As used in this Article,unless the context clearly requires otherwise, the following terms have themeanings specified:
(1) "Adult carehome" means a facility with seven or more beds licensed under Part 1 ofArticle 1 of Chapter 131D of the General Statutes or Chapter 131E of theGeneral Statutes that provides residential care for aged or disabled personswhose principal need is a home which provides the supervision and personal careappropriate to their age and disability and for whom medical care is onlyoccasional or incidental.
(1a) (See note)"Air ambulance" means aircraft used to provide air transport of sickor injured persons between destinations within the State.
(1b) "Ambulatorysurgical facility" means a facility designed for the provision of aspecialty ambulatory surgical program or a multispecialty ambulatory surgicalprogram. An ambulatory surgical facility serves patients who require local,regional or general anesthesia and a period of post‑operativeobservation. An ambulatory surgical facility may only admit patients for aperiod of less than 24 hours and must provide at least one designated operatingroom or gastrointestinal endoscopy room, as defined in Article 5 Part 1 andArticle 6, Part 4 of this Chapter, and at least one designated recovery room,have available the necessary equipment and trained personnel to handleemergencies, provide adequate quality assurance and assessment by an evaluationand review committee, and maintain adequate medical records for each patient.An ambulatory surgical facility may be operated as a part of a physician ordentist's office, provided the facility is licensed under G.S. Chapter 131E,Article 6, Part D, but the performance of incidental, limited ambulatorysurgical procedures which do not constitute an ambulatory surgical program asdefined in subdivision (1c) of this section and which are performed in aphysician's or dentist's office does not make that office an ambulatorysurgical facility.
(1c) "Ambulatorysurgical program" means a formal program for providing on a same‑daybasis those surgical procedures which require local, regional or generalanesthesia and a period of post‑operative observation to patients whoseadmission for more than 24 hours is determined, prior to surgery orgastrointestinal endoscopy, to be medically unnecessary.
(2) "Bedcapacity" means space used exclusively for inpatient care, including spacedesigned or remodeled for licensed inpatient beds even though temporarily notused for such purposes. The number of beds to be counted in any patient roomshall be the maximum number for which adequate square footage is provided asestablished by rules of the Department except that single beds in single roomsare counted even if the room contains inadequate square footage. The term"bed capacity" also refers to the number of dialysis stations inkidney disease treatment centers, including freestanding dialysis units.
(2a) "Bone marrowtransplantation services" means the process of infusing bone marrow intopersons with diseases to stimulate the production of blood cells.
(2b) "Burn intensivecare services" means services provided in a unit designed to care forpatients who have been severely burned.
(2c) "Campus"means the adjacent grounds and buildings, or grounds and buildings notseparated by more than a public right‑of‑way, of a health servicefacility and related health care entities.
(2d) "Capitalexpenditure" means an expenditure for a project, including but not limitedto the cost of construction, engineering, and equipment which under generallyaccepted accounting principles is not properly chargeable as an expense ofoperation and maintenance. Capital expenditure includes, in addition, the fairmarket value of an acquisition made by donation, lease, or comparablearrangement by which a person obtains equipment, the expenditure for whichwould have been considered a capital expenditure under this Article if theperson had acquired it by purchase.
(2e) Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
(2f) "Cardiaccatheterization equipment" means the equipment used to provide cardiaccatheterization services.
(2g) "Cardiaccatheterization services" means those procedures, excluding pulmonaryangiography procedures, in which a catheter is introduced into a vein or arteryand threaded through the circulatory system into the heart specifically todiagnose abnormalities in the motion, contraction, and blood flow of the movingheart or to perform surgical therapeutic interventions to restore, repair, orreconstruct the coronary blood vessels of the heart.
(3) "Certificate ofneed" means a written order which affords the person so designated as thelegal proponent of the proposed project the opportunity to proceed with thedevelopment of such project.
(4) Repealed by SessionLaws 1993, c. 7, s. 2.
(5) "Change in bedcapacity" means (i) any relocation of health service facility beds, ordialysis stations from one licensed facility or campus to another, or (ii) anyredistribution of health service facility bed capacity among the categories ofhealth service facility bed as defined in G.S. 131E‑176(9c), or (iii) anyincrease in the number of health service facility beds, or dialysis stations inkidney disease treatment centers, including freestanding dialysis units.
(5a) "Chemicaldependency treatment facility" means a public or private facility, or unitin a facility, which is engaged in providing 24‑hour a day treatment forchemical dependency or substance abuse. This treatment may includedetoxification, administration of a therapeutic regimen for the treatment ofchemically dependent or substance abusing persons and related services. Thefacility or unit may be:
a. A unit within ageneral hospital or an attached or freestanding unit of a general hospitallicensed under Article 5, Chapter 131E, of the General Statutes,
b. A unit within apsychiatric hospital or an attached or freestanding unit of a psychiatrichospital licensed under Article 1A of General Statutes Chapter 122 or Article 2of General Statutes Chapter 122C,
c. A freestandingfacility specializing in treatment of persons who are substance abusers orchemically dependent licensed under Article 1A of General Statutes Chapter 122or Article 2 of General Statutes Chapter 122C; and may be identified as"chemical dependency, substance abuse, alcoholism, or drug abuse treatmentunits," "residential chemical dependency, substance abuse, alcoholismor drug abuse facilities," or by other names if the purpose is to providetreatment of chemically dependent or substance abusing persons, but shall notinclude social setting detoxification facilities, medical detoxificationfacilities, halfway houses or recovery farms.
(5b) "Chemicaldependency treatment beds" means beds that are licensed for the inpatienttreatment of chemical dependency. Residential treatment beds for the treatmentof chemical dependency or substance abuse are chemical dependency treatmentbeds. Chemical dependency treatment beds shall not include beds licensed fordetoxification.
(6) "Department"means the North Carolina Department of Health and Human Services.
(7) To"develop" when used in connection with health services, means toundertake those activities which will result in the offering of institutionalhealth service or the incurring of a financial obligation in relation to theoffering of such a service.
(7a) "Diagnosticcenter" means a freestanding facility, program, or provider, including butnot limited to, physicians' offices, clinical laboratories, radiology centers,and mobile diagnostic programs, in which the total cost of all the medicaldiagnostic equipment utilized by the facility which cost ten thousand dollars($10,000) or more exceeds five hundred thousand dollars ($500,000). In determiningwhether the medical diagnostic equipment in a diagnostic center costs more thanfive hundred thousand dollars ($500,000), the costs of the equipment, studies,surveys, designs, plans, working drawings, specifications, construction,installation, and other activities essential to acquiring and makingoperational the equipment shall be included. The capital expenditure for theequipment shall be deemed to be the fair market value of the equipment or thecost of the equipment, whichever is greater.
(7b) "Expeditedreview" means the status given to an application's review process when theapplicant petitions for the review and the Department approves the requestbased on findings that all of the following are met:
a. The review is notcompetitive.
b. The proposed capitalexpenditure is less than five million dollars ($5,000,000).
c. A request for apublic hearing is not received within the time frame defined in G.S. 131E‑185.
d. The agency has notdetermined that a public hearing is in the public interest.
(7c) "Gammaknife" means equipment which emits photon beams from a stationaryradioactive cobalt source to treat lesions deep within the brain and is onetype of stereotactic radiosurgery.
(7d) "Gastrointestinalendoscopy room" means a room used for the performance of procedures thatrequire the insertion of a flexible endoscope into a gastrointestinal orificeto visualize the gastrointestinal lining and adjacent organs for diagnostic ortherapeutic purposes.
(8),(9) Repealed by SessionLaws 1987, c. 511, s. 1.
(9a) "Healthservice" means an organized, interrelated medical, diagnostic,therapeutic, and/or rehabilitative activity that is integral to the preventionof disease or the clinical management of a sick, injured, or disabled person."Health service" does not include administrative and other activitiesthat are not integral to clinical management.
(9b) "Health servicefacility" means a hospital; long‑term care hospital; psychiatricfacility; rehabilitation facility; nursing home facility; adult care home;kidney disease treatment center, including freestanding hemodialysis units;intermediate care facility for the mentally retarded; home health agencyoffice; chemical dependency treatment facility; diagnostic center; hospiceoffice, hospice inpatient facility, hospice residential care facility; andambulatory surgical facility.
(9c) "Health servicefacility bed" means a bed licensed for use in a health service facility inthe categories of (i) acute care beds; (ii) psychiatric beds; (iii)rehabilitation beds; (iv) nursing home beds; (v) intermediate care beds for thementally retarded; (vi) chemical dependency treatment beds; (vii) hospiceinpatient facility beds; (viii) hospice residential care facility beds; (ix)adult care home beds; and (x) long‑term care hospital beds.
(10) "Healthmaintenance organization (HMO)" means a public or private organizationwhich has received its certificate of authority under Article 67 of Chapter 58of the General Statutes and which either is a qualified health maintenanceorganization under Section 1310(d) of the Public Health Service Act or:
a. Provides orotherwise makes available to enrolled participants health care services,including at least the following basic health care services: usual physicianservices, hospitalization, laboratory, X ray, emergency and preventiveservices, and out‑of‑area coverage;
b. Is compensated,except for copayments, for the provision of the basic health care serviceslisted above to enrolled participants by a payment which is paid on a periodicbasis without regard to the date the health care services are provided andwhich is fixed without regard to the frequency, extent, or kind of healthservice actually provided; and
c. Provides physicians'services primarily (i) directly through physicians who are either employees orpartners of such organizations, or (ii) through arrangements with individualphysicians or one or more groups of physicians organized on a group practice orindividual practice basis.
(10a) "Heart‑lungbypass machine" means the equipment used to perform extra‑corporealcirculation and oxygenation during surgical procedures.
(11) Repealed by SessionLaws 1991, c. 692, s. 1.
(12) "Home healthagency" means a private organization or public agency, whether owned oroperated by one or more persons or legal entities, which furnishes or offers tofurnish home health services.
"Homehealth services" means items and services furnished to an individual by ahome health agency, or by others under arrangements with such others made by theagency, on a visiting basis, and except for paragraph e. of this subdivision,in a place of temporary or permanent residence used as the individual's home asfollows:
a. Part‑time orintermittent nursing care provided by or under the supervision of a registerednurse;
b. Physical,occupational or speech therapy;
c. Medical socialservices, home health aid services, and other therapeutic services;
d. Medical supplies,other than drugs and biologicals and the use of medical appliances;
e. Any of the foregoingitems and services which are provided on an outpatient basis under arrangementsmade by the home health agency at a hospital or nursing home facility orrehabilitation center and the furnishing of which involves the use of equipmentof such a nature that the items and services cannot readily be made availableto the individual in his home, or which are furnished at such facility while heis there to receive any such item or service, but not including transportationof the individual in connection with any such item or service.
(13) "Hospital"means a public or private institution which is primarily engaged in providingto inpatients, by or under supervision of physicians, diagnostic services andtherapeutic services for medical diagnosis, treatment, and care of injured,disabled, or sick persons, or rehabilitation services for the rehabilitation ofinjured, disabled, or sick persons. The term includes all facilities licensedpursuant to G.S. 131E‑77 of the General Statutes, except long‑termcare hospitals.
(13a) "Hospice"means any coordinated program of home care with provision for inpatient carefor terminally ill patients and their families. This care is provided by amedically directed interdisciplinary team, directly or through an agreementunder the direction of an identifiable hospice administration. A hospiceprogram of care provides palliative and supportive medical and other healthservices to meet the physical, psychological, social, spiritual and specialneeds of patients and their families, which are experienced during the finalstages of terminal illness and during dying and bereavement.
(13b) "Hospiceinpatient facility" means a freestanding licensed hospice facility or adesignated inpatient unit in an existing health service facility which providespalliative and supportive medical and other health services to meet thephysical, psychological, social, spiritual, and special needs of terminally illpatients and their families in an inpatient setting. For purposes of thisArticle only, a hospital which has a contractual agreement with a licensedhospice to provide inpatient services to a hospice patient as defined in G.S.131E‑201(4) and provides those services in a licensed acute care bed isnot a hospice inpatient facility and is not subject to the requirements in G.S.131E‑176(5)(ii) for hospice inpatient beds.
(13c) "Hospiceresidential care facility" means a freestanding licensed hospice facilitywhich provides palliative and supportive medical and other health services tomeet the physical, psychological, social, spiritual, and special needs ofterminally ill patients and their families in a group residential setting.
(14) Repealed by SessionLaws 1987, c. 511, s. 1.
(14a) "Intermediatecare facility for the mentally retarded" means facilities licensedpursuant to Article 2 of Chapter 122C of the General Statutes for the purposeof providing health and habilitative services based on the developmental modeland principles of normalization for persons with mental retardation, autism,cerebral palsy, epilepsy or related conditions.
(14b) Repealed by SessionLaws 1991, c. 692, s. 1.
(14c) Reserved for futurecodification.
(14d) Repealed by SessionLaws 2001‑234, s. 2, effective January 1, 2002.
(14e) "Kidney diseasetreatment center" means a facility that is certified as an end‑stagerenal disease facility by the Centers for Medicare and Medicaid Services,Department of Health and Human Services, pursuant to 42 C.F.R. § 405.
(14f) Reserved for futurecodification.
(14g) "Linearaccelerator" means a machine used to produce ionizing radiation in excessof 1,000,000 electron volts in the form of a beam of electrons or photons totreat cancer patients.
(14h) Reserved for futurecodification.
(14i) "Lithotriptor"means extra‑corporeal shock wave technology used to treat persons withkidney stones and gallstones.
(14j) Reserved for futurecodification.
(14k) "Long‑termcare hospital" means a hospital that has been classified and designated asa long‑term care hospital by the Centers for Medicare and MedicaidServices, Department of Health and Human Services, pursuant to 42 C.F.R. § 412.
(14l) Reserved for futurecodification.
(14m) "Magneticresonance imaging scanner" means medical imaging equipment that usesnuclear magnetic resonance.
(14n) Reserved for futurecodification.
(14o) "Major medicalequipment" means a single unit or single system of components with relatedfunctions which is used to provide medical and other health services and whichcosts more than seven hundred fifty thousand dollars ($750,000). In determiningwhether the major medical equipment costs more than seven hundred fiftythousand dollars ($750,000), the costs of the equipment, studies, surveys,designs, plans, working drawings, specifications, construction, installation,and other activities essential to acquiring and making operational the majormedical equipment shall be included. The capital expenditure for the equipmentshall be deemed to be the fair market value of the equipment or the cost of theequipment, whichever is greater. Major medical equipment does not includereplacement equipment as defined in this section.
(15) Repealed by SessionLaws 1987, c. 511, s. 1.
(15a) "Multispecialtyambulatory surgical program" means a formal program for providing on asame‑day basis surgical procedures for at least three of the followingspecialty areas: gynecology, otolaryngology, plastic surgery, general surgery,ophthalmology, orthopedic, or oral surgery.
(15b) "Neonatalintensive care services" means those services provided by a health servicefacility to high‑risk newborn infants who require constant nursing care,including but not limited to continuous cardiopulmonary and other supportivecare.
(16) "Newinstitutional health services" means any of the following:
a. The construction, development,or other establishment of a new health service facility.
b. Except as otherwiseprovided in G.S. 131E‑184(e), the obligation by any person of a capitalexpenditure exceeding two million dollars ($2,000,000) to develop or expand ahealth service or a health service facility, or which relates to the provisionof a health service. The cost of any studies, surveys, designs, plans, workingdrawings, specifications, and other activities, including staff effort andconsulting and other services, essential to the acquisition, improvement,expansion, or replacement of any plant or equipment with respect to which anexpenditure is made shall be included in determining if the expenditure exceedstwo million dollars ($2,000,000).
c. Any change in bedcapacity as defined in G.S. 131E‑176(5).
d. The offering ofdialysis services or home health services by or on behalf of a health servicefacility if those services were not offered within the previous 12 months by oron behalf of the facility.
e. A change in a projectthat was subject to certificate of need review and for which a certificate ofneed was issued, if the change is proposed during the development of theproject or within one year after the project was completed. For purposes ofthis subdivision, a change in a project is a change of more than fifteenpercent (15%) of the approved capital expenditure amount or the addition of ahealth service that is to be located in the facility, or portion thereof, thatwas constructed or developed in the project.
f. The development oroffering of a health service as listed in this subdivision by or on behalf ofany person:
1. Bone marrowtransplantation services.
2. Burn intensive careservices.
2a. Cardiaccatheterization services, except cardiac catheterization services provided onequipment furnished by a person authorized to operate such equipment in NorthCarolina pursuant to either a certificate of need issued for mobile cardiaccatheterization equipment or a settlement agreement executed by the Departmentfor provision of cardiac catheterization services.
3. Neonatal intensivecare services.
4. Open‑heartsurgery services.
5. Solid organtransplantation services.
f1. The acquisition bypurchase, donation, lease, transfer, or comparable arrangement of any of the followingequipment by or on behalf of any person:
1. Air ambulance.
2. Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
3. Cardiaccatheterization equipment.
4. Gamma knife.
5. Heart‑lungbypass machine.
5a. Linear accelerator.
6. Lithotriptor.
7. Magnetic resonanceimaging scanner.
8. Positron emissiontomography scanner.
9. Simulator.
g. to k. Repealed bySession Laws 1987, c. 511, s. 1.
l. The purchase,lease, or acquisition of any health service facility, or portion thereof, or acontrolling interest in the health service facility or portion thereof, if thehealth service facility was developed under a certificate of need issuedpursuant to G.S. 131E‑180.
m. Any conversion ofnonhealth service facility beds to health service facility beds.
n. The construction,development or other establishment of a hospice, hospice inpatient facility, orhospice residential care facility;
o. The opening of anadditional office by an existing home health agency or hospice within itsservice area as defined by rules adopted by the Department; or the opening ofany office by an existing home health agency or hospice outside its servicearea as defined by rules adopted by the Department.
p. The acquisition bypurchase, donation, lease, transfer, or comparable arrangement by any person ofmajor medical equipment.
q. The relocation of ahealth service facility from one service area to another.
r. The conversion of aspecialty ambulatory surgical program to a multispecialty ambulatory surgicalprogram or the addition of a specialty to a specialty ambulatory surgicalprogram.
s. The furnishing ofmobile medical equipment to any person to provide health services in NorthCarolina, which was not in use in North Carolina prior to the adoption of thisprovision, if such equipment would otherwise be subject to review in accordancewith G.S. 131E‑176(16)(f1.) or G.S. 131E‑176(16)(p) if it had beenacquired in North Carolina.
t. Repealed by SessionLaws 2001‑242, s. 4, effective June 23, 2001.
u. The construction,development, establishment, increase in the number, or relocation of anoperating room or gastrointestinal endoscopy room in a licensed health servicefacility, other than the relocation of an operating room or gastrointestinal endoscopyroom within the same building or on the same grounds or to grounds notseparated by more than a public right‑of‑way adjacent to thegrounds where the operating room or gastrointestinal endoscopy room iscurrently located.
v. The change indesignation, in a licensed health service facility, of an operating room to agastrointestinal endoscopy room or change in designation of a gastrointestinalendoscopy room to an operating room that results in a different number of eachtype of room than is reflected on the health service facility's license ineffect as of January 1, 2005.
(17) "North CarolinaState Health Coordinating Council" means the Council that prepares, withthe Department of Health and Human Services, the State Medical Facilities Plan.
(17a) "Nursingcare" means:
a. Skilled nursing careand related services for residents who require medical or nursing care;
b. Rehabilitationservices for the rehabilitation of injured, disabled, or sick persons; or
c. Health‑relatedcare and services provided on a regular basis to individuals who because oftheir mental or physical condition require care and services above the level ofroom and board, which can be made available to them only through institutionalfacilities.
Theseare services which are not primarily for the care and treatment of mentaldiseases.
(17b) "Nursing homefacility" means a health service facility whose bed complement of healthservice facility beds is composed principally of nursing home facility beds.
(18) To "offer,"when used in connection with health services, means that the person holdshimself out as capable of providing, or as having the means for the provisionof, specified health services.
(18a) Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
(18b) "Open‑heartsurgery services" means the provision of surgical procedures that utilizea heart‑lung bypass machine during surgery to correct cardiac andcoronary artery disease or defects.
(18c) "Operatingroom" means a room used for the performance of surgical proceduresrequiring one or more incisions and that is required to comply with allapplicable licensure codes and standards for an operating room.
(19) "Person"means an individual, a trust or estate, a partnership, a corporation, includingassociations, joint stock companies, and insurance companies; the State, or apolitical subdivision or agency or instrumentality of the State.
(19a) "Positronemission tomography scanner" means equipment that utilizes a computerizedradiographic technique that employs radioactive substances to examine themetabolic activity of various body structures.
(20) "Project"or "capital expenditure project" means a proposal to undertake acapital expenditure that results in the offering of a new institutional healthservice as defined by this Article. A project, or capital expenditure project,or proposed project may refer to the project from its earliest planning stagesup through the point at which the specified new institutional health service maybe offered. In the case of facility construction, the point at which the newinstitutional health service may be offered must take place after the facilityis capable of being fully licensed and operated for its intended use, and atthat time it shall be considered a health service facility.
(21) "Psychiatricfacility" means a public or private facility licensed pursuant to Article2 of Chapter 122C of the General Statutes and which is primarily engaged inproviding to inpatients, by or under the supervision of a physician,psychiatric services for the diagnosis and treatment of mentally ill persons.
(22) "Rehabilitationfacility" means a public or private inpatient facility which is operatedfor the primary purpose of assisting in the rehabilitation of disabled personsthrough an integrated program of medical and other services which are providedunder competent, professional supervision.
(22a) "Replacementequipment" means equipment that costs less than two million dollars($2,000,000) and is purchased for the sole purpose of replacing comparablemedical equipment currently in use which will be sold or otherwise disposed ofwhen replaced. In determining whether the replacement equipment costs less thantwo million dollars ($2,000,000), the costs of equipment, studies, surveys,designs, plans, working drawings, specifications, construction, installation,and other activities essential to acquiring and making operational thereplacement equipment shall be included. The capital expenditure for theequipment shall be deemed to be the fair market value of the equipment or thecost of the equipment, whichever is greater.
(23) Repealed by SessionLaws 1991, c. 692, s. 1.
(24) Repealed by SessionLaws 1993, c. 7, s. 2.
(24a) "Servicearea" means the area of the State, as defined in the State MedicalFacilities Plan or in rules adopted by the Department, which receives servicesfrom a health service facility.
(24b) "Simulator"means a machine that produces high quality diagnostic radiographs and preciselyreproduces the geometric relationships of megavoltage radiation therapyequipment to the patient.
(24c) Reserved for futurecodification.
(24d) "Solid organtransplantation services" means the provision of surgical procedures andthe interrelated medical services that accompany the surgery to remove an organfrom a patient and surgically implant an organ from a donor.
(24e) Reserved for futurecodification.
(24f) "Specialtyambulatory surgical program" means a formal program for providing on asame‑day basis surgical procedures for only the specialty areasidentified on the ambulatory surgical facility's 1993 Application for Licensureas an Ambulatory Surgical Center and authorized by its certificate of need.
(25) "State MedicalFacilities Plan" means the plan prepared by the Department of Health andHuman Services and the North Carolina State Health Coordinating Council, andapproved by the Governor. In preparing the Plan, the Department and the StateHealth Coordinating Council shall maintain a mailing list of persons who haverequested notice of public hearings regarding the Plan. Not less than 15 daysprior to a scheduled public hearing, the Department shall notify persons on itsmailing list of the date, time, and location of the hearing. The Departmentshall hold at least one public hearing prior to the adoption of the proposedPlan and at least six public hearings after the adoption of the proposed Planby the State Health Coordinating Council. The Council shall accept oral andwritten comments from the public concerning the Plan.
(26) Repealed by SessionLaws 1983 (Regular Session, 1984), c. 1002, s. 9.
(27) Repealed by SessionLaws 1987, c. 511, s. 1. (1977, 2nd Sess., c. 1182, s. 2; 1981, c. 651, ss. 1,2; c. 1127, ss. 24‑29; 1983, c. 775, s. 1; 1983 (Reg. Sess., 1984), c.1002, ss. 1‑9; c. 1022, ss. 2, 3; c. 1064, s. 1; c. 1110, ss. 1, 2; 1985,c. 589, ss. 42, 43(a); c. 740, ss. 1, 2, 6; 1985 (Reg. Sess., 1986), c. 1001,s. 2; 1987, c. 34; c. 511, s. 1; 1991, c. 692, s. 1; c. 701, s. 1; 1993, c. 7,s. 2; c. 376, ss. 1‑4; 1997‑443, s. 11A.118(a); 2000‑135, ss.1, 2; 2001‑234, s. 2; 2001‑242, ss. 2, 4; 2003‑229, s. 13;2003‑390, ss. 1, 2; 2005‑325, s. 1; 2005‑346, s. 6(a)‑(d);2009‑145, s. 2; 2009‑462, s. 4(k).)
As used in this Article,unless the context clearly requires otherwise, the following terms have themeanings specified:
(1) "Adult carehome" means a facility with seven or more beds licensed under Part 1 ofArticle 1 of Chapter 131D of the General Statutes or Chapter 131E of theGeneral Statutes that provides residential care for aged or disabled personswhose principal need is a home which provides the supervision and personal careappropriate to their age and disability and for whom medical care is onlyoccasional or incidental.
(1a) (See note)"Air ambulance" means aircraft used to provide air transport of sickor injured persons between destinations within the State.
(1b) "Ambulatorysurgical facility" means a facility designed for the provision of aspecialty ambulatory surgical program or a multispecialty ambulatory surgicalprogram. An ambulatory surgical facility serves patients who require local,regional or general anesthesia and a period of post‑operativeobservation. An ambulatory surgical facility may only admit patients for aperiod of less than 24 hours and must provide at least one designated operatingroom or gastrointestinal endoscopy room, as defined in Article 5 Part 1 andArticle 6, Part 4 of this Chapter, and at least one designated recovery room,have available the necessary equipment and trained personnel to handleemergencies, provide adequate quality assurance and assessment by an evaluationand review committee, and maintain adequate medical records for each patient.An ambulatory surgical facility may be operated as a part of a physician ordentist's office, provided the facility is licensed under G.S. Chapter 131E,Article 6, Part D, but the performance of incidental, limited ambulatorysurgical procedures which do not constitute an ambulatory surgical program asdefined in subdivision (1c) of this section and which are performed in aphysician's or dentist's office does not make that office an ambulatorysurgical facility.
(1c) "Ambulatorysurgical program" means a formal program for providing on a same‑daybasis those surgical procedures which require local, regional or generalanesthesia and a period of post‑operative observation to patients whoseadmission for more than 24 hours is determined, prior to surgery orgastrointestinal endoscopy, to be medically unnecessary.
(2) "Bedcapacity" means space used exclusively for inpatient care, including spacedesigned or remodeled for licensed inpatient beds even though temporarily notused for such purposes. The number of beds to be counted in any patient roomshall be the maximum number for which adequate square footage is provided asestablished by rules of the Department except that single beds in single roomsare counted even if the room contains inadequate square footage. The term"bed capacity" also refers to the number of dialysis stations inkidney disease treatment centers, including freestanding dialysis units.
(2a) "Bone marrowtransplantation services" means the process of infusing bone marrow intopersons with diseases to stimulate the production of blood cells.
(2b) "Burn intensivecare services" means services provided in a unit designed to care forpatients who have been severely burned.
(2c) "Campus"means the adjacent grounds and buildings, or grounds and buildings notseparated by more than a public right‑of‑way, of a health servicefacility and related health care entities.
(2d) "Capitalexpenditure" means an expenditure for a project, including but not limitedto the cost of construction, engineering, and equipment which under generallyaccepted accounting principles is not properly chargeable as an expense ofoperation and maintenance. Capital expenditure includes, in addition, the fairmarket value of an acquisition made by donation, lease, or comparablearrangement by which a person obtains equipment, the expenditure for whichwould have been considered a capital expenditure under this Article if theperson had acquired it by purchase.
(2e) Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
(2f) "Cardiaccatheterization equipment" means the equipment used to provide cardiaccatheterization services.
(2g) "Cardiaccatheterization services" means those procedures, excluding pulmonaryangiography procedures, in which a catheter is introduced into a vein or arteryand threaded through the circulatory system into the heart specifically todiagnose abnormalities in the motion, contraction, and blood flow of the movingheart or to perform surgical therapeutic interventions to restore, repair, orreconstruct the coronary blood vessels of the heart.
(3) "Certificate ofneed" means a written order which affords the person so designated as thelegal proponent of the proposed project the opportunity to proceed with thedevelopment of such project.
(4) Repealed by SessionLaws 1993, c. 7, s. 2.
(5) "Change in bedcapacity" means (i) any relocation of health service facility beds, ordialysis stations from one licensed facility or campus to another, or (ii) anyredistribution of health service facility bed capacity among the categories ofhealth service facility bed as defined in G.S. 131E‑176(9c), or (iii) anyincrease in the number of health service facility beds, or dialysis stations inkidney disease treatment centers, including freestanding dialysis units.
(5a) "Chemicaldependency treatment facility" means a public or private facility, or unitin a facility, which is engaged in providing 24‑hour a day treatment forchemical dependency or substance abuse. This treatment may includedetoxification, administration of a therapeutic regimen for the treatment ofchemically dependent or substance abusing persons and related services. Thefacility or unit may be:
a. A unit within ageneral hospital or an attached or freestanding unit of a general hospitallicensed under Article 5, Chapter 131E, of the General Statutes,
b. A unit within apsychiatric hospital or an attached or freestanding unit of a psychiatrichospital licensed under Article 1A of General Statutes Chapter 122 or Article 2of General Statutes Chapter 122C,
c. A freestandingfacility specializing in treatment of persons who are substance abusers orchemically dependent licensed under Article 1A of General Statutes Chapter 122or Article 2 of General Statutes Chapter 122C; and may be identified as"chemical dependency, substance abuse, alcoholism, or drug abuse treatmentunits," "residential chemical dependency, substance abuse, alcoholismor drug abuse facilities," or by other names if the purpose is to providetreatment of chemically dependent or substance abusing persons, but shall notinclude social setting detoxification facilities, medical detoxificationfacilities, halfway houses or recovery farms.
(5b) "Chemicaldependency treatment beds" means beds that are licensed for the inpatienttreatment of chemical dependency. Residential treatment beds for the treatmentof chemical dependency or substance abuse are chemical dependency treatmentbeds. Chemical dependency treatment beds shall not include beds licensed fordetoxification.
(6) "Department"means the North Carolina Department of Health and Human Services.
(7) To"develop" when used in connection with health services, means toundertake those activities which will result in the offering of institutionalhealth service or the incurring of a financial obligation in relation to theoffering of such a service.
(7a) "Diagnosticcenter" means a freestanding facility, program, or provider, including butnot limited to, physicians' offices, clinical laboratories, radiology centers,and mobile diagnostic programs, in which the total cost of all the medicaldiagnostic equipment utilized by the facility which cost ten thousand dollars($10,000) or more exceeds five hundred thousand dollars ($500,000). In determiningwhether the medical diagnostic equipment in a diagnostic center costs more thanfive hundred thousand dollars ($500,000), the costs of the equipment, studies,surveys, designs, plans, working drawings, specifications, construction,installation, and other activities essential to acquiring and makingoperational the equipment shall be included. The capital expenditure for theequipment shall be deemed to be the fair market value of the equipment or thecost of the equipment, whichever is greater.
(7b) "Expeditedreview" means the status given to an application's review process when theapplicant petitions for the review and the Department approves the requestbased on findings that all of the following are met:
a. The review is notcompetitive.
b. The proposed capitalexpenditure is less than five million dollars ($5,000,000).
c. A request for apublic hearing is not received within the time frame defined in G.S. 131E‑185.
d. The agency has notdetermined that a public hearing is in the public interest.
(7c) "Gammaknife" means equipment which emits photon beams from a stationaryradioactive cobalt source to treat lesions deep within the brain and is onetype of stereotactic radiosurgery.
(7d) "Gastrointestinalendoscopy room" means a room used for the performance of procedures thatrequire the insertion of a flexible endoscope into a gastrointestinal orificeto visualize the gastrointestinal lining and adjacent organs for diagnostic ortherapeutic purposes.
(8),(9) Repealed by SessionLaws 1987, c. 511, s. 1.
(9a) "Healthservice" means an organized, interrelated medical, diagnostic,therapeutic, and/or rehabilitative activity that is integral to the preventionof disease or the clinical management of a sick, injured, or disabled person."Health service" does not include administrative and other activitiesthat are not integral to clinical management.
(9b) "Health servicefacility" means a hospital; long‑term care hospital; psychiatricfacility; rehabilitation facility; nursing home facility; adult care home;kidney disease treatment center, including freestanding hemodialysis units;intermediate care facility for the mentally retarded; home health agencyoffice; chemical dependency treatment facility; diagnostic center; hospiceoffice, hospice inpatient facility, hospice residential care facility; andambulatory surgical facility.
(9c) "Health servicefacility bed" means a bed licensed for use in a health service facility inthe categories of (i) acute care beds; (ii) psychiatric beds; (iii)rehabilitation beds; (iv) nursing home beds; (v) intermediate care beds for thementally retarded; (vi) chemical dependency treatment beds; (vii) hospiceinpatient facility beds; (viii) hospice residential care facility beds; (ix)adult care home beds; and (x) long‑term care hospital beds.
(10) "Healthmaintenance organization (HMO)" means a public or private organizationwhich has received its certificate of authority under Article 67 of Chapter 58of the General Statutes and which either is a qualified health maintenanceorganization under Section 1310(d) of the Public Health Service Act or:
a. Provides orotherwise makes available to enrolled participants health care services,including at least the following basic health care services: usual physicianservices, hospitalization, laboratory, X ray, emergency and preventiveservices, and out‑of‑area coverage;
b. Is compensated,except for copayments, for the provision of the basic health care serviceslisted above to enrolled participants by a payment which is paid on a periodicbasis without regard to the date the health care services are provided andwhich is fixed without regard to the frequency, extent, or kind of healthservice actually provided; and
c. Provides physicians'services primarily (i) directly through physicians who are either employees orpartners of such organizations, or (ii) through arrangements with individualphysicians or one or more groups of physicians organized on a group practice orindividual practice basis.
(10a) "Heart‑lungbypass machine" means the equipment used to perform extra‑corporealcirculation and oxygenation during surgical procedures.
(11) Repealed by SessionLaws 1991, c. 692, s. 1.
(12) "Home healthagency" means a private organization or public agency, whether owned oroperated by one or more persons or legal entities, which furnishes or offers tofurnish home health services.
"Homehealth services" means items and services furnished to an individual by ahome health agency, or by others under arrangements with such others made by theagency, on a visiting basis, and except for paragraph e. of this subdivision,in a place of temporary or permanent residence used as the individual's home asfollows:
a. Part‑time orintermittent nursing care provided by or under the supervision of a registerednurse;
b. Physical,occupational or speech therapy;
c. Medical socialservices, home health aid services, and other therapeutic services;
d. Medical supplies,other than drugs and biologicals and the use of medical appliances;
e. Any of the foregoingitems and services which are provided on an outpatient basis under arrangementsmade by the home health agency at a hospital or nursing home facility orrehabilitation center and the furnishing of which involves the use of equipmentof such a nature that the items and services cannot readily be made availableto the individual in his home, or which are furnished at such facility while heis there to receive any such item or service, but not including transportationof the individual in connection with any such item or service.
(13) "Hospital"means a public or private institution which is primarily engaged in providingto inpatients, by or under supervision of physicians, diagnostic services andtherapeutic services for medical diagnosis, treatment, and care of injured,disabled, or sick persons, or rehabilitation services for the rehabilitation ofinjured, disabled, or sick persons. The term includes all facilities licensedpursuant to G.S. 131E‑77 of the General Statutes, except long‑termcare hospitals.
(13a) "Hospice"means any coordinated program of home care with provision for inpatient carefor terminally ill patients and their families. This care is provided by amedically directed interdisciplinary team, directly or through an agreementunder the direction of an identifiable hospice administration. A hospiceprogram of care provides palliative and supportive medical and other healthservices to meet the physical, psychological, social, spiritual and specialneeds of patients and their families, which are experienced during the finalstages of terminal illness and during dying and bereavement.
(13b) "Hospiceinpatient facility" means a freestanding licensed hospice facility or adesignated inpatient unit in an existing health service facility which providespalliative and supportive medical and other health services to meet thephysical, psychological, social, spiritual, and special needs of terminally illpatients and their families in an inpatient setting. For purposes of thisArticle only, a hospital which has a contractual agreement with a licensedhospice to provide inpatient services to a hospice patient as defined in G.S.131E‑201(4) and provides those services in a licensed acute care bed isnot a hospice inpatient facility and is not subject to the requirements in G.S.131E‑176(5)(ii) for hospice inpatient beds.
(13c) "Hospiceresidential care facility" means a freestanding licensed hospice facilitywhich provides palliative and supportive medical and other health services tomeet the physical, psychological, social, spiritual, and special needs ofterminally ill patients and their families in a group residential setting.
(14) Repealed by SessionLaws 1987, c. 511, s. 1.
(14a) "Intermediatecare facility for the mentally retarded" means facilities licensedpursuant to Article 2 of Chapter 122C of the General Statutes for the purposeof providing health and habilitative services based on the developmental modeland principles of normalization for persons with mental retardation, autism,cerebral palsy, epilepsy or related conditions.
(14b) Repealed by SessionLaws 1991, c. 692, s. 1.
(14c) Reserved for futurecodification.
(14d) Repealed by SessionLaws 2001‑234, s. 2, effective January 1, 2002.
(14e) "Kidney diseasetreatment center" means a facility that is certified as an end‑stagerenal disease facility by the Centers for Medicare and Medicaid Services,Department of Health and Human Services, pursuant to 42 C.F.R. § 405.
(14f) Reserved for futurecodification.
(14g) "Linearaccelerator" means a machine used to produce ionizing radiation in excessof 1,000,000 electron volts in the form of a beam of electrons or photons totreat cancer patients.
(14h) Reserved for futurecodification.
(14i) "Lithotriptor"means extra‑corporeal shock wave technology used to treat persons withkidney stones and gallstones.
(14j) Reserved for futurecodification.
(14k) "Long‑termcare hospital" means a hospital that has been classified and designated asa long‑term care hospital by the Centers for Medicare and MedicaidServices, Department of Health and Human Services, pursuant to 42 C.F.R. § 412.
(14l) Reserved for futurecodification.
(14m) "Magneticresonance imaging scanner" means medical imaging equipment that usesnuclear magnetic resonance.
(14n) Reserved for futurecodification.
(14o) "Major medicalequipment" means a single unit or single system of components with relatedfunctions which is used to provide medical and other health services and whichcosts more than seven hundred fifty thousand dollars ($750,000). In determiningwhether the major medical equipment costs more than seven hundred fiftythousand dollars ($750,000), the costs of the equipment, studies, surveys,designs, plans, working drawings, specifications, construction, installation,and other activities essential to acquiring and making operational the majormedical equipment shall be included. The capital expenditure for the equipmentshall be deemed to be the fair market value of the equipment or the cost of theequipment, whichever is greater. Major medical equipment does not includereplacement equipment as defined in this section.
(15) Repealed by SessionLaws 1987, c. 511, s. 1.
(15a) "Multispecialtyambulatory surgical program" means a formal program for providing on asame‑day basis surgical procedures for at least three of the followingspecialty areas: gynecology, otolaryngology, plastic surgery, general surgery,ophthalmology, orthopedic, or oral surgery.
(15b) "Neonatalintensive care services" means those services provided by a health servicefacility to high‑risk newborn infants who require constant nursing care,including but not limited to continuous cardiopulmonary and other supportivecare.
(16) "Newinstitutional health services" means any of the following:
a. The construction, development,or other establishment of a new health service facility.
b. Except as otherwiseprovided in G.S. 131E‑184(e), the obligation by any person of a capitalexpenditure exceeding two million dollars ($2,000,000) to develop or expand ahealth service or a health service facility, or which relates to the provisionof a health service. The cost of any studies, surveys, designs, plans, workingdrawings, specifications, and other activities, including staff effort andconsulting and other services, essential to the acquisition, improvement,expansion, or replacement of any plant or equipment with respect to which anexpenditure is made shall be included in determining if the expenditure exceedstwo million dollars ($2,000,000).
c. Any change in bedcapacity as defined in G.S. 131E‑176(5).
d. The offering ofdialysis services or home health services by or on behalf of a health servicefacility if those services were not offered within the previous 12 months by oron behalf of the facility.
e. A change in a projectthat was subject to certificate of need review and for which a certificate ofneed was issued, if the change is proposed during the development of theproject or within one year after the project was completed. For purposes ofthis subdivision, a change in a project is a change of more than fifteenpercent (15%) of the approved capital expenditure amount or the addition of ahealth service that is to be located in the facility, or portion thereof, thatwas constructed or developed in the project.
f. The development oroffering of a health service as listed in this subdivision by or on behalf ofany person:
1. Bone marrowtransplantation services.
2. Burn intensive careservices.
2a. Cardiaccatheterization services, except cardiac catheterization services provided onequipment furnished by a person authorized to operate such equipment in NorthCarolina pursuant to either a certificate of need issued for mobile cardiaccatheterization equipment or a settlement agreement executed by the Departmentfor provision of cardiac catheterization services.
3. Neonatal intensivecare services.
4. Open‑heartsurgery services.
5. Solid organtransplantation services.
f1. The acquisition bypurchase, donation, lease, transfer, or comparable arrangement of any of the followingequipment by or on behalf of any person:
1. Air ambulance.
2. Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
3. Cardiaccatheterization equipment.
4. Gamma knife.
5. Heart‑lungbypass machine.
5a. Linear accelerator.
6. Lithotriptor.
7. Magnetic resonanceimaging scanner.
8. Positron emissiontomography scanner.
9. Simulator.
g. to k. Repealed bySession Laws 1987, c. 511, s. 1.
l. The purchase,lease, or acquisition of any health service facility, or portion thereof, or acontrolling interest in the health service facility or portion thereof, if thehealth service facility was developed under a certificate of need issuedpursuant to G.S. 131E‑180.
m. Any conversion ofnonhealth service facility beds to health service facility beds.
n. The construction,development or other establishment of a hospice, hospice inpatient facility, orhospice residential care facility;
o. The opening of anadditional office by an existing home health agency or hospice within itsservice area as defined by rules adopted by the Department; or the opening ofany office by an existing home health agency or hospice outside its servicearea as defined by rules adopted by the Department.
p. The acquisition bypurchase, donation, lease, transfer, or comparable arrangement by any person ofmajor medical equipment.
q. The relocation of ahealth service facility from one service area to another.
r. The conversion of aspecialty ambulatory surgical program to a multispecialty ambulatory surgicalprogram or the addition of a specialty to a specialty ambulatory surgicalprogram.
s. The furnishing ofmobile medical equipment to any person to provide health services in NorthCarolina, which was not in use in North Carolina prior to the adoption of thisprovision, if such equipment would otherwise be subject to review in accordancewith G.S. 131E‑176(16)(f1.) or G.S. 131E‑176(16)(p) if it had beenacquired in North Carolina.
t. Repealed by SessionLaws 2001‑242, s. 4, effective June 23, 2001.
u. The construction,development, establishment, increase in the number, or relocation of anoperating room or gastrointestinal endoscopy room in a licensed health servicefacility, other than the relocation of an operating room or gastrointestinal endoscopyroom within the same building or on the same grounds or to grounds notseparated by more than a public right‑of‑way adjacent to thegrounds where the operating room or gastrointestinal endoscopy room iscurrently located.
v. The change indesignation, in a licensed health service facility, of an operating room to agastrointestinal endoscopy room or change in designation of a gastrointestinalendoscopy room to an operating room that results in a different number of eachtype of room than is reflected on the health service facility's license ineffect as of January 1, 2005.
(17) "North CarolinaState Health Coordinating Council" means the Council that prepares, withthe Department of Health and Human Services, the State Medical Facilities Plan.
(17a) "Nursingcare" means:
a. Skilled nursing careand related services for residents who require medical or nursing care;
b. Rehabilitationservices for the rehabilitation of injured, disabled, or sick persons; or
c. Health‑relatedcare and services provided on a regular basis to individuals who because oftheir mental or physical condition require care and services above the level ofroom and board, which can be made available to them only through institutionalfacilities.
Theseare services which are not primarily for the care and treatment of mentaldiseases.
(17b) "Nursing homefacility" means a health service facility whose bed complement of healthservice facility beds is composed principally of nursing home facility beds.
(18) To "offer,"when used in connection with health services, means that the person holdshimself out as capable of providing, or as having the means for the provisionof, specified health services.
(18a) Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
(18b) "Open‑heartsurgery services" means the provision of surgical procedures that utilizea heart‑lung bypass machine during surgery to correct cardiac andcoronary artery disease or defects.
(18c) "Operatingroom" means a room used for the performance of surgical proceduresrequiring one or more incisions and that is required to comply with allapplicable licensure codes and standards for an operating room.
(19) "Person"means an individual, a trust or estate, a partnership, a corporation, includingassociations, joint stock companies, and insurance companies; the State, or apolitical subdivision or agency or instrumentality of the State.
(19a) "Positronemission tomography scanner" means equipment that utilizes a computerizedradiographic technique that employs radioactive substances to examine themetabolic activity of various body structures.
(20) "Project"or "capital expenditure project" means a proposal to undertake acapital expenditure that results in the offering of a new institutional healthservice as defined by this Article. A project, or capital expenditure project,or proposed project may refer to the project from its earliest planning stagesup through the point at which the specified new institutional health service maybe offered. In the case of facility construction, the point at which the newinstitutional health service may be offered must take place after the facilityis capable of being fully licensed and operated for its intended use, and atthat time it shall be considered a health service facility.
(21) "Psychiatricfacility" means a public or private facility licensed pursuant to Article2 of Chapter 122C of the General Statutes and which is primarily engaged inproviding to inpatients, by or under the supervision of a physician,psychiatric services for the diagnosis and treatment of mentally ill persons.
(22) "Rehabilitationfacility" means a public or private inpatient facility which is operatedfor the primary purpose of assisting in the rehabilitation of disabled personsthrough an integrated program of medical and other services which are providedunder competent, professional supervision.
(22a) "Replacementequipment" means equipment that costs less than two million dollars($2,000,000) and is purchased for the sole purpose of replacing comparablemedical equipment currently in use which will be sold or otherwise disposed ofwhen replaced. In determining whether the replacement equipment costs less thantwo million dollars ($2,000,000), the costs of equipment, studies, surveys,designs, plans, working drawings, specifications, construction, installation,and other activities essential to acquiring and making operational thereplacement equipment shall be included. The capital expenditure for theequipment shall be deemed to be the fair market value of the equipment or thecost of the equipment, whichever is greater.
(23) Repealed by SessionLaws 1991, c. 692, s. 1.
(24) Repealed by SessionLaws 1993, c. 7, s. 2.
(24a) "Servicearea" means the area of the State, as defined in the State MedicalFacilities Plan or in rules adopted by the Department, which receives servicesfrom a health service facility.
(24b) "Simulator"means a machine that produces high quality diagnostic radiographs and preciselyreproduces the geometric relationships of megavoltage radiation therapyequipment to the patient.
(24c) Reserved for futurecodification.
(24d) "Solid organtransplantation services" means the provision of surgical procedures andthe interrelated medical services that accompany the surgery to remove an organfrom a patient and surgically implant an organ from a donor.
(24e) Reserved for futurecodification.
(24f) "Specialtyambulatory surgical program" means a formal program for providing on asame‑day basis surgical procedures for only the specialty areasidentified on the ambulatory surgical facility's 1993 Application for Licensureas an Ambulatory Surgical Center and authorized by its certificate of need.
(25) "State MedicalFacilities Plan" means the plan prepared by the Department of Health andHuman Services and the North Carolina State Health Coordinating Council, andapproved by the Governor. In preparing the Plan, the Department and the StateHealth Coordinating Council shall maintain a mailing list of persons who haverequested notice of public hearings regarding the Plan. Not less than 15 daysprior to a scheduled public hearing, the Department shall notify persons on itsmailing list of the date, time, and location of the hearing. The Departmentshall hold at least one public hearing prior to the adoption of the proposedPlan and at least six public hearings after the adoption of the proposed Planby the State Health Coordinating Council. The Council shall accept oral andwritten comments from the public concerning the Plan.
(26) Repealed by SessionLaws 1983 (Regular Session, 1984), c. 1002, s. 9.
(27) Repealed by SessionLaws 1987, c. 511, s. 1. (1977, 2nd Sess., c. 1182, s. 2; 1981, c. 651, ss. 1,2; c. 1127, ss. 24‑29; 1983, c. 775, s. 1; 1983 (Reg. Sess., 1984), c.1002, ss. 1‑9; c. 1022, ss. 2, 3; c. 1064, s. 1; c. 1110, ss. 1, 2; 1985,c. 589, ss. 42, 43(a); c. 740, ss. 1, 2, 6; 1985 (Reg. Sess., 1986), c. 1001,s. 2; 1987, c. 34; c. 511, s. 1; 1991, c. 692, s. 1; c. 701, s. 1; 1993, c. 7,s. 2; c. 376, ss. 1‑4; 1997‑443, s. 11A.118(a); 2000‑135, ss.1, 2; 2001‑234, s. 2; 2001‑242, ss. 2, 4; 2003‑229, s. 13;2003‑390, ss. 1, 2; 2005‑325, s. 1; 2005‑346, s. 6(a)‑(d);2009‑145, s. 2; 2009‑462, s. 4(k).)
As used in this Article,unless the context clearly requires otherwise, the following terms have themeanings specified:
(1) "Adult carehome" means a facility with seven or more beds licensed under Part 1 ofArticle 1 of Chapter 131D of the General Statutes or Chapter 131E of theGeneral Statutes that provides residential care for aged or disabled personswhose principal need is a home which provides the supervision and personal careappropriate to their age and disability and for whom medical care is onlyoccasional or incidental.
(1a) (See note)"Air ambulance" means aircraft used to provide air transport of sickor injured persons between destinations within the State.
(1b) "Ambulatorysurgical facility" means a facility designed for the provision of aspecialty ambulatory surgical program or a multispecialty ambulatory surgicalprogram. An ambulatory surgical facility serves patients who require local,regional or general anesthesia and a period of post‑operativeobservation. An ambulatory surgical facility may only admit patients for aperiod of less than 24 hours and must provide at least one designated operatingroom or gastrointestinal endoscopy room, as defined in Article 5 Part 1 andArticle 6, Part 4 of this Chapter, and at least one designated recovery room,have available the necessary equipment and trained personnel to handleemergencies, provide adequate quality assurance and assessment by an evaluationand review committee, and maintain adequate medical records for each patient.An ambulatory surgical facility may be operated as a part of a physician ordentist's office, provided the facility is licensed under G.S. Chapter 131E,Article 6, Part D, but the performance of incidental, limited ambulatorysurgical procedures which do not constitute an ambulatory surgical program asdefined in subdivision (1c) of this section and which are performed in aphysician's or dentist's office does not make that office an ambulatorysurgical facility.
(1c) "Ambulatorysurgical program" means a formal program for providing on a same‑daybasis those surgical procedures which require local, regional or generalanesthesia and a period of post‑operative observation to patients whoseadmission for more than 24 hours is determined, prior to surgery orgastrointestinal endoscopy, to be medically unnecessary.
(2) "Bedcapacity" means space used exclusively for inpatient care, including spacedesigned or remodeled for licensed inpatient beds even though temporarily notused for such purposes. The number of beds to be counted in any patient roomshall be the maximum number for which adequate square footage is provided asestablished by rules of the Department except that single beds in single roomsare counted even if the room contains inadequate square footage. The term"bed capacity" also refers to the number of dialysis stations inkidney disease treatment centers, including freestanding dialysis units.
(2a) "Bone marrowtransplantation services" means the process of infusing bone marrow intopersons with diseases to stimulate the production of blood cells.
(2b) "Burn intensivecare services" means services provided in a unit designed to care forpatients who have been severely burned.
(2c) "Campus"means the adjacent grounds and buildings, or grounds and buildings notseparated by more than a public right‑of‑way, of a health servicefacility and related health care entities.
(2d) "Capitalexpenditure" means an expenditure for a project, including but not limitedto the cost of construction, engineering, and equipment which under generallyaccepted accounting principles is not properly chargeable as an expense ofoperation and maintenance. Capital expenditure includes, in addition, the fairmarket value of an acquisition made by donation, lease, or comparablearrangement by which a person obtains equipment, the expenditure for whichwould have been considered a capital expenditure under this Article if theperson had acquired it by purchase.
(2e) Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
(2f) "Cardiaccatheterization equipment" means the equipment used to provide cardiaccatheterization services.
(2g) "Cardiaccatheterization services" means those procedures, excluding pulmonaryangiography procedures, in which a catheter is introduced into a vein or arteryand threaded through the circulatory system into the heart specifically todiagnose abnormalities in the motion, contraction, and blood flow of the movingheart or to perform surgical therapeutic interventions to restore, repair, orreconstruct the coronary blood vessels of the heart.
(3) "Certificate ofneed" means a written order which affords the person so designated as thelegal proponent of the proposed project the opportunity to proceed with thedevelopment of such project.
(4) Repealed by SessionLaws 1993, c. 7, s. 2.
(5) "Change in bedcapacity" means (i) any relocation of health service facility beds, ordialysis stations from one licensed facility or campus to another, or (ii) anyredistribution of health service facility bed capacity among the categories ofhealth service facility bed as defined in G.S. 131E‑176(9c), or (iii) anyincrease in the number of health service facility beds, or dialysis stations inkidney disease treatment centers, including freestanding dialysis units.
(5a) "Chemicaldependency treatment facility" means a public or private facility, or unitin a facility, which is engaged in providing 24‑hour a day treatment forchemical dependency or substance abuse. This treatment may includedetoxification, administration of a therapeutic regimen for the treatment ofchemically dependent or substance abusing persons and related services. Thefacility or unit may be:
a. A unit within ageneral hospital or an attached or freestanding unit of a general hospitallicensed under Article 5, Chapter 131E, of the General Statutes,
b. A unit within apsychiatric hospital or an attached or freestanding unit of a psychiatrichospital licensed under Article 1A of General Statutes Chapter 122 or Article 2of General Statutes Chapter 122C,
c. A freestandingfacility specializing in treatment of persons who are substance abusers orchemically dependent licensed under Article 1A of General Statutes Chapter 122or Article 2 of General Statutes Chapter 122C; and may be identified as"chemical dependency, substance abuse, alcoholism, or drug abuse treatmentunits," "residential chemical dependency, substance abuse, alcoholismor drug abuse facilities," or by other names if the purpose is to providetreatment of chemically dependent or substance abusing persons, but shall notinclude social setting detoxification facilities, medical detoxificationfacilities, halfway houses or recovery farms.
(5b) "Chemicaldependency treatment beds" means beds that are licensed for the inpatienttreatment of chemical dependency. Residential treatment beds for the treatmentof chemical dependency or substance abuse are chemical dependency treatmentbeds. Chemical dependency treatment beds shall not include beds licensed fordetoxification.
(6) "Department"means the North Carolina Department of Health and Human Services.
(7) To"develop" when used in connection with health services, means toundertake those activities which will result in the offering of institutionalhealth service or the incurring of a financial obligation in relation to theoffering of such a service.
(7a) "Diagnosticcenter" means a freestanding facility, program, or provider, including butnot limited to, physicians' offices, clinical laboratories, radiology centers,and mobile diagnostic programs, in which the total cost of all the medicaldiagnostic equipment utilized by the facility which cost ten thousand dollars($10,000) or more exceeds five hundred thousand dollars ($500,000). In determiningwhether the medical diagnostic equipment in a diagnostic center costs more thanfive hundred thousand dollars ($500,000), the costs of the equipment, studies,surveys, designs, plans, working drawings, specifications, construction,installation, and other activities essential to acquiring and makingoperational the equipment shall be included. The capital expenditure for theequipment shall be deemed to be the fair market value of the equipment or thecost of the equipment, whichever is greater.
(7b) "Expeditedreview" means the status given to an application's review process when theapplicant petitions for the review and the Department approves the requestbased on findings that all of the following are met:
a. The review is notcompetitive.
b. The proposed capitalexpenditure is less than five million dollars ($5,000,000).
c. A request for apublic hearing is not received within the time frame defined in G.S. 131E‑185.
d. The agency has notdetermined that a public hearing is in the public interest.
(7c) "Gammaknife" means equipment which emits photon beams from a stationaryradioactive cobalt source to treat lesions deep within the brain and is onetype of stereotactic radiosurgery.
(7d) "Gastrointestinalendoscopy room" means a room used for the performance of procedures thatrequire the insertion of a flexible endoscope into a gastrointestinal orificeto visualize the gastrointestinal lining and adjacent organs for diagnostic ortherapeutic purposes.
(8),(9) Repealed by SessionLaws 1987, c. 511, s. 1.
(9a) "Healthservice" means an organized, interrelated medical, diagnostic,therapeutic, and/or rehabilitative activity that is integral to the preventionof disease or the clinical management of a sick, injured, or disabled person."Health service" does not include administrative and other activitiesthat are not integral to clinical management.
(9b) "Health servicefacility" means a hospital; long‑term care hospital; psychiatricfacility; rehabilitation facility; nursing home facility; adult care home;kidney disease treatment center, including freestanding hemodialysis units;intermediate care facility for the mentally retarded; home health agencyoffice; chemical dependency treatment facility; diagnostic center; hospiceoffice, hospice inpatient facility, hospice residential care facility; andambulatory surgical facility.
(9c) "Health servicefacility bed" means a bed licensed for use in a health service facility inthe categories of (i) acute care beds; (ii) psychiatric beds; (iii)rehabilitation beds; (iv) nursing home beds; (v) intermediate care beds for thementally retarded; (vi) chemical dependency treatment beds; (vii) hospiceinpatient facility beds; (viii) hospice residential care facility beds; (ix)adult care home beds; and (x) long‑term care hospital beds.
(10) "Healthmaintenance organization (HMO)" means a public or private organizationwhich has received its certificate of authority under Article 67 of Chapter 58of the General Statutes and which either is a qualified health maintenanceorganization under Section 1310(d) of the Public Health Service Act or:
a. Provides orotherwise makes available to enrolled participants health care services,including at least the following basic health care services: usual physicianservices, hospitalization, laboratory, X ray, emergency and preventiveservices, and out‑of‑area coverage;
b. Is compensated,except for copayments, for the provision of the basic health care serviceslisted above to enrolled participants by a payment which is paid on a periodicbasis without regard to the date the health care services are provided andwhich is fixed without regard to the frequency, extent, or kind of healthservice actually provided; and
c. Provides physicians'services primarily (i) directly through physicians who are either employees orpartners of such organizations, or (ii) through arrangements with individualphysicians or one or more groups of physicians organized on a group practice orindividual practice basis.
(10a) "Heart‑lungbypass machine" means the equipment used to perform extra‑corporealcirculation and oxygenation during surgical procedures.
(11) Repealed by SessionLaws 1991, c. 692, s. 1.
(12) "Home healthagency" means a private organization or public agency, whether owned oroperated by one or more persons or legal entities, which furnishes or offers tofurnish home health services.
"Homehealth services" means items and services furnished to an individual by ahome health agency, or by others under arrangements with such others made by theagency, on a visiting basis, and except for paragraph e. of this subdivision,in a place of temporary or permanent residence used as the individual's home asfollows:
a. Part‑time orintermittent nursing care provided by or under the supervision of a registerednurse;
b. Physical,occupational or speech therapy;
c. Medical socialservices, home health aid services, and other therapeutic services;
d. Medical supplies,other than drugs and biologicals and the use of medical appliances;
e. Any of the foregoingitems and services which are provided on an outpatient basis under arrangementsmade by the home health agency at a hospital or nursing home facility orrehabilitation center and the furnishing of which involves the use of equipmentof such a nature that the items and services cannot readily be made availableto the individual in his home, or which are furnished at such facility while heis there to receive any such item or service, but not including transportationof the individual in connection with any such item or service.
(13) "Hospital"means a public or private institution which is primarily engaged in providingto inpatients, by or under supervision of physicians, diagnostic services andtherapeutic services for medical diagnosis, treatment, and care of injured,disabled, or sick persons, or rehabilitation services for the rehabilitation ofinjured, disabled, or sick persons. The term includes all facilities licensedpursuant to G.S. 131E‑77 of the General Statutes, except long‑termcare hospitals.
(13a) "Hospice"means any coordinated program of home care with provision for inpatient carefor terminally ill patients and their families. This care is provided by amedically directed interdisciplinary team, directly or through an agreementunder the direction of an identifiable hospice administration. A hospiceprogram of care provides palliative and supportive medical and other healthservices to meet the physical, psychological, social, spiritual and specialneeds of patients and their families, which are experienced during the finalstages of terminal illness and during dying and bereavement.
(13b) "Hospiceinpatient facility" means a freestanding licensed hospice facility or adesignated inpatient unit in an existing health service facility which providespalliative and supportive medical and other health services to meet thephysical, psychological, social, spiritual, and special needs of terminally illpatients and their families in an inpatient setting. For purposes of thisArticle only, a hospital which has a contractual agreement with a licensedhospice to provide inpatient services to a hospice patient as defined in G.S.131E‑201(4) and provides those services in a licensed acute care bed isnot a hospice inpatient facility and is not subject to the requirements in G.S.131E‑176(5)(ii) for hospice inpatient beds.
(13c) "Hospiceresidential care facility" means a freestanding licensed hospice facilitywhich provides palliative and supportive medical and other health services tomeet the physical, psychological, social, spiritual, and special needs ofterminally ill patients and their families in a group residential setting.
(14) Repealed by SessionLaws 1987, c. 511, s. 1.
(14a) "Intermediatecare facility for the mentally retarded" means facilities licensedpursuant to Article 2 of Chapter 122C of the General Statutes for the purposeof providing health and habilitative services based on the developmental modeland principles of normalization for persons with mental retardation, autism,cerebral palsy, epilepsy or related conditions.
(14b) Repealed by SessionLaws 1991, c. 692, s. 1.
(14c) Reserved for futurecodification.
(14d) Repealed by SessionLaws 2001‑234, s. 2, effective January 1, 2002.
(14e) "Kidney diseasetreatment center" means a facility that is certified as an end‑stagerenal disease facility by the Centers for Medicare and Medicaid Services,Department of Health and Human Services, pursuant to 42 C.F.R. § 405.
(14f) Reserved for futurecodification.
(14g) "Linearaccelerator" means a machine used to produce ionizing radiation in excessof 1,000,000 electron volts in the form of a beam of electrons or photons totreat cancer patients.
(14h) Reserved for futurecodification.
(14i) "Lithotriptor"means extra‑corporeal shock wave technology used to treat persons withkidney stones and gallstones.
(14j) Reserved for futurecodification.
(14k) "Long‑termcare hospital" means a hospital that has been classified and designated asa long‑term care hospital by the Centers for Medicare and MedicaidServices, Department of Health and Human Services, pursuant to 42 C.F.R. § 412.
(14l) Reserved for futurecodification.
(14m) "Magneticresonance imaging scanner" means medical imaging equipment that usesnuclear magnetic resonance.
(14n) Reserved for futurecodification.
(14o) "Major medicalequipment" means a single unit or single system of components with relatedfunctions which is used to provide medical and other health services and whichcosts more than seven hundred fifty thousand dollars ($750,000). In determiningwhether the major medical equipment costs more than seven hundred fiftythousand dollars ($750,000), the costs of the equipment, studies, surveys,designs, plans, working drawings, specifications, construction, installation,and other activities essential to acquiring and making operational the majormedical equipment shall be included. The capital expenditure for the equipmentshall be deemed to be the fair market value of the equipment or the cost of theequipment, whichever is greater. Major medical equipment does not includereplacement equipment as defined in this section.
(15) Repealed by SessionLaws 1987, c. 511, s. 1.
(15a) "Multispecialtyambulatory surgical program" means a formal program for providing on asame‑day basis surgical procedures for at least three of the followingspecialty areas: gynecology, otolaryngology, plastic surgery, general surgery,ophthalmology, orthopedic, or oral surgery.
(15b) "Neonatalintensive care services" means those services provided by a health servicefacility to high‑risk newborn infants who require constant nursing care,including but not limited to continuous cardiopulmonary and other supportivecare.
(16) "Newinstitutional health services" means any of the following:
a. The construction, development,or other establishment of a new health service facility.
b. Except as otherwiseprovided in G.S. 131E‑184(e), the obligation by any person of a capitalexpenditure exceeding two million dollars ($2,000,000) to develop or expand ahealth service or a health service facility, or which relates to the provisionof a health service. The cost of any studies, surveys, designs, plans, workingdrawings, specifications, and other activities, including staff effort andconsulting and other services, essential to the acquisition, improvement,expansion, or replacement of any plant or equipment with respect to which anexpenditure is made shall be included in determining if the expenditure exceedstwo million dollars ($2,000,000).
c. Any change in bedcapacity as defined in G.S. 131E‑176(5).
d. The offering ofdialysis services or home health services by or on behalf of a health servicefacility if those services were not offered within the previous 12 months by oron behalf of the facility.
e. A change in a projectthat was subject to certificate of need review and for which a certificate ofneed was issued, if the change is proposed during the development of theproject or within one year after the project was completed. For purposes ofthis subdivision, a change in a project is a change of more than fifteenpercent (15%) of the approved capital expenditure amount or the addition of ahealth service that is to be located in the facility, or portion thereof, thatwas constructed or developed in the project.
f. The development oroffering of a health service as listed in this subdivision by or on behalf ofany person:
1. Bone marrowtransplantation services.
2. Burn intensive careservices.
2a. Cardiaccatheterization services, except cardiac catheterization services provided onequipment furnished by a person authorized to operate such equipment in NorthCarolina pursuant to either a certificate of need issued for mobile cardiaccatheterization equipment or a settlement agreement executed by the Departmentfor provision of cardiac catheterization services.
3. Neonatal intensivecare services.
4. Open‑heartsurgery services.
5. Solid organtransplantation services.
f1. The acquisition bypurchase, donation, lease, transfer, or comparable arrangement of any of the followingequipment by or on behalf of any person:
1. Air ambulance.
2. Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
3. Cardiaccatheterization equipment.
4. Gamma knife.
5. Heart‑lungbypass machine.
5a. Linear accelerator.
6. Lithotriptor.
7. Magnetic resonanceimaging scanner.
8. Positron emissiontomography scanner.
9. Simulator.
g. to k. Repealed bySession Laws 1987, c. 511, s. 1.
l. The purchase,lease, or acquisition of any health service facility, or portion thereof, or acontrolling interest in the health service facility or portion thereof, if thehealth service facility was developed under a certificate of need issuedpursuant to G.S. 131E‑180.
m. Any conversion ofnonhealth service facility beds to health service facility beds.
n. The construction,development or other establishment of a hospice, hospice inpatient facility, orhospice residential care facility;
o. The opening of anadditional office by an existing home health agency or hospice within itsservice area as defined by rules adopted by the Department; or the opening ofany office by an existing home health agency or hospice outside its servicearea as defined by rules adopted by the Department.
p. The acquisition bypurchase, donation, lease, transfer, or comparable arrangement by any person ofmajor medical equipment.
q. The relocation of ahealth service facility from one service area to another.
r. The conversion of aspecialty ambulatory surgical program to a multispecialty ambulatory surgicalprogram or the addition of a specialty to a specialty ambulatory surgicalprogram.
s. The furnishing ofmobile medical equipment to any person to provide health services in NorthCarolina, which was not in use in North Carolina prior to the adoption of thisprovision, if such equipment would otherwise be subject to review in accordancewith G.S. 131E‑176(16)(f1.) or G.S. 131E‑176(16)(p) if it had beenacquired in North Carolina.
t. Repealed by SessionLaws 2001‑242, s. 4, effective June 23, 2001.
u. The construction,development, establishment, increase in the number, or relocation of anoperating room or gastrointestinal endoscopy room in a licensed health servicefacility, other than the relocation of an operating room or gastrointestinal endoscopyroom within the same building or on the same grounds or to grounds notseparated by more than a public right‑of‑way adjacent to thegrounds where the operating room or gastrointestinal endoscopy room iscurrently located.
v. The change indesignation, in a licensed health service facility, of an operating room to agastrointestinal endoscopy room or change in designation of a gastrointestinalendoscopy room to an operating room that results in a different number of eachtype of room than is reflected on the health service facility's license ineffect as of January 1, 2005.
(17) "North CarolinaState Health Coordinating Council" means the Council that prepares, withthe Department of Health and Human Services, the State Medical Facilities Plan.
(17a) "Nursingcare" means:
a. Skilled nursing careand related services for residents who require medical or nursing care;
b. Rehabilitationservices for the rehabilitation of injured, disabled, or sick persons; or
c. Health‑relatedcare and services provided on a regular basis to individuals who because oftheir mental or physical condition require care and services above the level ofroom and board, which can be made available to them only through institutionalfacilities.
Theseare services which are not primarily for the care and treatment of mentaldiseases.
(17b) "Nursing homefacility" means a health service facility whose bed complement of healthservice facility beds is composed principally of nursing home facility beds.
(18) To "offer,"when used in connection with health services, means that the person holdshimself out as capable of providing, or as having the means for the provisionof, specified health services.
(18a) Repealed by SessionLaws 2005‑325, s. 1, effective for hospices and hospice offices December31, 2005.
(18b) "Open‑heartsurgery services" means the provision of surgical procedures that utilizea heart‑lung bypass machine during surgery to correct cardiac andcoronary artery disease or defects.
(18c) "Operatingroom" means a room used for the performance of surgical proceduresrequiring one or more incisions and that is required to comply with allapplicable licensure codes and standards for an operating room.
(19) "Person"means an individual, a trust or estate, a partnership, a corporation, includingassociations, joint stock companies, and insurance companies; the State, or apolitical subdivision or agency or instrumentality of the State.
(19a) "Positronemission tomography scanner" means equipment that utilizes a computerizedradiographic technique that employs radioactive substances to examine themetabolic activity of various body structures.
(20) "Project"or "capital expenditure project" means a proposal to undertake acapital expenditure that results in the offering of a new institutional healthservice as defined by this Article. A project, or capital expenditure project,or proposed project may refer to the project from its earliest planning stagesup through the point at which the specified new institutional health service maybe offered. In the case of facility construction, the point at which the newinstitutional health service may be offered must take place after the facilityis capable of being fully licensed and operated for its intended use, and atthat time it shall be considered a health service facility.
(21) "Psychiatricfacility" means a public or private facility licensed pursuant to Article2 of Chapter 122C of the General Statutes and which is primarily engaged inproviding to inpatients, by or under the supervision of a physician,psychiatric services for the diagnosis and treatment of mentally ill persons.
(22) "Rehabilitationfacility" means a public or private inpatient facility which is operatedfor the primary purpose of assisting in the rehabilitation of disabled personsthrough an integrated program of medical and other services which are providedunder competent, professional supervision.
(22a) "Replacementequipment" means equipment that costs less than two million dollars($2,000,000) and is purchased for the sole purpose of replacing comparablemedical equipment currently in use which will be sold or otherwise disposed ofwhen replaced. In determining whether the replacement equipment costs less thantwo million dollars ($2,000,000), the costs of equipment, studies, surveys,designs, plans, working drawings, specifications, construction, installation,and other activities essential to acquiring and making operational thereplacement equipment shall be included. The capital expenditure for theequipment shall be deemed to be the fair market value of the equipment or thecost of the equipment, whichever is greater.
(23) Repealed by SessionLaws 1991, c. 692, s. 1.
(24) Repealed by SessionLaws 1993, c. 7, s. 2.
(24a) "Servicearea" means the area of the State, as defined in the State MedicalFacilities Plan or in rules adopted by the Department, which receives servicesfrom a health service facility.
(24b) "Simulator"means a machine that produces high quality diagnostic radiographs and preciselyreproduces the geometric relationships of megavoltage radiation therapyequipment to the patient.
(24c) Reserved for futurecodification.
(24d) "Solid organtransplantation services" means the provision of surgical procedures andthe interrelated medical services that accompany the surgery to remove an organfrom a patient and surgically implant an organ from a donor.
(24e) Reserved for futurecodification.
(24f) "Specialtyambulatory surgical program" means a formal program for providing on asame‑day basis surgical procedures for only the specialty areasidentified on the ambulatory surgical facility's 1993 Application for Licensureas an Ambulatory Surgical Center and authorized by its certificate of need.
(25) "State MedicalFacilities Plan" means the plan prepared by the Department of Health andHuman Services and the North Carolina State Health Coordinating Council, andapproved by the Governor. In preparing the Plan, the Department and the StateHealth Coordinating Council shall maintain a mailing list of persons who haverequested notice of public hearings regarding the Plan. Not less than 15 daysprior to a scheduled public hearing, the Department shall notify persons on itsmailing list of the date, time, and location of the hearing. The Departmentshall hold at least one public hearing prior to the adoption of the proposedPlan and at least six public hearings after the adoption of the proposed Planby the State Health Coordinating Council. The Council shall accept oral andwritten comments from the public concerning the Plan.
(26) Repealed by SessionLaws 1983 (Regular Session, 1984), c. 1002, s. 9.
(27) Repealed by SessionLaws 1987, c. 511, s. 1. (1977, 2nd Sess., c. 1182, s. 2; 1981, c. 651, ss. 1,2; c. 1127, ss. 24‑29; 1983, c. 775, s. 1; 1983 (Reg. Sess., 1984), c.1002, ss. 1‑9; c. 1022, ss. 2, 3; c. 1064, s. 1; c. 1110, ss. 1, 2; 1985,c. 589, ss. 42, 43(a); c. 740, ss. 1, 2, 6; 1985 (Reg. Sess., 1986), c. 1001,s. 2; 1987, c. 34; c. 511, s. 1; 1991, c. 692, s. 1; c. 701, s. 1; 1993, c. 7,s. 2; c. 376, ss. 1‑4; 1997‑443, s. 11A.118(a); 2000‑135, ss.1, 2; 2001‑234, s. 2; 2001‑242, ss. 2, 4; 2003‑229, s. 13;2003‑390, ss. 1, 2; 2005‑325, s. 1; 2005‑346, s. 6(a)‑(d);2009‑145, s. 2; 2009‑462, s. 4(k).)
