Link to law: http://reports.oah.state.nc.us/ncac/title 10a - health and human services/chapter 14 - director, division of health service regulation/subchapter g/subchapter g rules.html
Published: 2015

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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.