Massachusetts General Laws
Chapter 111 - Public Health
Section 25b - Definitions Applicable to Secs. 25b to 25g

Section 25B. In this section and sections twenty-five C to twenty-five G, inclusive, the following words shall have the following meanings:
''Appropriate regional comprehensive health planning agency,'' the regional agency designated pursuant to the provisions of section three hundred and fourteen (b) the Federal Public Health Service Act, or its successor agency.
''Construction'', construction of a new health care facility; the alteration of, expansion of, making of major repairs to, remodeling of, renovation of or replacement of an existing health care facility; the initial, additional or replacement equipping of any such facility; the acquisition of consulting, architectural, and engineering services, and of site, when such acquisition is directed toward an undertaking sufficiently specific to constitute part of the subject matter of an application for determination of need under section twenty-five C.
''Department'', the department of public health; provided, however, that no member of the public health council who is an owner, in whole or in part, an officer or an employee of a health care facility, or who bears any other fiduciary relationship to such a facility, shall participate in any decision which would substantially affect the facility to which he is related.
''Expenditure minimum with respect to substantial capital expenditures'', with respect to expenditures and acquisitions made by or for: (1) hospitals and comprehensive cancer centers as defined in section 8A of chapter 118E, only, $7,500,000, except that expenditures for, or the acquisition of, major movable equipment not otherwise defined by the department as new technology or innovative services shall not require a determination of need and shall not be included in the calculation of the expenditure minimum; and (2) health care facilities, other than hospitals, and facilities subject to licensing under chapter 111B, with respect to: (a) expenditures for, or the acquisition of, medical, diagnostic or therapeutic equipment, $400,000; and (b) all other expenditures and acquisitions, $800,000; provided, however, that expenditures for, or the acquisition of, any replacement of medical, diagnostic or therapeutic equipment defined as new technology or innovative services for which a determination of need has been issued or which was exempt from determination of need, shall not require a determination of need and shall not be included in the calculation of the expenditure minimum; provided further, that expenditures and acquisitions concerned solely with outpatient services other than ambulatory surgery, not otherwise defined as new technology or innovative services by the department, shall not require a determination of need and shall not be included in the calculation of the expenditure minimum, unless the expenditures and acquisitions are at least $25,000,000, in which case a determination of need shall be required. Notwithstanding the above limitations, hospitals only may elect at their option to apply for determination of need for expenditures and acquisitions less than the expenditure minimum.
''Health care facility'', a hospital or clinic, as defined in section fifty-two; a long-term care facility, a convalescent or nursing home, a rest home or a charitable home for the aged, as defined in section seventy-one; a clinical laboratory subject to licensing under chapter one hundred and eleven D, a public medical institution, which is any medical institution, and, after December first, nineteen hundred and seventy-two, any institution for the developmentally disabled or mentally ill, supported in whole or in part by public funds, staffed by professional, medical and nursing personnel and providing medical care, in accordance with standards established through licensing, approval or certification for participation in the programs administered under Titles 18 and 19 of the Federal Social Security Act, by the department; and any part of such facilities; provided, however, that ''health care facility'' shall not include a facility operated by and for persons who rely exclusively upon treatment by spiritual means through prayer for healing, in accordance with the creed or tenets of a church or religious denomination and in which health care by or under the supervision of doctors of medicine, osteopathy, or dentistry is not provided.
''Health maintenance organization'' or ''HMO'', a public or private organization as defined in section one of chapter one hundred and seventy-six G.
''State comprehensive health planning agency'', the agency designated pursuant to the provisions of section three hundred fourteen (a) of the Federal Public Health Service Act.
''Acute-care hospital'', any hospital licensed under section fifty-one of chapter one hundred and eleven, and the teaching hospital of the University of Massachusetts Medical School, which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department.
''Acute psychiatric service'', a service for inpatients in need of intensive, twenty-four hour per day, psychiatric and nursing care and supervision, not including persons hospitalized for alcohol problems, and which includes a staff of mental health specialists who provide psychiatric, psychological and social evaluation, treatment and aftercare planning.
''Ambulatory surgery'', health care services restricted to those defined by the department as surgical services, not requiring overnight stay, typically provided to ambulatory patients on an elective, urgent, or emergency basis whether provided in a free standing ambulatory surgical center licensed as a clinic pursuant to section 51 or by a hospital.
''Innovative service'', a service or procedure, which for reasons of quality, access, or cost is determined to be innovative by the department.
''Inpatient services'', health care services requiring at least one overnight stay, provided to patients on an elective, urgent, or emergency basis.
''Major movable equipment'', equipment that is not permanently attached to the building and that has a depreciable life of three or more years.
''New technology'', equipment such as magnetic resonance imagers and linear accelerators, as defined by the department, or a service, as defined by the department, which for reasons of quality, access or cost is determined to be new technology by the department.
''Outpatient services'', health care services, not requiring overnight stay, typically provided to ambulatory patients on an elective basis.
''Substantial capital expenditures'', (1) the expenditure, or obligation of a sum of money for construction of a health care facility (a) which under generally accepted accounting principles is not properly chargeable as an expense of operation and maintenance, or is made by lease or comparable arrangement, and (b) which exceeds, or may reasonably be regarded as leading to an expenditure for construction in excess of, the expenditure minimum determined pursuant to this section for an undertaking sufficiently specific to constitute the subject matter of an application for a determination of need under section twenty-five C; or (2) the obtaining by lease or comparable arrangement, by donation, or by transfer for less than fair market value in excess of the expenditure minimum.
''Substantial change in services'', shall mean: (1)(a) with regard to acute-care hospitals only, the addition or expansion of, or conversion to, a new technology or innovative service regardless of whether an expenditure minimum is exceeded; (b) for any acute-care hospital, the addition or expansion of, or conversion to any services which may be provided by facilities which are not acute-care hospitals; except that conversions of acute-care services to skilled nursing, rehabilitation, acute psychiatric, and substance abuse services located in an underbedded areas shall be determined by criteria developed by the department in consultation with the department of elder affairs, department of mental health, the Massachusetts federation of nursing homes, the Massachusetts hospital association and other interested parties, and that no such conversion shall occur until the department has certified in writing the conversions meet the criteria established. The department shall promulgate regulations to implement the provisions of said criteria for underbedded areas including, but not limited to medicaid access, and regulations to define criteria for reconversion; and (2) for any health care facility other than an acute-care hospital (a) the addition of a service which entails annual operating costs in excess of the expenditure minimum determined pursuant to this section; (b) any increase in bed capacity of more than twelve beds; (c) the addition or expansion of, or conversion to, A new technology or innovative service regardless of whether an expenditure minimum is exceeded; (d) provided, however, that no decrease in the level of a service that, pursuant to department regulations, may be offered by a nursing, convalescent, or rest home which does not involve a capital expenditure in excess of eight hundred thousand dollars shall be subject to the provisions of sections twenty-five C to twenty-five G, inclusive; (e) provided, further, that an increase in staff by itself shall not be defined by the department to constitute a substantial change in service unless said increase in staff will result in an addition to annual operating costs which exceeds the expenditure minimum determined pursuant to this section. Notwithstanding any other provisions to the contrary, a change of service concerned solely with outpatient services other than ambulatory surgery, not otherwise defined as a new technology or innovative services, shall not be defined by the department to constitute a substantial change of service.
''Expenditure minimum with respect to expenditures for a change in service or increase in staff'', shall mean three hundred and fifty thousand dollars in annual operating costs.

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