24 LC 33 9654
House Bill 1339
By: Representatives Parrish of the 158
th
, Burns of the 159
th
, Hawkins of the 27
th
, Beverly of
the 143
rd
, and Taylor of the 173
rd
A BILL TO BE ENTITLED
AN ACT
To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to
1
revise relative to certificate of need; to revise a definition; to provide for review of the state2
health plan every five years; to eliminate capital expenditure thresholds in certain3
circumstances; to revise provisions relating to acceptance and review of applications; to4
provide a timeframe for opposing an application; to revise exemptions from certificate of5
need requirements; to provide for a review of the statutory framework of the certificate of6
need program; to provide for automatic repeal; to increase fines for reporting deficiencies;7
to amend Code Section 48-7-29.20 of the Official Code of Georgia Annotated, relating to tax8
credits for contributions to rural hospital organizations, so as to increase the aggregate limit9
for tax credits for contributions to rural hospital organizations; to extend the sunset provision;10
to amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated,11
relating to medical assistance generally, so as to provide for the creation of the12
Comprehensive Health Coverage Commission; to provide for its members; to provide for its13
purpose and duties; to provide for assistance from experts and consultants; to provide for14
semiannual reports; to provide for the automatic repeal of the commission; to provide for15
related matters; to provide for effective dates; to repeal conflicting laws; and for other16
purposes.17
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
18
SECTION 1.19
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising20
paragraph (14) of Code Section 31-6-2, relating to definitions relative to state health planning21
and development, as follows:22
"(14) 'Develop,' with reference to a project, means constructing, remodeling, installing,
23
or proceeding with a project, or any part of a project, or a capital expenditure project, the24
cost estimate for which exceeds $10 million. Notwithstanding the provisions of this25
paragraph, the expenditure or commitment or incurring an obligation for the expenditure26
of funds to develop certificate of need applications, studies, reports, schematics,27
preliminary plans and specifications, or working drawings or to acquire, develop, or28
prepare sites shall not be considered to be the developing of a project. Reserved."29
SECTION 2.30
Said title is further amended in Code Section 31-6-21, relating to Department of Community31
Health functions and powers with respect to state health planning and development, by32
revising subsection (a) as follows:33
"(a) The Department of Community Health, established under Chapter 2 of this title, is34
authorized to administer the certificate of need program established under this chapter and,35
within the appropriations made available to the department by the General Assembly of36
Georgia and consistently with the laws of the State of Georgia, a state health plan adopted37
by the board. The department shall review and update the state health plan at least every38
five years beginning no later than January 1, 2025, to ensure the plan meets the evolving39
needs of the state. The department shall provide, by rule, for procedures to administer its40
functions until otherwise provided by the board."41
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SECTION 3.
42
Said title is further amended in Code Section 31-6-40, relating to certificate of need required43
for new institutional health services and exemption, by revising subsections (a), (b), and (c)44
as follows:45
"(a) On and after July 1, 2008, any new institutional health service shall be required to46
obtain a certificate of need pursuant to this chapter. New institutional health services47
include:48
(1) The construction, development, or other establishment of a new, expanded, or
49
relocated health care facility, except as otherwise provided in Code Section 31-6-47;50
Reserved;51
(2) Any expenditure by or on behalf of a health care facility in excess of $10 million52
which, under generally accepted accounting principles consistently applied, is a capital53
expenditure, except expenditures for acquisition of an existing health care facility. The54
dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-255
shall be adjusted annually by an amount calculated by multiplying such dollar amounts56
(as adjusted for the preceding year) by the annual percentage of change in the composite57
index of construction material prices, or its successor or appropriate replacement index,58
if any, published by the United States Department of Commerce for the preceding59
calendar year, commencing on July 1, 2019, and on each anniversary thereafter of60
publication of the index. The department shall immediately institute rule-making61
procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of62
a proposed project for purposes of this paragraph and paragraph (14) of Code Section63
31-6-2, the costs of all items subject to review by this chapter and items not subject to64
review by this chapter associated with and simultaneously developed or proposed with65
the project shall be counted, except for the expenditure or commitment of or incurring an66
obligation for the expenditure of funds to develop certificate of need applications, studies,67
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reports, schematics, preliminary plans and specifications or working drawings, or to68
acquire sites; Reserved;69
(3) The purchase or lease by or on behalf of a health care facility or a diagnostic,70
treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as71
otherwise provided in Code Section 31-6-47;72
(4) Any increase in the bed capacity of a health care facility except as provided in Code73
Section 31-6-47;74
(5) Clinical health services which are offered in or through a health care facility, which75
were not offered on a regular basis in or through such health care facility within the 1276
month period prior to the time such services would be offered;77
(6) Any conversion or upgrading of any general acute care hospital to a specialty hospital78
or of a facility such that it is converted from a type of facility not covered by this chapter79
to any of the types of health care facilities which are covered by this chapter;80
(7) Clinical health services which are offered in or through a diagnostic, treatment, or81
rehabilitation center which were not offered on a regular basis in or through that center82
within the 12 month period prior to the time such services would be offered, but only if83
the clinical health services are any of the following:84
(A) Radiation therapy;85
(B) Biliary lithotripsy;86
(C) Surgery in an operating room environment, including but not limited to ambulatory87
surgery; and88
(D) Cardiac catheterization; and89
(8) The conversion of a destination cancer hospital to a general cancer hospital.90
(b) Any person proposing to develop or offer a new institutional health service or health91
care facility shall, before commencing such activity, submit a letter of intent and an92
application to the department and obtain a certificate of need in the manner provided in this93
chapter unless such activity is excluded from the scope of this chapter.94
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(c)(1) Any person who had a valid exemption granted or approved by the former Health
95
Planning Agency or the department prior to July 1, 2008, shall not be required to obtain96
a certificate of need in order to continue to offer those previously offered services.97
(2) Any facility offering ambulatory surgery pursuant to the exclusion designated on98
June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment,99
or rehabilitation center offering diagnostic imaging or other imaging services in operation100
and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of101
nonreviewability and offering diagnostic imaging services prior to July 1, 2008, shall:102
(A) Provide annual reports in the same manner and in accordance with Code Section103
31-6-70; and104
(B)(i) Provide care to Medicaid beneficiaries and, if the facility provides medical care105
and treatment to children, to PeachCare for Kids beneficiaries and provide106
uncompensated indigent and charity care in an amount equal to or greater than 2107
percent of its adjusted gross revenue; or108
(ii) If the facility is not a participant in Medicaid or the PeachCare for Kids Program,109
provide uncompensated care for Medicaid beneficiaries and, if the facility provides110
medical care and treatment to children, for PeachCare for Kids beneficiaries,111
uncompensated indigent and charity care, or both in an amount equal to or greater112
than 4 percent of its adjusted gross revenue if it:113
(I) Makes a capital expenditure associated with the construction, development,
114
expansion, or other establishment of a clinical health service or the acquisition or115
replacement of diagnostic or therapeutic equipment with a value in excess of116
$800,000.00 over a two-year period;117
(II) Builds a new operating room; or118
(III) Chooses to relocate in accordance with Code Section 31-6-47.119
Noncompliance with any condition of this paragraph shall result in a monetary penalty120
in the amount of the difference between the services which the center is required to121
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provide and the amount actually provided and may be subject to revocation of its
122
exemption status by the department for repeated failure to pay any fees or moneys due123
to the department or for repeated failure to produce data as required by Code Section124
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of125
Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount specified in this126
paragraph shall be adjusted annually by an amount calculated by multiplying such dollar127
amount (as adjusted for the preceding year) by the annual percentage of change in the128
consumer price index, or its successor or appropriate replacement index, if any, published129
by the United States Department of Labor for the preceding calendar year, commencing130
on July 1, 2009. In calculating the dollar amounts of a proposed project for the purposes131
of this paragraph, the costs of all items subject to review by this chapter and items not132
subject to review by this chapter associated with and simultaneously developed or
133
proposed with the project shall be counted, except for the expenditure or commitment of134
or incurring an obligation for the expenditure of funds to develop certificate of need135
applications, studies, reports, schematics, preliminary plans and specifications or working136
drawings, or to acquire sites. Subparagraph (B) of this paragraph shall not apply to137
facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated138
on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by139
physicians in the practice of ophthalmology."140
SECTION 4.141
Said title is further amended in Code Section 31-6-42, relating to qualifications for issuance142
of certificate, by revising subsection (b) as follows:143
"(b) In the case of applications for the development or offering of a new institutional health144
service or health care facility for osteopathic medicine, the need for such service or facility145
shall be determined on the basis of the need and availability in the community for146
osteopathic services and facilities in addition to the considerations in subsection (a) of this147
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Code section. Nothing in this chapter shall, however, be construed as otherwise
148
recognizing any distinction between allopathic and osteopathic medicine."149
SECTION 5.150
Said title is further amended by revising Code Section 31-6-43, relating to acceptance or151
rejection of application for certificate, as follows:152
"31-6-43.153
(a) At least 30
25 days prior to submitting an application for a certificate of need for154
clinical health services, a person shall submit a letter of intent to the department. The155
department shall provide by rule a process for submitting letters of intent and a mechanism156
by which applications may be filed to compete with and be reviewed comparatively with157
proposals described in submitted letters of intent.158
(b) Each application for a certificate of need shall be reviewed received by the department,159
and within ten working days after the date of its receipt a determination shall be made as160
to whether the application complies with the rules governing the preparation and161
submission of applications. If the application complies with the rules governing the162
preparation and submission of applications, and the department shall declare the163
application complete for review, shall accept and date the application, and shall notify the164
applicant of the timetable for its review. The department shall also notify a newspaper of165
general circulation in the county in which the project shall be developed that the166
application has been deemed complete. The department shall also notify the appropriate167
regional commission and the chief elected official of the county and municipal168
governments, if any, in whose boundaries the proposed project will be located that the169
application is complete for review. If the application does not comply with the rules170
governing the preparation and submission of applications, the department shall notify the171
applicant in writing and provide a list of all deficiencies. The applicant shall be afforded172
an opportunity to correct such deficiencies, and upon such correction, the application shall173
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then be declared complete for review within ten days of the correction of such deficiencies,
174
and notice given to a newspaper of general circulation in the county in which the project175
shall be developed that the application has been so declared. The department shall also176
notify the appropriate regional commission and the chief elected official of the county and177
municipal governments, if any, in whose boundaries the proposed project will be located178
that the application is complete for review or when in the determination of the department179
a significant amendment is filed.180
(c) The department shall specify by rule the time within which an applicant may amend181
its application. The department may request an applicant to make amendments. The182
department decision shall be made on an application as amended, if at all, by the applicant.183
(d)(1) There shall be a time limit of 120 days for review of a project, beginning on the184
day the department declares the application complete for review or in the case of
185
applications joined for comparative review, beginning on the day the department declares186
the final application complete receives the application. The department may adopt rules187
for determining when it is not practicable to complete a review in 120 days and may188
extend the review period upon written notice to the applicant but only for an extended189
period of not longer than an additional 30 days. The department shall adopt rules190
governing the submission of additional information by the applicant and for opposing an191
application; provided, however, that such rules shall provide that any party permitted to192
oppose an application shall submit a notice of opposition no later than 30 days of receipt193
by the department of such application.194
(2) No party may oppose an application for a certificate of need for a proposed project195
unless:196
(A) Such party offers substantially similar services as proposed within a 35 mile radius197
of the proposed project or has a service area that overlaps the applicant's proposed198
service area; or199
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(B) Such party has submitted a competing application in the same batching cycle and
200
is proposing to establish the same type of facility proposed or offers substantially201
similar services as proposed and has a service area that overlaps the applicant's202
proposed service area.203
(e) To allow the opportunity for comparative review of applications, the department may204
provide by rule for applications for a certificate of need to be submitted on a timetable or205
batching cycle basis no less often than two times per calendar year for each clinical health206
service. Applications for services, facilities, or expenditures for which there is no specified207
batching cycle may be filed at any time.208
(f) The department may order the joinder of an application which is determined to be209
complete by the department for comparative review with one or more subsequently filed210
applications declared complete for review during the same batching cycle when:211
(1) The first and subsequent applications involve similar clinical health service projects212
in the same service area or overlapping service areas; and213
(2) The subsequent applications are filed and are declared complete for review within 30214
days of the date the first application was declared complete for review.215
Following joinder of the first application with subsequent applications, none of the216
subsequent applications so joined may be considered as a first application for the purposes217
of future joinder. The department shall notify the applicant to whose application a joinder218
is ordered and all other applicants previously joined to such application of the fact of each219
joinder pursuant to this subsection. In the event one or more applications have been joined220
pursuant to this subsection, the time limits for department action for all of the applicants221
shall run from the latest date that any one of the joined applications was declared complete222
for review. In the event of the consideration of one or more applications joined pursuant223
to this subsection, the department may award no certificate of need or one or more224
certificates of need to the application or applications, if any, which are consistent with the225
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considerations contained in Code Section 31-6-42, the department's applicable rules, and
226
the award of which will best satisfy the purposes of this chapter.227
(g) The department shall review the application and all written information submitted by228
the applicant in support of the application and all information submitted in opposition to229
the application to determine the extent to which the proposed project is consistent with the230
applicable considerations stated in Code Section 31-6-42 and in the department's applicable231
rules. During the course of the review, the department staff may request additional232
information from the applicant as deemed appropriate. Pursuant to rules adopted by the233
department, a public hearing on applications covered by those regulations may be held234
prior to the date of the department's decision thereon. Such rules shall provide that when235
good cause has been shown, a public hearing shall be held by the department. Any236
interested person may submit information to the department concerning an application, and237
an applicant shall be entitled to notice of and to respond to any such submission.238
(h) The department shall within 30 days of receipt of the application
provide the applicant239
an opportunity to meet with the department to discuss the such application and to provide240
the applicant an opportunity to submit additional information. Such additional information241
shall be submitted within the time limits adopted by the department. The department shall242
also provide an opportunity for any party that is permitted to oppose an application243
pursuant to paragraph (2) of subsection (d) of this Code section to meet with the244
department and to provide additional information to the department. In order for any such245
opposing party to have standing to appeal an adverse decision pursuant to Code Section246
31-6-44, such party must attend and participate in an opposition meeting.247
(i) Unless extended by the department for an additional period of up to 30 days pursuant248
to subsection (d) of this Code section, the department shall, no later than 120 days after an249
application is determined to be complete for review, or, in the event of joined applications,250
120 days after the last application is declared complete for review, provide written251
notification to an applicant of the department's decision to issue or to deny issuance of a252
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certificate of need for the proposed project. Such notice shall contain the department's
253
written findings of fact and decision as to each applicable consideration or rule and a254
detailed statement of the reasons and evidentiary support for issuing or denying a certificate255
of need for the action proposed by each applicant. The department shall also mail such256
notification to the appropriate regional commission and the chief elected official of the257
county and municipal governments, if any, in whose boundaries the proposed project will258
be located. In the event such decision is to issue a certificate of need, the certificate of259
need shall be effective on the day of the decision unless the decision is appealed to the260
Certificate of Need Appeal Panel in accordance with this chapter. Within seven days of261
the decision, the department shall publish notice of its decision to grant or deny an262
application in the same manner as it publishes notice of the filing of an application.263
(j) Should the department fail to provide written notification of the decision within the264
time limitations set forth in this Code section, an application shall be deemed to have been265
approved as of the one hundred twenty-first day following notice from the department that266
an application, or the last of any applications joined pursuant to subsection (f) of this Code267
section, is declared 'complete for review.'268
(k) Notwithstanding other provisions of this article, when the Governor has declared a269
state of emergency in a region of the state, existing health care facilities in the affected270
region may seek emergency approval from the department to make expenditures in excess
271
of the capital expenditure threshold or to offer services that may otherwise require a272
certificate of need. The department shall give special expedited consideration to such273
requests and may authorize such requests for good cause. Once the state of emergency has274
been lifted, any services offered by an affected health care facility under this subsection275
shall cease to be offered until such time as the health care facility that received the276
emergency authorization has requested and received a certificate of need. For purposes of277
this subsection, the term 'good cause' means that authorization of the request shall directly278
resolve a situation posing an immediate threat to the health and safety of the public. The279
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department shall establish, by rule, procedures whereby requirements for the process of
280
review and issuance of a certificate of need may be modified and expedited as a result of281
emergency situations."282
SECTION 6.283
Said title is further amended in Code Section 31-6-45, relating to revocation of certificate of284
need, enforcement of chapter, and regulatory investigations and examinations, by revising285
subsections (b) and (c) as follows:286
"(b) Any health care facility offering a new institutional health service without having287
obtained a certificate of need and which has not been previously licensed as a health care
288
facility shall be denied a license to operate.289
(c) In the event that a new institutional health service is knowingly offered or developed290
without having obtained a certificate of need as required by this chapter, or the certificate291
of need for such service is revoked according to the provisions of this Code section, a292
facility or applicant may be fined an amount of $5,000.00 per day up to 30 days,293
$10,000.00 per day from 31 days through 60 days, and $25,000.00 per day after 60 days294
for each day that the violation of this chapter has existed and knowingly and willingly295
continues; provided, however, that the expenditure or commitment of or incurring an296
obligation for the expenditure of funds to take or perform actions not subject to this chapter297
or to acquire, develop, or prepare a health care facility site for which a certificate of need298
application is denied shall not be a violation of this chapter and shall not be subject to such299
a fine. The commissioner shall determine, after notice and a hearing, whether the fines300
provided in this Code section shall be levied."301
SECTION 7.302
Said title is further amended by revising Code Section 31-6-47, relating to exemptions from303
certificate of need requirements, as follows:304
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"31-6-47.
305
(a) Notwithstanding the other provisions of this chapter, this chapter shall not apply to:306
(1) Infirmaries operated by educational institutions for the sole and exclusive benefit of307
students, faculty members, officers, or employees thereof;308
(2) Infirmaries or facilities operated by businesses for the sole and exclusive benefit of309
officers or employees thereof, provided that such infirmaries or facilities make no310
provision for overnight stay by persons receiving their services;311
(3) Institutions operated exclusively by the federal government or by any of its agencies;312
(4) Offices of private physicians or dentists whether for individual or group practice,313
except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code314
Section 31-6-40;315
(5) Religious, nonmedical health care institutions as defined in 42 U.S.C.316
Section 1395x(ss)(1), listed and certified by a national accrediting organization;317
(6) Site acquisitions for health care facilities or preparation or development costs for318
such sites prior to the decision to file a certificate of need application;319
(7) Expenditures related to adequate preparation and development of an application for320
a certificate of need;321
(8) The commitment of funds conditioned upon the obtaining of a certificate of need;322
(9) Expenditures for the restructuring or acquisition of existing health care facilities by323
stock or asset purchase, merger, consolidation, or other lawful means;324
(9.1) The purchase of a closing hospital or of a hospital that has been closed for no more325
than 12
24 months by a hospital in a contiguous county to repurpose the facility as a326
micro-hospital;327
(10) Expenditures of less than $870,000.00 for any minor or major repair or replacement328
of equipment by a health care facility that is not owned by a group practice of physicians329
or a hospital and that provides diagnostic imaging services if such facility received a330
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letter of nonreviewability from the department prior to July 1, 2008. This paragraph shall
331
not apply to such facilities in rural counties;332
(10.1) Except as provided in paragraph (10) of this subsection, an
expenditure for the333
minor or major repair of a health care facility or a facility that is exempt from the334
requirements of this chapter, parts thereof, or services provided or equipment used335
therein; or the replacement of equipment, including but not limited to CT scanners,336
magnetic resonance imaging, positron emission tomography (PET), and positron337
emission tomography/computed tomography previously approved for a certificate of338
need;339
(11) Capital expenditures otherwise covered by this chapter required solely to eliminate340
or prevent safety hazards as defined by federal, state, or local fire, building,341
environmental, occupational health, or life safety codes or regulations, to comply with342
licensing requirements of the department, or to comply with accreditation standards of343
a nationally recognized health care accreditation body;344
(12) Cost overruns whose percentage of the cost of a project is equal to or less than the345
cumulative annual rate of increase in the composite construction index, published by the346
United States Bureau of the Census of the Department of Commerce, calculated from the347
date of approval of the project;348
(13) Transfers from one health care facility to another such facility of major medical349
equipment previously approved under or exempted from certificate of need review,350
except where such transfer results in the institution of a new clinical health service for351
which a certificate of need is required in the facility acquiring such equipment, provided352
that such transfers are recorded at net book value of the medical equipment as recorded353
on the books of the transferring facility;354
(14) New institutional health services provided by or on behalf of health maintenance355
organizations or related health care facilities in circumstances defined by the department356
pursuant to federal law;357
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(15) Increases in the bed capacity of a hospital up to ten beds or 10 20 percent of358
capacity, whichever is greater, in any consecutive two-year three-year period, in a359
hospital that has maintained an overall occupancy rate greater than 75 60 percent for the360
previous 12 month period;361
(16) Expenditures for nonclinical projects, including parking lots, parking decks, and362
other parking facilities; computer systems, software, and other information technology;363
medical office buildings; administrative office space; conference rooms; education364
facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;365
bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;366
grounds; signage; family meeting or lounge areas; other nonclinical physical plant367
renovations or upgrades that do not result in new or expanded clinical health services, and368
state mental health facilities;369
(17) Life plan communities, provided that the skilled nursing component of the facility370
is for the exclusive use of residents of the life plan community and that a written371
exemption is obtained from the department; provided, however, that new sheltered372
nursing home beds may be used on a limited basis by persons who are not residents of373
the life plan community for a period up to five years after the date of issuance of the374
initial nursing home license, but such beds shall not be eligible for Medicaid375
reimbursement. For the first year, the life plan community sheltered nursing facility may376
utilize not more than 50 percent of its licensed beds for patients who are not residents of377
the life plan community. In the second year of operation, the life plan community shall378
allow not more than 40 percent of its licensed beds for new patients who are not residents379
of the life plan community. In the third year of operation, the life plan community shall380
allow not more than 30 percent of its licensed beds for new patients who are not residents381
of the life plan community. In the fourth year of operation, the life plan community shall382
allow not more than 20 percent of its licensed beds for new patients who are not residents383
of the life plan community. In the fifth year of operation, the life plan community shall384
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allow not more than 10 percent of its licensed beds for new patients who are not residents
385
of the life plan community. At no time during the first five years shall the life plan386
community sheltered nursing facility occupy more than 50 percent of its licensed beds387
with patients who are not residents under contract with the life plan community. At the388
end of the five-year period, the life plan community sheltered nursing facility shall be389
utilized exclusively by residents of the life plan community, and at no time shall a390
resident of a life plan community be denied access to the sheltered nursing facility. At391
no time shall any existing patient be forced to leave the life plan community to comply392
with this paragraph. The department is authorized to promulgate rules and regulations393
regarding the use and definition of the term
'sheltered nursing facility' in a manner394
consistent with this Code section. Agreements to provide continuing care include395
agreements to provide care for any duration, including agreements that are terminable by396
either party;397
(18) Any single specialty ambulatory surgical center that:398
(A)(i) Has capital expenditures associated with the construction, development, or399
other establishment of the clinical health service which do not exceed $2.5 million;400
or401
(ii) Is the only single specialty ambulatory surgical center in the county owned by the402
group practice and has two or fewer operating rooms; provided, however, that a center403
exempt pursuant to this division shall be required to obtain a certificate of need in404
order to add any additional operating rooms;405
(B) Has a hospital affiliation agreement with a hospital within a reasonable distance406
from the facility or the medical staff at the center has admitting privileges or other407
acceptable documented arrangements with such hospital to ensure the necessary backup408
for the center for medical complications. The center shall have the capability to transfer409
a patient immediately to a hospital within a reasonable distance from the facility with410
H. B. 1339
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adequate emergency room services. Hospitals shall not unreasonably deny a transfer
411
agreement or affiliation agreement to the center;412
(C)(i) Provides care to Medicaid beneficiaries and, if the facility provides medical413
care and treatment to children, to PeachCare for Kids beneficiaries and provides414
uncompensated indigent and charity care in an amount equal to or greater than 2415
percent of its adjusted gross revenue; or416
(ii) If the center is not a participant in Medicaid or the PeachCare for Kids Program,417
provides uncompensated care to Medicaid beneficiaries and, if the facility provides418
medical care and treatment to children, to PeachCare for Kids beneficiaries,419
uncompensated indigent and charity care, or both in an amount equal to or greater420
than 4 percent of its adjusted gross revenue;421
provided, however, that single specialty ambulatory surgical centers owned by422
physicians in the practice of ophthalmology shall not be required to comply with this423
subparagraph; and424
(D) Provides annual reports in the same manner and in accordance with Code Section425
31-6-70.426
Noncompliance with any condition of this paragraph shall result in a monetary penalty427
in the amount of the difference between the services which the center is required to428
provide and the amount actually provided and may be subject to revocation of its429
exemption status by the department for repeated failure to pay any fines or moneys due430
to the department or for repeated failure to produce data as required by Code Section431
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of432
Title 50, the 'Georgia Administrative Procedure Act.
'; The dollar amount specified in this433
paragraph shall be adjusted annually by an amount calculated by multiplying such dollar434
amount (as adjusted for the preceding year) by the annual percentage of change in the435
composite index of construction material prices, or its successor or appropriate436
replacement index, if any, published by the United States Department of Commerce for437
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the preceding calendar year, commencing on July 1, 2009, and on each anniversary438
thereafter of publication of the index. The department shall immediately institute439
rule-making procedures to adopt such adjusted dollar amounts. In calculating the dollar440
amounts of a proposed project for purposes of this paragraph, the costs of all items441
subject to review by this chapter and items not subject to review by this chapter442
associated with and simultaneously developed or proposed with the project shall be443
counted, except for the expenditure or commitment of or incurring an obligation for the444
expenditure of funds to develop certificate of need applications, studies, reports,445
schematics, preliminary plans and specifications or working drawings, or to acquire sites;446
(19) Any joint venture ambulatory surgical center that:447
(A) Has capital expenditures associated with the construction, development, or other448
establishment of the clinical health service which do not exceed $5 million;449
(B)(i) Provides care to Medicaid beneficiaries and, if the facility provides medical450
care and treatment to children, to PeachCare for Kids beneficiaries and provides451
uncompensated indigent and charity care in an amount equal to or greater than 2452
percent of its adjusted gross revenue; or453
(ii) If the center is not a participant in Medicaid or the PeachCare for Kids Program,454
provides uncompensated care to Medicaid beneficiaries and, if the facility provides455
medical care and treatment to children, to PeachCare for Kids beneficiaries,456
uncompensated indigent and charity care, or both in an amount equal to or greater457
than 4 percent of its adjusted gross revenue; and458
(C)(B) Provides annual reports in the same manner and in accordance with Code459
Section 31-6-70.460
Noncompliance with any condition of this paragraph shall result in a monetary penalty461
in the amount of the difference between the services which the center is required to462
provide and the amount actually provided and may be subject to revocation of its463
exemption status by the department for repeated failure to pay any fines or moneys due464
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to the department or for repeated failure to produce data as required by Code
465
Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to466
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.
'; The dollar amount467
specified in this paragraph shall be adjusted annually by an amount calculated by468
multiplying such dollar amount (as adjusted for the preceding year) by the annual469
percentage of change in the composite index of construction material prices, or its470
successor or appropriate replacement index, if any, published by the United States471
Department of Commerce for the preceding calendar year, commencing on July 1, 2009,472
and on each anniversary thereafter of publication of the index. The department shall473
immediately institute rule-making procedures to adopt such adjusted dollar amounts. In474
calculating the dollar amounts of a proposed project for purposes of this paragraph, the475
costs of all items subject to review by this chapter and items not subject to review by this476
chapter associated with and simultaneously developed or proposed with the project shall477
be counted, except for the expenditure or commitment of or incurring an obligation for478
the expenditure of funds to develop certificate of need applications, studies, reports,479
schematics, preliminary plans and specifications or working drawings, or to acquire sites;480
(20) Expansion of services by an imaging center based on a population needs481
methodology taking into consideration whether the population residing in the area served482
by the imaging center has a need for expanded services, as determined by the department483
in accordance with its rules and regulations, if such imaging center:484
(A) Was in existence and operational in this state on January 1, 2008;485
(B) Is owned by a hospital or by a physician or a group of physicians comprising at486
least 80 percent ownership who are currently board certified in radiology;487
(C) Provides three or more diagnostic and other imaging services;488
(D) Accepts all patients regardless of ability to pay; and489
(E) Provides uncompensated indigent and charity care in an amount equal to or greater490
than the amount of such care provided by the geographically closest general acute care491
H. B. 1339
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hospital; provided, however, that this paragraph shall not apply to an imaging center in
492
a rural county;493
(21) Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age494
and older;495
(22) Therapeutic cardiac catheterization in hospitals selected by the department prior to496
July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research497
Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as498
determined by the department on an annual basis, meet the criteria to participate in the499
C-PORT Study but have not been selected for participation; provided, however, that if500
the criteria requires a transfer agreement to another hospital, no hospital shall501
unreasonably deny a transfer agreement to another hospital;502
(23) Infirmaries or facilities operated by, on behalf of, or under contract with the503
Department of Corrections or the Department of Juvenile Justice for the sole and504
exclusive purpose of providing health care services in a secure environment to prisoners505
within a penal institution, penitentiary, prison, detention center, or other secure506
correctional institution, including correctional institutions operated by private entities in507
this state which house inmates under the Department of Corrections or the Department508
of Juvenile Justice;509
(24) The relocation of any skilled nursing facility, intermediate care facility, or510
micro-hospital within the same county, any other health care facility in a rural county511
within the same county, and any other health care facility in an urban county within a512
three-mile
five-mile radius of the existing facility so long as the facility does not propose513
to offer any new or expanded clinical health services at the new location;514
(25) Facilities which are devoted to the provision of treatment and rehabilitative care for515
periods continuing for 24 hours or longer for persons who have traumatic brain injury,516
as defined in Code Section 37-3-1;517
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(26) Capital expenditures for a project otherwise requiring a certificate of need if those
518
expenditures are for a project to remodel, renovate, replace, or any combination thereof,519
a medical-surgical hospital and such project does not result in any of the following
:520
(A) That hospital:521
(i) Has a bed capacity of not more than 50 beds;522
(ii) Is located in a county in which no other medical-surgical hospital is located;523
(iii) Has at any time been designated as a disproportionate share hospital by the524
department; and525
(iv) Has at least 45 percent of its patient revenues derived from medicare, Medicaid,526
or any combination thereof, for the immediately preceding three years; and527
(B) That project:528
(i) Does not result in any of the following:529
(I)(A) The offering of any new clinical health services;530
(II)(B) Any increase in bed capacity;531
(III)(C) Any redistribution of existing beds among existing clinical health services;532
or533
(IV)(D) Any increase in capacity of existing clinical health services;534
(ii) Has at least 80 percent of its capital expenditures financed by the proceeds of a535
special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8536
of Title 48; and537
(iii) Is located within a three-mile radius of and within the same county as the538
hospital's existing facility;539
(27) The renovation, remodeling, refurbishment, or upgrading of a health care facility,540
so long as the project does not result in any of the following:541
(A) The offering of any new or expanded clinical health services;542
(B) Any increase in inpatient bed capacity; or543
(C) Any redistribution of existing beds among existing clinical health services; or544
H. B. 1339
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(D) A capital expenditure exceeding the threshold contained in paragraph (2) of545
subsection (a) of Code Section 31-6-40;546
(28) Other than for equipment used to provide positron emission tomography (PET)547
services, the acquisition of diagnostic, therapeutic, or other imaging equipment with a548
value of $3 million or less, by or on behalf of:549
(A) A hospital; or550
(B) An individual private physician or single group practice of physicians exclusively551
for use on patients of such private physician or single group practice of physicians and552
such private physician or member of such single group practice of physicians is553
physically present at the practice location where the diagnostic or other imaging554
equipment is located at least 75 percent of the time that the equipment is in use.;555
The amount specified in this paragraph shall not include build-out costs, as defined by556
the department, but shall include all functionally related equipment, software, and any557
warranty and services contract costs for the first five years. The acquisition of one or558
more items of functionally related diagnostic or therapeutic equipment shall be559
considered as one project. The dollar amount specified in this paragraph and in560
paragraph (10) of this subsection shall be adjusted annually by an amount calculated by561
multiplying such dollar amounts (as adjusted for the preceding year) by the annual562
percentage of change in the consumer price index, or its successor or appropriate563
replacement index, if any, published by the United States Department of Labor for the564
preceding calendar year, commencing on July 1, 2010; and565
(29) Any capital expenditures A capital expenditure of $10 million or less by a hospital566
at such hospital's primary campus for:567
(A) The expansion or addition of the following clinical health services: operating568
rooms, other than dedicated outpatient operating rooms; medical-surgical services;569
gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;570
cardiac care or other general hospital services; provided, however, that such571
H. B. 1339
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expenditure does not include the expansion or addition of inpatient beds or the
572
conversion of one type of inpatient bed to another type of inpatient bed; or573
(B) The movement of clinical health services from one location on the hospital's574
primary campus to another location on such hospital's primary campus;
575
(30) New or expanded psychiatric or substance abuse inpatient programs or contracted576
beds that serve Medicaid and uninsured patients; that are open 365 days per year, seven577
days per week, and 24 hours per day; and that have an agreement with a hospital within578
a reasonable distance to ensure the necessary backup for medical complications;579
(31) A facility providing new or expanded basic hospital obstetric services that are580
available 365 days per year, seven days per week, and 24 hours per day and that has an581
agreement with a hospital within a reasonable distance to ensure the necessary backup582
for medical complications;583
(32) A new acute care facility in a rural county that:584
(A) Agrees to serve as a teaching hospital;585
(B) Agrees to participate as a trauma center and obtain and maintain verification as586
such by the American College of Surgeons;587
(C) Provides access to comprehensive behavioral health services;588
(D) Provides uncompensated indigent and charity care in an amount equal to or greater589
than 5 percent of its adjusted gross revenue; and590
(E) Provides adequate access to graduates of medical schools in this state for the591
purpose of training; and592
(33) Transfer of existing beds or services from one hospital campus to another hospital593
campus within the same hospital system within a ten-mile radius of the original campus.594
(b) By rule, the department shall establish a procedure for expediting or waiving reviews595
of certain projects, the nonreview of which it deems compatible with the purposes of this596
chapter, in addition to expenditures exempted from review by this Code section."597
H. B. 1339
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SECTION 8.
598
Said title is further amended in Article 3 of Chapter 6, relating to the Certificate of Need599
Program, by adding a new Code section to read as follows:600
"31-6-51.
601
(a) The department, in conjunction with the Office of Legislative Counsel, shall review the602
statutory framework and provisions of this chapter and the certificate of need program603
generally and shall make recommendations relating to rewriting, reorganizing, and604
clarifying the provisions of this chapter. Such review shall also include recommendations605
to streamline the statutory procedures required to obtain a certificate of need or a letter of606
determination.607
(b) The department may consult with and obtain input from certificate of need applicants,608
certificate of need holders, local government representatives, citizens, or other interested609
parties in conducting such review.610
(c) The department shall submit its recommendations to the General Assembly, which may611
include proposed legislation, no later than December 1, 2024.612
(d) This Code section shall stand repealed on December 31, 2024."613
SECTION 9.614
Said title is further amended in Code Section 31-6-70, relating to reports to the department615
by certain health care facilities an all ambulatory surgical centers and imaging centers and616
public availability, by revising subsection (e) as follows:617
"(e)(1) In the event the department does not receive an annual report from a health care618
facility requiring a certificate of need or an ambulatory surgical center or imaging center,619
whether or not exempt from obtaining a certificate of need under this chapter, on or620
before the date such report was due or receives a timely but incomplete report, the621
department shall notify the health care facility or center regarding the deficiencies and622
shall be authorized to fine such health care facility or center an amount not to exceed623
H. B. 1339
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$500.00 $2,000.00 per day for every day up to 30 days and $1,000.00 $5,000.00 per day624
for every day over 30 days for every day of such untimely or deficient report.625
(2) In the event the department does not receive an annual report from a health care626
facility within 180 days following the date such report was due or receives a timely but627
incomplete report which is not completed within such 180 days, the department shall be628
authorized to revoke such health care facility's certificate of need in accordance with629
Code Section 31-6-45."630
SECTION 10.631
Code Section 48-7-29.20 of the Official Code of Georgia Annotated, relating to tax credits632
for contributions to rural hospital organizations, is amended by revising paragraph (1) of 633
subsection (e) and subsection (k) as follows:634
"(e)(1) In no event shall the aggregate amount of tax credits allowed under this Code635
section exceed $75 $100 million per taxable year."636
"(k) This Code section shall stand automatically repealed on December 31, 2024 2029."637
SECTION 11.638
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to639
medical assistance generally, is amended by adding a new Code section to read as follows:640
"49-4-156.641
(a) There is created the Comprehensive Health Coverage Commission. The commission642
shall be attached to the Department of Community Health for administrative purposes only643
as provided by Code Section 50-4-3.644
(b) The commission shall consist of nine members, who shall be appointed no later than645
July 1, 2024, as follows:646
(1) The chairperson, who shall be a subject matter expert on health policy, and shall not647
be an employee of the State of Georgia, to be appointed by the Governor;648
H. B. 1339
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(2) Four nonlegislative members to be appointed by the Speaker of the House of649
Representatives; and650
(3) Four nonlegislative members to be appointed by the President of the Senate.651
(c) Members of the commission shall not be registered lobbyists in the State of Georgia.652
(d) Members of the commission shall serve without compensation.653
(e) The purpose of the commission shall be to advise the Governor, the General Assembly,654
and the Department of Community Health, as the administrator of the state medical655
assistance program, on issues related to access and quality of healthcare for Georgia's656
low-income and uninsured populations. The commission shall be tasked with reviewing657
the following:658
(1) Opportunities related to reimbursement and funding for Georgia healthcare providers,659
including premium assistance programs;660
(2) Opportunities related to quality improvement of healthcare for Georgia's low income661
and uninsured populations; and662
(3) Opportunities to enhance service delivery and coordination of healthcare among and663
across state agencies.664
(f) Subject to appropriations, the commission shall contract with experts and consultants665
to produce a semiannual report on its findings for the Governor and the General Assembly. 666
The commission shall provide its initial report to the Governor and the General Assembly667
no later than December 1, 2024.668
(g) The commission shall stand abolished on December 31, 2026, unless extended by the669
General Assembly prior to such date."670
SECTION 12.671
(a) Except as provided in subsection (b) of this Section, this Act shall become effective on672
July 1, 2024.673
(b) Sections 1, 3, 4, 5, 6, 7, and 9 of this Act shall become effective on July 1, 2025.674
H. B. 1339
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SECTION 13.
675
All laws and parts of laws in conflict with this Act are repealed.676
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