The Va. Code requires COPN approval for “[a]ny capital expenditure of $15 million or more, not defined as reviewable in subdivisions 1 through 7 of this definition, by or on behalf of a medical care facility...[t]he amounts specified in this subdivision shall be revised effective July 1, 2008, and annually thereafter to reflect inflation using appropriate measures incorporating construction costs and medical inflation.” 32.1-102.1 (emphasis added).  In order to comply with the Va. Code, the Virginia Department of Health should amend the proposed fast track rule to state that the revised thresholds will become effective annually, on July 1.  The proposed rule should also be amended to require that each year the revised thresholds be published in the General Notices section of the Virginia Register and posted to the Department’s website by July 1.

The Virginia Hospital & Healthcare Association has shared with numerous planning and legal experts these fast-track regulations proposing the use of the Consumer Price Index for All Urban Consumers (CPI-U) to update the annual capital expenditure threshold.  We appreciate this opportunity to submit these comments noting the consensus among these experts on the proposal.  Generally, we support the use of the CPI-U to calculate the capital expenditure threshold.  However, we suggest that the regulations should be clarified in two respects:

• While the draft regulation refers to “expense category,” the proper term seems to be “expenditure category.” 
• The draft regulation references the “expense category ‘Medical Care.’”  However, the CPI-U includes two categories similarly named – “Medical care commodities” and “Medical care services.” This reference should be clarified.