Georgia House Bill HB1339 Enrolled / Bill

                    24 HB 1339/AP
House Bill 1339 (AS PASSED HOUSE AND SENATE)
By: Representatives Parrish of the 158
th
, Burns of the 159
th
, Hawkins of the 27
th
, Beverly of
the 143
rd
, Taylor of the 173
rd
, and others 
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 provisions relative to certificate of need; to revise definitions; to provide for review2
of the state 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 provisions relating to appeals; to5
revise exemptions from certificate of need requirements; to provide for a review of the6
statutory framework of the certificate of need program; to provide for automatic repeal; to7
increase fines for reporting deficiencies; to amend Code Section 48-7-29.20 of the Official8
Code of Georgia Annotated, relating to tax credits for contributions to rural hospital9
organizations, so as to increase the tax credit limit for contributions by corporate donors; to10
increase the aggregate limit for tax credits for contributions to rural hospital organizations;11
to provide for preapproval of proportional amounts of contributions under certain12
circumstances; to provide for certain timelines; to extend the sunset provision; to amend13
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to14
medical assistance generally, so as to provide for the creation of the Comprehensive Health15
Coverage Commission; to provide for its members; to provide for its purpose and duties; to16
provide for assistance from experts and consultants; to provide for semiannual reports; to17
provide for the automatic repeal of the commission; to provide for related matters; to provide18
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for effective dates; to provide for applicability; to repeal conflicting laws; and for other
19
purposes.20
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:21
SECTION 1.22
Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by revising23
paragraphs (23) and (33) of Code Section 31-6-2, relating to definitions relative to state24
health planning and development, as follows:25
"(23)  'Joint venture ambulatory surgical center' means a freestanding ambulatory surgical26
center that is jointly owned by a hospital in the same county as the center or a hospital in27
a contiguous county if there is no hospital in the same county as the center and a single28
group of physicians practicing in the center and that provides surgery in a single specialty29
as defined by the department.  Such ambulatory surgical center shall only be utilized by
30
physicians who are of the same single specialty, who may include physicians who are not31
owners or employees of the single group practice of physicians that own and operate the32
center; provided, however, that general surgery, a group practice which includes one or33
more physiatrists who perform services that are reasonably related to the surgical34
procedures performed in the center, and a group practice in orthopedics which includes35
plastic hand surgeons with a certificate of added qualifications in Surgery of the Hand36
from the American Board of Plastic and Reconstructive Surgery shall be considered a37
single specialty.  The ownership interest of the hospital shall be no less than 30 percent38
and the collective ownership of the physicians or group of physicians shall be no less than39
30 percent. Nothing in this paragraph shall prohibit the owners of the center from40
entering into an arrangement with an outside entity for practice management,41
administrative services, or both."42
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"(33)  'Single specialty ambulatory surgical center' means an ambulatory surgical center
43
where surgery is performed in the offices of an individual private physician or single44
group practice of private physicians if such surgery is performed in a facility that is45
owned,
 and operated, and utilized by such the individual physician or single group46
practice of private physicians or single group of physicians who also are of a single47
specialty.  Such ambulatory surgical center shall only be utilized by physicians who are48
of the same single specialty, who may include physicians who are not owners or49
employees of the individual private physician or single group practice of private50
physicians that own and operate the center; provided, however, that general surgery, a51
group practice which includes one or more physiatrists who perform services that are52
reasonably related to the surgical procedures performed in the center, and a group53
practice in orthopedics which includes plastic hand surgeons with a certificate of added54
qualifications in Surgery of the Hand from the American Board of Plastic and55
Reconstructive Surgery shall be considered a single specialty.  Nothing in this paragraph56
shall prohibit an individual private physician or a single group practice of private57
physicians from entering into an arrangement with an outside entity for practice58
management, administrative services, or both."59
SECTION 2.60
Said title is further amended in Code Section 31-6-21, relating to Department of Community61
Health functions and powers with respect to state health planning and development, by62
revising subsection (a) as follows:63
"(a)  The Department of Community Health, established under Chapter 2 of this title, is64
authorized to administer the certificate of need program established under this chapter and,65
within the appropriations made available to the department by the General Assembly of66
Georgia and consistently with the laws of the State of Georgia, a state health plan adopted67
by the board.  The department shall review and update the state health plan at least every68
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five years beginning no later than January 1, 2025, to ensure the plan meets the evolving69
needs of the state. The department shall provide, by rule, for procedures to administer its70
functions until otherwise provided by the board."71
SECTION 3.72
Said title is further amended in Code Section 31-6-40, relating to certificate of need required73
for new institutional health services and exemption, by revising subsections (a), (b), and (c)74
as follows:75
"(a)  On and after July 1, 2008, any new institutional health service shall be required to76
obtain a certificate of need pursuant to this chapter.  New institutional health services77
include:78
(1)  The construction, development, or other establishment of a new, expanded, or79
relocated health care facility, except as otherwise provided in Code Section 31-6-47;80
(2)  Any expenditure by or on behalf of a health care facility in excess of $10 million81
which, under generally accepted accounting principles consistently applied, is a capital82
expenditure, except expenditures for acquisition of an existing health care facility.  The83
dollar amounts specified in this paragraph and in paragraph (14) of Code Section 31-6-284
shall be adjusted annually by an amount calculated by multiplying such dollar amounts85
(as adjusted for the preceding year) by the annual percentage of change in the composite86
index of construction material prices, or its successor or appropriate replacement index,87
if any, published by the United States Department of Commerce for the preceding88
calendar year, commencing on July 1, 2019, and on each anniversary thereafter of89
publication of the index. The department shall immediately institute rule-making90
procedures to adopt such adjusted dollar amounts.  In calculating the dollar amounts of91
a proposed project for purposes of this paragraph and paragraph (14) of Code Section92
31-6-2, the costs of all items subject to review by this chapter and items not subject to93
review by this chapter associated with and simultaneously developed or proposed with94
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the project shall be counted, except for the expenditure or commitment of or incurring an95
obligation for the expenditure of funds to develop certificate of need applications, studies,96
reports, schematics, preliminary plans and specifications or working drawings, or to97
acquire sites; Reserved;98
(3)  The purchase or lease by or on behalf of a health care facility or a diagnostic,99
treatment, or rehabilitation center of diagnostic or therapeutic equipment, except as100
otherwise provided in Code Section 31-6-47;101
(4)  Any increase in the bed capacity of a health care facility except as provided in Code102
Section 31-6-47;103
(5)  Clinical health services which are offered in or through a health care facility, which104
were not offered on a regular basis in or through such health care facility within the 12105
month period prior to the time such services would be offered;106
(6)  Any conversion or upgrading of any general acute care hospital to a specialty hospital107
or of a facility such that it is converted from a type of facility not covered by this chapter108
to any of the types of health care facilities which are covered by this chapter;109
(7)  Clinical health services which are offered in or through a diagnostic, treatment, or110
rehabilitation center which were not offered on a regular basis in or through that center111
within the 12 month period prior to the time such services would be offered, but only if112
the clinical health services are any of the following:113
(A)  Radiation therapy;114
(B)  Biliary lithotripsy;115
(C) Surgery in an operating room environment, including, but not limited to,116
ambulatory surgery; and117
(D)  Cardiac catheterization; and118
(8)  The conversion of a destination cancer hospital to a general cancer hospital.119
(b)  Any person proposing to develop or offer a new institutional health service or health120
care facility shall, before commencing such activity, submit a letter of intent and an121
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application to the department and obtain a certificate of need in the manner provided in this
122
chapter unless such activity is excluded from the scope of this chapter.123
(c)(1)  Any person who had a valid exemption granted or approved by the former Health124
Planning Agency or the department prior to July 1, 2008, shall not be required to obtain125
a certificate of need in order to continue to offer those previously offered services.126
(2)  Any facility offering ambulatory surgery pursuant to the exclusion designated on127
June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2; any diagnostic, treatment,128
or rehabilitation center offering diagnostic imaging or other imaging services in operation129
and exempt prior to July 1, 2008; or any facility operating pursuant to a letter of130
nonreviewability and offering diagnostic imaging services prior to July 1, 2008, shall:131
(A)  Provide annual reports in the same manner and in accordance with Code Section132
31-6-70; and133
(B)(i)  Provide care to Medicaid beneficiaries and, if the facility provides medical care134
and treatment to children, to PeachCare for Kids beneficiaries and provide135
uncompensated indigent and charity care in an amount equal to or greater than 2136
percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount
137
equal to or greater than the minimum amount established by the department which138
shall be reviewed by the department every 12 months; or139
(ii)  If the facility is not a participant in Medicaid or the PeachCare for Kids Program,140
provide uncompensated care for Medicaid beneficiaries and, if the facility provides141
medical care and treatment to children, for PeachCare for Kids beneficiaries,142
uncompensated indigent and charity care, or both in an amount equal to or greater143
than 4 percent of its adjusted gross revenue, and on and after January 1, 2026, in an144
amount equal to or greater than the minimum amount established by the department145
which shall be reviewed by the department every 12 months, if it:146
(I)  Makes a capital expenditure associated with the construction, development,147
expansion, or other establishment of a clinical health service or the acquisition or148
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replacement of diagnostic or therapeutic equipment with a value in excess of
149
$800,000.00 over a two-year period;150
(II)  Builds a new operating room; or151
(III)  Chooses to relocate in accordance with Code Section 31-6-47.152
Noncompliance with any condition of this paragraph shall result in a monetary penalty153
in the amount of the difference between the services which the center is required to154
provide and the amount actually provided and may be subject to revocation of its155
exemption status by the department for repeated failure to pay any fees or moneys due156
to the department or for repeated failure to produce data as required by Code Section157
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of158
Title 50, the 'Georgia Administrative Procedure Act.'  The dollar amount specified in this159
paragraph shall be adjusted annually by an amount calculated by multiplying such dollar160
amount (as adjusted for the preceding year) by the annual percentage of change in the161
consumer price index, or its successor or appropriate replacement index, if any, published162
by the United States Department of Labor for the preceding calendar year, commencing163
on July 1, 2009.  In calculating the dollar amounts of a proposed project for the purposes164
of this paragraph, the costs of all items subject to review by this chapter and items not165
subject to review by this chapter associated with and simultaneously developed or166
proposed with the project shall be counted, except for the expenditure or commitment of167
or incurring an obligation for the expenditure of funds to develop certificate of need168
applications, studies, reports, schematics, preliminary plans and specifications or working169
drawings, or to acquire sites.  Subparagraph (B) of this paragraph shall not apply to170
facilities offering ophthalmic ambulatory surgery pursuant to the exclusion designated171
on June 30, 2008, as division (14)(G)(iii) of Code Section 31-6-2 that are owned by172
physicians in the practice of ophthalmology."173
SECTION 4.174
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Said title is further amended by revising Code Section 31-6-43, relating to acceptance or
175
rejection of application for certificate, as follows:176
"31-6-43.177
(a)  At least 30
 25 days prior to submitting an application for a certificate of need for178
clinical health services, a person shall submit a letter of intent to the department.  The179
department shall provide by rule a process for submitting letters of intent and a mechanism180
by which applications may be filed to compete with and be reviewed comparatively with181
proposals described in submitted letters of intent.182
(b)  Each application for a certificate of need shall be reviewed received by the department,183
and within ten working days after the date of its receipt a determination shall be made as184
to whether the application complies with the rules governing the preparation and185
submission of applications.  If the application complies with the rules governing the186
preparation and submission of applications, and the department shall declare the187
application complete for review, shall accept and date the application, and shall notify the188
applicant of the timetable for its review.  The department shall also notify a newspaper of189
general circulation in the county in which the project shall be developed that the190
application has been deemed complete.  The department shall also notify the appropriate191
regional commission and the chief elected official of the county and municipal192
governments, if any, in whose boundaries the proposed project will be located that the193
application is complete for review.  If the application does not comply with the rules194
governing the preparation and submission of applications, the department shall notify the195
applicant in writing and provide a list of all deficiencies.  The applicant shall be afforded196
an opportunity to correct such deficiencies, and upon such correction, the application shall197
then be declared complete for review within ten days of the correction of such deficiencies,198
and notice given to a newspaper of general circulation in the county in which the project199
shall be developed that the application has been so declared.  The department shall also200
notify the appropriate regional commission and the chief elected official of the county and201
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municipal governments, if any, in whose boundaries the proposed project will be located
202
that the application is complete for review or when in the determination of the department203
a significant amendment is filed.204
(c)  The department shall specify by rule the time within which an applicant may amend205
its application.  The department may request an applicant to make amendments.  The206
department decision shall be made on an application as amended, if at all, by the applicant.207
(d)(1)  There shall be a time limit of 120 days for review of a project, beginning on the208
day the department declares the application complete for review or in the case of
209
applications joined for comparative review, beginning on the day the department declares210
the final application complete receives the application.  The department may adopt rules211
for determining when it is not practicable to complete a review in 120 days and may212
extend the review period upon written notice to the applicant but only for an extended213
period of not longer than an additional 30 days.  The department shall adopt rules214
governing the submission of additional information by the applicant and for opposing an215
application; provided, however, that such rules shall provide that any party permitted to216
oppose an application shall submit a notice of opposition no later than 30 days of receipt217
by the department of such application.218
(2)  No party may oppose an application for a certificate of need for a proposed project219
unless:220
(A)  Such party offers substantially similar services as proposed within a 35 mile radius221
of the proposed project or has a service area that overlaps the applicant's proposed222
service area; or223
(B)  Such party has submitted a competing application in the same batching cycle and224
is proposing to establish the same type of facility proposed or offers substantially225
similar services as proposed and has a service area that overlaps the applicant's226
proposed service area.227
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(e)  To allow the opportunity for comparative review of applications, the department may
228
provide by rule for applications for a certificate of need to be submitted on a timetable or229
batching cycle basis no less often than two times per calendar year for each clinical health230
service.  Applications for services, facilities, or expenditures for which there is no specified231
batching cycle may be filed at any time.232
(f)  The department may order the joinder of an application which is determined to be233
complete by the department for comparative review with one or more subsequently filed234
applications declared complete for review during the same batching cycle when:235
(1)  The first and subsequent applications involve similar clinical health service projects236
in the same service area or overlapping service areas; and237
(2)  The subsequent applications are filed and are declared complete for review within 30238
days of the date the first application was declared complete for review.239
Following joinder of the first application with subsequent applications, none of the240
subsequent applications so joined may be considered as a first application for the purposes241
of future joinder.  The department shall notify the applicant to whose application a joinder242
is ordered and all other applicants previously joined to such application of the fact of each243
joinder pursuant to this subsection.  In the event one or more applications have been joined244
pursuant to this subsection, the time limits for department action for all of the applicants245
shall run from the latest date that any one of the joined applications was declared complete246
for review.  In the event of the consideration of one or more applications joined pursuant247
to this subsection, the department may award no certificate of need or one or more248
certificates of need to the application or applications, if any, which are consistent with the249
considerations contained in Code Section 31-6-42, the department's applicable rules, and250
the award of which will best satisfy the purposes of this chapter.251
(g)  The department shall review the application and all written information submitted by252
the applicant in support of the application and all information submitted in opposition to253
the application to determine the extent to which the proposed project is consistent with the254
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applicable considerations stated in Code Section 31-6-42 and in the department's applicable
255
rules.  During the course of the review, the department staff may request additional256
information from the applicant as deemed appropriate.  Pursuant to rules adopted by the257
department, a public hearing on applications covered by those regulations may be held258
prior to the date of the department's decision thereon.  Such rules shall provide that when259
good cause has been shown, a public hearing shall be held by the department.  Any260
interested person may submit information to the department concerning an application, and261
an applicant shall be entitled to notice of and to respond to any such submission.262
(h)  The department shall within 30 days of receipt of the application
 provide the applicant263
an opportunity to meet with the department to discuss the such application and to provide264
the applicant an opportunity to submit additional information.  Such additional information265
shall be submitted within the time limits adopted by the department.  The department shall266
also provide an opportunity for any party that is permitted to oppose an application267
pursuant to paragraph (2) of subsection (d) of this Code section to meet with the268
department and to provide additional information to the department.  In order for any such269
opposing party to have standing to appeal an adverse decision pursuant to Code Section270
31-6-44, such party must attend and participate in an opposition meeting.271
(i)  Unless extended by the department for an additional period of up to 30 days pursuant272
to subsection (d) of this Code section, the department shall, no later than 120 days after an273
application is determined to be complete for review, or, in the event of joined applications,274
120 days after the last application is declared complete for review, provide written275
notification to an applicant of the department's decision to issue or to deny issuance of a276
certificate of need for the proposed project.  Such notice shall contain the department's277
written findings of fact and decision as to each applicable consideration or rule and a278
detailed statement of the reasons and evidentiary support for issuing or denying a certificate279
of need for the action proposed by each applicant.  The department shall also mail such280
notification to the appropriate regional commission and the chief elected official of the281
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county and municipal governments, if any, in whose boundaries the proposed project will
282
be located.  In the event such decision is to issue a certificate of need, the certificate of283
need shall be effective on the day of the decision unless the decision is appealed to the284
Certificate of Need Appeal Panel in accordance with this chapter.  Within seven days of285
the decision, the department shall publish notice of its decision to grant or deny an286
application in the same manner as it publishes notice of the filing of an application.287
(j)  Should the department fail to provide written notification of the decision within the288
time limitations set forth in this Code section, an application shall be deemed to have been289
approved as of the one hundred twenty-first day following notice from the department that290
an application, or the last of any applications joined pursuant to subsection (f) of this Code291
section, is declared 'complete for review.'292
(k)  Notwithstanding other provisions of this article, when the Governor has declared a293
state of emergency in a region of the state, existing health care facilities in the affected294
region may seek emergency approval from the department to make expenditures in excess
295
of the capital expenditure threshold or to offer services that may otherwise require a296
certificate of need.  The department shall give special expedited consideration to such297
requests and may authorize such requests for good cause.  Once the state of emergency has298
been lifted, any services offered by an affected health care facility under this subsection299
shall cease to be offered until such time as the health care facility that received the300
emergency authorization has requested and received a certificate of need.  For purposes of301
this subsection, the term 'good cause' means that authorization of the request shall directly302
resolve a situation posing an immediate threat to the health and safety of the public.  The303
department shall establish, by rule, procedures whereby requirements for the process of304
review and issuance of a certificate of need may be modified and expedited as a result of305
emergency situations."306
SECTION 5.307
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Said title is further amended by revising subsections (h), (i), (j), (k), (l), (m), and (n) of Code
308
Section 31-6-44, relating to the Certificate of Need Appeal Panel, as follows:309
"(h)  After the issuance of a decision by the department pursuant to Code Section 31-6-43,310
no party to an appeal hearing, nor any person on behalf of such party, including the311
department, shall make any ex parte contact with the appeal panel hearing officer appointed312
to conduct the appeal hearing,
 or any other member of the appeal panel, or the313
commissioner in regard to a decision under appeal.314
(i)  Within 30 days after the conclusion of the hearing, the hearing officer shall make315
written findings of fact and conclusions of law as to each consideration as set forth in Code316
Section 31-6-42 and the department's rules, including a detailed statement of the reasons317
for the decision of the hearing officer.  If any party has alleged that an appeal lacks318
substantial justification or was undertaken primarily for the purpose of delay or harassment,319
the decision of the hearing officer shall make findings of fact addressing the merits of the320
allegation.  The hearing officer shall file such decision with the chairperson of the appeal321
panel who shall serve such decision upon all parties, and shall transmit the administrative322
record to the commissioner department.  Any party, including the department, which323
disputes any finding of fact or conclusion of law rendered by the hearing officer in such324
hearing officer's decision and which wishes to appeal that decision may appeal to the325
commissioner and shall file its specific objections with the commissioner or his or her326
designee within 30 days of the date of the hearing officer's decision pursuant to rules327
adopted by the department.328
(j)  The decision of the appeal panel hearing officer will become shall constitute the final329
decision of the department upon the sixty-first day following the date of the decision unless330
an objection thereto is filed with the commissioner within the time limit established in331
subsection (i) of this Code section.332
(k)(1)  In the event an appeal of the hearing officer's decision is filed, the commissioner333
may adopt the hearing officer's order as the final order of the department or the334
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commissioner may reject or modify the conclusions of law over which the department has335
substantive jurisdiction and the interpretation of administrative rules over which it has336
substantive jurisdiction. By rejecting or modifying such conclusion of law or337
interpretation of administrative rule, the department must state with particularity its338
reasons for rejecting or modifying such conclusion of law or interpretation of339
administrative rule and must make a finding that its substituted conclusion of law or340
interpretation of administrative rule is as or more reasonable than that which was rejected341
or modified.  Rejection or modification of conclusions of law may not form the basis for342
rejection or modification of findings of fact.  The commissioner may not reject or modify343
the findings of fact unless the commissioner first determines from a review of the entire344
record, and states with particularity in the order, that the findings of fact were not based345
upon any competent substantial evidence or that the proceedings on which the findings346
were based did not comply with the essential requirements of law.347
(2)  If, before the date set for the commissioner's decision, application is made to the348
commissioner for leave to present additional evidence and it is shown to the satisfaction349
of the commissioner that the additional evidence is material and there were good reasons350
for failure to present it in the proceedings before the hearing officer, the commissioner351
may order that the additional evidence be taken before the same hearing officer who352
rendered the initial decision upon conditions determined by the commissioner.  The353
hearing officer may modify the initial decision by reason of the additional evidence and354
shall file that evidence and any modifications, new findings, or decision with the355
commissioner. Unless leave is given by the commissioner in accordance with the356
provisions of this subsection, the appeal panel may not consider new evidence under any357
circumstances.  In all circumstances, the commissioner's decision shall be based upon358
considerations as set forth in Code Section 31-6-42 and the department's rules.359
(l)  If, based upon the findings of fact by the hearing officer, the commissioner determines360
that the appeal filed by any party of a decision of the department lacks substantial361
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justification and was undertaken primarily for the purpose of delay or harassment, the362
commissioner may enter an award in his or her written order against such party and in363
favor of the successful party or parties, including the department, of all or any part of their364
respective reasonable and necessary attorney's fees and expenses of litigation, as the365
commissioner deems just.  Such award may be enforced by any court undertaking judicial366
review of the final decision.  In the absence of any petition for judicial review, then such367
award shall be enforced, upon due application, by any court having personal jurisdiction368
over the party against whom such an award is made.369
(m)  Unless the hearing officer's decision becomes the department's final decision by370
operation of law as provided in subsection (j) of this Code section, the decision of the371
commissioner shall become the department's final decision by operation of law. Such final372
decision shall be the final department decision for purposes of Chapter 13 of Title 50, the373
'Georgia Administrative Procedure Act.'  The appeals process provided by this Code374
section shall be the administrative remedy only for decisions made by the department375
pursuant to Code Section 31-6-43 which involve the approval or denial of applications for376
certificates of need.377
(n)  A party responding to an appeal to the commissioner may be entitled to reasonable378
attorney's fees and costs of such appeal if it is determined that the appeal lacked substantial379
justification and was undertaken primarily for the purpose of delay or harassment;380
provided, however, that the department shall not be required to pay attorney's fees or costs.381
This subsection shall not apply to the portion of attorney's fees accrued on behalf of a party382
responding to or bringing a challenge to the department's authority to enact a rule or383
regulation or the department's jurisdiction or another challenge that could not have been384
decided in the administrative proceeding, nor shall it apply to costs accrued when the only385
argument raised by the appealing party is one described in this subsection."386
SECTION 6.387
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Said title is further amended by revising subsection (a) of Code Section 31-6-44.1, relating
388
to judicial review, as follows:389
"(a)  Any party to the initial administrative appeal hearing conducted by the appointed390
appeal panel hearing officer, excluding the department, may seek judicial review of the391
final decision in accordance with the method set forth in Chapter 13 of Title 50, the392
'Georgia Administrative Procedure Act,' except as otherwise modified by this Code section;393
provided, however, that in conducting such review, the court may reverse or modify the394
final decision only if substantial rights of the appellant have been prejudiced because the395
procedures followed by the department,
 or the hearing officer, or the commissioner or the396
administrative findings, inferences, and conclusions contained in the final decision are:397
(1)  In violation of constitutional or statutory provisions;398
(2)  In excess of the statutory authority of the department;399
(3)  Made upon unlawful procedures;400
(4)  Affected by other error of law;401
(5)  Not supported by substantial evidence, which shall mean that the record does not402
contain such relevant evidence as a reasonable mind might accept as adequate to support403
such findings, inferences, conclusions, or decisions, which such evidentiary standard shall404
be in excess of the 'any evidence' standard contained in other statutory provisions; or405
(6)  Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted406
exercise of discretion."407
SECTION 7.408
Said title is further amended by revising Code Section 31-6-47, relating to exemptions from409
certificate of need requirements, as follows:410
"31-6-47.411
(a)  Notwithstanding the other provisions of this chapter, this chapter shall not apply to:412
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(1)  Infirmaries operated by educational institutions for the sole and exclusive benefit of
413
students, faculty members, officers, or employees thereof;414
(2)  Infirmaries or facilities operated by businesses for the sole and exclusive benefit of415
officers or employees thereof, provided that such infirmaries or facilities make no416
provision for overnight stay by persons receiving their services;417
(3)  Institutions operated exclusively by the federal government or by any of its agencies;418
(4)  Offices of private physicians or dentists whether for individual or group practice,419
except as otherwise provided in paragraph (3) or (7) of subsection (a) of Code420
Section 31-6-40;421
(5) Religious, nonmedical health care institutions as defined in 42 U.S.C.422
Section 1395x(ss)(1), listed and certified by a national accrediting organization;423
(6)  Site acquisitions for health care facilities or preparation or development costs for424
such sites prior to the decision to file a certificate of need application;425
(7)  Expenditures related to adequate preparation and development of an application for426
a certificate of need;427
(8)  The commitment of funds conditioned upon the obtaining of a certificate of need;428
(9)  Expenditures for the restructuring or acquisition of existing health care facilities by429
stock or asset purchase, merger, consolidation, or other lawful means;430
(9.1)  The purchase of a closing hospital or of a hospital that has been closed for no more431
than 12
 24 months by a hospital in a contiguous county to repurpose the facility as a432
micro-hospital;433
(10)  Expenditures of less than $870,000.00 for any minor or major repair or replacement434
of The acquisition, replacement, or repair of diagnostic, therapeutic, or other imaging435
equipment by a any existing health care facility that is not owned by a group practice of436
physicians or a hospital and that provides diagnostic imaging services so long as it does437
not result in the offering of any new clinical health services if such facility received a438
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letter of nonreviewability from the department prior to July 1, 2008.  This paragraph shall439
not apply to such facilities in rural counties;440
(10.1)  Except as provided in paragraph (10) of this subsection, An expenditure for the441
minor or major repair of a health care facility or a facility that is exempt from the442
requirements of this chapter, parts thereof, or services provided or equipment used443
therein; or the replacement of equipment, including but not limited to CT scanners,444
magnetic resonance imaging, positron emission tomography (PET), and positron445
emission tomography/computed tomography previously approved for a certificate of446
need;447
(11)  Capital expenditures otherwise covered by this chapter required solely to eliminate448
or prevent safety hazards as defined by federal, state, or local fire, building,449
environmental, occupational health, or life safety codes or regulations, to comply with450
licensing requirements of the department, or to comply with accreditation standards of451
a nationally recognized health care accreditation body;452
(12)  Cost overruns whose percentage of the cost of a project is equal to or less than the453
cumulative annual rate of increase in the composite construction index, published by the454
United States Bureau of the Census of the Department of Commerce, calculated from the455
date of approval of the project;456
(13)  Transfers from one health care facility to another such facility of major medical457
equipment previously approved under or exempted from certificate of need review,458
except where such transfer results in the institution of a new clinical health service for459
which a certificate of need is required in the facility acquiring such equipment, provided460
that such transfers are recorded at net book value of the medical equipment as recorded461
on the books of the transferring facility;462
(14)  New institutional health services provided by or on behalf of health maintenance463
organizations or related health care facilities in circumstances defined by the department464
pursuant to federal law;465
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(15)  Increases in the bed capacity of a hospital up to ten beds or 10 20 percent of466
capacity, whichever is greater, in any consecutive two-year three-year period, in a467
hospital that has maintained an overall occupancy rate greater than 75 60 percent for the468
previous 12 month period;469
(16)  Expenditures for nonclinical projects, including parking lots, parking decks, and470
other parking facilities; computer systems, software, and other information technology;471
medical office buildings; administrative office space; conference rooms; education472
facilities; lobbies; common spaces; clinical staff lounges and sleep areas; waiting rooms;473
bathrooms; cafeterias; hallways; engineering facilities; mechanical systems; roofs;474
grounds; signage; family meeting or lounge areas; other nonclinical physical plant475
renovations or upgrades that do not result in new or expanded clinical health services, and476
state mental health facilities;477
(17)  Life plan communities, provided that the skilled nursing component of the facility478
is for the exclusive use of residents of the life plan community and that a written479
exemption is obtained from the department; provided, however, that new sheltered480
nursing home beds may be used on a limited basis by persons who are not residents of481
the life plan community for a period up to five years after the date of issuance of the482
initial nursing home license, but such beds shall not be eligible for Medicaid483
reimbursement.  For the first year, the life plan community sheltered nursing facility may484
utilize not more than 50 percent of its licensed beds for patients who are not residents of485
the life plan community.  In the second year of operation, the life plan community shall486
allow not more than 40 percent of its licensed beds for new patients who are not residents487
of the life plan community.  In the third year of operation, the life plan community shall488
allow not more than 30 percent of its licensed beds for new patients who are not residents489
of the life plan community.  In the fourth year of operation, the life plan community shall490
allow not more than 20 percent of its licensed beds for new patients who are not residents491
of the life plan community.  In the fifth year of operation, the life plan community shall492
H. B. 1339
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allow not more than 10 percent of its licensed beds for new patients who are not residents
493
of the life plan community.  At no time during the first five years shall the life plan494
community sheltered nursing facility occupy more than 50 percent of its licensed beds495
with patients who are not residents under contract with the life plan community.  At the496
end of the five-year period, the life plan community sheltered nursing facility shall be497
utilized exclusively by residents of the life plan community, and at no time shall a498
resident of a life plan community be denied access to the sheltered nursing facility.  At499
no time shall any existing patient be forced to leave the life plan community to comply500
with this paragraph.  The department is authorized to promulgate rules and regulations501
regarding the use and definition of the term
 'sheltered nursing facility' in a manner502
consistent with this Code section. Agreements to provide continuing care include503
agreements to provide care for any duration, including agreements that are terminable by504
either party;505
(18)  Any single specialty ambulatory surgical center that:506
(A)(i)  Has capital expenditures associated with the construction, development, or507
other establishment of the clinical health service which do not exceed $2.5 million;508
or509
(ii)  Is the only single specialty ambulatory surgical center in the county owned by the510
group practice and has two or fewer operating rooms; provided, however, that a center511
exempt pursuant to this division shall be required to obtain a certificate of need in512
order to add any additional operating rooms;513
(B)  Has a hospital affiliation agreement with a hospital within a reasonable distance514
from the facility or the medical staff at the center has admitting privileges or other515
acceptable documented arrangements with such hospital to ensure the necessary backup516
for the center for medical complications.  The center shall have the capability to transfer517
a patient immediately to a hospital within a reasonable distance from the facility with518
H. B. 1339
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adequate emergency room services.  Hospitals shall not unreasonably deny a transfer
519
agreement or affiliation agreement to
 with the center;520
(C)(i)  Provides care to Medicaid beneficiaries and, if the facility provides medical521
care and treatment to children, to PeachCare for Kids beneficiaries and provides522
uncompensated indigent and charity care in an amount equal to or greater than 2523
percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount524
equal to or greater than the minimum amount established by the department which525
shall be reviewed by the department every 12 months; or526
(ii)  If the center is not a participant in Medicaid or the PeachCare for Kids Program,527
provides uncompensated care to Medicaid beneficiaries and, if the facility provides528
medical care and treatment to children, to PeachCare for Kids beneficiaries,529
uncompensated indigent and charity care, or both in an amount equal to or greater530
than 4 percent of its adjusted gross revenue, and on and after January 1, 2026, in an531
amount equal to or greater than the minimum amount established by the department532
which shall be reviewed by the department every 12 months;533
provided, however, that single specialty ambulatory surgical centers owned by534
physicians in the practice of ophthalmology shall not be required to comply with this535
subparagraph; and536
(D) Provides annual reports in the same manner and in accordance with Code537
Section 31-6-70.538
Noncompliance with any condition of this paragraph shall result in a monetary penalty539
in the amount of the difference between the services which the center is required to540
provide and the amount actually provided and may be subject to revocation of its541
exemption status by the department for repeated failure to pay any fines or moneys due542
to the department or for repeated failure to produce data as required by Code Section543
31-6-70 after notice to the exemption holder and a fair hearing pursuant to Chapter 13 of544
Title 50, the 'Georgia Administrative Procedure Act.'  The dollar amount specified in this545
H. B. 1339
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paragraph shall be adjusted annually by an amount calculated by multiplying such dollar
546
amount (as adjusted for the preceding year) by the annual percentage of change in the547
composite index of construction material prices, or its successor or appropriate548
replacement index, if any, published by the United States Department of Commerce for549
the preceding calendar year, commencing on July 1, 2009, and on each anniversary550
thereafter of publication of the index. The department shall immediately institute551
rule-making procedures to adopt such adjusted dollar amounts.  In calculating the dollar552
amounts of a proposed project for purposes of this paragraph, the costs of all items553
subject to review by this chapter and items not subject to review by this chapter554
associated with and simultaneously developed or proposed with the project shall be555
counted, except for the expenditure or commitment of or incurring an obligation for the556
expenditure of funds to develop certificate of need applications, studies, reports,557
schematics, preliminary plans and specifications or working drawings, or to acquire sites;558
(19)  Any joint venture ambulatory surgical center that:559
(A)  Has capital expenditures associated with the construction, development, or other560
establishment of the clinical health service which do not exceed $5 million;561
(B)(i)  Provides care to Medicaid beneficiaries and, if the facility provides medical562
care and treatment to children, to PeachCare for Kids beneficiaries and provides563
uncompensated indigent and charity care in an amount equal to or greater than 2564
percent of its adjusted gross revenue, and on and after January 1, 2026, in an amount
565
equal to or greater than the minimum amount established by the department which566
shall be reviewed by the department every 12 months; or567
(ii)  If the center is not a participant in Medicaid or the PeachCare for Kids Program,568
provides uncompensated care to Medicaid beneficiaries and, if the facility provides569
medical care and treatment to children, to PeachCare for Kids beneficiaries,570
uncompensated indigent and charity care, or both in an amount equal to or greater571
than 4 percent of its adjusted gross revenue, and on and after January 1, 2026, in an572
H. B. 1339
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amount equal to or greater than the minimum amount established by the department573
which shall be reviewed by the department every 12 months; and574
(C)  Provides annual reports in the same manner and in accordance with Code Section575
31-6-70.576
Noncompliance with any condition of this paragraph shall result in a monetary penalty577
in the amount of the difference between the services which the center is required to578
provide and the amount actually provided and may be subject to revocation of its579
exemption status by the department for repeated failure to pay any fines or moneys due580
to the department or for repeated failure to produce data as required by Code581
Section 31-6-70 after notice to the exemption holder and a fair hearing pursuant to582
Chapter 13 of Title 50, the 'Georgia Administrative Procedure Act.'  The dollar amount583
specified in this paragraph shall be adjusted annually by an amount calculated by584
multiplying such dollar amount (as adjusted for the preceding year) by the annual585
percentage of change in the composite index of construction material prices, or its586
successor or appropriate replacement index, if any, published by the United States587
Department of Commerce for the preceding calendar year, commencing on July 1, 2009,588
and on each anniversary thereafter of publication of the index. The department shall589
immediately institute rule-making procedures to adopt such adjusted dollar amounts.  In590
calculating the dollar amounts of a proposed project for purposes of this paragraph, the591
costs of all items subject to review by this chapter and items not subject to review by this592
chapter associated with and simultaneously developed or proposed with the project shall593
be counted, except for the expenditure or commitment of or incurring an obligation for594
the expenditure of funds to develop certificate of need applications, studies, reports,595
schematics, preliminary plans and specifications or working drawings, or to acquire sites;596
(20) Expansion of services by an imaging center based on a population needs597
methodology taking into consideration whether the population residing in the area served598
H. B. 1339
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by the imaging center has a need for expanded services, as determined by the department
599
in accordance with its rules and regulations, if such imaging center:600
(A)  Was in existence and operational in this state on January 1, 2008;601
(B)  Is owned by a hospital or by a physician or a group of physicians comprising at602
least 80 percent ownership who are currently board certified in radiology;603
(C)  Provides three or more diagnostic and other imaging services;604
(D)  Accepts all patients regardless of ability to pay; and605
(E)  Provides uncompensated indigent and charity care in an amount equal to or greater606
than the amount of such care provided by the geographically closest general acute care607
hospital; provided, however, that this paragraph shall not apply to an imaging center in608
a rural county;609
(21)  Diagnostic cardiac catheterization in a hospital setting on patients 15 years of age610
and older;611
(22)  Therapeutic cardiac catheterization in hospitals selected by the department prior to612
July 1, 2008, to participate in the Atlantic Cardiovascular Patient Outcomes Research613
Team (C-PORT) Study and therapeutic cardiac catheterization in hospitals that, as614
determined by the department on an annual basis, meet the criteria to participate in the615
C-PORT Study but have not been selected for participation; provided, however, that if616
the criteria requires a transfer agreement to
 with another hospital, no hospital shall617
unreasonably deny a transfer agreement to with another hospital;618
(23)  Infirmaries or facilities operated by, on behalf of, or under contract with the619
Department of Corrections or the Department of Juvenile Justice for the sole and620
exclusive purpose of providing health care services in a secure environment to prisoners621
within a penal institution, penitentiary, prison, detention center, or other secure622
correctional institution, including correctional institutions operated by private entities in623
this state which house inmates under the Department of Corrections or the Department624
of Juvenile Justice;625
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(24) The relocation of any skilled nursing facility, intermediate care facility, or
626
micro-hospital within the same county, any other health care facility in a rural county627
within the same county, and any other health care facility in an urban county within a628
three-mile
 five-mile radius of the existing facility so long as the facility does not propose629
to offer any new or expanded clinical health services at the new location;630
(25)  Facilities which are devoted to the provision of treatment and rehabilitative care for631
periods continuing for 24 hours or longer for persons who have traumatic brain injury,632
as defined in Code Section 37-3-1;633
(26)  Capital expenditures for a project otherwise requiring a certificate of need if those634
expenditures are for a project to remodel, renovate, replace, or any combination thereof,635
a medical-surgical hospital and:636
(A)  That hospital:637
(i)  Has a bed capacity of not more than 50 beds;638
(ii)  Is located in a county in which no other medical-surgical hospital is located;639
(iii)  Has at any time been designated as a disproportionate share hospital by the640
department; and641
(iv)  Has at least 45 percent of its patient revenues derived from medicare, Medicaid,642
or any combination thereof, for the immediately preceding three years; and643
(B)  That project:644
(i)  Does not result in any of the following:645
(I)  The offering of any new clinical health services;646
(II)  Any increase in bed capacity;647
(III)  Any redistribution of existing beds among existing clinical health services; or648
(IV)  Any increase in capacity of existing clinical health services;649
(ii)  Has at least 80 percent of its capital expenditures financed by the proceeds of a650
special purpose county sales and use tax imposed pursuant to Article 3 of Chapter 8651
of Title 48; and652
H. B. 1339
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(iii)  Is located within a three-mile five-mile radius of and within the same county as653
the hospital's existing facility;654
(27)  The renovation, remodeling, refurbishment, or upgrading of a health care facility,655
so long as the project does not result in any of the following:656
(A)  The offering of any new or expanded clinical health services;657
(B)  Any increase in inpatient bed capacity; or658
(C)  Any redistribution of existing beds among existing clinical health services; or659
(D)  A capital expenditure exceeding the threshold contained in paragraph (2) of660
subsection (a) of Code Section 31-6-40;661
(28)  Other than for equipment used to provide positron emission tomography (PET)662
services, the The acquisition of diagnostic, therapeutic, or other imaging equipment with663
a value of $3 million or less, by or on behalf of:664
(A)  A hospital; or665
(B)  An individual private physician or single group practice of physicians exclusively666
for use on patients of such private physician or single group practice of physicians and667
such private physician or member of such single group practice of physicians is668
physically present at the practice location where the diagnostic or other imaging669
equipment is located at least 75 percent of the time that the equipment is in use.;670
The amount specified in this paragraph shall not include build-out costs, as defined by671
the department, but shall include all functionally related equipment, software, and any672
warranty and services contract costs for the first five years.  The acquisition of one or673
more items of functionally related diagnostic or therapeutic equipment shall be674
considered as one project. The dollar amount specified in this paragraph and in675
paragraph (10) of this subsection shall be adjusted annually by an amount calculated by676
multiplying such dollar amounts (as adjusted for the preceding year) by the annual677
percentage of change in the consumer price index, or its successor or appropriate678
H. B. 1339
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replacement index, if any, published by the United States Department of Labor for the679
preceding calendar year, commencing on July 1, 2010; and680
(29)  Any capital expenditures A capital expenditure of $10 million or less by a hospital681
at such hospital's primary campus for:682
(A)  The expansion or addition of the following clinical health services: operating683
rooms, other than dedicated outpatient operating rooms; medical-surgical services;684
gynecology; procedure rooms; intensive care; pharmaceutical services; pediatrics;685
cardiac care or other general hospital services; provided, however, that such686
expenditure does not include the expansion or addition of inpatient beds or the687
conversion of one type of inpatient bed to another type of inpatient bed; or688
(B)  The movement of clinical health services from one location on the hospital's689
primary campus to another location on such hospital's primary campus;690
(30)  New or expanded psychiatric or substance abuse inpatient programs or state funded691
beds that serve Medicaid and uninsured patients that:692
(A)  Are open 365 days per year, seven days per week, and 24 hours per day;693
(B)  Provide uncompensated indigent and charity care in an amount equal to or greater694
than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an695
amount equal to or greater than the minimum amount established by the department by696
rule which shall be at least 3 percent and which shall be reviewed by the department697
every 12 months;698
(C)  Participate as providers of medical assistance for Medicaid purposes;699
(D)  Have hospital affiliation agreements with acute care hospitals within a reasonable700
distance from the programs or state funded beds or the medical staffs at the programs701
or state funded beds have admitting privileges or other acceptable documented702
arrangements with such hospitals to ensure the necessary backup for the programs or703
state funded beds for medical complications.  The programs or state funded beds shall704
have the capability to transfer a patient immediately to a hospital within a reasonable705
H. B. 1339
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distance from the programs or state funded beds with adequate emergency room706
services.  Acute care hospitals shall not unreasonably deny a transfer agreement or707
affiliation agreement with the programs or state funded beds; and708
(E)  Provide annual reports in the same manner and in accordance with Code Section709
31-6-70;710
(31)  The offering of new or expanded basic perinatal services by a hospital in a rural711
county provided that:712
(A)  Such services are available 365 days per year, seven days per week, and 24 hours713
per day;714
(B) The hospital participates as a provider of medical assistance for Medicaid715
purposes;716
(C)  The hospital has a hospital affiliation agreement with an acute care hospital with717
at least Level III perinatal services within a reasonable distance from the hospital718
providing the perinatal services or the medical staff at the hospital providing the719
perinatal services has admitting privileges or other acceptable documented720
arrangements with such acute care hospital to ensure the necessary backup for the721
hospital providing the perinatal services for medical complications.  The hospital722
providing the perinatal services shall have the capability to transfer a patient723
immediately to the acute care hospital within a reasonable distance from the hospital724
providing the perinatal services with adequate emergency room services.  Acute care725
hospitals shall not unreasonably deny a transfer agreement or affiliation agreement with726
the hospital providing the perinatal services.  This subparagraph shall not apply if the727
hospital providing the basic perinatal services is itself an acute care hospital with at728
least Level III perinatal services; and729
(D)  Provides annual reports in the same manner and in accordance with Code Section730
31-6-70;731
H. B. 1339
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(31.1)  Any new or expanded building or facility where human births occur on a regular732
and ongoing basis and which is classified as a birthing center by the department for733
purposes of Chapter 7 of this title, provided that:734
(A)  Services are available 365 days per year, seven days per week, and 24 hours per735
day;736
(B)  The birthing center participates as a provider of medical assistance for Medicaid737
purposes;738
(C)  The birthing center has a hospital affiliation agreement with an acute care hospital739
with at least Level III perinatal services within a reasonable distance from the birthing740
center or the medical staff at the birthing center has admitting privileges or other741
acceptable documented arrangements with such acute care hospital to ensure the742
necessary backup for the birthing center for medical complications.  The birthing center743
shall have the capability to transfer a patient immediately to the acute care hospital744
within a reasonable distance from the birthing center.  Acute care hospitals shall not745
unreasonably deny a transfer agreement or affiliation agreement with the birthing746
center;747
(D)  The birthing center:748
(i)  Provides basic perinatal services, as defined by the department, which shall749
include but not be limited to a combination of such services as determined by the750
department;751
(ii)  Meets the standards for certification established by the American Association of752
Birth Centers, or equivalent or higher standards as determined by the department;753
(iii)  Schedules routine visits and visits with other appropriate providers, as necessary,754
and tracks patients to verify that services have been received;755
(iv)  Prior to 20 weeks gestation, certifies that a patient has been deemed to be a low756
risk patient, as defined by the department for purposes of this paragraph;757
(v)  Admits and provides services only to patients certified as low risk; and758
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(vi)  Refers patients to other appropriate providers if, at any point between the 20759
weeks gestation certification and antepartum, the birthing center determines that a760
patient no longer qualifies as a low risk patient for any reason; and761
(E)  The birthing center provides annual reports in the same manner and in accordance762
with Code Section 31-6-70;763
(32)  A new general acute care hospital in a rural county that:764
(A)(i) Attains status as a teaching hospital within 36 months of opening, and765
maintains such status thereafter; or766
(ii)  Obtains verification as a Level I, II, III, or IV trauma center from the American767
College of Surgeons within 36 months of opening, and maintains such verification768
thereafter;769
(B)  Provides emergency, inpatient, and outpatient psychiatric and behavioral health770
services;771
(C)  Has an emergency department that is open 365 days per year, seven days per week,772
and 24 hours per day;773
(D)  Provides uncompensated indigent and charity care in an amount equal to or greater774
than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an775
amount equal to or greater than the minimum amount established by the department by776
rule which shall be no less than 3 percent and which shall be reviewed by the777
department every 12 months;778
(E)  Participates as a provider of medical assistance for Medicaid purposes; and779
(F)  Provides annual reports in the same manner and in accordance with Code Section780
31-6-70;781
(33)  A new acute care hospital where a short-stay general hospital in a rural county has782
been closed for more than 12 months and a new replacement hospital has not opened that:783
(A)  Is located in the same rural county where the short-stay general hospital was784
closed;785
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(B)  Has no more than the number of licensed beds that were previously licensed in the786
closed hospital;787
(C)  Has an emergency department that is open 365 days per year, seven days per week,788
and 24 hours per day;789
(D)  Provides all required clinical health services as generally offered by a short-stay790
general hospital to meet licensure requirements; and791
(E)  Provides uncompensated indigent and charity care in an amount equal to or greater792
than 3 percent of its adjusted gross revenue, and on and after January 1, 2026, in an793
amount equal to or greater than the minimum amount established by the department by794
rule which shall be no less than 3 percent and which shall be reviewed by the795
department every 12 months.796
Such new acute care hospital may provide basic perinatal services;797
(34)(A)  A new short-stay general hospital to address the underserved population798
previously served by a short-stay general hospital that was closed within the 48 months799
preceding the filing of a request for a letter of determination that:800
(i)  Is located within a county with a population of more than 1 million according to801
the United States decennial census of 2020 or any future such census;802
(ii)  Is located within five miles of and in the same county as the main campus of a803
medical school that is accredited by the Liaison Committee on Medical Education to804
confer Doctor of Medicine (M.D.) degrees;805
(iii)  Has in place at the time of filing of a request for a letter of determination a806
written agreement to serve as a teaching hospital for students of the medical school807
described in division (ii) of this subparagraph;808
(iv)  Has a maximum number of short-stay general hospital beds not greater than 50809
percent of the maximum number of short-stay general hospital beds for which the810
closed short-stay general hospital had previously been licensed at any time during the811
12 months prior to its closure;812
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(v)  Has an emergency department that is open 365 days per year, seven days per813
week, and 24 hours per day; and814
(vi)  Provides uncompensated indigent and charity care in an amount equal to or815
greater than 3 percent of its adjusted gross revenue, and on and after January 1, 2026,816
in an amount equal to or greater than the minimum amount established by the817
department by rule which shall be no less than 3 percent and which shall be reviewed818
by the department every 12 months;819
(B)  An exemption for a new short-stay general hospital under this paragraph shall820
include an exemption for all clinical services and equipment generally utilized at an821
acute care short-stay general hospital and required for licensure, including, but not822
limited to, an emergency department; Level II perinatal/neonatal services, including823
labor, delivery, recovery, and Level II neonatal intermediate care services; diagnostic824
imaging services; and surgical services; and825
(C)  For a period of ten years following the issuance of its original license, a new826
short-stay general hospital approved for an exemption pursuant to this paragraph shall827
be entitled to one or more determinations from the department to add additional828
short-stay general hospital beds, so long as the total licensed capacity of such hospital829
does not exceed the maximum number of short-stay general hospital beds for which the830
closed short-stay general hospital had previously been licensed at any time during the831
12 months prior to its closure; and832
(35)  Transfer of existing beds from one general acute care hospital's primary campus to833
another general acute care hospital's primary campus within the same hospital system834
within a 15 mile radius of the original campus, provided that all of the following are835
satisfied:836
(A)  Both hospitals involved in the transfer are general acute care hospitals and neither837
is a specialty hospital;838
(B)  Both hospitals involved in the transfer are under common ownership or control;839
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(C)  The transferring hospital may not, for a period of 12 months after the transfer is840
effective, seek to expand the bed type which was transferred; and841
(D)  The transferring hospital is open and operational at the time of transfer and shall842
not close within 12 months after the transfer is effective.843
(b)  By rule, the department shall establish a procedure for expediting or waiving reviews844
of certain projects, the nonreview of which it deems compatible with the purposes of this845
chapter, in addition to expenditures exempted from review by this Code section."846
SECTION 8.847
Said title is further amended by revising Code Section 31-6-47.1, relating to prior notice and848
approval of certain activities, as follows:849
"31-6-47.1.850
(a) The department shall require prior notice from a new health care facility for approval851
of any activity which is believed to be exempt pursuant to Code Section 31-6-47 or852
excluded from the requirements of this chapter under other provisions of this chapter.  The853
department shall require prior notice and approval of any activity which is believed to be854
exempt pursuant to paragraphs (31.1), (32), (33), and (34) of subsection (a) of Code855
Section 31-6-47. The department may require prior notice and approval of any activity856
which is believed to be exempt pursuant to paragraphs (10), (15), (16), (17), (20), (21),857
(23), (25), (26), (27), (28), and (29), (30), and (31) of subsection (a) of Code Section858
31-6-47.  The department shall establish timeframes, forms, and criteria to request a letter859
of determination that an activity is properly exempt or excluded under this chapter prior to860
its implementation.  The department shall publish notice of all requests for letters of861
determination regarding exempt activity and opposition to such request.  Persons opposing862
a request for approval of an exempt activity shall be entitled to file an objection with the863
department and the department shall consider any filed objection when determining864
whether an activity is exempt.  After the department's decision, an opposing party shall865
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have the right to a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia
866
Administrative Procedure Act,' on an adverse decision of the department and judicial867
review of a final decision in the same manner and under the same provisions as in Code868
Section 31-6-44.1.  If no objection to a request for determination is filed within 30 days of869
the department's receipt of such request for determination, the department shall have 60870
days from the date of the department's receipt of such request to review the request and871
issue a letter of determination.  The department may adopt rules for deciding when it is not872
practicable to provide a determination in 60 days and may extend the review period upon873
written notice to the requestor but only for an extended period of no longer than an874
additional 30 days.875
(b) Noncompliance with any condition of paragraph (30), (31), (31.1), or (32) of
876
subsection (a) of Code Section 31-6-47 shall result in a monetary penalty in the amount of877
the difference between the services which the exemption holder is required to provide and878
the amount actually provided and shall be subject to revocation of its exemption status by879
the department for repeated failure to meet any one or more requirements for the880
exemption, for repeated failure to pay any fines or moneys due to the department, or for881
repeated failure to produce data as required by Code Section 31-6-70 after notice to the882
exemption holder and a fair hearing pursuant to Chapter 13 of Title 50, the 'Georgia883
Administrative Procedure Act.'"884
SECTION 9.885
Said title is further amended in Article 3 of Chapter 6, relating to the Certificate of Need886
Program, by adding a new Code section to read as follows:887
"31-6-51.888
(a)  The department, in conjunction with the Office of Legislative Counsel, shall review the889
statutory framework and provisions of this chapter and the certificate of need program890
generally and shall make recommendations relating to rewriting, reorganizing, and891
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clarifying the provisions of this chapter.  Such review shall also include recommendations892
to streamline the statutory procedures required to obtain a certificate of need or a letter of893
determination.894
(b)  The department may consult with and obtain input from certificate of need applicants,895
certificate of need holders, local government representatives, citizens, or other interested896
parties in conducting such review.897
(c)  The department shall submit its recommendations to the General Assembly, which may898
include proposed legislation, no later than December 1, 2024.899
(d)  This Code section shall stand repealed on December 31, 2024."900
SECTION 10.901
Said title is further amended in Code Section 31-6-70, relating to reports to the department902
by certain health care facilities an all ambulatory surgical centers and imaging centers and903
public availability, by revising subsection (e) as follows:904
"(e)(1)  In the event the department does not receive an annual report from a health care905
facility requiring a certificate of need or an ambulatory surgical center or imaging center,906
whether or not exempt from obtaining a certificate of need under this chapter, on or907
before the date such report was due or receives a timely but incomplete report, the908
department shall notify the health care facility or center regarding the deficiencies and909
shall be authorized to fine such health care facility or center an amount not to exceed910
$500.00 $2,000.00 per day for every day up to 30 days and $1,000.00 $5,000.00 per day911
for every day over 30 days for every day of such untimely or deficient report.912
(2)  In the event the department does not receive an annual report from a health care913
facility within 180 days following the date such report was due or receives a timely but914
incomplete report which is not completed within such 180 days, the department shall be915
authorized to revoke such health care facility's certificate of need in accordance with916
Code Section 31-6-45."917
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SECTION 11.
918
Code Section 48-7-29.20 of the Official Code of Georgia Annotated, relating to tax credits919
for contributions to rural hospital organizations, is amended by revising subsections (b.1),920
(e), and (k) as follows:921
"(b.1)  From January 1 to June 30 each taxable year, an individual taxpayer shall be limited922
in its qualified rural hospital organization expenses allowable for credit under this Code923
section, and the commissioner shall not approve qualified rural hospital organization924
expenses incurred from January 1 to June 30 each taxable year, which exceed the following925
limits:926
(1)  In the case of a single individual or a head of household, $5,000.00;927
(2)  In the case of a married couple filing a joint return, $10,000.00; or928
(3)  In the case of an individual who is a member of a limited liability company duly929
formed under state law, a shareholder of a Subchapter 'S' corporation, or a partner in a930
partnership, $10,000.00
 $25,000.00."931
"(e)(1)  In no event shall the aggregate amount of tax credits allowed under this Code932
section exceed $75 $100 million per taxable year.933
(2)(A)  No more than $4 million of the aggregate limit established by paragraph (1) of934
this subsection shall be contributed to any individual rural hospital organization in any935
taxable year.  From January 1 to June 30 each taxable year, the commissioner shall only936
preapprove contributions submitted by individual taxpayers in an amount not to exceed937
$2 million, and from corporate donors in an amount not to exceed $2 million.  From938
July 1 to December 31 each taxable year, subject to the aggregate limit in paragraph (1)939
of this subsection and the individual rural hospital organization limit in this paragraph,940
the commissioner shall approve contributions submitted by individual taxpayers and941
corporations or other entities.942
(B)  In the event an individual or corporate donor desires to make a contribution to an943
individual rural hospital organization that has received the maximum amount of944
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contributions for that taxable year, the Department of Community Health shall provide945
the individual or corporate donor with a list, ranked in order of financial need, as946
determined by the Department of Community Health, of rural hospital organizations947
still eligible to receive contributions for the taxable year.948
(C)  In the event an individual or corporate donor desires to make a contribution to an949
individual rural hospital organization that would cause such rural hospital organization950
to exceed its maximum amount of contributions for that year, the commissioner shall951
not deny such desired contribution, but shall approve the proportional amount of the952
desired contribution up to the rural hospital organization's maximum allowed amount953
and any remainder shall be attributed as provided for in subparagraph (D) of this954
paragraph.955
(C)(D) In the event that an individual or corporate donor desires to make a contribution956
to an unspecified or undesignated rural hospital organization, either directly to the957
department or through a third party that participates in soliciting, administering, or958
managing donations, such donation shall be attributed to the rural hospital organization959
ranked with the highest financial need that has not yet received the maximum amount960
of contributions for that taxable year, regardless of whether a third party has a961
contractual relationship or agreement with such rural hospital organization.962
(D)(E) Any third party that participates in soliciting, advertising, or managing963
donations shall provide the complete list of rural hospital organizations eligible to964
receive the tax credit provided pursuant to this Code section including their ranking in965
order of financial need as determined by the Department of Community Health966
pursuant to Code Section 31-8-9.1, to any potential donor regardless of whether a third967
party has a contractual relationship or agreement with such rural hospital organization.968
(3) For purposes of paragraphs (1) and (2) of this subsection, a rural hospital969
organization shall notify a potential donor of the requirements of this Code section. 970
Before making a contribution to a rural hospital organization, the taxpayer shall971
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electronically notify the department, in a manner specified by the department, of the total
972
amount of contribution that the taxpayer intends to make to the rural hospital973
organization.  The commissioner shall preapprove or deny the requested amount or a
974
portion of such amount, if applicable pursuant to subparagraph (C) of paragraph (2) of975
this subsection, within 30 days after receiving the request from the taxpayer and shall976
provide written notice to the taxpayer and rural hospital organization of such preapproval977
or denial which shall not require any signed release or notarized approval by the taxpayer. 978
In order to receive a tax credit under this Code section, the taxpayer shall make the979
contribution to the rural hospital organization within 180 days after receiving notice from980
the department that the requested amount was preapproved. In order to receive a tax981
credit under this Code section, a taxpayer preapproved by the commissioner on or before982
September 30 shall make the contribution to the rural hospital organization within 180983
days after receiving notice of preapproval from the commissioner, but not later than984
October 31.  A taxpayer preapproved by the commissioner after September 30 shall make985
the contribution to the rural hospital organization on or before December 31. If the986
taxpayer does not comply with this paragraph, the commissioner shall not include this987
preapproved contribution amount when calculating the limits prescribed in paragraphs988
(1) and (2) of this subsection.989
(4)(A)  Preapproval of contributions by the commissioner shall be based solely on the990
availability of tax credits subject to the aggregate total limit established under991
paragraph (1) of this subsection and the individual rural hospital organization limit992
established under paragraph (2) of this subsection.993
(B)  Any taxpayer preapproved by the department commissioner pursuant to this994
subsection shall retain their approval in the event the credit percentage in this Code995
section is modified for the year in which the taxpayer was preapproved.996
(C)  Upon the rural hospital organization's confirmation of receipt of donations that997
have been preapproved by the department commissioner, any taxpayer preapproved by998
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the department commissioner pursuant to subsection (c) of this Code section shall999
receive the full benefit of the income tax credit established by this Code section even1000
though the rural hospital organization to which the taxpayer made a donation does not1001
properly comply with the reports or filings required by this Code section.1002
(5)  Notwithstanding any laws to the contrary, the department shall not take any adverse1003
action against donors to rural hospital organizations if the commissioner preapproved a1004
donation for a tax credit prior to the date the rural hospital organization is removed from1005
the Department of Community Health list pursuant to Code Section 31-8-9.1, and all such1006
donations shall remain as preapproved tax credits subject only to the donor's compliance1007
with paragraph (3) of this subsection."1008
"(k)  This Code section shall stand automatically repealed and reserved on December 31,1009
2024 2029."1010
SECTION 12.1011
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to1012
medical assistance generally, is amended by adding a new Code section to read as follows:1013
"49-4-156.1014
(a)  There is created the Comprehensive Health Coverage Commission.  The commission1015
shall be attached to the Department of Community Health for administrative purposes only1016
as provided by Code Section 50-4-3.1017
(b)  The commission shall consist of nine members, who shall be appointed no later than1018
July 1, 2024, as follows:1019
(1)  The chairperson, who shall be a subject matter expert on health policy, and shall not1020
be an employee of the State of Georgia, to be appointed by the Governor;1021
(2)  Three nonlegislative members to be appointed by the Speaker of the House of1022
Representatives;1023
(3)  Three nonlegislative members to be appointed by the President of the Senate;1024
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(4)  One nonlegislative member to be appointed by the minority leader of the Senate; and1025
(5)  One nonlegislative member to be appointed by the minority leader of the House of1026
Representatives.1027
(c)  Members of the commission shall not be registered lobbyists in the State of Georgia.1028
(d)  Members of the commission shall serve without compensation.1029
(e)  The purpose of the commission shall be to advise the Governor, the General Assembly,1030
and the Department of Community Health, as the administrator of the state medical1031
assistance program, on issues related to access and quality of healthcare for Georgia's1032
low-income and uninsured populations.  The commission shall be tasked with reviewing1033
the following:1034
(1)  Opportunities related to reimbursement and funding for Georgia healthcare providers,1035
including premium assistance programs;1036
(2)  Opportunities related to quality improvement of healthcare for Georgia's low-income1037
and uninsured populations; and1038
(3)  Opportunities to enhance service delivery and coordination of healthcare among and1039
across state agencies.1040
(f)  Subject to appropriations, the commission shall contract with experts and consultants1041
to produce a semiannual report on its findings for the Governor and the General Assembly. 1042
The commission shall provide its initial report to the Governor and the General Assembly1043
no later than December 1, 2024.1044
(g)  The commission shall stand abolished on December 31, 2026, unless extended by the1045
General Assembly prior to such date."1046
SECTION 13.1047
(a)  Sections 2, 9, 12, 13, and 14 of this Act shall become effective upon approval of the Act1048
by the Governor or upon its becoming law without such approval.1049
(b)  Sections 1, 3, 4, 5, 6, 7, 8, and 10 of this Act shall become effective on July 1, 2024.1050
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(c)  Section 11 of this Act shall become effective on January 1, 2025, and shall be applicable
1051
to taxable years beginning on or after January 1, 2025.1052
SECTION 14.1053
All laws and parts of laws in conflict with this Act are repealed.1054
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