The State CON program applies to the obligation of capital expenditures, the establishment of new health care facilities, the offering of defined new institutional health services, clinical health services, and the acquisition of major medical equipment.
Within these parameters, no person shall engage in any of the following activities without obtaining a CON from the Department:
2.1.1 Any capital expenditure that exceeds the expenditure threshold. This capital expenditure includes the cost of any studies, surveys, designs, plans, working drawings, specification and other activities (including staff efforts and other services) associated with the capital expenditure and includes an acquisition for less than fair market value if the acquisition at fair market value would exceed the expenditure threshold. A capital expenditure shall include the acquisition, whether by lease, sufferance, gift, devise, legacy, settlement of a trust or other means, of any facility or part thereof, or equipment for a facility, the expenditure for which would have been considered a capital expenditure if acquired by purchase. Transactions which are separated in time but are planned to be undertaken within 12 months of each other and are components of an overall plan for meeting patient care objectives shall, for purposes of this definition, be viewed in their entirety without regard to their timing.
In those instances where a health care facility or other provider of health services proposes to provide a service in which the capital expenditure for major medical equipment or other than major medical equipment or a combination of the two may have been split between separate parties, the total capital expenditure required to provide the proposed service shall be considered in determining the necessity of CON review and in determining the appropriate CON review fee to be paid. The capital expenditure associated with facilities and equipment to provide services in Mississippi shall be considered regardless of where the capital expenditure was made, in state or out of state, and regardless of the domicile of the party making the capital expenditure, in state or out of state.
NOTE: A capital expenditure is considered to be incurred:
(a) when a contract enforceable under state law is entered into for the construction, acquisition, lease or financing of the capital asset or(b) when the governing board of a health care facility takes formal action to commit its own funds for a construction project under-taken by personnel of the health care facility (force account expenditure) or(c) in the case of donated property, on the date on which the gift is complete under applicable state law.2.1.2 The construction, development, or establishment of a new health care facility, which establishment shall include the reopening of a health care facility that has ceased to operate for a period of sixty (60) months or more;.2.1.3 The relocation of a health care facility or portion thereof, or major medical equipment unless such relocation of a healthcare facility or portion thereof, or major medical equipment, which does not involve a capital expenditure by or on behalf of a health care facility, is within five thousand two hundred eighty (5,280) feet from the main entrance of the health care facility. NOTE: The relocation of a health care facility is defined as the relocation of a health care facility from one physical location or site to another.
A portion of a health care facility is considered to be a wing, unit, service(s), or beds.
The relocation of major medical equipment shall include, but is not limited to, the relocation of major medical equipment from one physical facility to another physical facility.
2.1.4 Any change in the existing bed complement of any health care facility through the addition or conversion of any beds or the alteration, modernizing or refurbishing of any unit or department in which the beds may be located; however, if a health care facility has voluntarily de-licensed some of its existing bed complement, it may later relicense some or all of its de-licensed beds without the necessity of having to acquire a certificate of need. The State Department of Health shall maintain a record of the de-licensing health care facility and its voluntarily de-licensed beds and continue counting those beds as part of the state's total bed count for health care planning purposes. If a health care facility that has voluntarily de-licensed some of its beds later desires to relicense some or all of its voluntarily de-licensed beds, it shall notify the State Department of Health of its intent to increase the number of its licensed beds. The State Department of Health shall survey the health care facility within thirty (30) calendar days of that notice and, if appropriate, issue the health care facility a new license reflecting the new contingent of beds. However, in no event may a health care facility that has voluntarily de-licensed some of its beds be reissued a license to operate beds in excess of its bed count before the voluntary de-licensure of some of its beds without seeking certificate of need approval. A healthcare facility seeking to place beds in abeyance (a state of voluntary temporary suspension/de-license) or re-license beds must submit a letter to the Mississippi State Department of Health - Division of Health Planning and Resource Development requesting that the beds be placed in abeyance (de-license) or removed from abeyance (re-licensed).
A fee of Five Hundred Dollars ($500.00) shall be assessed for the processing and handling of all abeyance requests and is payable to the Mississippi State Department of Health by check, draft, or money order.
2.1.5 Offering of the following health services if those services have not been provided on a regular basis by the proposed provider of such services within the period of 12 months before the time such services will be offered: Open heart surgery services; 1. Open heart surgery services;2. Cardiac catheterization services;3. Comprehensive inpatient rehabilitation services;4. Licensed psychiatric services;5. Licensed chemical dependency services;6. Radiation therapy services;7. Diagnostic imaging services of an invasive nature, i.e., invasive digital angiography;8. Nursing home care as defined in subparagraphs (iv) (skilled nursing facility), (vi) (intermediate care facility), and (vii) (intermediate care facility for the mentally retarded) of Section 41-7-173(h);11. Ambulatory surgical services;12. Magnetic resonance imaging services;13. Positron emission tomography services; and14. Long term care hospital services.2.1.6 The relocation of one or more health services from one physical facility or site to another, unless such relocation, which does not involve a capital expenditure by or on behalf of the health care facility, (i) is to a physical facility or site within five thousand two hundred eighty (5,280) feet from the main entrance of the health care facility where the health care service is located, or (ii) is the result of an order of a court of appropriate jurisdiction or a result of pending litigation in such courts, or by order of the State Department of Health, or by order of any other agency of legal entity of the State, the federal government, or any political subdivision of either, whose order is also approved by the Department.2.1.7 The acquisition or otherwise control of any major medical equipment for the provision of medical services, provided, however, (i) the acquisition of any major medical equipment used only for research purposes or (ii) the acquisition of major medical equipment to replace medical equipment for which a facility is already providing medical services and for which the State Department of Health has been notified before the date of such acquisition shall be exempt from this paragraph; an acquisition for less than fair market value must be reviewed, if the acquisition at fair market value would be subject to review.2.1.8 Changes of ownership of existing health care facilities, major medical equipment, a health service, or an institutional health service, in which a notice of intent is not filed with the State Department of Health at least 15 calendar days before the date such change of ownership occurs.2.1.9 Regardless of paragraph 2.1.8 above, the change of ownership of any skilled nursing facility, intermediate care facility, or intermediate care facility for the mentally retarded in which a notice of intent as described in 2.1.8 has not been filed and if the Executive Director, Division of Medicaid, Office of the Governor, has not certified in writing that there will be no increase in allowable costs to Medicaid from revaluation of the assets or from increased interest and depreciation as a result of the proposed change of ownership. 2.1.10 Any activity described in paragraphs 2.1.1 through 2.1.9, if undertaken by any person if that same activity would require CON approval if undertaken by a health care facility.2.1.11 Any capital expenditure or deferred capital expenditure by or on behalf of a health care facility not covered by paragraphs 2.1.1 through 2.2.10. NOTE: Examples of capital expenditures "by or on behalf of a health care facility" include, but are not limited to the following:
1. Medical office building (MOB) or other structure is constructed on land adjacent to a health care facility;2. Land is leased from a health care facility for the construction of a MOB or other construction to benefit the health care facility;3. The health care facility has an option to purchase the MOB or other structure;4. The health care facility maintains the authority to approve tenants of the MOB or other structure; and/or5. The health care facility retains the right to assume control of the MOB or other structure and collect rent.2.1.12 The contracting of a health care facility as defined in subparagraphs (i) through (viii) of Section 41-7-173(h), Mississippi Code of 1972 Annotated, as amended to establish a home office, sub-unit, or branch office in the space operated as a health care facility through a formal arrangement with an existing health care facility as defined in subparagraph (ix) of Section 41-7-173(h).15 Miss. Code. R. 9-91-2.1