§ 44-401 — Definitions.

District of Columbia § 44-401

• Jurisdiction: District of Columbia
• Title 44: Charitable and Curative Institutions.
• Ch. 4: Health Services Planning.

Text

(a) For the purposes of this chapter, the term:

(1) “Acquiring of effective control” means:

(A) Any transfer, assignment or other disposition of 50% or more of the stock, voting rights thereunder, ownership interest, or operating assets of a corporation or other entity which is a HCF or is the operator or owner of a HCF;

(B) Any transaction which results in any person, or any group of persons acting in concert, owning or controlling, directly or indirectly, 50% or more of the stock, voting rights thereunder, ownership interest, or operating assets of such a corporation or other entity;

(C) Any transaction which results in any person, or any group of persons acting in concert, having the ability to elect or cause the election of a majority of the board of directors of such a corporation; or

(D) Any conversion which results in the selling, transferring, leasing, exchanging, conveying, or otherwise disposing of, directly or indirectly, all the assets or a material amount of the assets, as defined by § 44-602 , of a nonprofit HCF to a for-profit entity whether a corporation, mutual benefit corporation, limited liability partnership, general partnership, joint venture, or sole proprietorship, including such an entity that results from, or is created in connection with, the conversion.

(2) “Annual Implementation Plan” means the plan prepared annually by the State Health Planning and Development Agency and the Statewide Health Coordinating Council to specify actions which will achieve the goals and objectives of the Health Systems Plan.

(A) “Bad debt” means an account receivable based on physician and hospital medical services furnished to any patient for which payment is:

(i) Expected, but is regarded as uncollectible following reasonable collection efforts; and

(ii) Not the obligation of any federal, state, or local governmental unit.

(B) The term “bad debt” does not include charity care.

(A) "Capital expenditure" means:

(i) Any expenditure by or on behalf of a hospital, including a private general, rehabilitation, or psychiatric or other specialty hospital that is, under generally accepted accounting principles, not properly chargeable as an expense of operation or maintenance and exceeds $15 million; except, that the SHPDA shall, by rule, adjust this threshold every 2 years to reflect the change in the Producer Price Index for New Health Care Building Construction issued by the United States Bureau of Labor Statistics or a comparable index;

(ii) For all health care facilities not specified in sub-subparagraph (i) of this subparagraph, any expenditure by or on behalf of a health care facility, or by or on behalf of a person that is, under generally accepted accounting principles, not properly chargeable as an expense of operation or maintenance and exceeds $5 million; except, that the SHPDA shall, by rule, adjust this threshold every 2 years to reflect the change in the Producer Price Index for New Health Care Building Construction issued by the United States Bureau of Labor Statistics or a comparable index;

(iii) Any expenditure for the acquisition of major medical equipment; except, for the replacement of existing major medical equipment with new equipment intended for the same purpose;

(iv) Any expenditure for any acquisition under a lease or comparable arrangement, or through any other type of transfer that would have constituted a capital expenditure under this paragraph if the acquisition had been made at fair market value;

(v) Any expenditure for any acquisition under a lease, comparable arrangement, through donation, or through any other type of transfer by 2 or more persons acting in concert, where the aggregate cost of the acquisition would have constituted a capital expenditure under this paragraph if the acquisition had been by purchase at fair market value, notwithstanding that the cost or value to each participating person of the acquisition would not, alone, constitute a capital expenditure under this paragraph; and

(vi) Any expenditure for any action or combination of related actions by a person or by 2 or more persons acting in concert that results in acquiring effective control of a health care facility or any other corporation, partnership, limited liability company, or other entity that holds a certificate of need and which would have constituted a capital expenditure under this paragraph if the acquisition or intended acquisition had been by purchase at a fair market value.

(B) For purposes of this paragraph, the cost of studies, appraisals, charitable donations, title searches, in-kind contributions, Internal Revenue Service 1031 exchanges, acquisition of contracts, supplies and equipment, surveys, designs, plans, working drawings, specifications, site preparation, construction, related equipment, legal fees, and other activities essential to or related to the capital expenditure shall be included in determining the total costs of the expenditure.

(C) The term "capital expenditure" shall not include an expenditure on a nonpatient care project or renovations of existing facilities that do not increase or decrease the number of licensed beds or types of services provided by the facility.

(3A) "Certificate of need" means a document obtained from the SHPDA that demonstrates a public need for the new service or expenditure, as described in § 44-406(a) .

(3B) “Charity care” means the physician and hospital medical services provided to persons who are unable to pay for the cost of services, especially those persons who are low-income, uninsured and underinsured, but excluding those services determined to be caused by, or categorized as, bad debt.

(4) Repealed.

(5) Repealed.

(6) Repealed.

(6A) “Department” means the Department of Health.

(A) “Diagnostic health care facility” means:

(i) A diagnostic imaging center accredited by the American College of Radiology whose primary business is the provision of diagnostic imaging services to the public;

(ii) A cardiac catheterization laboratory;

(iii) A radiation therapy facility; or

(iv) An independent diagnostic laboratory whose primary business is the provision of diagnostic imaging services to the public and at which at least 3 of the following exams are performed:

(I) Magnetic resonance imaging;

(II) CAT scan;

(III) Nuclear medicine;

(IV) Ultrasound;

(V) X-ray; or

(VI) Mammography.

(B) The term "diagnostic health care facility" shall not include any facility that would be exempt from the definition of health care facility under paragraph (10) of this section.

(7) “Director” means the director of the SHPDA established by § 44-402 .

(7A) “Director of the Department of Mental Health” means the Director of the Department of Mental Health established by § 7-1131.03 .

(8) “District government” means the government of the District of Columbia.

(9) “Ex parte contact” means an oral or written communication not on the official record where reasonable contemporaneous notice to all parties is not given.

(9A) “Expedited administrative review” means a review conducted by the SHPDA staff, using the same criteria and standards that apply to projects reviewed through use of the regular process, the results of which are reported to the SHCC at the next regularly scheduled SHCC meeting.

(A) "Group practice" means a group of 2 or more health professionals legally organized as a partnership, professional corporation, foundation, not-for-profit corporation, faculty practice plan, or similar association authorized to do business in the District of Columbia, for which:

(i) Each health professional who is a member of the group is licensed to practice in the District of Columbia and provides substantially the full range of services that a health professional with that license routinely provides, including medical care, consultation, diagnosis, or treatment, through the joint use of shared office space, facilities, equipment and personnel;

(ii) Substantially all of the services of the health professionals who are members of the group are provided through the group and are billed under a billing number assigned to the group and amounts so received are treated as receipts of the group;

(iii) The overhead expenses of, and the income generated from, the practice are distributed in accordance with methods previously determined by group members;

(iv) Except as provided in subparagraph (B) of this pararaph, no health professional who is a member of the group directly or indirectly receives compensation based on the volume or value of referrals made by the health professional; and

(v) Members of the group personally conduct no less than 75 percent of the physician-patient encounters of the group practice.

(B) A health professional in a group practice may be paid a share of overall profits of the group, or a productivity bonus based on services personally performed or services incident to such personally performed services, so long as the share or bonus is not determined in any manner which is directly related to the volume or value of referrals made by such health professional.

(C) In the case of a faculty practice plan associated with a hospital, institution of higher education, or medical school with an approved medical residency training program in which health professional members may provide a variety of different specialty services and provide professional services both within and outside the group, as well as perform other tasks such as research, subparagraph (A) of this paragraph shall apply only with respect to the services provided within the faculty practice plan.

(A) "Health care facility" or "HCF" means any private general hospital, psychiatric hospital, other specialty hospital, rehabilitation facility, skilled nursing facility, intermediate care facility, freestanding emergency department, urgent care facility, ambulatory surgical facility with at least one operating room, kidney disease treatment center, freestanding hemodialysis facility, diagnostic health care facility, home health agency, hospice, or other comparable health care facility which has an annual operating budget of at least $500,000.

(B) The term "health care facility" shall not include:

(i) A private office facility, clinic, or other establishment with no operating room where one or more health professionals provide primary care services, specialty care services, or dental services according to the applicable scope of practice of the health professional's licensure;

(ii) A virtual provider network or virtual telehealth platform;

(iii) A facility providing outpatient or residential behavioral health services subject to the exclusive regulatory authority of the Department of Behavioral Health;

(iv) A federally qualified health center, as defined in section 1861(aa)(4) of the Social Security Act, approved July 30, 1965 (79 Stat. 313; 42 U.S.C. § 1395x(aa)(4)), or an entity that has been determined by the Health Resources and Services Administration of the United States Department of Health and Human Services to meet the definition of a federally qualified health center, but does not receive funding under section 330 of the Public Health Service Act, approved October 11, 1996 (110 Stat. 3626; 42 U.S.C. § 254b) ("federally qualified health center look-alike"); or

(v) A health care facility licensed or to be licensed as a community residence facility, except for an intermediate care facility, or an Assisted Living Residence as defined by § 44-102.01(4) .

(11) “Health Maintenance Organization” (“HMO”) means a private organization which is a qualifying HMO under federal regulations or has been determined to be an HMO pursuant to rules issued by the SHPDA in accordance with this chapter.

(12) “Health service” means any medical or clinical related service, including services that are diagnostic, curative, or rehabilitative, as well as those related to inpatient mental health services, home health care, hospice care, medically supervised day care, and renal dialysis. The term “health service” shall not include any service provided by an entity that would be exempt from the definition of health care facility under paragraph (10) of this section.

(13) “Health Systems Plan” (“HSP”) means the comprehensive health plan prepared by the SHPDA and the SHCC in accordance with this chapter.

(A) "Major medical equipment" means:

(i) For private general, rehabilitation, or psychiatric or other specialty hospitals, equipment used for the provision of medical or other health services that is acquired by lease, purchase, donation, or other comparable arrangement by or on behalf of such hospitals, and has a fair market value in excess of $3.5 million; except, that the SHPDA shall, by rule, adjust this threshold every 2 years to reflect the change in the Producer Price Index for Medical Equipment and Supplies Manufacturing issued by the United States Bureau of Labor Statistics or such comparable index;

(ii) For all health care facilities not specified in sub-subparagraph (i) of this subparagraph, equipment used for the provision of medical or other health services that is acquired by lease, purchase, donation, or other comparable arrangement by or on behalf of a health care facility, or by or on behalf of any private group practice of diagnostic radiology or radiation therapy and has a fair market value in excess of $2 million; except, that the SHPDA shall, by rule, adjust this threshold every 2 years to reflect the change in the Producer Price Index for Medical Equipment and Supplies Manufacturing issued by the United States Bureau of Labor Statistics or such comparable index; or

(iii) A single piece of diagnostic or therapeutic equipment that is acquired by lease, purchase, donation, or other comparable arrangement by or on behalf of a physician or group of physicians (excluding those referenced in sub-subparagraph (i) of this subparagraph), or an independent owner or operator of the equipment, and has a fair market value is in excess of $350,000; except, that the SHPDA shall, by rule, adjust this threshold every 2 years to reflect the change in the Producer Price Index for Medical Equipment and Supplies Manufacturing issued by the United States Bureau of Labor Statistics or such comparable index.

(B) In determining whether medical equipment has a fair market value in excess of the amount specified in subparagraph (A)(i) of this paragraph, the cost of studies, surveys, designs, plans, working drawings, specifications, site preparation, construction, related equipment, and other activities essential to the acquisition of the equipment shall be included.

(C) The term "major medical equipment" does not include medical equipment acquired by or on behalf of a clinical laboratory to provide clinical laboratory services if the clinical laboratory is independent of a physician's office or a hospital and meets the requirements of section 1861(s)(10) and (11) of the Social Security Act, approved August 14, 1935 (49 Stat. 420; 42 U.S.C. 1395x(s)).

(15) “New institutional health service” means:

(A) The construction, development, or other establishment of:

(i) A health care facility;

(ii) A home health or home nursing service;

(iii) Any new health service with a physical location; or

(iv) A change in the licensed bed capacity of a facility by 10 beds or 20%, whichever is less, within a 2-year period.

(B) Any health service offered by or on behalf of a HCF and which was not offered on a regular basis by the HCF within the 12-month period prior to the time the service would be offered or which involves an operating budget of at least $600,000 in direct costs for the first year of operation, except that the SHPDA shall, by rule, adjust this threshold every 2 years to reflect the change in the medical care component of the Consumer Price Index issued by the Bureau of Labor Statistics, U.S. Department of Labor or a comparable index, or which results in a capital expenditure in any amount.

(15A) "Nonpatient care project" means any capital project by a healthcare facility or a hospital that does not solely, directly or indirectly, impact clinical procedures, treatments, patient interactions, or clinical areas, such as the construction or renovation of administrative offices, purchase of non-medical equipment, such as office furniture or information technology systems, including electronic medical records, renovation or replacement of electrical, heating, cooling, ventilation systems, elevator and escalators or other means of ingress and egress, or fire and life safety systems, and other projects that are focused solely on supporting the administrative functions of the facility.

(16) “Person” means an individual, a trust, or estate, a partnership, or a corporation (including associations, joint stock companies, and insurance companies), the District government, or an agency, subdivision, or instrumentality of the District government.

(17) “Social Security Act” means the Social Security Act, approved August 14, 1935, as amended (49 Stat. 520; 42 U.S.C. 301 et seq.)

(18) “Statewide Health Coordinating Council” (“SHCC”) means the Statewide Health Coordinating Council established by § 44-403 to advise the State Health Planning and Development Agency on certain health planning functions as specified in this chapter.

(19) “State Health Planning and Development Agency” (“SHPDA”) means the agency for the District of Columbia within the Department of Health responsible for carrying out the District government’s health planning and development program established by § 44-402 .

(20) “Uncompensated care” means the cost of health care services rendered to a patient, regardless of the patient's residency, for which the health care facility does not receive payment. The term “uncompensated care” includes bad debt and charity care, but does not include contractual allowances.

(21) "Virtual provider network" means a provider-owned and managed entity which employs or contracts with licensed health care providers, and which exclusively provides telehealth or telemedicine health care services through a virtual telehealth platform. The term "virtual provider network" shall not include an entity that maintains a physical facility, office, or other similar location in any jurisdiction where a person may go to seek care in person.

(22) "Virtual telehealth platform" means a digital-only telehealth or telemedicine entity which facilitates the ability of patients to access licensed health care providers by exclusively providing health care services through a virtual provider network. The term "virtual telehealth platform" shall not include an entity that maintains a physical facility, office, or other similar location in any jurisdiction where a person may go to seek care in person.

Legislative History

Apr. 9, 1997, D.C. Law 11-191, § 2, 43 DCR 4535; Oct. 23, 1997, D.C. Law 12-32, § 12(a)(1), 44 DCR 4819; Apr. 20, 1999, D.C. Law 12-264, § 33, 46 DCR 2118; June 24, 2000, D.C. Law 13-127, § 1402, 47 DCR 2647; July 12, 2001, D.C. Law 14-18, § 8(1), 48 DCR 4047; Dec. 18, 2001, D.C. Law 14-56, § 116(i)(1), 48 DCR 7674; June 5, 2003, D.C. Law 14-307, § 2002(a), 49 DCR 11664; Mar. 13, 2004, D.C. Law 15-105, § 22(c), 51 DCR 881; Apr. 22, 2004, D.C. Law 15-149, § 2(a), 51 DCR 2802; Feb. 26, 2015, D.C. Law 20-155, § 5062, 61 DCR 9990