
and shall constitute the final decision of the Commission.
(f) A hearing may be delayed through a
continuance by either the applicant or the opponent(s) if the request is made
in writing to the Agency at least (10) days before the date of the hearing.
Neither the applicant nor the opponent(s) may request more than one
continuance, i.e. there will be no more than one continuance per side. This
language should not be read to deny any rights guaranteed by the Arkansas
Code.
13. Ex Parte
Contacts
After an application for Permit of Approval is filed with the
Agency there shall be no ex parte contacts between:
(a) an applicant or any person acting on
behalf of the applicant (or holder of a Permit of Approval in a decision to
withdraw a Permit) or any person opposed to the issuance (or in favor of
withdrawal) of a Permit of Approval and
(b) any member of the Commission.
An ex parte contact by an applicant or a person representing an
applicant may be grounds for the withdrawal of the application from
review.
NOTE: An ex parte communication is defined as oral or written
communication not on the public record with respect to which reasonable prior
notice to all parties is not given, but it shall not include requests for
status reports on any matter or proceeding.
SECTION VI. CONTINUING
EFFECT OF A PERMIT OF APPROVAL
A. Implementing
a Permit of Approval
1. Applicants approved to
construct a new facility or expand an existing facility have nine (9) months
from the date of the issuance of the Permit (or from the date of the final
judicial decision on the Permit of Approval application) to sign a construction
contract. The construction contract shall specify that the foundation for the
facility will be completed within six (6) months of the signing of the contract
and that the facility will be completed within eighteen (18) months from the
date of the signing. An application for licensure of the beds contained in the
new construction must be made within eighteen (18) months from the date of the
signing of construction contract. In the event that the construction contract
is not signed within nine (9) months, the foundation is not completed within
six (6) months of signing the construction contract, or the project is not
completed and an application for licensure not filed within eighteen (18)
months of the date of signing of the construction contract the Permit must be
terminated by the Agency. Appeals of the termination will be made to the Health
Services Commission within thirty (30) days of notice of termination. Notice of
the termination of a Permit will be through certified letter to the holder of
the Permit. Notice of hearings on appeal of the termination will be by mail to
the holder of the Permit and affected parties and legal notice in a newspaper
of statewide coverage.
2.
Applicants that have made a preliminary application for a HUD insured loan on
or before the 90th day following the issuance of their POA and have not
received an approval from HUD by the start of the eighteenth month following
the issuance of the POA may request an extension of the POA for up to an
additional six months. In order to receive the extension the applicant must
provide the Agency with a letter from HUD documenting:
1) the date of preliminary application and
2) that the delay in approval was
not due to inaction or delays by the applicant. This request for an extension
on the POA must be made at least three weeks prior to the end of the eighteenth
month.
3. Projects not
requiring construction or renovation must be licensed within one year of the
date of the Permit of Approval (or within one year of the date of the final
judicial decision on the Permit of Approval application).
4. After project approval, if the applicant
wishes to change the approved project, the proposed changes are subject to
Permit of Approval if they are such that in themselves they would be subject to
review. If an applicant proposes a change that was a significant reason for the
approval of the project then that proposed change must go before the Commission
to determine whether the change shall require review.
5. A Permit of Approval once issued to an
approved applicant, is not transferable to any other institution or party
without approval of the Commission.
6. Extensions - The Commission may approve a
request for extension of time if good cause is presented. Any request for an
extension must be made in writing to the Agency prior to the expiration of the
date on which the phase or project was to be completed. Under no circumstances
will an extension be granted for more than six months at a time. An applicant
may request subsequent extensions.
7. The above stated timelines also apply to
projects that were exempted from Permit of Approval review. The starting date
for exempted projects will be the date of the exemption. (e.g. exempted
construction projects will have nine (9) months from the date of exemption to
sign a construction contract).
B. REPORTING
1. It will be the sole responsibility of the
applicant to keep the Agency informed of its progress during the approval
period. Documentary evidence of the signed construction contract, the
construction of the foundation and the application for licensure must be
submitted to the Agency. A progress report to the Agency on the project is
required at the time the construction contract is due, at the time the
foundation is due to be completed and every six months after that until the
project is licensed. Failure to submit these progress reports may result in the
approved party having to appear before the Commission to show cause why the
permit should not be terminated.
C. TERMINATION OR SURRENDER OF A PERMIT OF
APPROVAL OR LICENSE:
Any increase or decrease in beds or services due to the
expiration, termination, revocation, or surrendering of a permit or the
expiration, termination, revocation, or surrendering of a license must be
recorded with the Agency at least sixty days prior to the deadline for filing
applications for a review cycle in order to be considered in the review
cycle.
SECTION
VII. EXCEPTIONS TO USE OF PROCEDURES
A. The Commission may approve an exception to
any of the required review procedures by a favorable 3/4 (75%) vote of the full
Commission.
B. In approving a
general exception the Commission will establish substitute procedures where
appropriate.
C. Upon receiving a
written request for an exception, the Agency will follow the notice and comment
procedures and will submit copies of all comments received by the Commission
with its request. Before approving the request, the Commission will:
1. review copies of the comments submitted by
the Agency, and
2. determine that
the procedures to be used are consistent with the purposes of the Act and will
not adversely and substantially affect the rights of affected
persons.
D. The Agency
will distribute a notice of the approved exception and of any substitute
procedures established under this Section.
SECTION X. UTILIZATION REPORTS AND FINES
Act 1271 of 2005 authorizes the Health Services Permit Agency to
collect utilization statistics annually from hospitals, nursing homes,
outpatient surgery centers, home health agencies, assisted living facilities,
residential care facilities and hospices. The Agency is also authorized to
impose fines on nursing homes, home health agencies, assisted living
facilities, residential care facilities, and hospices for the failure to timely
submit reports of statistics as required by the Agency. The fines are:
A. Up to one hundred dollars ($100) for a
report over thirty (30) days late;
B. Two hundred fifty dollars ($250) for a
report over sixty days late;F
C.
Five hundred dollars ($500) for a report over ninety days late.
