(a)  The licensing agency shall issue no new initial licenses for nursing facilities prior to July 1, 2022; provided, however, that any person holding a nursing facility license may undertake activities to construct and operate a replacement nursing facility with the same or lower bed capacity as is presently licensed, provided that the replacement facility may only be licensed upon the otherwise unconditional cessation of operation of the previously licensed nursing facility.

(b)  Prior to July 1, 2022, and with the exception of the culture initiative pursuant to subsection (d), the licensing agency shall not increase the licensed bed capacity of any existing licensed nursing facility, including any nursing facility approved for change in ownership pursuant to § 23-17-14.3 and § 23-17-14.4, to greater than the level of the facility’s licensed bed capacity as of August 21, 1996, plus the greater of ten (10) beds or ten percent (10%) of the licensed bed capacity. Any person holding a previously issued and valid certificate of need as of the date of passage of this section, or who shall subsequently be granted a certificate of need pursuant to subsection (a), shall be permitted to effect a prior certificate from the licensing agency consistent with any other statutory and regulatory provisions that may further apply. Notwithstanding any other provision of the law to the contrary, including any moratorium on increasing bed capacity in nursing facilities that may otherwise apply, the licensing agency shall be permitted to increase the licensed bed capacity of an existing nursing facility by no more than the number of beds previously licensed to one or more other licensed nursing facilities provided that:

(1)  All nursing facilities involved in any such transaction must be located within the same municipality;

(2)  The owner of a licensed nursing care facility seeking to increase its licensed bed capacity must receive approval, following review by the health services council from the licensing agency for change in owner of the nursing facility or facilities;

(3)  The nursing facility’s licensed bed capacity may only be increased upon the otherwise unconditional cessation of operation of the previously licensed other nursing facility or facilities and the return of the license of the nursing facility or nursing facilities to the licensing agency; and

(4)  The licensed nursing care facility seeking to increase its licensed bed complement must comply with any requirements of the health care certificate of need act, chapter 15 of this title.

(c)  Notwithstanding any other provision of the law to the contrary, including any moratorium on increasing bed capacity in nursing facilities that may otherwise apply, a nursing facility may take out of service any or all beds of its licensed capacity without impediment to its right to place back into service those beds at a future date under the same terms and conditions as applied at the time of taking them out of service.

(d) Culture-change initiative.  Notwithstanding any other provision of the law to the contrary, including any moratorium on increasing bed capacity in nursing facilities that may otherwise apply, the licensing agency may increase the licensed bed capacity of any existing licensed nursing facility, including any nursing facility approved for change in ownership pursuant to § 23-17-14.3 and § 23-17-14.4, for the purposes of nursing facility culture change, in accordance with the following criteria and procedures:

(1)  Culture-change definitions and criteria shall be established through regulation to restrict beds added under this initiative only to beds that are designed to provide enhanced quality of life to nursing facility residents through the adoption of principles and building designs established by the “Eden Alternative,” “Green House,” or “Small House” programs or other like means;

(2)  Only beds taken out of service due to facility closure after January 1, 2010, shall be available for facility expansion under this culture-change initiative subsection. The total number of beds that may be licensed to increase capacity under this culture-change initiative shall be limited to ninety percent (90%) of the first fifty (50) beds that are taken out of service, to seventy percent (70%) of the next fifty (50) beds that are taken out of service, and to fifty percent (50%) of any additional beds taken out of service;

(3)  Only nursing facilities licensed in the state are eligible to expand under the culture-change initiative;

(4)  The department shall promulgate regulations to govern an open and competitive process to determine the licensure of expansion beds under this culture-change initiative, and shall consider the impact on the regional distribution of, and access to, nursing facility beds in the state; and

(5)  Any facility seeking to expand its licensed bed capacity under this initiative, that will result in an expenditure that meets or exceeds the criteria for determination of need review under chapter 15 of this title, shall be required to receive approval under chapter 15 of this title.