(m) In this section the terms "consolidation" and "merger" include increases
and decreases in bed capacity or services among the components of an organization
which:

(1) Operates more than one health care facility; or

(2) Operates one or more health care facilities and holds an outstanding
certificate of need to construct a health care facility.

(n) (1) Notwithstanding any other provision of this section, the Commission
shall consider the special needs and circumstances of a county where a medical
service, as defined in this section, does not exist; and

(2) The Commission shall consider and may approve under this
subsection a certificate of need application to establish, build, operate, or participate
in a health care project to provide a new medical service in a county if the
Commission, in its sole discretion, finds that:

(i) The proposed medical service does not exist in the county that
the project would be located;

(ii) The proposed medical service is necessary to meet the health
care needs of the residents of that county;

(iii) The proposed medical service would have a positive impact on
the existing health care system;

(iv) The proposed medical service would result in the delivery of
more efficient and effective health care services to the residents of that county; and

(v) The application meets any other standards or regulations
established by the Commission to approve applications under this subsection.

[19-116.3 19-124.

(a) In this section, "health maintenance organization" means a health
maintenance organization under Subtitle 7 of this title.

(b) (1) A health maintenance organization or a health care facility that
either controls, directly or indirectly, or is controlled by a health maintenance
organization shall have a certificate of need before the health maintenance
organization or health care facility builds, develops, operates, purchases, or
participates in building, developing, operating, or establishing:

(i) A hospital, as defined in § 19-301 of this title, or an ambulatory
surgical facility or center, as defined in [§ 19-101(f)] § 19-114(B) of this subtitle; and

(ii) Any other health care project for which a certificate of need is
required under [§ 19-115] § 19-123 of this subtitle if that health care project is
planned for or used by any nonsubscribers of that health maintenance organization.

(2) Notwithstanding paragraph (1)(i) of this subsection, a health
maintenance organization or a health care facility that either controls, directly or