Ch. 688                                          LAWS OF MARYLAND

(i) By a health care facility;

(ii) In space that is leased from a health care
facility; or

(iii) In space that is on land leased from a
health care facility.

(2) This subsection does not apply if:

(i) The Commission adopts limits for changes in
health care services and the proposed change would not exceed
those limits;

[(ii) The proposed change would add a new
health care service and:

1. During a 1-year period, the annual
operating revenue that would result from the addition is less
than $250,000 after an annual adjustment for inflation, based on
an appropriate index specified by the Commission; or

2.] (II) THE PROPOSED CHANGE AND the
annual operating revenue that would result from the addition is
entirely associated with the use of medical equipment;

[(iii) The proposed change would increase or
decrease the volume of one patient service and, during a 2-year
period, the change is less than 25 percent of that volume; or]

(III) THE PROPOSED CHANGE WOULD ESTABLISH,
INCREASE , OR DECREASE A HEALTH CARE SERVICE AND THE CHANGE
WOULD NOT RESULT IN THE:

1.  ESTABLISHMENT OF A NEW MEDICAL SERVICE
OR ELIMINATION OF AN EXISTING MEDICAL SERVICE;

2.  ESTABLISHMENT OF AN OPEN HEART
SURGERY, ORGAN TRANSPLANT SURGERY, BURN OR NEONATAL INTENSIVE
HEALTH CARE SERVICE;

3.  ESTABLISHMENT OF A HOME HEALTH
PROGRAM, HOSPICE PROGRAM, OR FREESTANDING AMBULATORY SURGICAL
CENTER OR FACILITY PROGRAM; OR

4.  EXPANSION OF A COMPREHENSIVE CARE
PROGRAM, INCLUDING AN INTERMEDIATE CARE OR EXTENDED CARE PROGRAM,
EXTENDED CARE, INTERMEDIATE CARE, RESIDENTIAL TREATMENT,
PSYCHIATRY, OR REHABILITATION MEDICAL SERVICE, EXCEPT FOR AN
EXPANSION RELATED TO AN INCREASE IN TOTAL BED CAPACITY IN
ACCORDANCE WITH SUBSECTION (H)(2)(I) OF THIS SECTION; OR

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