B.__In its discretion, the department may conduct additional supervisory activities by:

(1)__Soliciting and reviewing written submissions from the certificate holders, the Attorney General, the Governor's Office of Health Policy and Finance or the public;

(2)__ Conducting a hearing in accordance with Title 5, chapter 375, subchapter 4 and the department's administrative hearings rules; or

(3)__Using any alternative procedures appropriate under the circumstances.

C.__The department shall notify the certificate holders if it intends to consider the imposition of any additional conditions or measures authorized under subsection 3.__If the department notifies certificate holders under this paragraph, the certificate holders may request and are entitled to a hearing in accordance with Title 5, chapter 375, subchapter 4.

D.__A decision of the department regarding additional supervisory activities is governed by the standards set forth in subsection 3.__The burden of proof is on the parties seeking any remedial order.__A remedial order may not issue unless the basis for it is established by a preponderance of the evidence.

3.__Standards governing additional supervisory activities. The provisions of this subsection govern the standards of any additional supervisory activities conducted under subsection 2.

A.__If the department determines in any additional supervisory activities conducted under subsection 2 that the certificate holders are not in substantial compliance with any conditions included in the certificate under section 1844, subsection 5 or in a consent decree entered into by the department, the department may at its discretion:

(1) Impose additional conditions to secure compliance with any conditions included in the certificate or consent decree; or