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The House Committee on Health offers the following substitute to HB 1339:
A BILL TO BE ENTITLED
AN ACT
To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to1
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 tax credit limit9
for contributions by corporate donors; to increase the aggregate limit for tax credits for10
contributions to rural hospital organizations; to provide for preapproval of proportional11
amounts of contributions under certain circumstances; to provide for certain timelines; to12
extend the sunset provision; to amend Article 7 of Chapter 4 of Title 49 of the Official Code13
of Georgia Annotated, relating to medical assistance generally, so as to provide for the14
creation of the Comprehensive Health Coverage Commission; to provide for its members;15
to provide for its purpose and duties; to provide for assistance from experts and consultants;16
to provide for semiannual reports; to provide for the automatic repeal of the commission; to17
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provide for related matters; to provide for effective dates; to provide for applicability; to18
repeal conflicting laws; and for other purposes.19
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:20
SECTION 1.21
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising22
paragraph (14) of Code Section 31-6-2, relating to definitions relative to state health planning23
and development, as follows:24
"(14) 'Develop,' with reference to a project, means constructing, remodeling, installing,25
or proceeding with a project, or any part of a project, or a capital expenditure project, the26
cost estimate for which exceeds $10 million. Notwithstanding the provisions of this27
paragraph, the expenditure or commitment or incurring an obligation for the expenditure28
of funds to develop certificate of need applications, studies, reports, schematics,29
preliminary plans and specifications, or working drawings or to acquire, develop, or30
prepare sites shall not be considered to be the developing of a project."31
SECTION 2.32
Said title is further amended in Code Section 31-6-21, relating to Department of Community33
Health functions and powers with respect to state health planning and development, by34
revising subsection (a) as follows:35
"(a) The Department of Community Health, established under Chapter 2 of this title, is36
authorized to administer the certificate of need program established under this chapter and,37
within the appropriations made available to the department by the General Assembly of38
Georgia and consistently with the laws of the State of Georgia, a state health plan adopted39
by the board. The department shall review and update the state health plan at least every40
five years beginning no later than January 1, 2025, to ensure the plan meets the evolving41
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needs of the state. The department shall provide, by rule, for procedures to administer its42
functions until otherwise provided by the board."43
SECTION 3.44
Said title is further amended in Code Section 31-6-40, relating to certificate of need required45
for new institutional health services and exemption, by revising subsections (a), (b), and (c)46
as follows:47
"(a) On and after July 1, 2008, any new institutional health service shall be required to48
obtain a certificate of need pursuant to this chapter. New institutional health services49
include:50
(1) The construction, development, or other establishment of a new, expanded, or51
relocated health care facility, except as otherwise provided in Code Section 31-6-47;52
(2) Any expenditure by or on behalf of a health care facility in excess of $10 million53
which, under generally accepted accounting principles consistently applied, is a capital54
expenditure, except expenditures for acquisition of an existing health care facility. The55
dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-256
shall be adjusted annually by an amount calculated by multiplying such dollar amounts57
(as adjusted for the preceding year) by the annual percentage of change in the composite58
index of construction material prices, or its successor or appropriate replacement index,59
if any, published by the United States Department of Commerce for the preceding60
calendar year, commencing on July 1, 2019, and on each anniversary thereafter of61
publication of the index. The department shall immediately institute rule-making62
procedures to adopt such adjusted dollar amounts. In calculating the dollar amounts of63
a proposed project for purposes of this paragraph and paragraph (14) of Code Section64
31-6-2, the costs of all items subject to review by this chapter and items not subject to65
review by this chapter associated with and simultaneously developed or proposed with66
the project shall be counted, except for the expenditure or commitment of or incurring an67
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obligation for the expenditure of funds to develop certificate of need applications, studies,68
reports, schematics, preliminary plans and specifications or working drawings, or to69
acquire sites; Reserved;70
(3) The purchase or lease by or on behalf of a health care facility or a diagnostic,71
treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as72
otherwise provided in Code Section 31-6-47;73
(4) Any increase in the bed capacity of a health care facility except as provided in Code74
Section 31-6-47;75
(5) Clinical health services which are offered in or through a health care facility, which76
were not offered on a regular basis in or through such health care facility within the 1277
month period prior to the time such services would be offered;78
(6) Any conversion or upgrading of any general acute care hospital to a specialty hospital79
or of a facility such that it is converted from a type of facility not covered by this chapter80
to any of the types of health care facilities which are covered by this chapter;81
(7) Clinical health services which are offered in or through a diagnostic, treatment, or82
rehabilitation center which were not offered on a regular basis in or through that center83
within the 12 month period prior to the time such services would be offered, but only if84
the clinical health services are any of the following:85
(A) Radiation therapy;86
(B) Biliary lithotripsy;87
(C) Surgery in an operating room environment, including but not limited to ambulatory88
surgery; and89
(D) Cardiac catheterization; and90
(8) The conversion of a destination cancer hospital to a general cancer hospital.91
(b) Any person proposing to develop or offer a new institutional health service or health92
care facility shall, before commencing such activity, submit a letter of intent and an93
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application to the department and obtain a certificate of need in the manner provided in this94
chapter unless such activity is excluded from the scope of this chapter.95
(c)(1) Any person who had a valid exemption granted or approved by the former Health96
Planning Agency or the department prior to July 1, 2008, shall not be required to obtain97
a certificate of need in order to continue to offer those previously offered services.98
(2) Any facility offering ambulatory surgery pursuant to the exclusion designated on99
June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment,100
or rehabilitation center offering diagnostic imaging or other imaging services in operation101
and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of102
nonreviewability and offering diagnostic imaging services prior to July 1, 2008, shall:103
(A) Provide annual reports in the same manner and in accordance with Code Section104
31-6-70; and105
(B)(i) Provide care to Medicaid beneficiaries and, if the facility provides medical care106
and treatment to children, to PeachCare for Kids beneficiaries and provide107
uncompensated indigent and charity care in an amount equal to or greater than 2108
percent of its adjusted gross revenue; or109
(ii) If the facility is not a participant in Medicaid or the PeachCare for Kids Program,110
provide uncompensated care for Medicaid beneficiaries and, if the facility provides111
medical care and treatment to children, for PeachCare for Kids beneficiaries,112
uncompensated indigent and charity care, or both in an amount equal to or greater113
than 4 percent of its adjusted gross revenue if it:114
(I) Makes a capital expenditure associated with the construction, development,115
expansion, or other establishment of a clinical health service or the acquisition or116
replacement of diagnostic or therapeutic equipment with a value in excess of117
$800,000.00 over a two-year period;118
(II) Builds a new operating room; or119
(III) Chooses to relocate in accordance with Code Section 31-6-47.120
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Noncompliance with any condition of this paragraph shall result in a monetary penalty121
in the amount of the difference between the services which the center is required to122
provide and the amount actually provided and may be subject to revocation of its123
exemption status by the department for repeated failure to pay any fees or moneys due124
to the department or for repeated failure to produce data as required by Code Section125
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of126
Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount specified in this127
paragraph shall be adjusted annually by an amount calculated by multiplying such dollar128
amount (as adjusted for the preceding year) by the annual percentage of change in the129
consumer price index, or its successor or appropriate replacement index, if any, published130
by the United States Department of Labor for the preceding calendar year, commencing131
on July 1, 2009. In calculating the dollar amounts of a proposed project for the purposes132
of this paragraph, the costs of all items subject to review by this chapter and items not133
subject to review by this chapter associated with and simultaneously developed or134
proposed with the project shall be counted, except for the expenditure or commitment of135
or incurring an obligation for the expenditure of funds to develop certificate of need136
applications, studies, reports, schematics, preliminary plans and specifications or working137
drawings, or to acquire sites. Subparagraph (B) of this paragraph shall not apply to138
facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated139
on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by140
physicians in the practice of ophthalmology."141
SECTION 4.142
Said title is further amended by revising Code Section 31-6-43, relating to acceptance or143
rejection of application for certificate, as follows:144
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"31-6-43.145
(a) At least 30 25 days prior to submitting an application for a certificate of need for146
clinical health services, a person shall submit a letter of intent to the department. The147
department shall provide by rule a process for submitting letters of intent and a mechanism148
by which applications may be filed to compete with and be reviewed comparatively with149
proposals described in submitted letters of intent.150
(b) Each application for a certificate of need shall be reviewed received by the department,151
and within ten working days after the date of its receipt a determination shall be made as152
to whether the application complies with the rules governing the preparation and153
submission of applications. If the application complies with the rules governing the154
preparation and submission of applications, and the department shall declare the155
application complete for review, shall accept and date the application, and shall notify the156
applicant of the timetable for its review. The department shall also notify a newspaper of157
general circulation in the county in which the project shall be developed that the158
application has been deemed complete. The department shall also notify the appropriate159
regional commission and the chief elected official of the county and municipal160
governments, if any, in whose boundaries the proposed project will be located that the161
application is complete for review. If the application does not comply with the rules162
governing the preparation and submission of applications, the department shall notify the163
applicant in writing and provide a list of all deficiencies. The applicant shall be afforded164
an opportunity to correct such deficiencies, and upon such correction, the application shall165
then be declared complete for review within ten days of the correction of such deficiencies,166
and notice given to a newspaper of general circulation in the county in which the project167
shall be developed that the application has been so declared. The department shall also168
notify the appropriate regional commission and the chief elected official of the county and169
municipal governments, if any, in whose boundaries the proposed project will be located170
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that the application is complete for review or when in the determination of the department171
a significant amendment is filed.172
(c) The department shall specify by rule the time within which an applicant may amend173
its application. The department may request an applicant to make amendments. The174
department decision shall be made on an application as amended, if at all, by the applicant.175
(d)(1) There shall be a time limit of 120 days for review of a project, beginning on the176
day the department declares the application complete for review or in the case of177
applications joined for comparative review, beginning on the day the department declares178
the final application complete receives the application. The department may adopt rules179
for determining when it is not practicable to complete a review in 120 days and may180
extend the review period upon written notice to the applicant but only for an extended181
period of not longer than an additional 30 days. The department shall adopt rules182
governing the submission of additional information by the applicant and for opposing an183
application; provided, however, that such rules shall provide that any party permitted to184
oppose an application shall submit a notice of opposition no later than 30 days of receipt185
by the department of such application.186
(2) No party may oppose an application for a certificate of need for a proposed project187
unless:188
(A) Such party offers substantially similar services as proposed within a 35 mile radius189
of the proposed project or has a service area that overlaps the applicant's proposed190
service area; or191
(B) Such party has submitted a competing application in the same batching cycle and192
is proposing to establish the same type of facility proposed or offers substantially193
similar services as proposed and has a service area that overlaps the applicant's194
proposed service area.195
(e) To allow the opportunity for comparative review of applications, the department may196
provide by rule for applications for a certificate of need to be submitted on a timetable or197
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batching cycle basis no less often than two times per calendar year for each clinical health198
service. Applications for services, facilities, or expenditures for which there is no specified199
batching cycle may be filed at any time.200
(f) The department may order the joinder of an application which is determined to be201
complete by the department for comparative review with one or more subsequently filed202
applications declared complete for review during the same batching cycle when:203
(1) The first and subsequent applications involve similar clinical health service projects204
in the same service area or overlapping service areas; and205
(2) The subsequent applications are filed and are declared complete for review within 30206
days of the date the first application was declared complete for review.207
Following joinder of the first application with subsequent applications, none of the208
subsequent applications so joined may be considered as a first application for the purposes209
of future joinder. The department shall notify the applicant to whose application a joinder210
is ordered and all other applicants previously joined to such application of the fact of each211
joinder pursuant to this subsection. In the event one or more applications have been joined212
pursuant to this subsection, the time limits for department action for all of the applicants213
shall run from the latest date that any one of the joined applications was declared complete214
for review. In the event of the consideration of one or more applications joined pursuant215
to this subsection, the department may award no certificate of need or one or more216
certificates of need to the application or applications, if any, which are consistent with the217
considerations contained in Code Section 31-6-42, the department's applicable rules, and218
the award of which will best satisfy the purposes of this chapter.219
(g) The department shall review the application and all written information submitted by220
the applicant in support of the application and all information submitted in opposition to221
the application to determine the extent to which the proposed project is consistent with the222
applicable considerations stated in Code Section 31-6-42 and in the department's applicable223
rules. During the course of the review, the department staff may request additional224
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information from the applicant as deemed appropriate. Pursuant to rules adopted by the225
department, a public hearing on applications covered by those regulations may be held226
prior to the date of the department's decision thereon. Such rules shall provide that when227
good cause has been shown, a public hearing shall be held by the department. Any228
interested person may submit information to the department concerning an application, and229
an applicant shall be entitled to notice of and to respond to any such submission.230
(h) The department shall within 30 days of receipt of the application provide the applicant231
an opportunity to meet with the department to discuss the such application and to provide232
the applicant an opportunity to submit additional information. Such additional information233
shall be submitted within the time limits adopted by the department. The department shall234
also provide an opportunity for any party that is permitted to oppose an application235
pursuant to paragraph (2) of subsection (d) of this Code section to meet with the236
department and to provide additional information to the department. In order for any such237
opposing party to have standing to appeal an adverse decision pursuant to Code Section238
31-6-44, such party must attend and participate in an opposition meeting.239
(i) Unless extended by the department for an additional period of up to 30 days pursuant240
to subsection (d) of this Code section, the department shall, no later than 120 days after an241
application is determined to be complete for review, or, in the event of joined applications,242
120 days after the last application is declared complete for review, provide written243
notification to an applicant of the department's decision to issue or to deny issuance of a244
certificate of need for the proposed project. Such notice shall contain the department's245
written findings of fact and decision as to each applicable consideration or rule and a246
detailed statement of the reasons and evidentiary support for issuing or denying a certificate247
of need for the action proposed by each applicant. The department shall also mail such248
notification to the appropriate regional commission and the chief elected official of the249
county and municipal governments, if any, in whose boundaries the proposed project will250
be located. In the event such decision is to issue a certificate of need, the certificate of251
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need shall be effective on the day of the decision unless the decision is appealed to the252
Certificate of Need Appeal Panel in accordance with this chapter. Within seven days of253
the decision, the department shall publish notice of its decision to grant or deny an254
application in the same manner as it publishes notice of the filing of an application.255
(j) Should the department fail to provide written notification of the decision within the256
time limitations set forth in this Code section, an application shall be deemed to have been257
approved as of the one hundred twenty-first day following notice from the department that258
an application, or the last of any applications joined pursuant to subsection (f) of this Code259
section, is declared 'complete for review.'260
(k) Notwithstanding other provisions of this article, when the Governor has declared a261
state of emergency in a region of the state, existing health care facilities in the affected262
region may seek emergency approval from the department to make expenditures in excess263
of the capital expenditure threshold or to offer services that may otherwise require a264
certificate of need. The department shall give special expedited consideration to such265
requests and may authorize such requests for good cause. Once the state of emergency has266
been lifted, any services offered by an affected health care facility under this subsection267
shall cease to be offered until such time as the health care facility that received the268
emergency authorization has requested and received a certificate of need. For purposes of269
this subsection, the term 'good cause' means that authorization of the request shall directly270
resolve a situation posing an immediate threat to the health and safety of the public. The271
department shall establish, by rule, procedures whereby requirements for the process of272
review and issuance of a certificate of need may be modified and expedited as a result of273
emergency situations."274
SECTION 5.275
Said title is further amended by revising Code Section 31-6-47, relating to exemptions from276
certificate of need requirements, as follows:277
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"31-6-47.278
(a) Notwithstanding the other provisions of this chapter, this chapter shall not apply to:279
(1) Infirmaries operated by educational institutions for the sole and exclusive benefit of280
students, faculty members, officers, or employees thereof;281
(2) Infirmaries or facilities operated by businesses for the sole and exclusive benefit of282
officers or employees thereof, provided that such infirmaries or facilities make no283
provision for overnight stay by persons receiving their services;284
(3) Institutions operated exclusively by the federal government or by any of its agencies;285
(4) Offices of private physicians or dentists whether for individual or group practice,286
except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code287
Section 31-6-40;288
(5) Religious, nonmedical health care institutions as defined in 42 U.S.C.289
Section 1395x(ss)(1), listed and certified by a national accrediting organization;290
(6) Site acquisitions for health care facilities or preparation or development costs for291
such sites prior to the decision to file a certificate of need application;292
(7) Expenditures related to adequate preparation and development of an application for293
a certificate of need;294
(8) The commitment of funds conditioned upon the obtaining of a certificate of need;295
(9) Expenditures for the restructuring or acquisition of existing health care facilities by296
stock or asset purchase, merger, consolidation, or other lawful means;297
(9.1) The purchase of a closing hospital or of a hospital that has been closed for no more298
than 12 24 months by a hospital in a contiguous county to repurpose the facility as a299
micro-hospital;300
(10) Expenditures of less than $870,000.00 for any minor or major repair or replacement301
of equipment by a health care facility that is not owned by a group practice of physicians302
or a hospital and that provides diagnostic imaging services if such facility received a303
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letter of nonreviewability from the department prior to July 1, 2008. This paragraph shall304
not apply to such facilities in rural counties;305
(10.1) Except as provided in paragraph (10) of this subsection, an expenditure for the306
minor or major repair of a health care facility or a facility that is exempt from the307
requirements of this chapter, parts thereof, or services provided or equipment used308
therein; or the replacement of equipment, including but not limited to CT scanners,309
magnetic resonance imaging, positron emission tomography (PET), and positron310
emission tomography/computed tomography previously approved for a certificate of311
need;312
(11) Capital expenditures otherwise covered by this chapter required solely to eliminate313
or prevent safety hazards as defined by federal, state, or local fire, building,314
environmental, occupational health, or life safety codes or regulations, to comply with315
licensing requirements of the department, or to comply with accreditation standards of316
a nationally recognized health care accreditation body;317
(12) Cost overruns whose percentage of the cost of a project is equal to or less than the318
cumulative annual rate of increase in the composite construction index, published by the319
United States Bureau of the Census of the Department of Commerce, calculated from the320
date of approval of the project;321
(13) Transfers from one health care facility to another such facility of major medical322
equipment previously approved under or exempted from certificate of need review,323
except where such transfer results in the institution of a new clinical health service for324
which a certificate of need is required in the facility acquiring such equipment, provided325
that such transfers are recorded at net book value of the medical equipment as recorded326
on the books of the transferring facility;327
(14) New institutional health services provided by or on behalf of health maintenance328
organizations or related health care facilities in circumstances defined by the department329
pursuant to federal law;330
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(15) Increases in the bed capacity of a hospital up to ten beds or 10 20 percent of331
capacity, whichever is greater, in any consecutive two-year three-year period, in a332
hospital that has maintained an overall occupancy rate greater than 75 60 percent for the333
previous 12 month period;334
(16) Expenditures for nonclinical projects, including parking lots, parking decks, and335
other parking facilities; computer systems, software, and other information technology;336
medical office buildings; administrative office space; conference rooms; education337
facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;338
bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;339
grounds; signage; family meeting or lounge areas; other nonclinical physical plant340
renovations or upgrades that do not result in new or expanded clinical health services, and341
state mental health facilities;342
(17) Life plan communities, provided that the skilled nursing component of the facility343
is for the exclusive use of residents of the life plan community and that a written344
exemption is obtained from the department; provided, however, that new sheltered345
nursing home beds may be used on a limited basis by persons who are not residents of346
the life plan community for a period up to five years after the date of issuance of the347
initial nursing home license, but such beds shall not be eligible for Medicaid348
reimbursement. For the first year, the life plan community sheltered nursing facility may349
utilize not more than 50 percent of its licensed beds for patients who are not residents of350
the life plan community. In the second year of operation, the life plan community shall351
allow not more than 40 percent of its licensed beds for new patients who are not residents352
of the life plan community. In the third year of operation, the life plan community shall353
allow not more than 30 percent of its licensed beds for new patients who are not residents354
of the life plan community. In the fourth year of operation, the life plan community shall355
allow not more than 20 percent of its licensed beds for new patients who are not residents356
of the life plan community. In the fifth year of operation, the life plan community shall357
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allow not more than 10 percent of its licensed beds for new patients who are not residents358
of the life plan community. At no time during the first five years shall the life plan359
community sheltered nursing facility occupy more than 50 percent of its licensed beds360
with patients who are not residents under contract with the life plan community. At the361
end of the five-year period, the life plan community sheltered nursing facility shall be362
utilized exclusively by residents of the life plan community, and at no time shall a363
resident of a life plan community be denied access to the sheltered nursing facility. At364
no time shall any existing patient be forced to leave the life plan community to comply365
with this paragraph. The department is authorized to promulgate rules and regulations366
regarding the use and definition of the term 'sheltered nursing facility' in a manner367
consistent with this Code section. Agreements to provide continuing care include368
agreements to provide care for any duration, including agreements that are terminable by369
either party;370
(18) Any single specialty ambulatory surgical center that:371
(A)(i) Has capital expenditures associated with the construction, development, or372
other establishment of the clinical health service which do not exceed $2.5 million;373
or374
(ii) Is the only single specialty ambulatory surgical center in the county owned by the375
group practice and has two or fewer operating rooms; provided, however, that a center376
exempt pursuant to this division shall be required to obtain a certificate of need in377
order to add any additional operating rooms;378
(B) Has a hospital affiliation agreement with a hospital within a reasonable distance379
from the facility or the medical staff at the center has admitting privileges or other380
acceptable documented arrangements with such hospital to ensure the necessary backup381
for the center for medical complications. The center shall have the capability to transfer382
a patient immediately to a hospital within a reasonable distance from the facility with383
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adequate emergency room services. Hospitals shall not unreasonably deny a transfer384
agreement or affiliation agreement to the center;385
(C)(i) Provides care to Medicaid beneficiaries and, if the facility provides medical386
care and treatment to children, to PeachCare for Kids beneficiaries and provides387
uncompensated indigent and charity care in an amount equal to or greater than 2388
percent of its adjusted gross revenue; or389
(ii) If the center is not a participant in Medicaid or the PeachCare for Kids Program,390
provides uncompensated care to Medicaid beneficiaries and, if the facility provides391
medical care and treatment to children, to PeachCare for Kids beneficiaries,392
uncompensated indigent and charity care, or both in an amount equal to or greater393
than 4 percent of its adjusted gross revenue;394
provided, however, that single specialty ambulatory surgical centers owned by395
physicians in the practice of ophthalmology shall not be required to comply with this396
subparagraph; and397
(D) Provides annual reports in the same manner and in accordance with Code Section398
31-6-70.399
Noncompliance with any condition of this paragraph shall result in a monetary penalty400
in the amount of the difference between the services which the center is required to401
provide and the amount actually provided and may be subject to revocation of its402
exemption status by the department for repeated failure to pay any fines or moneys due403
to the department or for repeated failure to produce data as required by Code Section404
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of405
Title 50, the 'Georgia Administrative Procedure Act.' The dollar amount specified in this406
paragraph shall be adjusted annually by an amount calculated by multiplying such dollar407
amount (as adjusted for the preceding year) by the annual percentage of change in the408
composite index of construction material prices, or its successor or appropriate409
replacement index, if any, published by the United States Department of Commerce for410
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the preceding calendar year, commencing on July 1, 2009, and on each anniversary411
thereafter of publication of the index. The department shall immediately institute412
rule-making procedures to adopt such adjusted dollar amounts. In calculating the dollar413
amounts of a proposed project for purposes of this paragraph, the costs of all items414
subject to review by this chapter and items not subject to review by this chapter415
associated with and simultaneously developed or proposed with the project shall be416
counted, except for the expenditure or commitment of or incurring an obligation for the417
expenditure of funds to develop certificate of need applications, studies, reports,418
schematics, preliminary plans and specifications or working drawings, or to acquire sites;419
(19) Any joint venture ambulatory surgical center that:420
(A) Has capital expenditures associated with the construction, development, or other421
establishment of the clinical health service which do not exceed $5 million;422
(B)(i) Provides care to Medicaid beneficiaries and, if the facility provides medical423
care and treatment to children, to PeachCare for Kids beneficiaries and provides424
uncompensated indigent and charity care in an amount equal to or greater than 2425
percent of its adjusted gross revenue; or426
(ii) If the center is not a participant in Medicaid or the PeachCare for Kids Program,427
provides uncompensated care to Medicaid beneficiaries and, if the facility provides428
medical care and treatment to children, to PeachCare for Kids beneficiaries,429
uncompensated indigent and charity care, or both in an amount equal to or greater430
than 4 percent of its adjusted gross revenue; and431
(C)(B) Provides annual reports in the same manner and in accordance with Code432
Section 31-6-70.433
Noncompliance with any condition of this paragraph shall result in a monetary penalty434
in the amount of the difference between the services which the center is required to435
provide and the amount actually provided and may be subject to revocation of its436
exemption status by the department for repeated failure to pay any fines or moneys due437
H. B. 1339 (SUB)
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to the department or for repeated failure to produce data as required by Code438
Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to439
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'; The dollar amount440
specified in this paragraph shall be adjusted annually by an amount calculated by441
multiplying such dollar amount (as adjusted for the preceding year) by the annual442
percentage of change in the composite index of construction material prices, or its443
successor or appropriate replacement index, if any, published by the United States444
Department of Commerce for the preceding calendar year, commencing on July 1, 2009,445
and on each anniversary thereafter of publication of the index. The department shall446
immediately institute rule-making procedures to adopt such adjusted dollar amounts. In447
calculating the dollar amounts of a proposed project for purposes of this paragraph, the448
costs of all items subject to review by this chapter and items not subject to review by this449
chapter associated with and simultaneously developed or proposed with the project shall450
be counted, except for the expenditure or commitment of or incurring an obligation for451
the expenditure of funds to develop certificate of need applications, studies, reports,452
schematics, preliminary plans and specifications or working drawings, or to acquire sites;453
(20) Expansion of services by an imaging center based on a population needs454
methodology taking into consideration whether the population residing in the area served455
by the imaging center has a need for expanded services, as determined by the department456
in accordance with its rules and regulations, if such imaging center:457
(A) Was in existence and operational in this state on January 1, 2008;458
(B) Is owned by a hospital or by a physician or a group of physicians comprising at459
least 80 percent ownership who are currently board certified in radiology;460
(C) Provides three or more diagnostic and other imaging services;461
(D) Accepts all patients regardless of ability to pay; and462
(E) Provides uncompensated indigent and charity care in an amount equal to or greater463
than the amount of such care provided by the geographically closest general acute care464
H. B. 1339 (SUB)
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hospital; provided, however, that this paragraph shall not apply to an imaging center in465
a rural county;466
(21) Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age467
and older;468
(22) Therapeutic cardiac catheterization in hospitals selected by the department prior to469
July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research470
Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as471
determined by the department on an annual basis, meet the criteria to participate in the472
C-PORT Study but have not been selected for participation; provided, however, that if473
the criteria requires a transfer agreement to another hospital, no hospital shall474
unreasonably deny a transfer agreement to another hospital;475
(23) Infirmaries or facilities operated by, on behalf of, or under contract with the476
Department of Corrections or the Department of Juvenile Justice for the sole and477
exclusive purpose of providing health care services in a secure environment to prisoners478
within a penal institution, penitentiary, prison, detention center, or other secure479
correctional institution, including correctional institutions operated by private entities in480
this state which house inmates under the Department of Corrections or the Department481
of Juvenile Justice;482
(24) The relocation of any skilled nursing facility, intermediate care facility, or483
micro-hospital within the same county, any other health care facility in a rural county484
within the same county, and any other health care facility in an urban county within a485
three-mile five-mile radius of the existing facility so long as the facility does not propose486
to offer any new or expanded clinical health services at the new location;487
(25) Facilities which are devoted to the provision of treatment and rehabilitative care for488
periods continuing for 24 hours or longer for persons who have traumatic brain injury,489
as defined in Code Section 37-3-1;490
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(26) Capital expenditures for a project otherwise requiring a certificate of need if those491
expenditures are for a project to remodel, renovate, replace, or any combination thereof,492
a medical-surgical hospital and:493
(A) That hospital:494
(i) Has a bed capacity of not more than 50 beds;495
(ii) Is located in a county in which no other medical-surgical hospital is located;496
(iii) Has at any time been designated as a disproportionate share hospital by the497
department; and498
(iv) Has at least 45 percent of its patient revenues derived from medicare, Medicaid,499
or any combination thereof, for the immediately preceding three years; and500
(B) That project:501
(i) Does not result in any of the following:502
(I) The offering of any new clinical health services;503
(II) Any increase in bed capacity;504
(III) Any redistribution of existing beds among existing clinical health services; or505
(IV) Any increase in capacity of existing clinical health services;506
(ii) Has at least 80 percent of its capital expenditures financed by the proceeds of a507
special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8508
of Title 48; and509
(iii) Is located within a three-mile five-mile radius of and within the same county as510
the hospital's existing facility;511
(27) The renovation, remodeling, refurbishment, or upgrading of a health care facility,512
so long as the project does not result in any of the following:513
(A) The offering of any new or expanded clinical health services;514
(B) Any increase in inpatient bed capacity; or515
(C) Any redistribution of existing beds among existing clinical health services; or516
H. B. 1339 (SUB)
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(D) A capital expenditure exceeding the threshold contained in paragraph (2) of517
subsection (a) of Code Section 31-6-40;518
(28) Other than for equipment used to provide positron emission tomography (PET)519
services, the acquisition of diagnostic, therapeutic, or other imaging equipment with a520
value of $3 million or less, by or on behalf of:521
(A) A hospital; or522
(B) An individual private physician or single group practice of physicians exclusively523
for use on patients of such private physician or single group practice of physicians and524
such private physician or member of such single group practice of physicians is525
physically present at the practice location where the diagnostic or other imaging526
equipment is located at least 75 percent of the time that the equipment is in use.;527
The amount specified in this paragraph shall not include build-out costs, as defined by528
the department, but shall include all functionally related equipment, software, and any529
warranty and services contract costs for the first five years. The acquisition of one or530
more items of functionally related diagnostic or therapeutic equipment shall be531
considered as one project. The dollar amount specified in this paragraph and in532
paragraph (10) of this subsection shall be adjusted annually by an amount calculated by533
multiplying such dollar amounts (as adjusted for the preceding year) by the annual534
percentage of change in the consumer price index, or its successor or appropriate535
replacement index, if any, published by the United States Department of Labor for the536
preceding calendar year, commencing on July 1, 2010; and537
(29) Any capital expenditures A capital expenditure of $10 million or less by a hospital538
at such hospital's primary campus for:539
(A) The expansion or addition of the following clinical health services: operating540
rooms, other than dedicated outpatient operating rooms; medical-surgical services;541
gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;542
cardiac care or other general hospital services; provided, however, that such543
H. B. 1339 (SUB)
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expenditure does not include the expansion or addition of inpatient beds or the544
conversion of one type of inpatient bed to another type of inpatient bed; or545
(B) The movement of clinical health services from one location on the hospital's546
primary campus to another location on such hospital's primary campus;547
(30) New or expanded psychiatric or substance abuse inpatient programs or contracted548
beds that serve Medicaid and uninsured patients that:549
(A) Are open 365 days per year, seven days per week, and 24 hours per day;550
(B) Provide uncompensated indigent and charity care in an amount equal to or greater551
than 5 percent of its adjusted gross revenue;552
(C) Participate as providers of medical assistance for Medicaid purposes;553
(D) Have hospital affiliation agreements with acute care hospitals within a reasonable554
distance from the programs or contracted beds or the medical staffs at the programs or555
contracted beds have admitting privileges or other acceptable documented arrangements556
with such hospitals to ensure the necessary backup for the programs or contracted beds557
for medical complications. The programs or contracted beds shall have the capability558
to transfer a patient immediately to a hospital within a reasonable distance from the559
programs or contracted beds with adequate emergency room services. Hospitals shall560
not unreasonably deny a transfer agreement or affiliation agreement to the programs or561
contracted beds; and562
(E) Provide annual reports in the same manner and in accordance with Code Section563
31-6-70;564
(31) The offering of new or expanded basic obstetric services by a hospital in a rural565
county provided that:566
(A) Such services are available 365 days per year, seven days per week, and 24 hours567
per day;568
(B) The hospital participates as a provider of medical assistance for Medicaid569
purposes;570
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(C) The hospital has a hospital affiliation agreement with an acute care hospital within571
a reasonable distance from the hospital providing the obstetric services or the medical572
staff at the hospital providing the obstetric services has admitting privileges or other573
acceptable documented arrangements with such acute care hospital to ensure the574
necessary backup for the hospital providing the obstetric services for medical575
complications. The hospital providing the obstetric services shall have the capability576
to transfer a patient immediately to the acute care hospital within a reasonable distance577
from the hospital providing the obstetric services with adequate emergency room578
services. Acute care hospitals shall not unreasonably deny a transfer agreement or579
affiliation agreement to the hospital providing the obstetric services, unless the hospital580
providing the obstetric services itself is an acute care hospital that can address medical581
complications; and582
(D) Provides annual reports in the same manner and in accordance with Code Section583
31-6-70;584
(32) A new general acute care hospital in a rural county that:585
(A) Attains status as a teaching hospital within 30 months of opening, and maintains586
such status thereafter;587
(B) Obtains verification as a Level I, II, or III trauma center from the American588
College of Surgeons within 30 months of opening, and maintains such verification589
thereafter;590
(C) Provides emergency, inpatient, and outpatient psychiatric and behavioral health591
services;592
(D) Provides uncompensated indigent and charity care in an amount equal to or greater593
than 5 percent of its adjusted gross revenue;594
(E) Participates as a provider of medical assistance for Medicaid purposes;595
(F) Reserves at least 51 percent of its residency slots for graduates of medical schools596
in this state for purposes of training; and597
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(G) Provides annual reports in the same manner and in accordance with Code Section598
31-6-70; and599
(33) Transfer of existing beds from one hospital campus to another hospital campus600
within the same hospital system within a ten-mile radius of the original campus; provided601
that the exemption in this paragraph has not been used by the transferring hospital in the602
prior 24 months.603
(b) By rule, the department shall establish a procedure for expediting or waiving reviews604
of certain projects, the nonreview of which it deems compatible with the purposes of this605
chapter, in addition to expenditures exempted from review by this Code section."606
SECTION 6.607
Said title is further amended by revising Code Section 31-7-47.1, relating to prior notice and608
approval of certain activities, as follows:609
"31-6-47.1.610
(a) The department shall require prior notice from a new health care facility for approval611
of any activity which is believed to be exempt pursuant to Code Section 31-6-47 or612
excluded from the requirements of this chapter under other provisions of this chapter. The613
department may require prior notice and approval of any activity which is believed to be614
exempt pursuant to paragraphs (10), (15), (16), (17), (20), (21), (23), (25), (26), (27), (28),615
and (29), (30), (31), and (32) of subsection (a) of Code Section 31-6-47. The department616
shall establish timeframes, forms, and criteria to request a letter of determination that an617
activity is properly exempt or excluded under this chapter prior to its implementation. The618
department shall publish notice of all requests for letters of determination regarding exempt619
activity and opposition to such request. Persons opposing a request for approval of an620
exempt activity shall be entitled to file an objection with the department and the department621
shall consider any filed objection when determining whether an activity is exempt. After622
the department's decision, an opposing party shall have the right to a fair hearing pursuant623
H. B. 1339 (SUB)
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to Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act,' on an adverse624
decision of the department and judicial review of a final decision in the same manner and625
under the same provisions as in Code Section 31-6-44.1. If no objection to a request for626
determination is filed within 30 days of the department's receipt of such request for627
determination, the department shall have 60 days from the date of the department's receipt628
of such request to review the request and issue a letter of determination. The department629
may adopt rules for deciding when it is not practicable to provide a determination in 60630
days and may extend the review period upon written notice to the requestor but only for an631
extended period of no longer than an additional 30 days.632
(b) Noncompliance with any condition of paragraph (30), (31), or (32) of subsection (a)633
of Code Section 31-7-47 shall result in a monetary penalty in the amount of the difference634
between the services which the exemption holder is required to provide and the amount635
actually provided and may be subject to revocation of its exemption status by the636
department for failure to meet any one or more requirements for the exemption, for637
repeated failure to pay any fines or moneys due to the department, or for repeated failure638
to produce data as required by Code Section 31-6-70 after notice to the exemption holder639
and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia Administrative640
Procedure Act.'"641
SECTION 7.642
Said title is further amended in Article 3 of Chapter 6, relating to the Certificate of Need643
Program, by adding a new Code section to read as follows:644
"31-6-51.645
(a) The department, in conjunction with the Office of Legislative Counsel, shall review the646
statutory framework and provisions of this chapter and the certificate of need program647
generally and shall make recommendations relating to rewriting, reorganizing, and648
clarifying the provisions of this chapter. Such review shall also include recommendations649
H. B. 1339 (SUB)
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to streamline the statutory procedures required to obtain a certificate of need or a letter of650
determination.651
(b) The department may consult with and obtain input from certificate of need applicants,652
certificate of need holders, local government representatives, citizens, or other interested653
parties in conducting such review.654
(c) The department shall submit its recommendations to the General Assembly, which may655
include proposed legislation, no later than December 1, 2024.656
(d) This Code section shall stand repealed on December 31, 2024."657
SECTION 8.658
Said title is further amended in Code Section 31-6-70, relating to reports to the department659
by certain health care facilities an all ambulatory surgical centers and imaging centers and660
public availability, by revising subsection (e) as follows:661
"(e)(1) In the event the department does not receive an annual report from a health care662
facility requiring a certificate of need or an ambulatory surgical center or imaging center,663
whether or not exempt from obtaining a certificate of need under this chapter, on or664
before the date such report was due or receives a timely but incomplete report, the665
department shall notify the health care facility or center regarding the deficiencies and666
shall be authorized to fine such health care facility or center an amount not to exceed667
$500.00 $2,000.00 per day for every day up to 30 days and $1,000.00 $5,000.00 per day668
for every day over 30 days for every day of such untimely or deficient report.669
(2) In the event the department does not receive an annual report from a health care670
facility within 180 days following the date such report was due or receives a timely but671
incomplete report which is not completed within such 180 days, the department shall be672
authorized to revoke such health care facility's certificate of need in accordance with673
Code Section 31-6-45."674
H. B. 1339 (SUB)
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SECTION 9.675
Said title is further amended in Code Section 31-8-9.1, relating to eligibility to receive tax676
credits, by revising paragraph (3) of subsection (a) as follows:677
"(3) 'Rural hospital organization' means an acute care hospital or rural freestanding678
emergency department licensed by the department pursuant to Article 1 of Chapter 7 of679
this title that:680
(A) Has its primary campus Provides inpatient hospital services at a facility located in681
a rural county or is a critical access hospital;682
(B) Participates in both Medicaid and medicare and accepts both Medicaid and683
medicare patients;684
(C) Provides health care services to indigent patients;685
(D) Has at least 10 percent of its annual net revenue categorized as indigent care,686
charity care, or bad debt;687
(E) Annually files IRS Form 990, Return of Organization Exempt From Income Tax,688
with the department, or for any hospital not required to file IRS Form 990, the689
department will provide a form that collects the same information to be submitted to the690
department on an annual basis;691
(F) Is operated by a county or municipal authority pursuant to Article 4 of Chapter 7692
of this title or is designated as a tax-exempt organization under Section 501(c)(3) of the693
Internal Revenue Code;694
(G) Is current with all audits and reports required by law; and695
(H) Has a three-year average patient margin, as a percent of expense, less than one696
standard deviation above the state-wide three-year average of organizations defined in697
subparagraphs (A) through (G) of this paragraph, as calculated by the department. For698
purposes of this subparagraph, the term 'patient margin' means gross patient revenues699
less contractual adjustments, bad debt, indigent and charity care, other uncompensated700
care, and total expenses."701
H. B. 1339 (SUB)
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SECTION 10.702
Code Section 48-7-29.20 of the Official Code of Georgia Annotated, relating to tax credits703
for contributions to rural hospital organizations, is amended by revising subsections (b.1),704
(e), and (k) as follows:705
"(b.1) From January 1 to June 30 each taxable year, an individual taxpayer shall be limited706
in its qualified rural hospital organization expenses allowable for credit under this Code707
section, and the commissioner shall not approve qualified rural hospital organization708
expenses incurred from January 1 to June 30 each taxable year, which exceed the following709
limits:710
(1) In the case of a single individual or a head of household, $5,000.00;711
(2) In the case of a married couple filing a joint return, $10,000.00; or712
(3) In the case of an individual who is a member of a limited liability company duly713
formed under state law, a shareholder of a Subchapter 'S' corporation, or a partner in a714
partnership, $10,000.00 $25,000.00."715
"(e)(1) In no event shall the aggregate amount of tax credits allowed under this Code716
section exceed $75 $100 million per taxable year.717
(2)(A) No more than $4 million of the aggregate limit established by paragraph (1) of718
this subsection shall be contributed to any individual rural hospital organization in any719
taxable year. From January 1 to June 30 each taxable year, the commissioner shall only720
preapprove contributions submitted by individual taxpayers in an amount not to exceed721
$2 million, and from corporate donors in an amount not to exceed $2 million. From722
July 1 to December 31 each taxable year, subject to the aggregate limit in paragraph (1)723
of this subsection and the individual rural hospital organization limit in this paragraph,724
the commissioner shall approve contributions submitted by individual taxpayers and725
corporations or other entities.726
(B) In the event an individual or corporate donor desires to make a contribution to an727
individual rural hospital organization that has received the maximum amount of728
H. B. 1339 (SUB)
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contributions for that taxable year, the Department of Community Health shall provide729
the individual or corporate donor with a list, ranked in order of financial need, as730
determined by the Department of Community Health, of rural hospital organizations731
still eligible to receive contributions for the taxable year.732
(C) In the event an individual or corporate donor desires to make a contribution to an733
individual rural hospital organization that would cause such rural hospital organization734
to exceed its maximum amount of contributions for that year, the commissioner shall735
not deny such desired contribution, but shall approve the proportional amount of the736
desired contribution up to the rural hospital organization's maximum allowed amount737
and any remainder shall be attributed as provided for in subparagraph (D) of this738
paragraph.739
(C)(D) In the event that an individual or corporate donor desires to make a contribution740
to an unspecified or undesignated rural hospital organization, either directly to the741
department or through a third party that participates in soliciting, administering, or742
managing donations, such donation shall be attributed to the rural hospital organization743
ranked with the highest financial need that has not yet received the maximum amount744
of contributions for that taxable year, regardless of whether a third party has a745
contractual relationship or agreement with such rural hospital organization.746
(D)(E) Any third party that participates in soliciting, advertising, or managing747
donations shall provide the complete list of rural hospital organizations eligible to748
receive the tax credit provided pursuant to this Code section including their ranking in749
order of financial need as determined by the Department of Community Health750
pursuant to Code Section 31-8-9.1, to any potential donor regardless of whether a third751
party has a contractual relationship or agreement with such rural hospital organization.752
(3) For purposes of paragraphs (1) and (2) of this subsection, a rural hospital753
organization shall notify a potential donor of the requirements of this Code section. 754
Before making a contribution to a rural hospital organization, the taxpayer shall755
H. B. 1339 (SUB)
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electronically notify the department, in a manner specified by the department, of the total756
amount of contribution that the taxpayer intends to make to the rural hospital757
organization. The commissioner shall preapprove or deny the requested amount or a758
portion of such amount, if applicable pursuant to subparagraph (C) of paragraph (2) of759
this subsection, within 30 days after receiving the request from the taxpayer and shall760
provide written notice to the taxpayer and rural hospital organization of such preapproval761
or denial which shall not require any signed release or notarized approval by the taxpayer. 762
In order to receive a tax credit under this Code section, the taxpayer shall make the763
contribution to the rural hospital organization within 180 days after receiving notice from764
the department that the requested amount was preapproved. In order to receive a tax765
credit under this Code section, a taxpayer preapproved by the commissioner on or before766
September 30 shall make the contribution to the rural hospital organization within 180767
days after receiving notice of preapproval from the commissioner, but not later than768
October 31. A taxpayer preapproved by the commissioner after September 30 shall make769
the contribution to the rural hospital organization on or before December 31. If the770
taxpayer does not comply with this paragraph, the commissioner shall not include this771
preapproved contribution amount when calculating the limits prescribed in paragraphs772
(1) and (2) of this subsection.773
(4)(A) Preapproval of contributions by the commissioner shall be based solely on the774
availability of tax credits subject to the aggregate total limit established under775
paragraph (1) of this subsection and the individual rural hospital organization limit776
established under paragraph (2) of this subsection.777
(B) Any taxpayer preapproved by the department commissioner pursuant to this778
subsection shall retain their approval in the event the credit percentage in this Code779
section is modified for the year in which the taxpayer was preapproved.780
(C) Upon the rural hospital organization's confirmation of receipt of donations that781
have been preapproved by the department commissioner, any taxpayer preapproved by782
H. B. 1339 (SUB)
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the department commissioner pursuant to subsection (c) of this Code section shall783
receive the full benefit of the income tax credit established by this Code section even784
though the rural hospital organization to which the taxpayer made a donation does not785
properly comply with the reports or filings required by this Code section.786
(5) Notwithstanding any laws to the contrary, the department shall not take any adverse787
action against donors to rural hospital organizations if the commissioner preapproved a788
donation for a tax credit prior to the date the rural hospital organization is removed from789
the Department of Community Health list pursuant to Code Section 31-8-9.1, and all such790
donations shall remain as preapproved tax credits subject only to the donor's compliance791
with paragraph (3) of this subsection."792
"(k) This Code section shall stand automatically repealed and reserved on December 31,793
2024 2029."794
SECTION 11.795
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to796
medical assistance generally, is amended by adding a new Code section to read as follows:797
"49-4-156.798
(a) There is created the Comprehensive Health Coverage Commission. The commission799
shall be attached to the Department of Community Health for administrative purposes only800
as provided by Code Section 50-4-3.801
(b) The commission shall consist of nine members, who shall be appointed no later than802
July 1, 2024, as follows:803
(1) The chairperson, who shall be a subject matter expert on health policy, and shall not804
be an employee of the State of Georgia, to be appointed by the Governor;805
(2) Four nonlegislative members to be appointed by the Speaker of the House of806
Representatives; and807
(3) Four nonlegislative members to be appointed by the President of the Senate.808
H. B. 1339 (SUB)
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(c) Members of the commission shall not be registered lobbyists in the State of Georgia.809
(d) Members of the commission shall serve without compensation.810
(e) The purpose of the commission shall be to advise the Governor, the General Assembly,811
and the Department of Community Health, as the administrator of the state medical812
assistance program, on issues related to access and quality of healthcare for Georgia's813
low-income and uninsured populations. The commission shall be tasked with reviewing814
the following:815
(1) Opportunities related to reimbursement and funding for Georgia healthcare providers,816
including premium assistance programs;817
(2) Opportunities related to quality improvement of healthcare for Georgia's low income818
and uninsured populations; and819
(3) Opportunities to enhance service delivery and coordination of healthcare among and820
across state agencies.821
(f) Subject to appropriations, the commission shall contract with experts and consultants822
to produce a semiannual report on its findings for the Governor and the General Assembly. 823
The commission shall provide its initial report to the Governor and the General Assembly824
no later than December 1, 2024.825
(g) The commission shall stand abolished on December 31, 2026, unless extended by the826
General Assembly prior to such date."827
SECTION 12.828
(a) Except as provided in subsection (b) of this Section, this Act shall become effective on829
July 1, 2024.830
(b) Sections 1, 3, 4, 5 ,6, 8, and 11 of this Act shall become effective on July 1, 2025.831
(c) Sections 9 and 10 of this Act shall be applicable to taxable years beginning on or after832
January 1, 2024.833
H. B. 1339 (SUB)
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SECTION 13.834
All laws and parts of laws in conflict with this Act are repealed.835
H. B. 1339 (SUB)
- 33 -