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.