D.C. Mun. Regs. tit. 22, r. 22-B4005
The Director shall specify in the CON the maximum amount of capital expenditure that may be obligated under the CON.
A CON holder shall report a proposed change in the project budget that will result in an expenditure greater than the maximum capital expenditure specified in the CON.
A CON holder shall request the Director's approval for a proposed change in the project budget that will result in an expenditure that is twenty-five per cent (25%) or more larger than the approved capital expenditure specified in the CON. The Director shall issue a decision on a proposed change in not more than thirty (30) days after receiving a request to modify the project budget. A CON holder shall not commence work on the proposed changes that are twenty-five per cent (25%) or more than the maximum capital expenditure before the Director approves the modification.
A CON holder shall report cumulative costs of individual budget changes to the Director for review and approval as part of the CON holder's regular, periodic reports. A CON holder shall submit a new application for any proposed change that exceeds the proposed budget by more than fifty per cent (50%) of the approved capital expenditure.
Except for routine construction change orders, the purpose of which is to correct architectural or engineering errors or to compensate for errors in "as built" drawings of existing buildings, errors in surveys, or similar types of errors, all proposed changes to an approved project budget shall be promptly reported to SHPDA.
A CON holder shall report routine construction change orders when the CON holder reports completion of the project.
If the Director determines that a proposed non-budgetary change will not affect patient care, the Director may approve the change (subject to reconsideration and appeal) without referring the change to SHCC for review. If the Director approves a change pursuant to this subsection, the Director shall notify SHCC of the change at the next monthly meeting of SHCC.
If patient care is not significantly affected, and, if either of the following conditions is met, SHPDA shall approve or disapprove the change without referral to SHCC, and shall notify SHCC at the next scheduled SHCC meeting:
If a new CON is required pursuant to Subsection 4005.4, the Director shall consider the date of issuance of the original CON to be the date of issuance of the consolidated CON for all SHPDA purposes, including quarterly reports and extension schedules.
A CON holder shall report each proposed change to the specifications (as stated in the approved CON) of a project. This report shall include any service, any equipment, and any other type of change whatsoever to the specifications of an approved project.
If the Director determines that a proposed non-budgetary change will not significantly affect patient care, the Director may issue a decision that the change may be made (subject to reconsideration and appeal) without prior approval of the SHCC.
SHPDA shall update its files concerning the nature of the change and shall notify the SHCC at the next scheduled SHCC meeting.
If the Director finds that a proposed non-budgetary change would substantially affect patient care, the Director shall require the CON holder to apply for and receive a new CON before the proposed change may be implemented.
If a new CON is required under Subsection 4005.13, SHPDA shall consider the date of issuance of the original CON to be the date of issuance of the consolidated CON for all SHPDA purposes, including quarterly reports and extension schedules.
A proposed change in a completed project associated with a capital expenditure for which SHPDA has previously issued a CON shall require review and issuance of a new CON if the change is proposed within two (2) years after the date the activity for which the expenditure was approved is undertaken. (For example, if a hospital receives approval to construct a new wing, the hospital will "undertake the activity" when it begins to provide services in the wing. If, in the two (2) years after undertaking the activity, the hospital decides to increase the number of beds in the wing by a number that would not otherwise trigger a review, a review would still be required.). For the purposes of this section, a CON holder has undertaken an activity when it begins to provide services under the CON.
The provisions of Subsection 4005.15 shall apply to a change associated with capital expenditures that are subject to review under this title.
SHPDA review and approval shall be required regardless of whether a capital expenditure is associated with the proposed change.
A "change in a project" shall include, at a minimum, any change in the bed capacity of a facility or the addition or termination of a health service.
D.C. Mun. Regs. tit. 22, r. 22-B4005