Subcommittee advances expedited CON review for residential substance-use facilities, keeps oversight on bed increases

The Insurance and Pharmaceutical Subcommittee of the Health and Government Operations Committee voted unanimously to give House Bill 15 15 a favorable report, creating an expedited Certificate of Need (CON) pathway for intermediate care facilities that offer medically managed residential substance use disorder services while adding a notice and oversight requirement for changes in bed capacity.

Erin, speaking to the subcommittee, said the bill "provide[s] that a certificate of need is not required for the establishment or operation of an intermediate care facility that offers medically managed residential substance use disorder services if written notice of the attempt to establish or operate the intermediate care facility is filed with the Maryland Health Care Commission at least 45 days before the establishment and the commission in its sole discretion finds that the proposed intermediate care facility is not inconsistent with the State Health Plan, will result in the delivery of more efficient and effective health care services, and is in the public interest." The bill also requires notice 45 days before increasing or decreasing bed capacity for licensed facilities.

Winnie Hawk cautioned that the word "exemption" in the bill title has been confusing. She told the panel that the change is an expedited review rather than the removal of regulatory standards, and that applicants must still satisfy State Health Plan requirements. "The main difference is that it's an... expedited review within 45 days," Hawk said, adding that the process would eliminate the "interested party" participation that occurs in a full CON process.

Hawk described why the change is needed, saying the Maryland Health Care Commission has encountered rapid, large capacity additions at some facilities: "we have come across some facilities that are stacking as many as 6 patients in a room for the highest level" and cited an example in which a 21-bed CON was followed by a notice to add 81 beds after licensing. She and other staff said the bill is intended to preserve the commission's ability to review need and quality while streamlining establishment for this specific type of facility.

Delegate Johnson and Delegate Tavares asked for clarifications. Members were told the bill does not allow facilities to expand beyond a building's physical bed capacity; rather, it creates a required notice-and-review step so the commission can oversee capacity changes. The committee also clarified that "medically managed" intermediate care refers to a 3.7 intermediate care level and is distinct from hospital or psychiatric beds, which are governed by different CON and licensure rules.

The chair then called for a motion. A motion for a favorable report was made and seconded; the subcommittee approved the motion by voice vote with members saying "aye." The chair announced the bill passed unanimously.

The subcommittee concluded its work and noted the full Health and Government Operations Committee would meet for a voting session at 2:00 p.m.

Sources: Remarks and testimony on House Bill 15 15 at the Insurance and Pharmaceutical Subcommittee hearing; statements by Erin and Winnie Hawk; questions from Delegate Johnson and Delegate Tavares; procedural motion and unanimous voice vote recorded by Chair Cullison.