Section 68-11-1609 - Decision on application(a) The commission shall, upon consideration of an application and review of the evaluation and other relevant information:(1) Approve part or all of the application and grant a certificate of need, upon lawful conditions that the commission deems appropriate and enforceable on the grounds that those parts of the proposal appear to meet applicable criteria. However: (A) A condition that is placed on a certificate of need, and that appears on the face of the certificate of need when issued, must also be made a condition of any corresponding license issued by the commission or department of mental health and substance abuse services. Notwithstanding a law to the contrary, the condition survives the expiration of the certificate of need and remains effective until removed or modified by the commission. The condition becomes a requirement of licensure and must be enforced by the respective licensing entity; and(B) The holder of a license or certificate of need that has a condition placed on it by the commission may subsequently request that the condition be removed or modified, for good cause shown. The commission shall consider the request and determine whether or not to remove or modify the condition. The procedure for requesting a determination must be done as provided by commission rules. If the holder of the license or certificate of need is aggrieved by the commission's decision, then the holder may request a contested case hearing as permitted by this part;(2) Disapprove part or all of the application and deny a certificate of need on the grounds that the applicant has not affirmatively demonstrated that those parts of the proposal meet the applicable criteria; or(3) Defer making a decision for no more than ninety (90) days to obtain a clarification of information concerning applications properly before the commission, if there are no simultaneous review applications being concurrently considered by the commission with the deferred application.(b) A certificate of need shall not be granted unless the action proposed in the application is necessary to provide needed health care in the area to be served, will provide health care that meets appropriate quality standards, and the effects attributed to competition or duplication would be positive for consumers. In making these determinations, the commission shall use as guidelines the goals, objectives, criteria, and standards adopted to guide the commission in issuing certificates of need. Until the commission adopts its own criteria and standards by rule, those in the state health plan apply. Additional criteria for review of applications must also be prescribed by the rules of the commission.(c) Activity authorized by a certificate of need must be completed within a period not to exceed three (3) years for hospital and nursing home projects, and two (2) years for all other projects, from the date of its issuance and after such time the certificate of need authorization expires. However, the commission may, in granting the certificate of need, allow longer periods of validity for certificates of need for good cause shown. Subsequent to granting the certificate of need, the commission may extend a certificate of need for a period upon application and good cause shown, accompanied by a nonrefundable reasonable filing fee, as prescribed by rule. A certificate of need authorization that has been extended expires at the end of the extended time period. The decision whether to grant an extension is within the sole discretion of the commission and is not subject to review, reconsideration, or appeal.(d) If the time period authorized by a certificate of need has expired, then the certificate of need authorization is void. A revocation proceeding is not required. A license or occupancy approval shall not be issued by the commission or the department of mental health and substance abuse services for an activity for which a certificate of need has become void.(e) The commission's decision to approve or deny an application is final and shall not be reconsidered after the adjournment of the meeting in which the matter was considered. This subsection (e) does not limit the right to file a petition for a contested case hearing pursuant to § 68-11-1610, nor does it limit the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, pertaining to contested case hearings.(f) Written notice of the commission decision approving, disapproving, or deferring an application, or parts of an application, must be transmitted to the applicant, simultaneous review applicants, the department of health, the department of mental health and substance abuse services, the department of disability and aging, and others upon request.(g)(1) A healthcare institution wishing to oppose a certificate of need application must be located within a thirty-five-mile radius of the location of the action proposed, and must have served patients within that radius within the three hundred sixty-five (365) days immediately preceding the date of filing the certificate of need application. A healthcare institution wishing to oppose an application for the establishment of a home care organization, the modification of a certificate of need issued to a home care organization, or the addition of counties to the licensed service area of an existing home care organization must have served patients in at least one (1) of the counties in the application's proposed service area within the seven hundred thirty (730) days immediately preceding the filing date of the certificate of need application, rather than demonstrate proximity within a thirty-five-mile radius of the location.(2) Subject to subdivision (g)(1), a healthcare institution wishing to oppose a certificate of need application must file a written objection with the commission specifying reasons why one (1) or more of the criteria of subsection (b) are not satisfied. A healthcare institution wishing to oppose a certificate of need application must serve a copy to the contact person for the applicant, not later than fifteen (15) days before the commission meeting at which the application is originally scheduled. An application for which the commission has received opposition must be designated on the commission's agenda as an opposed application.(3)(A) Subject to subdivision (g)(1), a healthcare institution wishing to oppose a certificate of need application may appear before the commission and express opposition to the application as long as the healthcare institution has submitted written opposition in accordance with subdivision (g)(2).(B) This subsection (g) does not prohibit an individual acting in the individual's capacity as a private citizen from appearing before the commission and expressing opposition to an application.(4) A healthcare institution or other person expressing opposition to an application does not have a veto over an application. The merits of opposition may be considered by the commission while determining whether to approve or deny a certificate of need application in whole or in part.(h) The commission shall maintain continuing oversight over a certificate of need that it approves on or after July 1, 2016. Oversight by the commission includes requiring annual reports for the first three (3) years of the implementation of the certificate of need concerning appropriate quality measures as determined by the commission. The commission may impose conditions on a certificate of need that require the demonstration of compliance with quality measures as long as the conditions for quality measures are not more stringent than those measures identified by the applicant in the applicant's submitted application.(i)(1)(A) Notwithstanding a law to the contrary, and except as provided in subdivision (i)(2), a certificate of need and activity the certificate authorizes become void if the actions the certificate authorizes have not been performed for a continuous period of two (2) years after the date the certificate of need is implemented. A revocation proceeding is not required. The commission and the department of mental health and substance abuse services shall not issue or renew a license for an activity for which certificate of need authorization has become void.(B) With respect to a home care organization, this subsection (i) applies to whether the home care organization provides home health services anywhere within its service area, and not on the basis of each county for which the home care organization is licensed.(2)(A) The commission may issue a temporary exemption to subdivision (i)(1) upon finding that sufficient cause for the temporary cessation of the activity has been presented to the commission along with a plan to resume the activity in the future.(B) The commission shall prescribe the procedures for issuing temporary exemptions by rule.(C) The commission's approval or denial of a temporary exemption is a final commission decision subject to appeal in the chancery court of Davidson County.(3) This subsection (i) does not apply to the establishment of a healthcare institution or a healthcare institution's number of licensed beds if the healthcare institution has a license issued under this title, whether active or inactive.(j) If an applicant's application is denied by the commission, then the commission shall provide to the applicant written documentation with an explanation of the factual and legal basis upon which the commission denied the certificate of need.Amended by 2024 Tenn. Acts, ch. 688,s 170, eff. 7/1/2024.Amended by 2022 Tenn. Acts, ch. 1119, Secs.s 131, s 167 eff. 7/1/2022.Amended by 2022 Tenn. Acts, ch. 1119, Secs.s 132, s 133, s 134, s 168, s 169 eff. 7/1/2022.Amended by 2021 Tenn. Acts, ch. 557, s 1, eff. 10/1/2021.Amended by 2021 Tenn. Acts, ch. 557, s 8, eff. 5/26/2021.Amended by 2016 Tenn. Acts, ch. 1043, s 15, eff. 7/1/2016.Amended by 2016 Tenn. Acts, ch. 1043, Secs.s 16, s 17 eff. 7/1/2016.Amended by 2016 Tenn. Acts, ch. 785, s 1, eff. 7/1/2016.Amended by 2015 Tenn. Acts, ch. 359, s 1, eff. 7/1/2015.Amended by 2014 Tenn. Acts, ch. 874, s 1, eff. 7/1/2014.Amended by 2013 Tenn. Acts, ch. 311, s 1, eff. 7/1/2013.Acts 2002, ch. 780, § 4; 2004, ch. 942, § 6; 2005, ch. 237, § 1; 2007 , ch. 347, § 1; 2009 , ch. 461, § 1; 2010 , ch. 1100, §§ 119-121; 2011 , ch. 479, § 1; 2012 , ch. 575, § 1.