SUBCHAPTER 14G - EXEMPTIONS FROM PROHIBITIONS OF
SELF-REFERRALS BY HEALTH CARE PROVIDERS FOR UNDERSERVED AREAS
SECTION .0100 – GENERAL INFORMATION
10A NCAC 14G .0101 DEFINITIONS
(a) The terms defined in G.S. 90-405 shall have the same
meaning in this Subchapter.
(b) As used in this Subchapter "Commercial
lender" means commercial banks, savings banks, and savings and loan
organizations and all branches of any of those three categories.
(c) As used in this Subchapter "Regional daily
newspaper" shall mean the newspaper from the following list which has the
primary circulation for the area in which the entity is located or proposed to
be located:
(1) Asheville Citizen-Times,
(2) Charlotte Observer,
(3) Winston-Salem Journal,
(4) Greensboro News and Record,
(5) Raleigh News and Observer,
(6) Fayetteville Observer,
(7) The Daily Reflector (Greenville),
(8) Wilmington Star.
History Note: Authority G.S. 90-408;
Eff. April 1, 1995.
10A NCAC 14G .0102 APPLICATION
(a) An application must be submitted to the Department by
any health care provider wishing to be exempt from G.S. 90-406.
(b) The application shall include the following
information:
(1) the name, address, and telephone number of
the health care provider applicant;
(2) the name, address, and telephone number of
the manager of the entity to which the health care provider wishes to be able
to make referrals;
(3) an explanation of the ownership of the
entity to which referrals would be made including the names and ownership
interests of all individuals or entities having an investment interest in the
entity;
(4) a description of the designated health care
services provided or to be provided by the entity;
(5) an analysis of the need for the health care
service in the area sufficient to allow the Department to determine that the
area is an underserved area for the particular service to be provided; and
(6) documentation of attempts made to obtain
alternative financing to develop the entity in which the health care provider
has an interest and an explanation as to why any proposed alternative was not
reasonable.
(c) Applications shall be sent to the Director's Office,
Division of Health Service Regulation, North Carolina Department of Human
Resources, 701 Barbour Drive, P.O. Box 29530, Raleigh, N.C. 27626-0530, and
shall indicate the purpose of the application.
History Note: Authority G.S. 90-408;
Eff. April 1, 1995.
10A NCAC 14G .0103 CRITERIA FOR AN UNDERSERVED AREA
EXEMPTION - NEW ENTITY
(a) In order for the Department to determine that there is
a demonstrated need in the county where the entity is proposed to be located
for the designated health care services to be offered by the entity the
Department must conclude that:
(1) the service or services proposed are not
provided in the county within 15 miles of the proposed site of the entity; or
(2) any existing provider of the same service
or services proposed by the new entity, located in the county or within 10
miles of the proposed site of the entity, is not able to provide services to
all who require the service and is unwilling or unable to expand services in
order to accommodate those in need of the service. The application shall
provide written confirmation from the existing provider acknowledging unmet
need and unwillingness or inability to accommodate it.
(b) In order for the Department to determine that
alternative financing is not available for a proposed new entity the applicant
shall provide all of the following:
(1) when an applicant health care provider is
proposing to invest in an entity which includes non-health care providers,
documentation that the non-health care providers have applied for financing
from at least three commercial lenders located in the county, except that if
the county does not have three commercial lenders one or more of the three may
be from outside the county, and that the commercial lenders have considered and
rejected the application to finance the proposed new entity; and
(2) documentation that the plan of finance
proposed to include the applicant health care provider in an entity which
includes non-health care providers has the applicant health care provider
participating on essentially the same terms as those proposed to the commercial
lenders referenced in Subparagraph (b)(1) of this Rule; and
(3) documentation that any non health care
providers who are proposed to be parties to the financing, are proposed to be
participating under the same terms and conditions as that proposed for the
health care providers; and
(4) documentation that an advertisement at
least 3 inches wide and 3 inches long has been placed in four successive Sunday
editions of a regional daily newspaper by any proposed non-health care provider
owners under the heading "Investment Opportunity" describing the type
of investment available, and that no responses have been received within 30
days of the fourth advertisement or that interested parties have been unable or
unwilling to provide financing under the same terms and conditions that are
proposed for the health care provider investor.
History Note: Authority G.S. 90-408;
Eff. April 1, 1995.
10A NCAC 14g .0104 CRITERIA FOR AN UNDERSERVED AREA
EXEMPTION - EXISTING ENTITY
(a) In order for the Department to determine that there is
a demonstrated need in the county where the entity is located for the
designated health care services offered by the entity, the Department must
conclude that:
(1) No other entity is providing the service or
services in the county within 15 miles of the existing entity; or
(2) Any other entity located in the county
within 15 miles of the existing entity which offers the same service or
services provided by the existing entity is not able to provide services to all
who require the service and is unwilling or unable to expand services in order
to accommodate those in need of the service. The application shall provide written
confirmation from the existing provider acknowledging unmet need and
unwillingness or inability to accommodate it.
(b) In order for the Department to determine that
alternative financing is not available for an existing entity the applicant
shall provide with its application each of the following:
(1) documentation that an appraisal of the
entity has been made and that the portion of the entity owned by the applicant
has been offered for sale to other current and potential investors at a price
represented by the proportionate share of the appraised value owned by the
applicant seeking an exemption and that the offer has been rejected within 30
days of the date the application was submitted; and
(2) documentation that the portion of the
entity owned by the applicant seeking an exemption has been publicly offered
for sale at a price represented by its appraised value plus the cost of the
appraisal, including affidavits of publication that an advertisement at least 3
inches wide and 3 inches long has appeared in four successive Sunday editions
of a regional daily newspaper under the heading "Investment
Opportunity" describing the type of investment available, and that no
responses have been received within 30 days of the fourth advertisement or that
interested parties have been unable or unwilling to purchase the portion of the
entity owned by the applicant.
History Note: Authority G.S. 90-408;
Eff. April 1, 1995.
