(i) (1) A certificate of need is required before the type or scope of any health
care service is changed if the health care service is offered:

(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 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 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, or burn or neonatal intensive health care service;

3. Establishment of a home health program, hospice
program, or freestanding ambulatory surgical center or facility; or

4. Expansion of a comprehensive care, 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

(iv) 1. At least 45 days before increasing or decreasing the
volume of 1 or more health care services, written notice of intent to change the volume
of health care services is filed with the Commission;

2. The Commission in its sole discretion finds that the

proposed change:

A. Is pursuant to the consolidation or merger of 2 or more
health care facilities, or conversion of a health care facility or part of a facility to a
nonhealth-related use;

B. Is not inconsistent with the State health plan or the
institution-specific plan developed and adopted by the Commission;

C. Will result in the delivery of more efficient and effective
health care services; and