135.63 CERTIFICATE OF NEED REQUIRED -- EXCLUSIONS.
1. A new institutional health service or changed institutional
health service shall not be offered or developed in this state
without prior application to the department for and receipt of a
certificate of need, pursuant to this division. The application
shall be made upon forms furnished or prescribed by the department
and shall contain such information as the department may require
under this division. The application shall be accompanied by a fee
equivalent to three-tenths of one percent of the anticipated cost of
the project with a minimum fee of six hundred dollars and a maximum
fee of twenty-one thousand dollars. The fee shall be remitted by the
department to the treasurer of state, who shall place it in the
general fund of the state. If an application is voluntarily
withdrawn within thirty calendar days after submission, seventy-five
percent of the application fee shall be refunded; if the application
is voluntarily withdrawn more than thirty but within sixty days after
submission, fifty percent of the application fee shall be refunded;
if the application is withdrawn voluntarily more than sixty days
after submission, twenty-five percent of the application fee shall be
refunded. Notwithstanding the required payment of an application fee
under this subsection, an applicant for a new institutional health
service or a changed institutional health service offered or
developed by an intermediate care facility for persons with mental
retardation or an intermediate care facility for persons with mental
illness as defined pursuant to section 135C.1 is exempt from payment
of the application fee.
2. This division shall not be construed to augment, limit,
contravene, or repeal in any manner any other statute of this state
which may authorize or relate to licensure, regulation, supervision,
or control of, nor to be applicable to:
a. Private offices and private clinics of an individual
physician, dentist, or other practitioner or group of health care
providers, except as provided by section 135.61, subsection 18,
paragraphs "g", "h", and "m", and subsections 20 and 21.
b. Dispensaries and first aid stations, located within
schools, businesses, or industrial establishments, which are
maintained solely for the use of students or employees of those
establishments and which do not contain inpatient or resident beds
that are customarily occupied by the same individual for more than
twenty-four consecutive hours.
c. Establishments such as motels, hotels, and boarding houses
which provide medical, nursing personnel, and other health related
services as an incident to their primary business or function.
d. The remedial care or treatment of residents or patients in
any home or institution conducted only for those who rely solely upon
treatment by prayer or spiritual means in accordance with the creed
or tenets of any recognized church or religious denomination.
e. A health maintenance organization or combination of health
maintenance organizations or an institutional health facility
controlled directly or indirectly by a health maintenance
organization or combination of health maintenance organizations,
except when the health maintenance organization or combination of
health maintenance organizations does any of the following:
(1) Constructs, develops, renovates, relocates, or otherwise
establishes an institutional health facility.
(2) Acquires major medical equipment as provided by section
135.61, subsection 18, paragraphs "i" and "j".
f. A residential care facility, as defined in section 135C.1,
including a residential care facility for persons with mental
retardation, notwithstanding any provision in this division to the
contrary.
g. (1) A reduction in bed capacity of an institutional health
facility, notwithstanding any provision in this division to the
contrary, if all of the following conditions exist:
(a) The institutional health facility reports to the department
the number and type of beds reduced on a form prescribed by the
department at least thirty days before the reduction. In the case of
a health care facility, the new bed total must be consistent with the
number of licensed beds at the facility. In the case of a hospital,
the number of beds must be consistent with bed totals reported to the
department of inspections and appeals for purposes of licensure and
certification.
(b) The institutional health facility reports the new bed total
on its next annual report to the department.
(2) If these conditions are not met, the institutional health
facility is subject to review as a "new institutional health
service" or "changed institutional health service" under
section 135.61, subsection 18, paragraph "d", and subject to
sanctions under section 135.73. If the institutional health facility
reestablishes the deleted beds at a later time, review as a "new
institutional health service" or "changed institutional health
service" is required pursuant to section 135.61, subsection 18,
paragraph "d".
h. (1) The deletion of one or more health services,
previously offered on a regular basis by an institutional health
facility or health maintenance organization, notwithstanding any
provision of this division to the contrary, if all of the following
conditions exist:
(a) The institutional health facility or health maintenance
organization reports to the department the deletion of the service or
services at least thirty days before the deletion on a form
prescribed by the department.
(b) The institutional health facility or health maintenance
organization reports the deletion of the service or services on its
next annual report to the department.
(2) If these conditions are not met, the institutional health
facility or health maintenance organization is subject to review as a
"new institutional health service" or "changed institutional
health service" under section 135.61, subsection 18, paragraph
"f", and subject to sanctions under section 135.73.
(3) If the institutional health facility or health maintenance
organization reestablishes the deleted service or services at a later
time, review as a "new institutional health service" or
"changed institutional health service" may be required pursuant
to section 135.61, subsection 18.
i. A residential program exempt from licensing as a health
care facility under chapter 135C in accordance with section 135C.6,
subsection 8.
j. The construction, modification, or replacement of
nonpatient care services, including parking facilities, heating,
ventilation and air conditioning systems, computers, telephone
systems, medical office buildings, and other projects of a similar
nature, notwithstanding any provision in this division to the
contrary.
k. (1) The redistribution of beds by a hospital within the
acute care category of bed usage, notwithstanding any provision in
this division to the contrary, if all of the following conditions
exist:
(a) The hospital reports to the department the number and type of
beds to be redistributed on a form prescribed by the department at
least thirty days before the redistribution.
(b) The hospital reports the new distribution of beds on its next
annual report to the department.
(2) If these conditions are not met, the redistribution of beds
by the hospital is subject to review as a new institutional health
service or changed institutional health service pursuant to section
135.61, subsection 18, paragraph "d", and is subject to sanctions
under section 135.73.
l. The replacement or modernization of any institutional
health facility if the replacement or modernization does not add new
health services or additional bed capacity for existing health
services, notwithstanding any provision in this division to the
contrary. With respect to a nursing facility, "replacement"
means establishing a new facility within the same county as the prior
facility to be closed. With reference to a hospital,
"replacement" means establishing a new hospital that demonstrates
compliance with all of the following criteria through evidence
submitted to the department:
(1) Is designated as a critical access hospital pursuant to 42
U.S.C. § 1395i-4.
(2) Serves at least seventy-five percent of the same service area
that was served by the prior hospital to be closed and replaced by
the new hospital.
(3) Provides at least seventy-five percent of the same services
that were provided by the prior hospital to be closed and replaced by
the new hospital.
(4) Is staffed by at least seventy-five percent of the same
staff, including medical staff, contracted staff, and employees, as
constituted the staff of the prior hospital to be closed and replaced
by the new hospital.
m. Hemodialysis services provided by a hospital or
freestanding facility, notwithstanding any provision in this division
to the contrary.
n. Hospice services provided by a hospital, notwithstanding
any provision in this division to the contrary.
o. The change in ownership, licensure, organizational
structure, or designation of the type of institutional health
facility if the health services offered by the successor
institutional health facility are unchanged. This exclusion is
applicable only if the institutional health facility consents to the
change in ownership, licensure, organizational structure, or
designation of the type of institutional health facility and ceases
offering the health services simultaneously with the initiation of
the offering of health services by the successor institutional health
facility.
p. The conversion of an existing number of beds by an
intermediate care facility for persons with mental retardation to a
smaller facility environment, including but not limited to a
community-based environment which does not result in an increased
number of beds, notwithstanding any provision in this division to the
contrary, including subsection 4, if all of the following conditions
exist:
(1) The intermediate care facility for persons with mental
retardation reports the number and type of beds to be converted on a
form prescribed by the department at least thirty days before the
conversion.
(2) The intermediate care facility for persons with mental
retardation reports the conversion of beds on its next annual report
to the department.
3. This division shall not be construed to be applicable to a
health care facility operated by and for the exclusive use of members
of a religious order, which does not admit more than two individuals
to the facility from the general public, and which was in operation
prior to July 1, 1986. However, this division is applicable to such
a facility if the facility is involved in the offering or developing
of a new or changed institutional health service on or after July 1,
1986.
4. A copy of the application shall be sent to the department of
human services at the time the application is submitted to the Iowa
department of public health. The department shall not process
applications for and the council shall not consider a new or changed
institutional health service for an intermediate care facility for
persons with mental retardation unless both of the following
conditions are met:
a. The new or changed beds shall not result in an increase in
the total number of medical assistance certified intermediate care
facility beds for persons with mental retardation in the state,
exclusive of those beds at the state resource centers or other state
institutions, beyond one thousand six hundred thirty-six beds.
b. A letter of support for the application is provided by the
county board of supervisors, or the board's designee, in the county
in which the beds would be located.
135.63 CERTIFICATE OF NEED REQUIRED -- EXCLUSIONS.
1. A new institutional health service or changed institutional
health service shall not be offered or developed in this state
without prior application to the department for and receipt of a
certificate of need, pursuant to this division. The application
shall be made upon forms furnished or prescribed by the department
and shall contain such information as the department may require
under this division. The application shall be accompanied by a fee
equivalent to three-tenths of one percent of the anticipated cost of
the project with a minimum fee of six hundred dollars and a maximum
fee of twenty-one thousand dollars. The fee shall be remitted by the
department to the treasurer of state, who shall place it in the
general fund of the state. If an application is voluntarily
withdrawn within thirty calendar days after submission, seventy-five
percent of the application fee shall be refunded; if the application
is voluntarily withdrawn more than thirty but within sixty days after
submission, fifty percent of the application fee shall be refunded;
if the application is withdrawn voluntarily more than sixty days
after submission, twenty-five percent of the application fee shall be
refunded. Notwithstanding the required payment of an application fee
under this subsection, an applicant for a new institutional health
service or a changed institutional health service offered or
developed by an intermediate care facility for persons with mental
retardation or an intermediate care facility for persons with mental
illness as defined pursuant to section 135C.1 is exempt from payment
of the application fee.
2. This division shall not be construed to augment, limit,
contravene, or repeal in any manner any other statute of this state
which may authorize or relate to licensure, regulation, supervision,
or control of, nor to be applicable to:
a. Private offices and private clinics of an individual
physician, dentist, or other practitioner or group of health care
providers, except as provided by section 135.61, subsection 18,
paragraphs "g", "h", and "m", and subsections 20 and 21.
b. Dispensaries and first aid stations, located within
schools, businesses, or industrial establishments, which are
maintained solely for the use of students or employees of those
establishments and which do not contain inpatient or resident beds
that are customarily occupied by the same individual for more than
twenty-four consecutive hours.
c. Establishments such as motels, hotels, and boarding houses
which provide medical, nursing personnel, and other health related
services as an incident to their primary business or function.
d. The remedial care or treatment of residents or patients in
any home or institution conducted only for those who rely solely upon
treatment by prayer or spiritual means in accordance with the creed
or tenets of any recognized church or religious denomination.
e. A health maintenance organization or combination of health
maintenance organizations or an institutional health facility
controlled directly or indirectly by a health maintenance
organization or combination of health maintenance organizations,
except when the health maintenance organization or combination of
health maintenance organizations does any of the following:
(1) Constructs, develops, renovates, relocates, or otherwise
establishes an institutional health facility.
(2) Acquires major medical equipment as provided by section
135.61, subsection 18, paragraphs "i" and "j".
f. A residential care facility, as defined in section 135C.1,
including a residential care facility for persons with mental
retardation, notwithstanding any provision in this division to the
contrary.
g. (1) A reduction in bed capacity of an institutional health
facility, notwithstanding any provision in this division to the
contrary, if all of the following conditions exist:
(a) The institutional health facility reports to the department
the number and type of beds reduced on a form prescribed by the
department at least thirty days before the reduction. In the case of
a health care facility, the new bed total must be consistent with the
number of licensed beds at the facility. In the case of a hospital,
the number of beds must be consistent with bed totals reported to the
department of inspections and appeals for purposes of licensure and
certification.
(b) The institutional health facility reports the new bed total
on its next annual report to the department.
(2) If these conditions are not met, the institutional health
facility is subject to review as a "new institutional health
service" or "changed institutional health service" under
section 135.61, subsection 18, paragraph "d", and subject to
sanctions under section 135.73. If the institutional health facility
reestablishes the deleted beds at a later time, review as a "new
institutional health service" or "changed institutional health
service" is required pursuant to section 135.61, subsection 18,
paragraph "d".
h. (1) The deletion of one or more health services,
previously offered on a regular basis by an institutional health
facility or health maintenance organization, notwithstanding any
provision of this division to the contrary, if all of the following
conditions exist:
(a) The institutional health facility or health maintenance
organization reports to the department the deletion of the service or
services at least thirty days before the deletion on a form
prescribed by the department.
(b) The institutional health facility or health maintenance
organization reports the deletion of the service or services on its
next annual report to the department.
(2) If these conditions are not met, the institutional health
facility or health maintenance organization is subject to review as a
"new institutional health service" or "changed institutional
health service" under section 135.61, subsection 18, paragraph
"f", and subject to sanctions under section 135.73.
(3) If the institutional health facility or health maintenance
organization reestablishes the deleted service or services at a later
time, review as a "new institutional health service" or
"changed institutional health service" may be required pursuant
to section 135.61, subsection 18.
i. A residential program exempt from licensing as a health
care facility under chapter 135C in accordance with section 135C.6,
subsection 8.
j. The construction, modification, or replacement of
nonpatient care services, including parking facilities, heating,
ventilation and air conditioning systems, computers, telephone
systems, medical office buildings, and other projects of a similar
nature, notwithstanding any provision in this division to the
contrary.
k. (1) The redistribution of beds by a hospital within the
acute care category of bed usage, notwithstanding any provision in
this division to the contrary, if all of the following conditions
exist:
(a) The hospital reports to the department the number and type of
beds to be redistributed on a form prescribed by the department at
least thirty days before the redistribution.
(b) The hospital reports the new distribution of beds on its next
annual report to the department.
(2) If these conditions are not met, the redistribution of beds
by the hospital is subject to review as a new institutional health
service or changed institutional health service pursuant to section
135.61, subsection 18, paragraph "d", and is subject to sanctions
under section 135.73.
l. The replacement or modernization of any institutional
health facility if the replacement or modernization does not add new
health services or additional bed capacity for existing health
services, notwithstanding any provision in this division to the
contrary. With respect to a nursing facility, "replacement"
means establishing a new facility within the same county as the prior
facility to be closed. With reference to a hospital,
"replacement" means establishing a new hospital that demonstrates
compliance with all of the following criteria through evidence
submitted to the department:
(1) Is designated as a critical access hospital pursuant to 42
U.S.C. § 1395i-4.
(2) Serves at least seventy-five percent of the same service area
that was served by the prior hospital to be closed and replaced by
the new hospital.
(3) Provides at least seventy-five percent of the same services
that were provided by the prior hospital to be closed and replaced by
the new hospital.
(4) Is staffed by at least seventy-five percent of the same
staff, including medical staff, contracted staff, and employees, as
constituted the staff of the prior hospital to be closed and replaced
by the new hospital.
m. Hemodialysis services provided by a hospital or
freestanding facility, notwithstanding any provision in this division
to the contrary.
n. Hospice services provided by a hospital, notwithstanding
any provision in this division to the contrary.
o. The change in ownership, licensure, organizational
structure, or designation of the type of institutional health
facility if the health services offered by the successor
institutional health facility are unchanged. This exclusion is
applicable only if the institutional health facility consents to the
change in ownership, licensure, organizational structure, or
designation of the type of institutional health facility and ceases
offering the health services simultaneously with the initiation of
the offering of health services by the successor institutional health
facility.
p. The conversion of an existing number of beds by an
intermediate care facility for persons with mental retardation to a
smaller facility environment, including but not limited to a
community-based environment which does not result in an increased
number of beds, notwithstanding any provision in this division to the
contrary, including subsection 4, if all of the following conditions
exist:
(1) The intermediate care facility for persons with mental
retardation reports the number and type of beds to be converted on a
form prescribed by the department at least thirty days before the
conversion.
(2) The intermediate care facility for persons with mental
retardation reports the conversion of beds on its next annual report
to the department.
3. This division shall not be construed to be applicable to a
health care facility operated by and for the exclusive use of members
of a religious order, which does not admit more than two individuals
to the facility from the general public, and which was in operation
prior to July 1, 1986. However, this division is applicable to such
a facility if the facility is involved in the offering or developing
of a new or changed institutional health service on or after July 1,
1986.
4. A copy of the application shall be sent to the department of
human services at the time the application is submitted to the Iowa
department of public health. The department shall not process
applications for and the council shall not consider a new or changed
institutional health service for an intermediate care facility for
persons with mental retardation unless both of the following
conditions are met:
a. The new or changed beds shall not result in an increase in
the total number of medical assistance certified intermediate care
facility beds for persons with mental retardation in the state,
exclusive of those beds at the state resource centers or other state
institutions, beyond one thousand six hundred thirty-six beds.
b. A letter of support for the application is provided by the
county board of supervisors, or the board's designee, in the county
in which the beds would be located.
135.63 CERTIFICATE OF NEED REQUIRED -- EXCLUSIONS.
1. A new institutional health service or changed institutional
health service shall not be offered or developed in this state
without prior application to the department for and receipt of a
certificate of need, pursuant to this division. The application
shall be made upon forms furnished or prescribed by the department
and shall contain such information as the department may require
under this division. The application shall be accompanied by a fee
equivalent to three-tenths of one percent of the anticipated cost of
the project with a minimum fee of six hundred dollars and a maximum
fee of twenty-one thousand dollars. The fee shall be remitted by the
department to the treasurer of state, who shall place it in the
general fund of the state. If an application is voluntarily
withdrawn within thirty calendar days after submission, seventy-five
percent of the application fee shall be refunded; if the application
is voluntarily withdrawn more than thirty but within sixty days after
submission, fifty percent of the application fee shall be refunded;
if the application is withdrawn voluntarily more than sixty days
after submission, twenty-five percent of the application fee shall be
refunded. Notwithstanding the required payment of an application fee
under this subsection, an applicant for a new institutional health
service or a changed institutional health service offered or
developed by an intermediate care facility for persons with mental
retardation or an intermediate care facility for persons with mental
illness as defined pursuant to section 135C.1 is exempt from payment
of the application fee.
2. This division shall not be construed to augment, limit,
contravene, or repeal in any manner any other statute of this state
which may authorize or relate to licensure, regulation, supervision,
or control of, nor to be applicable to:
a. Private offices and private clinics of an individual
physician, dentist, or other practitioner or group of health care
providers, except as provided by section 135.61, subsection 18,
paragraphs "g", "h", and "m", and subsections 20 and 21.
b. Dispensaries and first aid stations, located within
schools, businesses, or industrial establishments, which are
maintained solely for the use of students or employees of those
establishments and which do not contain inpatient or resident beds
that are customarily occupied by the same individual for more than
twenty-four consecutive hours.
c. Establishments such as motels, hotels, and boarding houses
which provide medical, nursing personnel, and other health related
services as an incident to their primary business or function.
d. The remedial care or treatment of residents or patients in
any home or institution conducted only for those who rely solely upon
treatment by prayer or spiritual means in accordance with the creed
or tenets of any recognized church or religious denomination.
e. A health maintenance organization or combination of health
maintenance organizations or an institutional health facility
controlled directly or indirectly by a health maintenance
organization or combination of health maintenance organizations,
except when the health maintenance organization or combination of
health maintenance organizations does any of the following:
(1) Constructs, develops, renovates, relocates, or otherwise
establishes an institutional health facility.
(2) Acquires major medical equipment as provided by section
135.61, subsection 18, paragraphs "i" and "j".
f. A residential care facility, as defined in section 135C.1,
including a residential care facility for persons with mental
retardation, notwithstanding any provision in this division to the
contrary.
g. (1) A reduction in bed capacity of an institutional health
facility, notwithstanding any provision in this division to the
contrary, if all of the following conditions exist:
(a) The institutional health facility reports to the department
the number and type of beds reduced on a form prescribed by the
department at least thirty days before the reduction. In the case of
a health care facility, the new bed total must be consistent with the
number of licensed beds at the facility. In the case of a hospital,
the number of beds must be consistent with bed totals reported to the
department of inspections and appeals for purposes of licensure and
certification.
(b) The institutional health facility reports the new bed total
on its next annual report to the department.
(2) If these conditions are not met, the institutional health
facility is subject to review as a "new institutional health
service" or "changed institutional health service" under
section 135.61, subsection 18, paragraph "d", and subject to
sanctions under section 135.73. If the institutional health facility
reestablishes the deleted beds at a later time, review as a "new
institutional health service" or "changed institutional health
service" is required pursuant to section 135.61, subsection 18,
paragraph "d".
h. (1) The deletion of one or more health services,
previously offered on a regular basis by an institutional health
facility or health maintenance organization, notwithstanding any
provision of this division to the contrary, if all of the following
conditions exist:
(a) The institutional health facility or health maintenance
organization reports to the department the deletion of the service or
services at least thirty days before the deletion on a form
prescribed by the department.
(b) The institutional health facility or health maintenance
organization reports the deletion of the service or services on its
next annual report to the department.
(2) If these conditions are not met, the institutional health
facility or health maintenance organization is subject to review as a
"new institutional health service" or "changed institutional
health service" under section 135.61, subsection 18, paragraph
"f", and subject to sanctions under section 135.73.
(3) If the institutional health facility or health maintenance
organization reestablishes the deleted service or services at a later
time, review as a "new institutional health service" or
"changed institutional health service" may be required pursuant
to section 135.61, subsection 18.
i. A residential program exempt from licensing as a health
care facility under chapter 135C in accordance with section 135C.6,
subsection 8.
j. The construction, modification, or replacement of
nonpatient care services, including parking facilities, heating,
ventilation and air conditioning systems, computers, telephone
systems, medical office buildings, and other projects of a similar
nature, notwithstanding any provision in this division to the
contrary.
k. (1) The redistribution of beds by a hospital within the
acute care category of bed usage, notwithstanding any provision in
this division to the contrary, if all of the following conditions
exist:
(a) The hospital reports to the department the number and type of
beds to be redistributed on a form prescribed by the department at
least thirty days before the redistribution.
(b) The hospital reports the new distribution of beds on its next
annual report to the department.
(2) If these conditions are not met, the redistribution of beds
by the hospital is subject to review as a new institutional health
service or changed institutional health service pursuant to section
135.61, subsection 18, paragraph "d", and is subject to sanctions
under section 135.73.
l. The replacement or modernization of any institutional
health facility if the replacement or modernization does not add new
health services or additional bed capacity for existing health
services, notwithstanding any provision in this division to the
contrary. With respect to a nursing facility, "replacement"
means establishing a new facility within the same county as the prior
facility to be closed. With reference to a hospital,
"replacement" means establishing a new hospital that demonstrates
compliance with all of the following criteria through evidence
submitted to the department:
(1) Is designated as a critical access hospital pursuant to 42
U.S.C. § 1395i-4.
(2) Serves at least seventy-five percent of the same service area
that was served by the prior hospital to be closed and replaced by
the new hospital.
(3) Provides at least seventy-five percent of the same services
that were provided by the prior hospital to be closed and replaced by
the new hospital.
(4) Is staffed by at least seventy-five percent of the same
staff, including medical staff, contracted staff, and employees, as
constituted the staff of the prior hospital to be closed and replaced
by the new hospital.
m. Hemodialysis services provided by a hospital or
freestanding facility, notwithstanding any provision in this division
to the contrary.
n. Hospice services provided by a hospital, notwithstanding
any provision in this division to the contrary.
o. The change in ownership, licensure, organizational
structure, or designation of the type of institutional health
facility if the health services offered by the successor
institutional health facility are unchanged. This exclusion is
applicable only if the institutional health facility consents to the
change in ownership, licensure, organizational structure, or
designation of the type of institutional health facility and ceases
offering the health services simultaneously with the initiation of
the offering of health services by the successor institutional health
facility.
p. The conversion of an existing number of beds by an
intermediate care facility for persons with mental retardation to a
smaller facility environment, including but not limited to a
community-based environment which does not result in an increased
number of beds, notwithstanding any provision in this division to the
contrary, including subsection 4, if all of the following conditions
exist:
(1) The intermediate care facility for persons with mental
retardation reports the number and type of beds to be converted on a
form prescribed by the department at least thirty days before the
conversion.
(2) The intermediate care facility for persons with mental
retardation reports the conversion of beds on its next annual report
to the department.
3. This division shall not be construed to be applicable to a
health care facility operated by and for the exclusive use of members
of a religious order, which does not admit more than two individuals
to the facility from the general public, and which was in operation
prior to July 1, 1986. However, this division is applicable to such
a facility if the facility is involved in the offering or developing
of a new or changed institutional health service on or after July 1,
1986.
4. A copy of the application shall be sent to the department of
human services at the time the application is submitted to the Iowa
department of public health. The department shall not process
applications for and the council shall not consider a new or changed
institutional health service for an intermediate care facility for
persons with mental retardation unless both of the following
conditions are met:
a. The new or changed beds shall not result in an increase in
the total number of medical assistance certified intermediate care
facility beds for persons with mental retardation in the state,
exclusive of those beds at the state resource centers or other state
institutions, beyond one thousand six hundred thirty-six beds.
b. A letter of support for the application is provided by the
county board of supervisors, or the board's designee, in the county
in which the beds would be located.
