Section 144-503-4-1 - Certificate of Need RequiredA. A person may not enter into any commitment for financing a project that requires a Certificate of Need or incur an expenditure for the project without having sought and received a Certificate of Need, except that this prohibition does not apply to obligations for financing conditioned upon the receipt of a Certificate of Need or to obligations for predevelopment activities. 22 M.R.S.A. Sec.329.B. A Certificate of Need from the Department is required for: 1Transfer of ownership acquisition by lease, donation, transfer; acquisition of control. Any transfer of ownership or acquisition under lease or comparable arrangement or through donation or any acquisition of control of a health care facility under lease, management agreement or comparable arrangement or through donation that would have required review if the transfer or acquisition had been by purchase, except in emergencies when that acquisition of control is at the direction of the Department ( 22 M.R.S.A. Sec.329(1));2Acquisitions of major medical equipment. The use of major medical equipment on a temporary basis in the case of a natural disaster, major accident or equipment failure and the use of replacement equipment does not require a Certificate of Need. Beginning September 30, 2004 and annually thereafter, the threshold amount for review must be updated by the Commissioner to reflect the change in the Consumer Price Index medical index ( 22 M.R.S.A. Sec.329(2));3Capital expenditures. Except as provided in subsection 6, the obligation by or on behalf of a health care facility of any capital expenditure of $2,400,000 or more. Capital expenditures in the case of a natural disaster, major accident or equipment failure for replacement equipment or for parking lots and garages, information and communication systems and physician office space do not require a Certificate of Need; however, the capital cost of these items must be included in the total capital expenditure for a project that otherwise requires a Certificate of Need. Beginning September 30, 2004 and annually thereafter, the threshold amount for review must be updated by the Commissioner to reflect the change in the Consumer Price Index medical index ( 22 M.R.S.A. Sec.329(3));4New health service. The offering or development of any new health service( 22 M.R.S.A. Sec.329(4) );5Changes in bed complement. An increase in the existing licensed bed complement or an increase in the licensed bed category of a health care facility, other than a nursing facility, of greater than 10% ( 22 M.R.S.A. Sec.329(5));6Nursing facilities. The obligation by a nursing facility, when related to nursing services provided by the nursing facility, of any capital expenditures of $510,000 or more. A Certificate of Need is not required for a nursing facility to convert beds used for the provision of nursing services to beds to be used for the provision of residential care services. If such a conversion occurs, public funds are not obligated for payment of services provided in the converted beds ( 22 M.R.S.A. Sec.329(6));7Other circumstances. The following circumstances: A. Any proposed use of major medical equipment to serve inpatients of a hospital, if the equipment is not located in a health care facility and was acquired without a Certificate of Need, except acquisitions exempt from review under subsection 2 or 3; orB. If a person adds a health service not subject to review under subsection 4, paragraph A and not subject to review under subsection 4, paragraph B at the time it was established and not reviewed and approved prior to establishment at the request of the applicant, and its actual 3rd fiscal year operating cost exceeds the expenditure minimum for annual operating costs in the 3rd fiscal year of operation following addition of these services ( 22 M.R.S.A. Sec.329(7)); and8Related Projects. Any projects that the Department determines are related projects if such projects, considered in the aggregate, would otherwise require a Certificate of Need under this section. 22 M.R.S.A. Sec329(8).Projects will be deemed related if the projects are (1) expected to be commenced by the same health care facility within 12 months of each other, and (2) provide associated services within outpatient or inpatient settings or financially impact like or similar cost centers.10-144 C.M.R. ch. 503, § 4-1