Certificate of public need (COPN) laws apply to the following medical care facilities:
- hospitals of any type, including general, outpatient surgical, psychiatric, and rehabilitative
- nursing homes
- intermediate care facilities for the medical, psychiatric, or psychological treatment and rehabilitation of individuals with substance abuse
- intermediate care facilities for persons with intellectual disabilities with more than 12 beds
- any specialized center or clinic or that portion of a physician's office developed for the provision of:
- outpatient or ambulatory surgery
- cardiac catheterization
- computed tomographic (CT) scanning
- magnetic resonance imaging (MRI)
- positron emission tomographic (PET) scanning
- radiation therapy
- stereotactic radiotherapy other than radiotherapy performed using a linear accelerator
- other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy
- proton beam therapy
Generally speaking, state law requires that a COPN be obtained prior to:
- establishing any medical care facility described above
- increasing the total number of beds or operating rooms in an existing medical care facility
- relocating beds from an existing medical care facility to another existing medical care facility
- adding any new nursing home service at an existing medical care facility
- introducing into an existing medical care facility any of the following services services if it the service has not been provided in the previous 12 months:
- cardiac catheterization
- computed tomographic (CT) scanning
- magnetic resonance imaging (MRI)
- medical rehabilitation
- neonatal special care
- open heart surgery
- positron emission tomographic (PET) scanning
- psychiatric, organ or tissue transplant service
- radiation therapy
- stereotactic radiotherapy other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy
- proton beam therapy
- substance abuse treatment
- converting beds in an existing medical care facility to medical rehabilitation beds or psychiatric beds
- adding in an existing medical care facility any new medical equipment for the provision of:
- cardiac catheterization
- computed tomographic (CT) scanning
- magnetic resonance imaging (MRI)
- open heart surgery
- positron emission tomographic (PET) scanning
- radiation therapy
- stereotactic radiotherapy other than radiotherapy performed using a linear accelerator or other medical equipment that uses concentrated doses of high-energy X-rays to perform external beam radiation therapy
- proton beam therapy
- capital expenditure of $15 million or more by or on behalf of a medical care facility other than a general hospital
- converting in an existing medical care facility of psychiatric inpatient beds approved pursuant to a Request for Applications (RFA) to nonpsychiatric inpatient beds
However, there are exceptions and exclusions to the list above. Please refer to Article 1.1 (§ 32.1-102.1 et seq.)of Chapter 4 of Title 32.1 of the Code of Virginia for more information.
The process for obtaining a COPN is described in the Medical Care Facilities Certificate of Public Need Rules and Regulations (12VAC5-220-10 et seq.).
The following medical care facilities/agencies are licensed by the State Health Commissioner:
- general and outpatient surgical hospitals
- nursing homes
- home care organizations
- hospice programs and hospice facilities
The State Health Commissioner also issues:
- certificates of public need for certain medical care facilities, services, and equipment
- certificates of quality assurance to managed care health insurance plan (MCHIP) carriers
- certificates of registration to private review agents (PRAs)
The Office of Licensure and Certification has the responsibility to investigate any state complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:
- general and outpatient surgical hospitals
- nursing homes
- home care organizations
- hospice programs and hospice facilities
- quality of care provided by managed care health insurance plans
The Office of Licensure and Certification also serves as the state survey agency for the U.S. Centers for Medicare and Medicaid Services and has the responsibility to investigate any federal complaints regarding alleged violations of regulation or applicable law regarding the following facilities and services:
- ambulatory surgical centers
- community mental health centers
- comprehensive outpatient rehabilitation facilities
- critical access hospitals
- end stage renal disease facilities
- federally qualified health centers
- home health agencies
- hospice
- hospitals
- inpatient rehabilitation facility
- intermediate care facilities for individuals with intellectual disabilities
- laboratories and any location performing diagnostic testing on human specimens
- nursing facilities and skilled nursing facilities
- organ transplant programs
- outpatient rehabilitation providers (physical therapy/speech pathology)
- portable x-ray
- psychiatric hospitals
- psychiatric residential treatment facilities
- rural health clinics
Complaints can be made in writing, via email at OLC-Complaints@vdh.virginia.gov, or by phone at 1-800-955-1819 or in the Richmond Metro Area at 804-367-2106.
The Virginia Department of Health does not regulate assisted living facilities. All complaints regarding assisted living facilities should be filed with the Division of Licensing Programs at the Department of Social Services here.
Not sure whether the facility you're complaining about is a nursing home or an assisted living facility? You can use our Inspection and Survey library to search for nursing homes and DSS's assisted living facility search to confirm which agency should receive your complaint.
Yes, but if you would like to receive the results of our investigations, we will need contact information.
All complaints regarding physicians, nurses, dentists and other licensed health care practitioners should be filed with the appropriate board of the Virginia Department of Health Professions at: 1-800-533-1560.
The Virginia Department of Health accepts complaints about health insurance plans if a consumer:
- has had a claim for a covered benefit was denied by the plan
- is misinformed about medical coverage provided by the plan
- is not notified or properly notified of changes in the plan or in the plan’s network of health care practitioners
- cannot get timely access to care
- does not receive acknowledgement or resolution of a grievance filed with their health insurance plan
The following types of complaints should be directed to the Office of the Managed Care Ombudsman in the State Corporation Commission's Bureau of Insurance at 1-877-310-6560 or in the Richmond Metro area at 804-371-9746:
- medical necessity denials and utilizations review denials
- experimental/investigation denials
- medication/pharmacy denials
- pre-existing conditions
- payment denials
- increases in premiums
- disability conditions