Maryland requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. Maryland maintains 32 independent CON requirements, and 18 specific exceptions. Maryland also maintains two moratoria, one of which prohibits general hospice services from acquiring homebased hospice services. Two of Maryland’s CON requirements are catch-all CONs. That is, if no other specific CON requirements apply, the catch-all CONs require hospitals to obtain a CON for any expenditure over $12.4 million and non-hospitals to obtain a CON for any expenditure above $6.2 million. Md. Code Regs. § 10.24.01.02(A)(5).
As of May 15, 2020, Maryland had not suspended any CON requirements in response to COVID-19. Existing state regulations, however, provide for an emergency CON application process. Md. Code Regs. § 10.24.01.20 Under the emergency process, providers may request an emergency CON “[i]f a situation presents hazards to employees or patients of a healthcare facility or the closing of a facility by State licensing authorities requires changes or adjustments in other facilities to accommodate displaced patients[.]” Md. Code Regs. § 10.24.01.20(A). As of July 1, 2020, the Maryland Health Care Commission had approved 36 emergency CON applications.
In Maryland, the CON application process takes up to 90 days if competitors do not request an evidentiary hearing or 150 days if competitors request a hearing. Md. Code Regs. § 10.24.01.09(E)(1). Applications can be submitted at any time, and, although the statute allows the establishment of an application fee through regulation, no such fee has been established. Md. Code Regs., Health-Gen. § 19-120(b). Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. Md. Code Regs. § 10.24.01.09(E)(6)(b).